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Hoskinson C, Medeleanu MV, Reyna ME, Dai DL, Chowdhury B, Moraes TJ, Mandhane PJ, Simons E, Kozyrskyj AL, Azad MB, Petersen C, Turvey SE, Subbarao P. Antibiotics within first year are linked to infant gut microbiome disruption and elevated atopic dermatitis risk. J Allergy Clin Immunol 2024:S0091-6749(24)00409-3. [PMID: 38670232 DOI: 10.1016/j.jaci.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in both pediatric and adult populations. The development of AD has been linked to antibiotic usage, which causes perturbation of the microbiome and has been associated with abnormal immune system function. However, imbalances in the gut microbiome itself associated with antibiotic usage have been inconsistently linked to AD. OBJECTIVE This study aimed to elucidate the timing and specific factors mediating the relationship between systemic (oral or intravenous) antibiotic usage and AD. METHODS We used statistical modelling and differential analysis to link CHILD participants' history of antibiotic usage and early-life gut microbiome alterations to atopic dermatitis. RESULTS Here we report that systemic antibiotics during the first year of life, as compared to later, are associated with AD risk (adjusted odds ratio (aOR) = 1.81 [95% CI = 1.28 - 2.57], p < 0.001), with an increased number of antibiotic courses corresponding to a dose-response-like increased risk of AD risk (1 course: aOR = 1.67 [95% CI = 1.17 - 2.38]; 2 or more courses: aOR = 2.16 [95% CI = 1.30 - 3.59]). Further, we demonstrate that microbiome alterations associated with both AD and systemic antibiotic usage fully mediate the effect of antibiotic usage on the development of AD (βindirect = 0.072, p < 0.001). Alterations in the 1-year infant gut microbiome of participants who would later develop AD included increased Tyzzerella nexilis, increased monosaccharide utilization, and parallel decreased Bifidobacterium, Eubacterium spp., and fermentative pathways. CONCLUSION Our findings indicate that early-life antibiotic usage, especially in the first year of life, modulates key gut microbiome components that may be used as markers to predict and possibly prevent the development of AD.
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Affiliation(s)
- Courtney Hoskinson
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria V Medeleanu
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Myrtha E Reyna
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Darlene Ly Dai
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Biswajit Chowdhury
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | - Theo J Moraes
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | | | - Elinor Simons
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Meghan B Azad
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada; Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Charisse Petersen
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Soliman Y, Yakandawala U, Leong C, Garlock ES, Brinkman FSL, Winsor GL, Kozyrskyj AL, Mandhane PJ, Turvey SE, Moraes TJ, Subbarao P, Nickel NC, Thiessen K, Azad MB, Kelly LE. The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study. Int Breastfeed J 2024; 19:23. [PMID: 38589955 PMCID: PMC11000278 DOI: 10.1186/s13006-024-00628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. METHODS Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. RESULTS A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. CONCLUSIONS In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.
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Affiliation(s)
- Youstina Soliman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Uma Yakandawala
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Leong
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Emma S Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Geoffrey L Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Piushkumar J Mandhane
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, MB, Canada
| | - Kellie Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- , 417-753 McDermot Ave, R3E 0T6, Winnipeg, MB, Canada.
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Bridgman SL, Penfold S, Field CJ, Haqq AM, Mandhane PJ, Moraes TJ, Turvey SE, Simons E, Subbarao P, Kozyrskyj AL. Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. Int J Obes (Lond) 2024:10.1038/s41366-024-01480-z. [PMID: 38302592 DOI: 10.1038/s41366-024-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND/OBJECTIVES Delivery by cesarean section (CS) compared to vaginal delivery has been associated with increased risk of overweight in childhood. Our study examined if the presence or absence of labor events in CS delivery altered risk of overweight in early childhood (1-5 years) compared to vaginal delivery and if this association differed according to infant sex. SUBJECTS/METHODS The study included 3073 mother-infant pairs from the CHILD Cohort Study in Canada. Data from birth records were used to categorize infants as having been vaginally delivered, or delivered by CS, with or without labor events. Age and sex adjusted weight-for-length (WFL) and body mass index (BMI) z scores were calculated from height and weight data from clinic visits at 1, 3 and 5 years and used to classify children as overweight. Associations between delivery mode and child overweight at each timepoint were assessed using regression models, adjusting for relevant confounding factors including maternal pre-pregnancy BMI. Effect modification by infant sex was tested. RESULTS One in four infants (24.6%) were born by CS delivery; 13.0% involved labor events and 11.6% did not. Infants born by CS without labor had an increased odds of being overweight at age 1 year compared to vaginally delivered infants after adjustment for maternal pre-pregnancy BMI, maternal diabetes, smoking, infant sex and birthweight-for-gestational age (aOR 1.68 [95% CI 1.05-2.67]). These effects did not persist to 3 or 5 years of age and, after stratification by sex, were only seen in boys (aOR at 1 year 2.21 [95% CI 1.26-3.88]). CONCLUSION AND RELEVANCE Our findings add to the body of evidence that CS, in particular CS without labor events, may be a risk factor for overweight in early life, and that this association may be sex-specific. These findings could help to identify children at higher risk for developing obesity.
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Affiliation(s)
- Sarah L Bridgman
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- London School of Hygiene and Tropical Medicine, University of London, London, UK.
| | - Suzanne Penfold
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Catherine J Field
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Elinor Simons
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Peng Y, Tun HM, Ng SC, Wai HKF, Zhang X, Parks J, Field CJ, Mandhane P, Moraes TJ, Simons E, Turvey SE, Subbarao P, Brook JR, Takaro TK, Scott JA, Chan FKL, Kozyrskyj AL. Maternal smoking during pregnancy increases the risk of gut microbiome-associated childhood overweight and obesity. Gut Microbes 2024; 16:2323234. [PMID: 38436093 PMCID: PMC10913716 DOI: 10.1080/19490976.2024.2323234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Childhood obesity is linked to maternal smoking during pregnancy. Gut microbiota may partially mediate this association and could be potential targets for intervention; however, its role is understudied. We included 1,592 infants from the Canadian Healthy Infants Longitudinal Development Cohort. Data on environmental exposure and lifestyle factors were collected prenatally and throughout the first three years. Weight outcomes were measured at one and three years of age. Stool samples collected at 3 and 12 months were analyzed by sequencing the V4 region of 16S rRNA to profile microbial compositions and magnetic resonance spectroscopy to quantify the metabolites. We showed that quitting smoking during pregnancy did not lower the risk of offspring being overweight. However, exclusive breastfeeding until the third month of age may alleviate these risks. We also reported that maternal smoking during pregnancy significantly increased Firmicutes abundance and diversity. We further revealed that Firmicutes diversity mediates the elevated risk of childhood overweight and obesity linked to maternal prenatal smoking. This effect possibly occurs through excessive microbial butyrate production. These findings add to the evidence that women should quit smoking before their pregnancies to prevent microbiome-mediated childhood overweight and obesity risk, and indicate the potential obesogenic role of excessive butyrate production in early life.
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Affiliation(s)
- Ye Peng
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Microbiota I-Center (MagIC), Hong Kong, SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Hein M Tun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Microbiota I-Center (MagIC), Hong Kong, SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Siew C Ng
- Microbiota I-Center (MagIC), Hong Kong, SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Hogan Kok-Fung Wai
- HKU-Pasteur Research Pole, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Xi Zhang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Catherine J Field
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child and Family Research Institute, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Francis KL Chan
- Microbiota I-Center (MagIC), Hong Kong, SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Moore LE, Serrano-Lomelin J, Rosychuk RJ, Kozyrskyj AL, Chari R, Crawford S, Bakal J, Hicks A, Ducharme FM, Ospina MB. Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study. BMJ Open Respir Res 2023; 10:e001928. [PMID: 37748808 PMCID: PMC10533801 DOI: 10.1136/bmjresp-2023-001928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Preventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control. METHODS This retrospective study used administrative health data from mothers and children born 2010-2012 with a diagnosis of asthma before age 5 years, in Alberta, Canada. The outcome was asthma control within 2 years after diagnosis. Associations between perinatal and early-life factors and risk of partly and uncontrolled asthma were evaluated by multinomial logistic regression. RESULTS Of 7206 preschoolers with asthma, 52% had controlled, 37% partly controlled and 12% uncontrolled asthma 2 years after diagnosis. Compared with controlled asthma, prenatal antibiotics (adjusted risk ratio (aRR): 1.19; 95% CI 1.06 to 1.33) and smoking (aRR: 1.18; 95% CI 1.02 to 1.37), C-section delivery (aRR: 1.11; 95% CI 1.00 to 1.25), summer birth (aRR: 1.16; 95% CI 1.00 to 1.34) and early-life hospitalisation for respiratory illness (aRR: 2.24; 95% CI 1.81 to 2.76) increased the risk of partly controlled asthma. Gestational diabetes (aRR: 1.41; 95% CI 1.06 to 1.87), C-section delivery (aRR: 1.18; 95% CI 1.00 to 1.39), antibiotics (aRR: 1.32; 95% CI 1.08 to 1.61) and hospitalisation for early-life respiratory illness (aRR: 1.65; 95% CI 1.19 to 2.27) were associated with uncontrolled asthma. CONCLUSION Maternal perinatal and early-life factors including antibiotics in pregnancy and childhood, gestational diabetes, prenatal smoking, C-section and summertime birth, and hospitalisations for respiratory illness are associated with partly or uncontrolled childhood asthma. These results underline the significance of perinatal health and the lasting effects of early-life experiences on lung development and disease programming.
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Affiliation(s)
- Linn E Moore
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Anne Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Maria B Ospina
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Hoskinson C, Dai DLY, Del Bel KL, Becker AB, Moraes TJ, Mandhane PJ, Finlay BB, Simons E, Kozyrskyj AL, Azad MB, Subbarao P, Petersen C, Turvey SE. Delayed gut microbiota maturation in the first year of life is a hallmark of pediatric allergic disease. Nat Commun 2023; 14:4785. [PMID: 37644001 PMCID: PMC10465508 DOI: 10.1038/s41467-023-40336-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
Allergic diseases affect millions of people worldwide. An increase in their prevalence has been associated with alterations in the gut microbiome, i.e., the microorganisms and their genes within the gastrointestinal tract. Maturation of the infant immune system and gut microbiota occur in parallel; thus, the conformation of the microbiome may determine if tolerant immune programming arises within the infant. Here we show, using deeply phenotyped participants in the CHILD birth cohort (n = 1115), that there are early-life influences and microbiome features which are uniformly associated with four distinct allergic diagnoses at 5 years: atopic dermatitis (AD, n = 367), asthma (As, n = 165), food allergy (FA, n = 136), and allergic rhinitis (AR, n = 187). In a subset with shotgun metagenomic and metabolomic profiling (n = 589), we discover that impaired 1-year microbiota maturation may be universal to pediatric allergies (AD p = 0.000014; As p = 0.0073; FA p = 0.00083; and AR p = 0.0021). Extending this, we find a core set of functional and metabolic imbalances characterized by compromised mucous integrity, elevated oxidative activity, decreased secondary fermentation, and elevated trace amines, to be a significant mediator between microbiota maturation at age 1 year and allergic diagnoses at age 5 years (βindirect = -2.28; p = 0.0020). Microbiota maturation thus provides a focal point to identify deviations from normative development to predict and prevent allergic disease.
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Affiliation(s)
- Courtney Hoskinson
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Darlene L Y Dai
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kate L Del Bel
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - B Brett Finlay
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charisse Petersen
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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7
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Lee-Sarwar KA, Chen YC, Yao Chen Y, Kozyrskyj AL, Mandhane PJ, Turvey SE, Subbarao P, Bisgaard H, Stokholm J, Chawes B, Sørensen SJ, Kelly RS, Lasky-Su J, Zeiger RS, O’Connor GT, Sandel MT, Bacharier LB, Beigelman A, Carey VJ, Harshfield BJ, Laranjo N, Gold DR, Weiss ST, Litonjua AA. The maternal prenatal and offspring early-life gut microbiome of childhood asthma phenotypes. Allergy 2023; 78:418-428. [PMID: 36107703 PMCID: PMC9892205 DOI: 10.1111/all.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The infant fecal microbiome is known to impact subsequent asthma risk, but the environmental exposures impacting this association, the role of the maternal microbiome, and how the microbiome impacts different childhood asthma phenotypes are unknown. METHODS Our objective was to identify associations between features of the prenatal and early-life fecal microbiomes and child asthma phenotypes. We analyzed fecal 16 s rRNA microbiome profiling and fecal metabolomic profiling from stool samples collected from mothers during the third trimester of pregnancy (n = 120) and offspring at ages 3-6 months (n = 265), 1 (n = 436) and 3 years (n = 506) in a total of 657 mother-child pairs participating in the Vitamin D Antenatal Asthma Reduction Trial. We used clinical data from birth to age 6 years to characterize subjects with asthma as having early, transient or active asthma phenotypes. In addition to identifying specific genera that were robustly associated with asthma phenotypes in multiple covariate-adjusted models, we clustered subjects by their longitudinal microbiome composition and sought associations between fecal metabolites and relevant microbiome and clinical features. RESULTS Seven maternal and two infant fecal microbial taxa were robustly associated with at least one asthma phenotype, and a longitudinal gut microenvironment profile was associated with early asthma (Fisher exact test p = .03). Though mode of delivery was not directly associated with asthma, we found substantial evidence for a pathway whereby cesarean section reduces fecal Bacteroides and microbial sphingolipids, increasing susceptibility to early asthma. CONCLUSION Overall, our results suggest that the early-life, including prenatal, fecal microbiome modifies risk of asthma, especially asthma with onset by age 3 years.
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Affiliation(s)
- Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yih-Chieh Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yuan Yao Chen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics & Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Søren J. Sørensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert S. Zeiger
- Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Megan T. Sandel
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Avraham Beigelman
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO and St Louis Children’s Hospital, St Louis, MO, USA
- The Kipper Institute of Allergy and Immunology, Schneider Children’s Medical Center of Israel, Tel Aviv University, Israel
| | - Vincent J. Carey
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin J. Harshfield
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Diane R. Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, NY, USA
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8
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Chen YY, Tun HM, Field CJ, Mandhane PJ, Moraes TJ, Simons E, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Impact of Cesarean Delivery and Breastfeeding on Secretory Immunoglobulin A in the Infant Gut Is Mediated by Gut Microbiota and Metabolites. Metabolites 2023; 13:metabo13020148. [PMID: 36837767 PMCID: PMC9959734 DOI: 10.3390/metabo13020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
How gut immunity in early life is shaped by birth in relation to delivery mode, intrapartum antibiotic prophylaxis (IAP) and labor remains undetermined. We aimed to address this gap with a study of secretory Immunoglobulin A (SIgA) in the infant gut that also tested SIgA-stimulating pathways mediated by gut microbiota and metabolites. Among 1017 Canadian full-term infants, gut microbiota of fecal samples collected at 3 and 12 months were profiled using 16S rRNA sequencing; C. difficile was quantified by qPCR; fecal metabolites and SIgA levels were measured by NMR and SIgA enzyme-linked immunosorbent assay, respectively. We assessed the putative causal relationships from birth events to gut microbiota and metabolites, and ultimately to SIgA, in statistical sequential mediation models, adjusted for maternal gravida status in 551 infants. As birth mode influences the ability to breastfeed, the statistical mediating role of breastfeeding status and milk metabolites was also evaluated. Relative to vaginal birth without maternal IAP, cesarean section (CS) after labor was associated with reduced infant gut SIgA levels at 3 months (6.27 vs. 4.85 mg/g feces, p < 0.05); this association was sequentially mediated through gut microbiota and metabolites of microbial or milk origin. Mediating gut microbiota included Enterobacteriaceae, C. difficile, and Streptococcus. The milk or microbial metabolites in CS-SIgA mediating pathways were galactose, fucose, GABA, choline, lactate, pyruvate and 1,2-propanediol. This cohort study documented the impact of birth on infant gut mucosal SIgA. It is the first to characterize gut microbe-metabolite mediated pathways for early-life SIgA maturation, pathways that require experimental verification.
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Affiliation(s)
- Yuan Yao Chen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Hein M. Tun
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Piushkumar J. Mandhane
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Theo J. Moraes
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Anita L. Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence: ; Tel.: +1-780-248-5508
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9
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Straughen JK, Kozyrskyj AL, Cassidy-Bushrow AE. Editorial: Allergic diseases and neurodevelopment. Front Pediatr 2023; 11:1199467. [PMID: 37152318 PMCID: PMC10157274 DOI: 10.3389/fped.2023.1199467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Jennifer K. Straughen
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Correspondence: Jennifer K. Straughen
| | | | - Andrea E. Cassidy-Bushrow
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
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10
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Bedard P, Winsor GL, Garlock ES, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Brinkman FSL, Kozyrskyj AL. From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants. Children 2022; 9:children9101475. [PMID: 36291411 PMCID: PMC9600175 DOI: 10.3390/children9101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.
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Affiliation(s)
- Pascal Bedard
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Geoffrey L. Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Emma S. Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Allan B. Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital and The University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Fiona S. L. Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
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11
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Obiakor CV, Parks J, Takaro TK, Tun HM, Morales-Lizcano N, Azad MB, Mandhane PJ, Moraes TJ, Simons E, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Early Life Antimicrobial Exposure: Impact on Clostridioides difficile Colonization in Infants. Antibiotics (Basel) 2022; 11:antibiotics11070981. [PMID: 35884235 PMCID: PMC9311587 DOI: 10.3390/antibiotics11070981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
The relationship between antibiotic use and Clostridioides difficile (C. difficile) has been well established in adults and older children but remains unclear and is yet to be fully examined in infant populations. This study aimed to determine the separate and cumulative impact from antibiotics and household cleaning products on C. difficile colonization in infants. This study included 1429 infants at 3–4 months of age and 1728 infants at 12 months of age from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. The levels of infant antimicrobial exposure were obtained from hospital birth charts and standardized questionnaires. Infant gut microbiota was characterized by Illumina 16S ribosomal ribonucleic acid (rRNA) gene sequencing. Analysis of C. difficile was performed using a quantitative polymerase chain reaction (qPCR). Overall, C. difficile colonized 31% and 46% of infants at 3–4 months and 12 months, respectively. At 3–4 months, C. difficile colonization was significantly higher in infants exposed to both antibiotics and higher (above average) usage of household cleaning products (adjusted odds ratio (aOR) 1.50, 95% CI 1.03–2.17; p = 0.032) than in infants who had the least antimicrobial exposure. This higher colonization persisted up to 12 months of age. Our study suggests that cumulative exposure to systemic antibiotics and higher usage of household cleaning products facilitates C. difficile colonization in infants. Further research is needed to understand the future health impacts.
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Affiliation(s)
| | - Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (J.P.); (T.K.T.)
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Tim K. Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (J.P.); (T.K.T.)
| | - Hein M. Tun
- School of Public Health, University of Hong Kong, Hong Kong;
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong
| | - Nadia Morales-Lizcano
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (N.M.-L.); (J.A.S.)
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada; (M.B.A.); (E.S.)
| | | | - Theo J. Moraes
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - Elinor Simons
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada; (M.B.A.); (E.S.)
| | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada;
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (N.M.-L.); (J.A.S.)
| | - Anita L. Kozyrskyj
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Correspondence:
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12
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Bridgman SL, Malmuthuge N, Mandal R, Field CJ, Haqq AM, Mandhane PJ, Moraes TJ, Turvey SE, Simons E, Subbarao P, Scott JA, Wishart DS, Kozyrskyj AL. Childhood body mass index and associations with infant gut metabolites and secretory IgA: findings from a prospective cohort study. Int J Obes (Lond) 2022; 46:1712-1719. [PMID: 35840772 DOI: 10.1038/s41366-022-01183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Differences in gut microbiota, metabolites and immune markers have been observed between individuals with and without obesity. Our study determined the temporal association between infant fecal gut metabolites, sIgA and body mass index (BMI) z score of preschool children, independent of pre/postnatal factors. SUBJECTS/METHODS The study includes a subset of 647 infants from the CHILD Cohort Study (recruited between January 1, 2009, and December 31, 2012). Fecal metabolites and sIgA were measured at 3-4 months of age, and age and sex adjusted BMI z scores at 1 and 3 years of age. Associations between the metabolites, IgA, and child BMI z scores at age 1 and 3 years were tested using linear regression adjusted for pre/postnatal factors (breastfeeding, birthweight-for-gestational age, birthmode and IAP, solid food introduction). RESULTS Mean BMI z score for all infants was 0.34 (SD 1.16) at 1 year (N = 647) and 0.71 (SD 1.06) at 3 years (N = 573). High fecal formate in infancy was associated with a significantly lower BMI z score (adjusted mean difference -0.23 (95% CI -0.42, -0.04)) and high butyrate was associated with a higher BMI z score (adjusted mean difference 0.21 (95% CI 0.01, 0.41)) at age 3 years only. The influence of formate and butyrate on BMI z score at age 3 were seen only in those that were not exclusively breastfed at stool sample collection (adjusted mean difference for high formate/EBF- group: -0.33 (95%CI -0.55, -0.10) and 0.25 (95% CI 0.02, 0.47) for high butyrate/EBF- group). No associations were seen between sIgA and BMI z score at age 1 or 3 years in adjusted regression models. CONCLUSION AND RELEVANCE Differences in fecal metabolite levels in early infancy were associated with childhood BMI. This study identifies an important area of future research in understanding the pathogenesis of obesity.
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Affiliation(s)
- Sarah L Bridgman
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nilusha Malmuthuge
- Agriculture Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge, AB, Canada
| | - Rupasri Mandal
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, Vancouver, BC, Canada
| | - Elinor Simons
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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13
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Damanhoury S, Morrison KM, Mian R, McPhee PG, Kozyrskyj AL, Newton AS, Buchholz A, Chanoine JP, Hamilton J, Ho J, Laberge AM, Legault L, Thabane L, Tremblay MS, Zenlea I, Ball GDC. Metabolically healthy obesity in children enrolled in the CANadian Pediatric Weight management Registry (CANPWR): An exploratory secondary analysis of baseline data. Clin Obes 2022; 12:e12490. [PMID: 34617401 DOI: 10.1111/cob.12490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022]
Abstract
Our study purpose was to determine the prevalence of metabolically healthy obesity (MHO) and examine factors associated with MHO in children with obesity. This cross-sectional study was a secondary, exploratory analysis of data that included 2-17 years old with a body mass index (BMI) ≥85th percentile from the CANadian Pediatric Weight management Registry. Children were classified as having MHO or metabolically unhealthy obesity (MUO) using consensus-based criteria. Those with MHO had normal triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting glucose. Logistic regression was used to examine factors associated with MHO, which included calculating odds ratios (ORs) and 95% confidence intervals (CIs). In total, 945 children were included (mean age: 12.3 years; 51% female). The prevalence of MHO was 31% (n = 297), with lower levels across increasing age categories (2-5 years [n = 18; 43%], 6-11 years [n = 127; 35%], 12-17 years [n = 152; 28%]). Children with MHO were younger, weighed less, and had lower BMI z-scores than their peers with MUO (all p < 0.01). MHO status was positively associated with physical activity (OR: 1.18; 95% CI: 1.01-1.38), skim milk intake (OR: 1.10; 95% CI: 1.01-1.19), and fruit intake (OR: 1.12; 95% CI: 1.01-1.24) and negatively associated with BMI z-score (OR: 0.69; 95% CI: 0.60-0.79), total screen time in hours (OR: 0.79; 96% CI: 0.68-0.92), and intake of fruit flavoured drinks (OR: 0.91; 95% CI: 0.84-0.99). These findings may help guide clinical decision-making regarding obesity management by focusing on children with MUO who are at relatively high cardiometabolic risk.
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Affiliation(s)
- Samah Damanhoury
- Department of Agricultural, Food, and Nutritional Science, Faculty of Agricultural, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Katherine M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rajibul Mian
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Patrick G McPhee
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Hamilton
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Laberge
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
- CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Laurent Legault
- Department of Pediatrics, Endocrine Division, Montreal Children's Hospital, McGill University, Montréal, Quebec, Canada
| | - Lehana Thabane
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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14
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Rodriguez N, Tessier CA, Mandhane PJ, Pei J, Simons E, Moraes TJ, Turvey SE, Subbarao P, Kozyrskyj AL. Sex-specific associations among infant food and atopic sensitizations and infant neurodevelopment. Front Pediatr 2022; 10:734428. [PMID: 36389362 PMCID: PMC9648178 DOI: 10.3389/fped.2022.734428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Food sensitization is a first and strong indicator of immune deviation in the progression to other allergic conditions. Sensitization to food or other allergens and related inflammation during critical windows of infant development may adversely affect neurodevelopmental milestones. However, additional research is needed to test this association further. METHODS Associations between atopic (any food or aeroallergen) or food sensitization (specific to egg, soybean, peanut, and milk) at age 1 year and neurodevelopment up to 2 years of age were evaluated in the national CHILD Cohort Study, with a secondary aim examining whether these associations were sex-specific. Food and atopic sensitization were assessed by skin prick tests (SPT) in 1-year-old infants, with neurodevelopment assessed using the cognitive, language, motor, and social-emotional subscales of the Bayley Scales of Infant Development (BSID-III) administered at 1 and 2 years of age. RESULTS Atopic sensitization was present among 16.4% of infants, while 13.4% had food sensitizations. Only socioemotional scores reached statistical significance among the four BSID-III domains. Both atopic and food sensitization at 1 year of age was associated with lower social-emotional scores, independent of the infant's ethnicity. These findings were sex-specific and only observed among boys, among whom social-emotional scores were lowered by 5 points if atopic sensitization was present (-5.22 [95% CI: -9.96, -0.47], p = 0.03) or if food sensitization was present (-4.85 [95% CI: -9.82,0.11], p = 0.06). Similar results were observed using the standard SPT cut-off of ≥3 mm - for atopic sensitization (-5.17 [95% CI: -11.14, -0.80], p = 0.09) and for food sensitization (-4.61 [95% CI: -10.96, 1.74], p = 0.15). CONCLUSION In our study of term infants, we found an inverse, cross-sectional association between atopic and food sensitization status and social-emotional development scores in male children but not female children.
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Affiliation(s)
- Nicole Rodriguez
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carmen A Tessier
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Piushkumar J Mandhane
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Department of Pediatrics, Faculty of Medicine, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Faculty of Medicine, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Obstetrics and Gynecology, School of Public Health, University of Alberta, Edmonton, AB, Canada
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15
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Tamana SK, Tun HM, Konya T, Chari RS, Field CJ, Guttman DS, Becker AB, Moraes TJ, Turvey SE, Subbarao P, Sears MR, Pei J, Scott JA, Mandhane PJ, Kozyrskyj AL. Bacteroides-dominant gut microbiome of late infancy is associated with enhanced neurodevelopment. Gut Microbes 2021; 13:1-17. [PMID: 34132157 PMCID: PMC8210878 DOI: 10.1080/19490976.2021.1930875] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Dysbiosis of gut microbiota has been retrospectively linked to autism spectrum disorders but the temporal association between gut microbiota and early neurodevelopment in healthy infants is largely unknown. We undertook this study to determine associations between gut microbiota at two critical periods during infancy and neurodevelopment in a general population birth cohort.Here, we analyzed data from 405 infants (199 females) from the CHILD (Canadian Healthy Infant Longitudinal Development) Cohort Study. Neurodevelopmental outcomes were objectively assessed using the Bayley Scale of Infant Development (BSID-III) at 1 and 2 years of age. Microbiota profiling with 16S rRNA gene sequencing was conducted on fecal samples obtained at a mean age of 4 and 12 months.Using clustering methods, we identified three groups of infants based on relative abundance of gut microbiota at 12 months: Proteobacteria-dominant cluster (22.4% higher abundance at 12 months), Firmicutes-dominant cluster (46.0% higher abundance at 12 months) and Bacteroidetes-dominant cluster (31.6% higher abundance at 12 months). Relative to the Proteobacteria-dominant cluster, the Bacteroidetes-dominant cluster was associated with higher scores for cognitive (4.8 points; FDRp = .02), language (4.2 points; FDRp≤0.001), and motor (3.1 points; FDRp = .03) development at age 2 in models adjusted for covariates. When stratified by sex, only male infants with a Bacteroidetes-dominant microbiota had more favorable cognitive (5.9 points, FDRp = .06) and language (7.9 points; FDRp≤0.001) development. Genus Bacteroides abundance in gut microbiota was positively correlated with cognitive and language scores at age 2. Fully adjusted linear mixed model analysis revealed a positive association between Bacteroidetes-dominant cluster and change in cognitive and language performance from 1 to 2 years, predominantly among males. No associations were evident between 4-month microbiota clusters and BSID-II scores. Noteworthy is that enhanced sphingolipid synthesis and metabolism, and antagonism or competition between Bacteroides and Streptococcus were characteristic of a Bacteroidetes-dominant gut microbiota.This study found strong evidence of positive associations between Bacteroidetes gut microbiota in late infancy and subsequent neurodevelopment, most prominently among males but not females.
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Affiliation(s)
| | - Hein M. Tun
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada,HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Theodore Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Radha S. Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Catherine J. Field
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - David S. Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, ON, Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, Child & Family Research Institute, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada,CONTACT Anita L. Kozyrskyj Department of Pediatrics, University of Alberta, 3-527 Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, ABT6G 1C9, Canada
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16
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Darlenski R, Kozyrskyj AL, Fluhr JW, Caraballo L. Association between barrier impairment and skin microbiota in atopic dermatitis from a global perspective: Unmet needs and open questions. J Allergy Clin Immunol 2021; 148:1387-1393. [PMID: 34688495 DOI: 10.1016/j.jaci.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/17/2022]
Abstract
Atopic diathesis encompassing atopic dermatitis (AD), allergic rhinoconjunctivitis, food allergy, eosinophilic esophagitis, and asthma is a widely prevalent condition with a broad heterogeneity in clinical course, age of onset, and lifespan persistence. A primary event in AD is the commonly inherited epidermal barrier dysfunction. Together with the host-microbiome interactions, barrier defect and allergen exposure modulate both innate and adaptive immunity, thus triggering and maintaining the inflammatory response. Microbiome diversity, together with the host's contact with nonpathogenic microbes in childhood, is a prerequisite for functional maturation of the immune system, which is in part mediated by microbiome-induced epigenetic changes. Yet, whether microbiome alterations are the result or the reason for barrier impairment and inflammatory response of the host is unclear. Exposure to locally prevalent microbial species could contribute to further modification of the disease course. The objective of this review is to reveal the link between changes in the skin microbiota, barrier dysfunction, and inflammation in AD. Addressing unmet needs includes determining the genetic background of AD susceptibility; the epigenetic modifications induced by the microbiota and other environmental factors; the role of globally diverse provoking factors; and the implementation of personalized, phenotype-specific therapies such as a epidermal barrier restoration in infancy and microbiota modulation via systemic or topical interventions, all of which open gaps for future research.
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Affiliation(s)
- Razvigor Darlenski
- Department of Dermatovenerology, ACC Tokuda Hospital, Sofia, Bulgaria; Department of Dermatovenerology, Trakia University, Stara Zagora, Bulgaria.
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Joachim W Fluhr
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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17
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Peng Y, Zhang D, Chen T, Xia Y, Wu P, Seto WK, Kozyrskyj AL, Cowling BJ, Zhao J, Tun HM. Gut microbiome and resistome changes during the first wave of the COVID-19 pandemic in comparison with pre-pandemic travel-related changes. J Travel Med 2021; 28:6265043. [PMID: 33949663 PMCID: PMC8135950 DOI: 10.1093/jtm/taab067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
COVID-19-associated measures had a greater impact on gut microbiota, ARGs, and BRGs than did pre-pandemic international travel. During the COVID-19 pandemic, Actinobacteria richness decreased while genes conferring resistance to beta-lactam, polystyrene and phthalate increased. Such alterations may affect both colonisation resistance and acquisition and spread of antimicrobial resistance in future travels.
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Affiliation(s)
- Ye Peng
- HKU-Pasteur Research Pole, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Dengwei Zhang
- HKU-Pasteur Research Pole, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Ting Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yankai Xia
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peng Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Wai-Kay Seto
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | | | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Jincun Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Institute of Infectious Disease, Guangzhou Eighth People's Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hein M Tun
- HKU-Pasteur Research Pole, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,School of Public Health, Nanjing Medical University, Nanjing, China
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18
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Chen YY, Zhao X, Moeder W, Tun HM, Simons E, Mandhane PJ, Moraes TJ, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Impact of Maternal Intrapartum Antibiotics, and Caesarean Section with and without Labour on Bifidobacterium and Other Infant Gut Microbiota. Microorganisms 2021; 9:microorganisms9091847. [PMID: 34576741 PMCID: PMC8467529 DOI: 10.3390/microorganisms9091847] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Few studies consider the joint effect of multiple factors related to birth, delivery mode, intrapartum antibiotic prophylaxis and the onset of labour, on the abundance of Bifidobacterium and the quantity of this genus and its species Bifidobacterium longum subsp. infantis in the infant gut microbiota. We implemented such a study. Methods: Among 1654 Canadian full-term infants, the gut microbiota of faecal samples collected at 3 months were profiled by 16S rRNA sequencing; the genus Bifidobacterium and Bifidobacterium longum subsp. infantis were quantified by qPCR. Associations between Bifidobacterium and other gut microbiota were examined by Spearman’s rank correlation. Results: Following vaginal birth, maternal IAP exposure was associated with reduced absolute quantities of bifidobacteria among vaginally delivered infants (6.80 vs. 7.14 log10 (gene-copies/g faeces), p < 0.05), as well as their lowered abundance relative to other gut microbiota. IAP differences in infant gut bifidobacterial quantity were independent of maternal pre-pregnancy body-mass-index (BMI), and remarkably, they were limited to breastfed infants. Pre-pregnancy BMI adjustment revealed negative associations between absolute quantities of bifidobacteria and CS with or without labour in non-breastfed infants, and CS with labour in exclusively breastfed infants. Significant correlations between Bifidobacterium abundance and other microbial taxa were observed. Conclusions: This study documented the impact of the birth mode and feeding status on the abundance of gut Bifidobacterium, and pointed to the important ecological role of the genus Bifidobacterium in gut microbiota due to its strong interaction with other gut microbiota in early infancy.
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Affiliation(s)
- Yuan Yao Chen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.C.); (X.Z.); (H.M.T.); (P.J.M.)
| | - Xin Zhao
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.C.); (X.Z.); (H.M.T.); (P.J.M.)
| | - Wolfgang Moeder
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1R4, Canada; (W.M.); (J.A.S.)
| | - Hein M. Tun
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.C.); (X.Z.); (H.M.T.); (P.J.M.)
- HKU-Pasteur Research Pole, School of Public Health, University of Hong Kong, Hong Kong SAR 999077, China
| | - Elinor Simons
- Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 0J9, Canada;
| | - Piushkumar J. Mandhane
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.C.); (X.Z.); (H.M.T.); (P.J.M.)
| | - Theo J. Moraes
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - Stuart E. Turvey
- Department of Pediatrics, Child and Family Research Institute, BC Children’s Hospital, University of British Columbia, Vancouver, BC V5Z 4H4, Canada;
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1R4, Canada; (W.M.); (J.A.S.)
| | - Anita L. Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.C.); (X.Z.); (H.M.T.); (P.J.M.)
- Correspondence: Anita Kozyrskyj
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19
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Rodriguez N, Tun HM, Field CJ, Mandhane PJ, Scott JA, Kozyrskyj AL. Prenatal Depression, Breastfeeding, and Infant Gut Microbiota. Front Microbiol 2021; 12:664257. [PMID: 34394021 PMCID: PMC8363245 DOI: 10.3389/fmicb.2021.664257] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/23/2021] [Indexed: 02/01/2023] Open
Abstract
Depressive symptoms are common during pregnancy and are estimated to affect 7-20% of pregnant women, with higher prevalence found in those with a prior history of depression, in ethnic minorities, and those with increased exposure to stressful life events. Maternal depression often remains undiagnosed, and its symptoms can increase adverse health risks to the infant, including impaired cognitive development, behavioral problems, and higher susceptibility to physical illnesses. Accumulating research evidence supports the association between maternal physical health elements to infant gut health, including factors such as mode of delivery, medication, feeding status, and antibiotic use. However, specific maternal prenatal psychosocial factors and their effect on infant gut microbiota and immunity remains an area that is not well understood. This article reviews the literature and supplements it with new findings to show that prenatal depression alters: (i) gut microbial composition in partially and fully formula-fed infants at 3-4 months of age, and (ii) gut immunity (i.e., secretory Immunoglobulin A) in all infants independent of breastfeeding status. Understanding the implications of maternal depression on the infant gut microbiome is important to enhance both maternal and child health and to better inform disease outcomes and management.
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Affiliation(s)
- Nicole Rodriguez
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hein M Tun
- HKU-Pasteur Research Pole, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | | | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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20
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Tun HM, Peng Y, Chen B, Konya TB, Morales-Lizcano NP, Chari R, Field CJ, Guttman DS, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Simons E, Scott JA, Kozyrskyj AL. Ethnicity Associations With Food Sensitization Are Mediated by Gut Microbiota Development in the First Year of Life. Gastroenterology 2021; 161:94-106. [PMID: 33741316 DOI: 10.1053/j.gastro.2021.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/25/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Increasing evidence supports the role of early-life gut microbiota in developing atopic diseases, but ecological changes to gut microbiota during infancy in relation to food sensitization remain unclear. We aimed to characterize and associate these changes with the development of food sensitization in children. METHODS In this observational study, using 16S rRNA amplicon sequencing, we characterized the composition of 2844 fecal microbiota in 1422 Canadian full-term infants. Atopic sensitization outcomes were measured by skin prick tests at age 1 year and 3 years. The association between gut microbiota trajectories, based on longitudinal shifts in community clusters, and atopic sensitization outcomes at age 1 and 3 years were determined. Ethnicity and early-life exposures influencing microbiota trajectories were initially examined, and post-hoc analyses were conducted. RESULTS Four identified developmental trajectories of gut microbiota were shaped by birth mode and varied by ethnicity. The trajectory with persistently low Bacteroides abundance and high Enterobacteriaceae/Bacteroidaceae ratio throughout infancy increased the risk of sensitization to food allergens, particularly to peanuts at age 3 years by 3-fold (adjusted odds ratio [OR] 2.82, 95% confidence interval [CI] 1.13-7.01). A much higher likelihood for peanut sensitization was found if infants with this trajectory were born to Asian mothers (adjusted OR 7.87, 95% CI 2.75-22.55). It was characterized by a deficiency in sphingolipid metabolism and persistent Clostridioides difficile colonization. Importantly, this trajectory of depleted Bacteroides abundance mediated the association between Asian ethnicity and food sensitization. CONCLUSIONS This study documented an association between persistently low gut Bacteroides abundance throughout infancy and sensitization to peanuts in childhood. It is the first to show a mediation role for infant gut microbiota in ethnicity-associated development of food sensitization.
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Affiliation(s)
- Hein M Tun
- HKU-Pasteur Research Pole, School of Public Health, University of Hong Kong, Hong Kong, China; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Ye Peng
- HKU-Pasteur Research Pole, School of Public Health, University of Hong Kong, Hong Kong, China
| | - Bolin Chen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore B Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Radha Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - David S Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, Ontario, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child and Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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21
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Wang A, Koleva P, du Toit E, Geddes DT, Munblit D, Prescott SL, Eggesbø M, Johnson CC, Wegienka G, Shimojo N, Campbell D, Kozyrskyj AL, Slupsky CM. The Milk Metabolome of Non-secretor and Lewis Negative Mothers. Front Nutr 2021; 7:576966. [PMID: 33634158 PMCID: PMC7901958 DOI: 10.3389/fnut.2020.576966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: The functional role of milk for the developing neonate is an area of great interest, and a significant amount of research has been done. However, a lot of work remains to fully understand the complexities of milk, and the variations imposed through genetics. It has previously been shown that both secretor (Se) and Lewis blood type (Le) status impacts the human milk oligosaccharide (HMO) content of human milk. While some studies have compared the non-HMO milk metabolome of Se+ and Se− women, none have reported on the non-HMO milk metabolome of Se− and Le– mothers. Method and Results: To determine the differences in the non-HMO milk metabolome between Se–Le– mothers and other HMO phenotypes (Se+Le+, Se+Le–, and Se–Le+), 10 milk samples from 10 lactating mothers were analyzed using nuclear magnetic resonance (NMR) spectroscopy. Se or Le HMO phenotypes were assigned based on the presence and absence of 6 HMOs generated by the Se and Le genes. After classification, 58 milk metabolites were compared among the HMO phenotypes. Principal component analysis (PCA) identified clear separation between Se–Le– milk and the other milks. Fold change analysis demonstrated that the Se–Le– milk had major differences in free fatty acids, free amino acids, and metabolites related to energy metabolism. Conclusion: The results of this brief research report suggest that the milk metabolome of mothers with the Se–Le– phenotype differs in its non-HMO metabolite composition from mothers with other HMO phenotypes.
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Affiliation(s)
- Aidong Wang
- Department of Food Science and Technology, University of California, Davis, Davis, CA, United States.,InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States
| | - Petya Koleva
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Elloise du Toit
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Donna T Geddes
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
| | - Daniel Munblit
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Susan L Prescott
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,The ORIGINS Project, Telethon Kids Institute, Perth Childrens Hospital, University of Western Australia, Crawley, WA, Australia
| | - Merete Eggesbø
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Christine C Johnson
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, United States
| | - Ganesa Wegienka
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, United States
| | - Naoki Shimojo
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Dianne Campbell
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Allergy and Immunology, Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - Anita L Kozyrskyj
- InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Carolyn M Slupsky
- Department of Food Science and Technology, University of California, Davis, Davis, CA, United States.,InVivo Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
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22
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Desai V, Kozyrskyj AL, Lau S, Sanni O, Dennett L, Walter J, Ospina MB. Effectiveness of Probiotic, Prebiotic, and Synbiotic Supplementation to Improve Perinatal Mental Health in Mothers: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:622181. [PMID: 33967849 PMCID: PMC8100186 DOI: 10.3389/fpsyt.2021.622181] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: There is an emerging interest in modulating the gut microbiota to target the gut-brain axis and improve maternal mental health in the perinatal period. This systematic review evaluated the effectiveness of prebiotics, probiotics, and synbiotics supplementation during pregnancy to reduce the risk of maternal mental health problems in the perinatal period. Methods: Electronic biomedical databases and clinical trial registries were searched from database inception through August 2020 to identify randomized controlled clinical trials (RCTs) evaluating the effect of probiotic, prebiotic, or synbiotic supplements administered to women during pregnancy on measures of perinatal depression, anxiety, and other mental health outcomes. Study selection, risk of bias appraisal, and data extraction were independently performed by two reviewers. Pooled mean differences (MD) and odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for the outcomes of interest in the review. Results: From 3,868 studies identified through the search strategy, three RCTs of low risk of bias involving 713 participants were included, all three testing probiotics. There were no differences between probiotics and control groups in the mean depression scores (MD -0.46; 95% CI -2.16, 1.25) at end of follow-up. Although statistical significance was not achieved, probiotics showed an advantage in the proportion of participants scoring below an established cut-off for depression (pOR 0.68; 95% CI 0.43, 1.07). Compared to placebo, probiotics in pregnancy reduced anxiety symptoms (MD -0.99; 95% CI -1.80, -0.18); however, this advantage was not translated in a reduction in the proportion of participants scoring above an established cut-off for anxiety (pOR 0.65; 95% CI 0.23, 1.85). There were no differences between probiotics and control groups in global mental health scores at end of follow-up (MD 1.09; 95% CI -2.04, 4.22). Conclusion: There is limited but promising evidence about the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring ABOVE a cut-off depression score. There is a lack of RCT evidence supporting prebiotics and synbiotics supplementation for similar purposes in the perinatal period. More research is needed before prebiotics, probiotics, and synbiotics are recommended to support maternal mental health and well-being in the perinatal period. Systematic Review Registration: PROSPERO, CRD42019137158.
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Affiliation(s)
- Vidhi Desai
- Department of Obstetrics & Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Anita L Kozyrskyj
- Department of Obstetrics & Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Stuart Lau
- Faculty of Science, McGill University, Montreal, QC, Canada
| | - Omolara Sanni
- Department of Obstetrics & Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jens Walter
- Department of Medicine, School of Microbiology, University College Cork, National University of Ireland, Cork, Ireland.,APC Microbiome Institute Ireland, University College Cork, National University of Ireland, Cork, Ireland
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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23
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Vu K, Lou W, Tun HM, Konya TB, Morales-Lizcano N, Chari RS, Field CJ, Guttman DS, Mandal R, Wishart DS, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Lefebvre DL, Sears MR, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. From Birth to Overweight and Atopic Disease: Multiple and Common Pathways of the Infant Gut Microbiome. Gastroenterology 2021; 160:128-144.e10. [PMID: 32946900 DOI: 10.1053/j.gastro.2020.08.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Few studies, even those with cohort designs, test the mediating effects of infant gut microbes and metabolites on the onset of disease. We undertook such a study. METHODS Using structural equation modeling path analysis, we tested directional relationships between first pregnancy, birth mode, prolonged labor and breastfeeding; infant gut microbiota, metabolites, and IgA; and childhood body mass index and atopy in 1667 infants. RESULTS After both cesarean birth and prolonged labor with a first pregnancy, a higher Enterobacteriaceae/Bacteroidaceae ratio at 3 months was the dominant path to overweight; higher Enterobacteriaceae/Bacteroidaceae ratios and Clostridioides difficile colonization at 12 months were the main pathway to atopic sensitization. Depletion of Bifidobacterium after prolonged labor was a secondary pathway to overweight. Influenced by C difficile colonization at 3 months, metabolites propionate and formate were secondary pathways to child outcomes, with a key finding that formate was at the intersection of several paths. CONCLUSIONS Pathways from cesarean section and first pregnancy to child overweight and atopy share many common mediators of the infant gut microbiome, notably C difficile colonization.
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Affiliation(s)
- Khanh Vu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hein M Tun
- School of Public Health, University of Hong Kong, Hong Kong
| | - Theodore B Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Radha S Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - David S Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, Ontario, Canada
| | - Rupasri Mandal
- The Metabolomics Innovation Centre, Edmonton, Alberta, Canada
| | - David S Wishart
- The Metabolomics Innovation Centre, Edmonton, Alberta, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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24
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Drall KM, Field CJ, Haqq AM, de Souza RJ, Tun HM, Morales-Lizcano NP, Konya TB, Guttman DS, Azad MB, Becker AB, Lefebvre DL, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Vitamin D supplementation in pregnancy and early infancy in relation to gut microbiota composition and C. difficile colonization: implications for viral respiratory infections. Gut Microbes 2020; 12:1799734. [PMID: 32779963 PMCID: PMC7524344 DOI: 10.1080/19490976.2020.1799734] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In Canada and the US, the infant diet is supplemented with vitamin D via supplement drops or formula. Pregnant and nursing mothers often take vitamin D supplements. Since little is known about the impact of this supplementation on infant gut microbiota, we undertook a study to determine the association between maternal and infant vitamin D supplementation, infant gut microbiota composition and Clostridioides difficile colonization in 1,157 mother-infant pairs of the CHILD (Canadian Healthy Infant Longitudinal Development) Cohort Study over 2009-2012. Logistic and MaAsLin regression were employed to assess associations between vitamin D supplementation, and C. difficile colonization, or other gut microbiota, respectively. Sixty-five percent of infants received a vitamin D supplement. Among all infants, infant vitamin D supplementation was associated with a lower abundance of genus Megamonas (q = 0.01) in gut microbiota. Among those exclusively breastfed, maternal prenatal supplementation was associated with lower abundance of Bilophila (q = 0.01) and of Lachnospiraceae (q = 0.02) but higher abundance of Haemophilus (q = 0.02). There were no differences in microbiota composition with vitamin D supplementation among partially and not breastfed infants. Neither infant nor maternal vitamin D supplementation were associated with C. difficile colonization, after adjusting for breastfeeding status and other factors. However, maternal consumption of vitamin-D fortified milk reduced the likelihood of C. difficile colonization in infants (adjustedOR: 0.40, 95% CI: 0.19-0.82). The impact of this compositional difference on later childhood health, especially defense against viral respiratory infection, may go beyond the expected effects of vitamin D supplements and remains to be ascertained.
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Affiliation(s)
- Kelsea M. Drall
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Andrea M. Haqq
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Hein M. Tun
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,HKU-Pasteur Research Pole, School of Public Health, Hong Kong University, Hong Kong SAR, China
| | | | - Theodore B. Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S. Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, Canada,Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON, Canada
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | - Piush J. Mandhane
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ONCanada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Medicine, McMaster University, Hamilton, ON, Canada,Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ONCanada
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,School of Public Health, University of Alberta, Edmonton, Canada,CONTACT : Anita L Kozyrskyj 3-527 Edmonton Clinic Health Academy, Edmonton, ABT6G 1C9, Canada
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25
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Nielsen CC, Gascon M, Osornio-Vargas AR, Shier C, Guttman DS, Becker AB, Azad MB, Sears MR, Lefebvre DL, Moraes TJ, Turvey SE, Subbarao P, Takaro TK, Brook JR, Scott JA, Mandhane PJ, Tun HM, Kozyrskyj AL. Natural environments in the urban context and gut microbiota in infants. Environ Int 2020; 142:105881. [PMID: 32610248 DOI: 10.1016/j.envint.2020.105881] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
The biodiversity hypothesis that contact with natural environments (e.g. native vegetation) and biodiversity, through the influence of environmental microbes, may be beneficial for human commensal microbiota has been insufficiently tested. We aimed to study the association between living near natural environments in the urban context, and gut microbiota diversity and composition in young infants. Based on data linkage between the unique Urban Primary Land and Vegetation Inventory (uPLVI) for the city of Edmonton and 355 infants in the CHILD Cohort Study, infant exposure to natural environments (any and specific types, yes/no) was determined within 500 m and 1000 m of their home residence. Gut microbiota composition and diversity at age 4 months was assessed in infant fecal samples. Adjusted for covariates, we observed a reduced odds of high microbial alpha-diversity in the gut of infants exposed to any natural environment within 500 m [Shannon index aOR (95%CI) = 0.63 (0.40, 0.98) and Simpson index = 0.63 (0.41, 0.98)]. In stratified analyses, these associations remained only among infants not breastfed or living with household pets. When doubly stratifying by these variables, the reduced likelihood of high alpha-diversity was present only among infants who were not breastfed and lived with household pets [9% of the study population, Shannon index = 0.07 (0.01, 0.49) and Simpson index = 0.11 (0.02, 0.66)]. Differences in beta-diversity was also seen (p = 0.04) with proximity to a nature space in not breastfed and pets-exposed infants. No associations were observed among infants who were fully formula-fed but without pets at home. When families and their pets had close access to a natural environment, Verrucomicrobiales colonization was reduced in the gut microbiota of formula-fed infants, the abundance of Clostridiales was depleted, whereas the abundance of Enterobacteriales was enriched. Our double-stratified results indicate that proximity to a natural environment plus pet ownership has the capacity to alter the gut microbiota of formula-fed infants. Further research is needed to replicate and better interpret these results, as well as to understand their health consequences.
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Affiliation(s)
- Charlene C Nielsen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; inVIVO Planetary Health, Canada
| | - Mireia Gascon
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Alvaro R Osornio-Vargas
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; inVIVO Planetary Health, Canada
| | - Catherine Shier
- Urban Form and Corporate Strategic Development, City Planning, City of Edmonton, Edmonton, AB, Canada
| | - David S Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, ON, Canada
| | - Allan B Becker
- Department of Pediatrics & Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics & Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hein M Tun
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; inVIVO Planetary Health, Canada.
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Department of Obstetrics & Gynecology, University of Alberta, AB, Canada; School of Public Health, University of Alberta, AB, Canada; inVIVO Planetary Health, Canada.
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26
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Stinson LF, Gay MCL, Koleva PT, Eggesbø M, Johnson CC, Wegienka G, du Toit E, Shimojo N, Munblit D, Campbell DE, Prescott SL, Geddes DT, Kozyrskyj AL. Human Milk From Atopic Mothers Has Lower Levels of Short Chain Fatty Acids. Front Immunol 2020; 11:1427. [PMID: 32903327 PMCID: PMC7396598 DOI: 10.3389/fimmu.2020.01427] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022] Open
Abstract
Short chain fatty acids (SFCAs) are microbial metabolites produced in the gut upon fermentation of dietary fiber. These metabolites interact with the host immune system and can elicit epigenetic effects. There is evidence to suggest that SCFAs may play a role in the developmental programming of immune disorders and obesity, though evidence in humans remains sparse. Here we have quantified human milk (HM) SCFA levels in an international cohort of atopic and non-atopic mothers (n = 109). Our results demonstrate that human milk contains detectable levels of the SCFAs acetate, butyrate, and formate. Samples from atopic mothers had significantly lower concentrations of acetate and butyrate than those of non-atopic mothers. HM SCFA levels in atopic and non-atopic women also varied based on maternal country of residence (Australia, Japan, Norway, South Africa, USA). Reduced exposure to HM SCFA in early life may program atopy or overweight risk in breastfed infants.
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Affiliation(s)
- Lisa F Stinson
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia.,inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States
| | - Melvin C L Gay
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia.,inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States
| | - Petya T Koleva
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Merete Eggesbø
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Christine C Johnson
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States
| | - Ganesa Wegienka
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States
| | - Elloise du Toit
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Naoki Shimojo
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pediatrics, Chiba University, Chiba, Japan
| | - Daniel Munblit
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair and Development Section, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Dianne E Campbell
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Allergy and Immunology, Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - Susan L Prescott
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,The ORIGINS Project, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Donna T Geddes
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia.,inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States
| | - Anita L Kozyrskyj
- inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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27
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Matenchuk BA, Mandhane PJ, Kozyrskyj AL. Sleep, circadian rhythm, and gut microbiota. Sleep Med Rev 2020; 53:101340. [PMID: 32668369 DOI: 10.1016/j.smrv.2020.101340] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 12/17/2022]
Abstract
From asthma and heart disease to diabetes and obesity, the human microbiome plays a role in the pathogenesis of each chronic health condition plaguing today's society. Recent work has shown that the gut microbiota and its metabolites exhibit diurnal rhythmicity which predominantly respond to the feeding/fasting cycle. Persistent jet lag, an obesogenic diet, and clock gene deficiency can dampen the oscillatory nature of gut bacterial composition, which can subsequently be rescued by time restricted feeding. Contrastingly, gut microbial metabolites influence central and hepatic clock gene expression and sleep duration in the host and regulate body composition through circadian transcription factors. Both sleep fragmentation and short sleep duration are associated with gut dysbiosis which may be due to activation of the HPA-axis. Metabolic disturbances associated with sleep loss may in fact be mediated through the overgrowth of specific gut bacteria. Reciprocally, the end products of bacterial species which grow in response to sleep loss are able to induce fatigue. Furthermore, probiotic supplementation has been found to improve subjective sleep quality. Sleep quality and duration may be an important target for supporting healthy gut microbiota composition, but the cyclic nature of this relationship should not be overlooked.
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Affiliation(s)
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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28
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Chow A, Dharma C, Chen E, Mandhane PJ, Turvey SE, Elliott SJ, Becker AB, Subbarao P, Sears MR, Kozyrskyj AL. Trajectories of Depressive Symptoms and Perceived Stress From Pregnancy to the Postnatal Period Among Canadian Women: Impact of Employment and Immigration. Am J Public Health 2020; 109:S197-S204. [PMID: 31242008 DOI: 10.2105/ajph.2018.304624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives. To identify trajectory patterns of maternal depressive symptoms and perceived stress from midpregnancy to 2 years postpartum and determine relationships with selected sociodemographic factors including income, education, immigration, and postpartum employment. Methods. Pregnant women (n = 3307) recruited from the general population in 4 regions in Canada provided 6 waves of data from pregnancy to 2 years postpartum. The study was conducted from 2009 to 2015. Results. We determined 5 trajectory groups distinguished by time and magnitude for both depressive symptoms and perceived stress. Immigrants living in Canada for more than 5 up to 10 years, but not more recent arrivals, were at higher risk for persistent stress and depression independent of income status. Being employed at 1 year postpartum was associated with a lower likelihood of postpartum depression and perceived stress, while mothers reporting work exhaustion were substantially more likely to experience persistent depression and stress. Conclusions. The study highlighted the heterogeneous nature of depressive symptoms and perceived stress. Targeting interventions toward women 5 to 10 years after immigration and those experiencing exhaustion from postpartum work may be particularly beneficial.
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Affiliation(s)
- Angela Chow
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Christoffer Dharma
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Edith Chen
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Piushkumar J Mandhane
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stuart E Turvey
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Susan J Elliott
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Allan B Becker
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Padmaja Subbarao
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Malcolm R Sears
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Anita L Kozyrskyj
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Patrick DM, Sbihi H, Dai DLY, Al Mamun A, Rasali D, Rose C, Marra F, Boutin RCT, Petersen C, Stiemsma LT, Winsor GL, Brinkman FSL, Kozyrskyj AL, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Subbarao P, Finlay BB, Turvey SE. Decreasing antibiotic use, the gut microbiota, and asthma incidence in children: evidence from population-based and prospective cohort studies. Lancet Respir Med 2020; 8:1094-1105. [PMID: 32220282 DOI: 10.1016/s2213-2600(20)30052-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Childhood asthma incidence is decreasing in some parts of Europe and North America. Antibiotic use in infancy has been associated with increased asthma risk. In the present study, we tested the hypothesis that decreases in asthma incidence are linked to reduced antibiotic prescribing and mediated by changes in the gut bacterial community. METHODS This study comprised population-based and prospective cohort analyses. At the population level, we used administrative data from British Columbia, Canada (population 4·7 million), on annual rates of antibiotic prescriptions and asthma diagnoses, to assess the association between antibiotic prescribing (at age <1 year) and asthma incidence (at age 1-4 years). At the individual level, 2644 children from the Canadian Healthy Infant Longitudinal Development (CHILD) prospective birth cohort were examined for the association of systemic antibiotic use (at age <1 year) with the diagnosis of asthma (at age 5 years). In the same cohort, we did a mechanistic investigation of 917 children with available 16S rRNA gene sequencing data from faecal samples (at age ≤1 year), to assess how composition of the gut microbiota relates to antibiotic exposure and asthma incidence. FINDINGS At the population level between 2000 and 2014, asthma incidence in children (aged 1-4 years) showed an absolute decrease of 7·1 new diagnoses per 1000 children, from 27·3 (26·8-28·3) per 1000 children to 20·2 (19·5-20·8) per 1000 children (a relative decrease of 26·0%). Reduction in incidence over the study period was associated with decreasing antibiotic use in infancy (age <1 year), from 1253·8 prescriptions (95% CI 1219·3-1288·9) per 1000 infants to 489·1 (467·6-511·2) per 1000 infants (Spearman's r=0·81; p<0·0001). Asthma incidence increased by 24% with each 10% increase in antibiotic prescribing (adjusted incidence rate ratio 1·24 [95% CI 1·20-1·28]; p<0·0001). In the CHILD cohort, after excluding children who received antibiotics for respiratory symptoms, asthma diagnosis in childhood was associated with infant antibiotic use (adjusted odds ratio [aOR] 2·15 [95% CI 1·37-3·39]; p=0·0009), with a significant dose-response; 114 (5·2%) of 2182 children unexposed to antibiotics had asthma by age 5 years, compared with 23 (8·1%) of 284 exposed to one course, five (10·2%) of 49 exposed to two courses, and six (17·6%) of 34 exposed to three or more courses (aOR 1·44 [1·16-1·79]; p=0·0008). Increasing α-diversity of the gut microbiota, defined as an IQR increase (25th to 75th percentile) in the Chao1 index, at age 1 year was associated with a 32% reduced risk of asthma at age 5 years (aOR for IQR increase 0·68 [0·46-0·99]; p=0·046). In a structural equation model, we found the gut microbiota at age 1 year, characterised by α-diversity, β-diversity, and amplicon sequence variants modified by antibiotic exposure, to be a significant mediator between outpatient antibiotic exposure in the first year of life and asthma diagnosis at age 5 years (β=0·08; p=0·027). INTERPRETATION Our findings suggest that the reduction in the incidence of paediatric asthma observed in recent years might be an unexpected benefit of prudent antibiotic use during infancy, acting via preservation of the gut microbial community. FUNDING British Columbia Ministry of Health, Pharmaceutical Services Branch; Canadian Institutes of Health Research; Allergy, Genes and Environment (AllerGen) Network of Centres of Excellence; Genome Canada; and Genome British Columbia.
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Affiliation(s)
- David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada.
| | - Hind Sbihi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Darlene L Y Dai
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Abdullah Al Mamun
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Drona Rasali
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Caren Rose
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Rozlyn C T Boutin
- Michael Smith Laboratories and Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Charisse Petersen
- Michael Smith Laboratories and Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Leah T Stiemsma
- Natural Science Division, Pepperdine University, Malibu, CA, USA
| | - Geoffrey L Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | | | | | | | | | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - B Brett Finlay
- Michael Smith Laboratories and Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada.
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van der Leek AP, Bahreinian S, Chartier M, Dahl ME, Azad MB, Brownell MD, Kozyrskyj AL. Maternal Distress During Pregnancy and Recurrence in Early Childhood Predicts Atopic Dermatitis and Asthma in Childhood. Chest 2020; 158:57-67. [PMID: 32173490 DOI: 10.1016/j.chest.2020.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. RESEARCH QUESTION Does the likelihood of asthma and atopic dermatitis in children increase when they are exposed to maternal distress pre- and postnatally in a sex-specific manner? STUDY DESIGN AND METHODS Using data from a provincial newborn screen and health-care database for 12,587 children born in 2004, maternal distress (depression or anxiety) was defined as prenatal, self-limiting, recurrent, or late-onset postpartum. Atopic dermatitis (AD) and asthma at ages 5 years and 7 years of age were diagnosed by using hospitalization, physician visit, or prescription records. Associations between maternal distress and childhood asthma and AD were determined by using multiple logistic regression. RESULTS After adjusting for risk factors, a significant association between maternal prenatal (OR, 1.27; 95% CI, 1.11-1.46), recurrent postpartum (OR, 1.28; 95% CI, 1.11-1.48), and late-onset postpartum (OR, 1.19, 95% CI, 1.06-1.34) distress was found with AD at age 5 years. Asthma at age 7 years was also associated with maternal prenatal distress (OR, 1.57; 95% CI, 1.29-1.91) and late-onset postnatal distress (OR, 1.22; 95% CI, 1.01-1.46). Self-limiting postnatal distress was not found to be a risk factor for either atopic condition. Associations with AD or asthma were of a similar magnitude in boys and girls; the exception was recurrent postnatal distress, which increased risk for asthma in boys only. INTERPRETATION This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.
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Affiliation(s)
| | - Salma Bahreinian
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew E Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Parks J, McCandless L, Dharma C, Brook J, Turvey SE, Mandhane P, Becker AB, Kozyrskyj AL, Azad MB, Moraes TJ, Lefebvre DL, Sears MR, Subbarao P, Scott J, Takaro TK. Association of use of cleaning products with respiratory health in a Canadian birth cohort. CMAJ 2020; 192:E154-E161. [PMID: 32071106 PMCID: PMC7030878 DOI: 10.1503/cmaj.190819] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Comprehensive longitudinal studies are important for understanding the complex risk factors, pathways, exposures and interactions that lead to the development and persistence of asthma. We aimed to examine associations between use of household cleaning products in early life and childhood respiratory and allergic disease using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. METHODS We summed responses from parental questionnaires that indicated the frequency of use of 26 household cleaning products in the homes of 2022 children from this birth cohort when they were 3-4 months of age to create a cumulative Frequency of Use Score (FUS). We used multivariable logistic regression models to assess whether frequent compared with less frequent use was associated with recurrent wheeze, atopy or asthma diagnosis, as defined by the questionnaire and clinical assessments at age 3 years. Data were collected between 2008 and 2015. RESULTS Children in homes with a higher frequency of use of cleaning products in infancy, as determined by an interquartile range increase, had higher odds of recurrent wheeze (adjusted odds ratio [OR] 1.35, 95% confidence interval [CI] 1.11-1.64), recurrent wheeze with atopy (adjusted OR 1.49, 95% CI 1.02-2.16) and asthma diagnosis (adjusted OR 1.37, 95% CI 1.09-1.70), but no increase in the odds of atopy at age 3 years (adjusted OR 1.14, 95% CI 0.96-1.35). Compared with the lowest tertile of FUS exposure, infants in the highest tertile had higher odds of acquiring asthma. Stratification of the results showed that females had higher ORs than males for all outcomes, although the p values for this sex difference did not reach statistical significance. INTERPRETATION Frequent use of household cleaning products in early life was associated with an increased risk for childhood wheeze and asthma but not atopy at age 3 years. Our findings add to the understanding of how early life exposures to cleaning products may be associated with the development of allergic airway disease and help to identify household behaviours as a potential area for intervention.
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Affiliation(s)
- Jaclyn Parks
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Lawrence McCandless
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Christoffer Dharma
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Jeffrey Brook
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Stuart E Turvey
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Piush Mandhane
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Allan B Becker
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Anita L Kozyrskyj
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Meghan B Azad
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Theo J Moraes
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Diana L Lefebvre
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Malcolm R Sears
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Padmaja Subbarao
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - James Scott
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Tim K Takaro
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont.
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Kang LJ, Vu KN, Koleva PT, Field CJ, Chow A, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Lefebvre DL, Turvey SE, Subbarao P, Lou WYW, Scott JA, Kozyrskyj AL. Cover Image. Clin Exp Allergy 2020. [DOI: 10.1111/cea.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kang LJ, Vu KN, Koleva PT, Field CJ, Chow A, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Lefebvre DL, Turvey SE, Subbarao P, Lou WYW, Scott JA, Kozyrskyj AL. Maternal psychological distress before birth influences gut immunity in mid-infancy. Clin Exp Allergy 2020; 50:178-188. [PMID: 31845414 DOI: 10.1111/cea.13551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maternal pre-postnatal psychosocial distress increases the risk for childhood allergic disease. This may occur through a host immunity pathway that involves intestinal secretory immunoglobulin A (sIgA). Experimental animal models show changes in the gut microbiome and immunity of offspring when exposed to direct or prenatal maternal stress, but little is known in humans. OBJECTIVE We determined the association between maternal depression and stress symptom trajectories and infant fecal sIgA concentrations. METHODS 1043 term infants from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort were studied. Trajectories of maternal perceived stress and depression were based on scored scales administered in pregnancy and postpartum. sIgA was quantified in infant stool (mean age 3.7 months) with Immundiagnostik ELISA. Linear regression and logistic regression were employed to test associations. RESULTS Very low fecal sIgA concentrations were more common in infants of mothers in the antepartum and persistent depression trajectories (6% and 2% of women, respectively). Independent of breastfeeding status at fecal sampling, infant antibiotic exposure or other covariates, the antepartum depressive symptom trajectory was associated with reduced mean infant sIgA concentrations (β=-0.07, P < .01) and a two fold risk for lowest quartile concentrations (OR, 1.86; 95% CI: 1.02, 3.40). This lowering of sIgA yielded a large effect size in older infants (4-8 months)-breastfed and not. No associations were seen with postpartum depressive symptoms (7% of women) or with any of the perceived stress trajectories. CONCLUSION AND CLINICAL RELEVANCE Despite improved mood postpartum and independent of breastfeeding status, mothers experiencing antepartum depressive symptoms delivered offspring who exhibited lower fecal sIgA concentrations especially in later infancy. The implications of lowered sIgA concentrations in infant stool are altered microbe-sIgA interactions, greater risk for C difficile colonization and atopic disease in later years.
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Affiliation(s)
- Liane J Kang
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Khanh N Vu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Petya T Koleva
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Angela Chow
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Wendy Y W Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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Drall KM, Tun HM, Morales-Lizcano NP, Konya TB, Guttman DS, Field CJ, Mandal R, Wishart DS, Becker AB, Azad MB, Lefebvre DL, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Clostridioides difficile Colonization Is Differentially Associated With Gut Microbiome Profiles by Infant Feeding Modality at 3-4 Months of Age. Front Immunol 2019; 10:2866. [PMID: 31921134 PMCID: PMC6917614 DOI: 10.3389/fimmu.2019.02866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
Colonization with Clostridioides difficile occurs in up to half of infants under the age of 3 months, is strongly influenced by feeding modality and is largely asymptomatic. In spite of this, C. difficile's presence has been associated with susceptibility to chronic disease later in childhood, perhaps by promoting or benefiting from changes in infant gut microbiome development, including colonization with pathogenic bacteria and disrupted production of microbial bioactive metabolites and proteins. In this study, the microbiomes of 1554 infants from the CHILD Cohort Study were described according to C. difficile colonization status and feeding mode at 3–4 months of age. C. difficile colonization was associated with a different gut microbiome profile in exclusively breastfed (EBF) vs. exclusively formula fed (EFF) infants. EBF infants colonized with C. difficile had an increased relative abundance of Firmicutes and Proteobacteria, decreased relative abundance of Bifidobacteriaceae, greater microbiota alpha-diversity, greater detectable fecal short chain fatty acids (SCFA), and lower detectable fecal secretory Immunoglobulin A (sIgA) than those not colonized. Similar but less pronounced differences were seen among partially breastfed infants (PBF) but EFF infants did not possess these differences in the gut microbiome according to colonization status. Thus, breastfed infants colonized with C. difficile appear to possess a gut microbiome that differs from non-colonized infants and resembles that of EFF infants, but the driving force and direction of this association remains unknown. Understanding these compositional differences as drivers of C. difficile colonization may be important to ensure future childhood health.
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Affiliation(s)
- Kelsea M Drall
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hein M Tun
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Theodore B Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, Canada.,Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Rupasri Mandal
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - David S Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James A Scott
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Tun MH, Tun HM, Mahoney JJ, Konya TB, Guttman DS, Becker AB, Mandhane PJ, Turvey SE, Subbarao P, Sears MR, Brook JR, Lou W, Takaro TK, Scott JA, Kozyrskyj AL. Postnatal exposure to household disinfectants, infant gut microbiota and subsequent risk of overweight in children. CMAJ 2019; 190:E1097-E1107. [PMID: 30224442 DOI: 10.1503/cmaj.170809] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Emerging links between household cleaning products and childhood overweight may involve the gut microbiome. We determined mediating effects of infant gut microbiota on associations between home use of cleaning products and future overweight. METHODS From the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort, we tested associations between maternal report of cleaning product use and overweight at age 3, and whether associations were mediated by microbial profiles of fecal samples in 3- to 4-month-old infants. RESULTS Among 757 infants, the abundance of specific gut microbiota was associated with household cleaning with disinfectants and eco-friendly products in a dose-dependent manner. With more frequent use of disinfectants, Lachnospiraceae increasingly became more abundant (highest v. lowest quintile of use: adjusted odds ratio [AOR] 1.93, 95% confidence interval [CI] 1.08 to 3.45) while genus Haemophilus declined in abundance (highest v. lowest quintile of use: AOR 0.36, 95% CI 0.20 to 0.65). Enterobacteriaceae were successively depleted with greater use of eco-friendly products (AOR 0.45, 95% CI 0.27 to 0.74). Lachnospiraceae abundance significantly mediated associations of the top 30th centile of household disinfectant use with higher body mass index (BMI) z score (p = 0.02) and with increased odds of overweight or obesity (p = 0.04) at age 3. Use of eco-friendly products was associated with decreased odds of overweight or obesity independently of Enterobacteriaceae abundance (AOR 0.44, 95% CI 0.22 to 0.86), with no significant mediation (p = 0.2). INTERPRETATION Exposure to household disinfectants was associated with higher BMI at age 3, mediated by gut microbial composition at age 3-4 months. Although child overweight was less common in households that cleaned with eco-friendly products, the lack of mediation by infant gut microbiota suggests another pathway for this association.
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Affiliation(s)
- Mon H Tun
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Hein M Tun
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Justin J Mahoney
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Theodore B Konya
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - David S Guttman
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Allan B Becker
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Piush J Mandhane
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Stuart E Turvey
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Padmaja Subbarao
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Malcolm R Sears
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Jeffrey R Brook
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Wendy Lou
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Tim K Takaro
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - James A Scott
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
| | - Anita L Kozyrskyj
- School of Public Health (M. Tun, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics (M. Tun, H. Tun, Mahoney, Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Dalla Lana School of Public Health (Konya, Brook, Lou, Scott), University of Toronto, Toronto, Ont.; Centre for the Analysis of Genome Evolution and Function (Guttman), University of Toronto, Toronto, Ont.; Department of Pediatrics and Child Health (Becker), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Turvey), Child and Family Research Institute, University of British Columbia, Vancouver, BC; Department of Pediatric Respiratory Medicine (Subbarao), University of Toronto. Toronto, Ont.; Department of Medicine (Sears), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Takarao), Simon Fraser University, Vancouver, BC; Canadian Healthy Infant Longitudinal Development Study (CHILD Study Investigators)
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Boix-Amorós A, Collado MC, Van't Land B, Calvert A, Le Doare K, Garssen J, Hanna H, Khaleva E, Peroni DG, Geddes DT, Kozyrskyj AL, Warner JO, Munblit D. Reviewing the evidence on breast milk composition and immunological outcomes. Nutr Rev 2019; 77:541-556. [PMID: 31111150 DOI: 10.1093/nutrit/nuz019] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A large number of biologically active components have been found in human milk (HM), and in both human and animal models, studies have provided some evidence suggesting that HM composition can be altered by maternal exposures, subsequently influencing health outcomes for the breastfed child. Evidence varies from the research studies on whether breastfeeding protects the offspring from noncommunicable diseases, including those associated with immunological dysfunction. It has been hypothesized that the conflicting evidence results from HM composition variations, which contain many immune active molecules, oligosaccharides, lactoferrin, and lysozyme in differing concentrations, along with a diverse microbiome. Determining the components that influence infant health outcomes in terms of both short- and long-term sequelae is complicated by a lack of understanding of the environmental factors that modify HM constituents and thereby offspring outcomes. Variations in HM immune and microbial composition (and the differing infantile responses) may in part explain the controversies that are evidenced in studies that aim to evaluate the prevalence of allergy by prolonged and exclusive breastfeeding. HM is a "mixture" of immune active factors, oligosaccharides, and microbes, which all may influence early immunological outcomes. This comprehensive review provides an in-depth overview of existing evidence on the studied relationships between maternal exposures, HM composition, vaccine responses, and immunological outcomes.
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Affiliation(s)
- Alba Boix-Amorós
- Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Valencia, Spain
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
| | - Maria Carmen Collado
- Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Valencia, Spain
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
| | - Belinda Van't Land
- Department of Immunology, Danone Nutricia Research, Utrecht, the Netherlands
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anna Calvert
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
- Imperial College London, London, United Kingdom
- Public Health England, Porton Down, United Kingdom, and the MRC Unit, Fajara, Gambia
| | - Johan Garssen
- Department of Immunology, Danone Nutricia Research, Utrecht, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Ekaterina Khaleva
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- University of Southampton, Southampton, UK
| | - Diego G Peroni
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Donna T Geddes
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- School of Molecular Sciences, the University of Western Australia, Perth, Australia
| | - Anita L Kozyrskyj
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- Department of Pediatrics, Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, School of Public Health, University of Alberta, Alberta, Canada
| | - John O Warner
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- Imperial College London, London, United Kingdom
- National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care for NW London, London, United Kingdom
| | - Daniel Munblit
- In-VIVO Global Network, an affiliate of the World Universities Network (WUN), New York, New York, United States
- Imperial College London, London, United Kingdom
- Department of Pediatrics, Sechenov University, Moscow, Russia, and the Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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Krzeczkowski JE, Lau A, Fitzpatrick J, Tamana S, Smithson L, de Souza R, Kozyrskyj AL, Lefebvre D, Becker AB, Subbarao P, Turvey SE, Pei J, Schmidt LA, Sears MR, Van Lieshout RJ, Mandhane PJ. Maternal Metabolic Complications in Pregnancy and Offspring Behavior Problems at 2 Years of Age. Matern Child Health J 2019; 23:746-755. [PMID: 30600520 DOI: 10.1007/s10995-018-2691-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Prenatal maternal metabolic problems such as pre-pregnancy adiposity, excess gestational weight gain, and gestational diabetes mellitus (GDM) are associated with an increased risk of psychopathology in offspring. We examined whether these exposures were linked to symptoms of emotional and behavioral problems in offspring at 2 years of age, or if associations were due to confounding variables. Methods Data from 815 mother-child pairs enrolled at the Edmonton site of the Canadian Healthy Infant Longitudinal Development cohort were used to examine associations between gestational metabolic complications and scores on the externalizing and internalizing scales of the Child Behavior Checklist (CBCL-1½ to 5) at age two. Associations between maternal metabolic complications and offspring psychopathology were assessed before and after adjustment for gestational diet, socioeconomic status (SES), postpartum depression (PPD), prenatal smoking and breastfeeding. Results Pre-pregnancy body mass index and GDM, but not gestational weight gain, predicted more offspring externalizing and internalizing problems. However, after adjustment for confounding variables, these associations were no longer statistically significant. Post-hoc analyses revealed that gestational diet accounted for unique variance in both externalizing (semi-partial rdiet = - 0.20, p < 0.001) and internalizing (semi-partial rdiet = - 0.16, p = 0.01) problems. PPD and SES also accounted for a similar amount of variance for both externalizing (semi-partial rPPD = 0.17, p < 0.001; rses = - 0.11, p = 0.03) and internalizing problems (semi-partial rPPD = 0.21, p < 0.001; rses = - 0.14, p = 0.004). Conclusions for Practice Since the confounding effect of gestational diet persisted after adjustment for, and was similar in magnitude to, SES and PPD, future research should consider the impact of unhealthy prenatal diets on offspring neurodevelopment.
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Affiliation(s)
| | - Amanda Lau
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Sukhpreet Tamana
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Russell de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Diana Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Allan B Becker
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Louis A Schmidt
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. .,Department of Pediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
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Matenchuk BA, Tamana SK, Lou WY, Lefebvre DL, Sears MR, Becker AB, Azad MB, Moraes TJ, Turvey SE, Subbarao P, Kozyrskyj AL, Mandhane PJ, Subbarao P, Turvey S, Anand S, Azad M, Becker A, Befus A, Brauer M, Brook J, Chen E, Cyr M, Daley D, Dell S, Denburg J, Duan Q, Eiwegger T, Grasemann H, HayGlass K, Hegele R, Holness D, Hystad P, Kobor M, Kollmann T, Kozyrskyj A, Laprise C, Lou W, Macri J, Mandhane P, Miller G, Moraes T, Paré P, Ramsey C, Ratjen F, Sandford A, Scott J, Scott J, Sears M, Silverman F, Simons E, Takaro T, Tebbutt S, To T. Prenatal depression and birth mode sequentially mediate maternal education's influence on infant sleep duration. Sleep Med 2019; 59:24-32. [DOI: 10.1016/j.sleep.2019.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/15/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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Dharma C, Lefebvre DL, Lu Z, Lou WYW, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Azad MB, Chen E, Elliott SJ, Kozyrskyj AL, Sears MR, Subbarao P. Risk for Maternal Depressive Symptoms and Perceived Stress by Ethnicities in Canada: From Pregnancy Through the Preschool Years. Can J Psychiatry 2019; 64:190-198. [PMID: 30068224 PMCID: PMC6405811 DOI: 10.1177/0706743718792190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Past cross-sectional studies have reported that mothers from ethnic minorities experience higher levels of prenatal and post-partum psychosocial distress compared with mothers from ethnic majorities. However, no studies have examined how the pattern varies longitudinally in a Canadian population of heterogeneous ethnicity. METHODS We analyzed data from 3,138 mothers participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a longitudinal multi-center study incorporating 10 distinct waves of psychosocial data collection from pregnancy until the index child was aged 5 y. Maternal self-identified ethnicity was grouped as White Caucasian, First Nations, Black, Southeast Asian, East Asian, South Asian, Middle Eastern, Hispanic and mixed ethnicity. We performed a multi-level regression to determine whether mothers of specific minority ethnicities were more likely to experience higher levels of distress (i.e. depressive symptoms and perceived stress) compared to white Caucasian mothers. RESULTS Mothers self-identifying as Black or First Nations had consistently higher distress scores than mothers from other ethnicities across all data collection times. After adjusting for relevant variables (history of depression, education, household income, marital status, and social support), First Nations mothers had a 20% increase in the mean scores of depressive symptoms compared to White Caucasian Mothers. CONCLUSIONS Increased levels of perinatal and post-partum distress were seen in only some ethnic minority groups. Studies should avoid collapsing all categories into ethnic minority or majority and may need to consider how ethnicity interacts with other sociodemographic factors such as poverty.
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Affiliation(s)
| | | | - Zihang Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Wendy Y. W. Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | | | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver,
Canada
| | - Theo J. Moraes
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | - Edith Chen
- Department of Psychology, Northwestern University, IL, USA
- Institute for Policy Research, Northwestern University, IL, USA
| | - Susan J. Elliott
- Department of Geography and Environmental Management, University of
Waterloo, Ontario, Canada
| | | | | | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
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40
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Protudjer JL, Kozyrskyj AL, Becker A. Maternal food allergy is associated with daughters’ menarche by age 11-14 years. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Drall KM, Tun HM, Kozyrskyj AL. Commentary: The Influence of Proton Pump Inhibitors on the Fecal Microbiome of Infants with Gastroesophageal Reflux-A Prospective Longitudinal Interventional Study. Front Cell Infect Microbiol 2019; 8:430. [PMID: 30619776 PMCID: PMC6302613 DOI: 10.3389/fcimb.2018.00430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/30/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelsea M Drall
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hein M Tun
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
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Affiliation(s)
| | - Stephane L Bourque
- Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Maria B Ospina
- Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
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43
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Ho NT, Li F, Lee-Sarwar KA, Tun HM, Brown BP, Pannaraj PS, Bender JM, Azad MB, Thompson AL, Weiss ST, Azcarate-Peril MA, Litonjua AA, Kozyrskyj AL, Jaspan HB, Aldrovandi GM, Kuhn L. Meta-analysis of effects of exclusive breastfeeding on infant gut microbiota across populations. Nat Commun 2018; 9:4169. [PMID: 30301893 PMCID: PMC6177445 DOI: 10.1038/s41467-018-06473-x] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
Previous studies on the differences in gut microbiota between exclusively breastfed (EBF) and non-EBF infants have provided highly variable results. Here we perform a meta-analysis of seven microbiome studies (1825 stool samples from 684 infants) to compare the gut microbiota of non-EBF and EBF infants across populations. In the first 6 months of life, gut bacterial diversity, microbiota age, relative abundances of Bacteroidetes and Firmicutes, and predicted microbial pathways related to carbohydrate metabolism are consistently higher in non-EBF than in EBF infants, whereas relative abundances of pathways related to lipid metabolism, vitamin metabolism, and detoxification are lower. Variation in predicted microbial pathways associated with non-EBF infants is larger among infants born by Caesarian section than among those vaginally delivered. Longer duration of exclusive breastfeeding is associated with reduced diarrhea-related gut microbiota dysbiosis. Furthermore, differences in gut microbiota between EBF and non-EBF infants persist after 6 months of age. Our findings elucidate some mechanisms of short and long-term benefits of exclusive breastfeeding across different populations.
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Affiliation(s)
- Nhan T Ho
- Gertrude H. Sergievsky Center, Columbia University, New York City, NY, 10032, USA
| | - Fan Li
- Department of Pediatrics, University of California, Los Angeles, CA, 90095, USA
| | - Kathleen A Lee-Sarwar
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Hein M Tun
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, T6G 1C9, AB, Canada
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bryan P Brown
- Duke University, Durham, NC, 27708, USA
- University of Cape Town Health Sciences Faculty, Institute of Infectious Disease and Molecular Medicine, Cape Town, 7701, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Pia S Pannaraj
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, 90027, USA
| | - Jeffrey M Bender
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, 90027, USA
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, R3E 3P4, Manitoba, Canada
| | - Amanda L Thompson
- Department of Anthropology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - M Andrea Azcarate-Peril
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
- Microbiome Core Facility, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Augusto A Litonjua
- Division of Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, T6G 1C9, AB, Canada
| | - Heather B Jaspan
- University of Cape Town Health Sciences Faculty, Institute of Infectious Disease and Molecular Medicine, Cape Town, 7701, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Grace M Aldrovandi
- Department of Pediatrics, University of California, Los Angeles, CA, 90095, USA
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Columbia University, New York City, NY, 10032, USA.
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Miliku K, Robertson B, Sharma AK, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Bode L, Azad MB, Anand SS, Azad M, Becker AB, Befus AD, Brauer M, Brook JR, Chen E, Cyr M, Daley D, Dell SD, Denburg JA, Duan Q, Eiwegger T, Grasemann H, HayGlass K, Hegele RG, Holness DL, Hystad P, Kobor M, Kollman TR, Kozyrskyj AL, Laprise C, Lou WYW, Macri J, Miller G, Moraes TJ, Ramsey C, Ratjen F, Sandford A, Scott JA, Scott J, Silverman F, Simons E, Takaro T, Tebbutt S, To T. Human milk oligosaccharide profiles and food sensitization among infants in the CHILD Study. Allergy 2018; 73:2070-2073. [PMID: 29775217 DOI: 10.1111/all.13476] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- K. Miliku
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
- The Generation R Study Group Departments of Pediatrics and Epidemiology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - B. Robertson
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence University of California San Diego La Jolla CA USA
| | - A. K. Sharma
- George & Fay Yee Centre for Healthcare Innovation University of Manitoba Winnipeg MB Canada
| | - P. Subbarao
- Departments of Pediatrics & Physiology University of Toronto Toronto ON Canada
| | - A. B. Becker
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
| | - P. J. Mandhane
- Department of Pediatrics University of Alberta Edmonton AB Canada
| | - S. E. Turvey
- Department of Pediatrics University of British Columbia Vancouver BC Canada
| | - D. L. Lefebvre
- Department of Medicine McMaster University Hamilton ON Canada
| | - M. R. Sears
- Department of Medicine McMaster University Hamilton ON Canada
| | - L. Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence University of California San Diego La Jolla CA USA
| | - M. B. Azad
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
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45
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Bridgman SL, Azad MB, Persaud RR, Chari RS, Becker AB, Sears MR, Mandhane PJ, Turvey SE, Subbarao P, Haqq AM, Kozyrskyj AL. Impact of maternal pre-pregnancy overweight on infant overweight at 1 year of age: associations and sex-specific differences. Pediatr Obes 2018; 13:579-589. [PMID: 29797797 DOI: 10.1111/ijpo.12291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/16/2018] [Accepted: 02/21/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Maternal overweight or obesity (OWOB) is linked to gestational diabetes, fetal macrosomia and higher rates of caesarean delivery. OBJECTIVES The study aims to assess whether maternal pre-pregnancy OWOB is associated with infant overweight in a sex-dependent manner, independent of microbiota-altering variables. METHODS Weight and length measurements of 955 mother-infant pairs were obtained from the Canadian Healthy Infant Longitudinal Development cohort. Maternal pre-pregnancy weight was defined as follows: normal, overweight (25 ≤ body mass index < 30) and obese (body mass index ≥ 30). Age and sex-adjusted weight-for-length z-scores >97th percentile were classified as infant overweight at age 1 year. Associations between pre-pregnancy and infant overweight were determined by linear and logistic regression, adjusting for covariates. RESULTS Maternal pre-pregnancy OWOB were associated with infant weight-for-length and overweight risk at 1 year. Except for pre-pregnancy obesity, these associations were not attenuated appreciably after adjustment for birth mode, exclusivity of breastfeeding, exposure to antibiotics and infant sex. Yet only boys born to mothers with obesity were three times more likely to become overweight at age 1 independent of microbiota-altering variables. Pre-pregnancy obesity was associated with weight-for-length in male and female infants. CONCLUSIONS Maternal pre-pregnancy OWOB increases the risk of infant overweight, and this association is more evident in male infants.
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Affiliation(s)
- S L Bridgman
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - M B Azad
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - R R Persaud
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - R S Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - A B Becker
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - M R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - P J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - S E Turvey
- Department of Pediatrics, Child and Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - A M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - A L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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46
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Obiakor CV, Tun HM, Bridgman SL, Arrieta MC, Kozyrskyj AL. The association between early life antibiotic use and allergic disease in young children: recent insights and their implications. Expert Rev Clin Immunol 2018; 14:841-855. [PMID: 30198345 DOI: 10.1080/1744666x.2018.1521271] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Greater prescribing of antibiotics to infants has coincided with an epidemic of allergic disease. Through meta-analytic synthesis, accumulating evidence from prospective or database cohorts suggests a link between infant antibiotic treatment and the development of atopy. Stronger associations seen with multiple course and broad-spectrum antibiotic treatment add to biological plausibility. A major bias, confounding by indication, has been addressed in studies on antibiotic treatment of conditions which do not precede allergic disease. Areas covered: Our review provides an up-to-date synthesis of the current literature on associations between infant antibiotic exposure and future allergic disease. We discuss methods that assist in reducing study bias and look at new insights from studies of the infant gut microbiome. Expert commentary: Large-scale profiling of the gut microbiome provides a new tool for disentangling biases found in observational studies of infant antibiotic use. To date, microbial dysbiosis of the infant gut has been reported to predict allergic disease independent of antibiotic exposure up to 3 months after birth. However, these studies have not accounted for antibiotic treatment in later infancy. Continued study of the infant gut microbiome, mycobiome, or resistome will provide a closer link to antibiotic treatment or refute it as a cause of allergic disease.
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Affiliation(s)
- Chinwe V Obiakor
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - Hein M Tun
- b Department of Pediatrics , University of Alberta , Edmonton , Canada.,c HKU-Pasteur Research Pole, School of Public Health , The University of Hong Kong, Hong Kong , Hong Kong
| | - Sarah L Bridgman
- b Department of Pediatrics , University of Alberta , Edmonton , Canada
| | - Marie-Claire Arrieta
- d Departments of Physiology and Pharmacology & Pediatrics , Cumming School of Medicine, University of Calgary , Calgary , Canada
| | - Anita L Kozyrskyj
- a School of Public Health , University of Alberta , Edmonton , Canada.,b Department of Pediatrics , University of Alberta , Edmonton , Canada.,e Department of Obstetrics and Gynecology , University of Alberta , Edmonton , Canada
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47
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Hüls A, Klümper C, MacIntyre EA, Brauer M, Melén E, Bauer M, Berdel D, Bergström A, Brunekreef B, Chan-Yeung M, Fuertes E, Gehring U, Gref A, Heinrich J, Standl M, Lehmann I, Kerkhof M, Koppelman GH, Kozyrskyj AL, Pershagen G, Carlsten C, Krämer U, Schikowski T. Atopic dermatitis: Interaction between genetic variants of GSTP1, TNF, TLR2, and TLR4 and air pollution in early life. Pediatr Allergy Immunol 2018; 29:596-605. [PMID: 29624745 DOI: 10.1111/pai.12903] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Associations between traffic-related air pollution (TRAP) and childhood atopic dermatitis (AD) remain inconsistent, possibly due to unexplored gene-environment interactions. The aim of this study was to examine whether a potential effect of TRAP on AD prevalence in children is modified by selected single nucleotide polymorphisms (SNPs) related to oxidative stress and inflammation. METHODS Doctor-diagnosed AD up to age 2 years and at 7-8 years, as well as AD symptoms up to age 2 years, was assessed using parental-reported questionnaires in six birth cohorts (N = 5685). Associations of nitrogen dioxide (NO2 ) estimated at the home address of each child at birth and nine SNPs within the GSTP1, TNF, TLR2, or TLR4 genes with AD were examined. Weighted genetic risk scores (GRS) were calculated from the above SNPs and used to estimate combined marginal genetic effects of oxidative stress and inflammation on AD and its interaction with TRAP. RESULTS GRS was associated with childhood AD and modified the association between NO2 and doctor-diagnosed AD up to the age of 2 years (P(interaction) = .029). This interaction was mainly driven by a higher susceptibility to air pollution in TNF rs1800629 minor allele (A) carriers. TRAP was not associated with the prevalence of AD in the general population. CONCLUSIONS The marginal genetic association of a weighted GRS from GSTP1, TNF, TLR2, and TLR4SNPs and its interaction with air pollution supports the role of oxidative stress and inflammation in AD.
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Affiliation(s)
- Anke Hüls
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Claudia Klümper
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.,Hochschule Hamm-Lippstadt, Hamm, Germany
| | - Elaina A MacIntyre
- Environmental and Occupational Health, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.,Sachs Children's Hospital, Stockholm, Sweden
| | - Mario Bauer
- Department for Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Dietrich Berdel
- Department of Pediatrics, Marien-Hospital Wesel, Research Institute, Wesel, Germany
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moira Chan-Yeung
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Fuertes
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anna Gref
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Irina Lehmann
- Department for Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Marjan Kerkhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Observational and Pragmatic Research Institute, Singapore
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Christopher Carlsten
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute for Heart and Lung Health, Vancouver, BC, Canada
| | - Ursula Krämer
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
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Gay MCL, Koleva PT, Slupsky CM, Toit ED, Eggesbo M, Johnson CC, Wegienka G, Shimojo N, Campbell DE, Prescott SL, Munblit D, Geddes DT, Kozyrskyj AL. Worldwide Variation in Human Milk Metabolome: Indicators of Breast Physiology and Maternal Lifestyle? Nutrients 2018; 10:nu10091151. [PMID: 30420587 PMCID: PMC6163258 DOI: 10.3390/nu10091151] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023] Open
Abstract
Human milk provides essential substrates for the optimal growth and development of a breastfed infant. Besides providing nutrients to the infant, human milk also contains metabolites which form an intricate system between maternal lifestyle, such as the mother's diet and the gut microbiome, and infant outcomes. This study investigates the variation of these human milk metabolites from five different countries. Human milk samples (n = 109) were collected one month postpartum from Australia, Japan, the USA, Norway, and South Africa and were analyzed by nuclear magnetic resonance. The partial least squares discriminant analysis (PLS-DA) showed separation between either maternal countries of origin or ethnicities. Variation between countries in concentration of metabolites, such as 2-oxoglutarate, creatine, and glutamine, in human milk, between countries, could provide insights into problems, such as mastitis and/or impaired functions of the mammary glands. Several important markers of milk production, such as lactose, betaine, creatine, glutamate, and glutamine, showed good correlation between each metabolite. This work highlights the importance of milk metabolites with respect to maternal lifestyle and the environment, and also provides the framework for future breastfeeding and microbiome studies in a global context.
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Affiliation(s)
- Melvin C L Gay
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia.
| | - Petya T Koleva
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, AB T6G 1C9, Canada.
| | - Carolyn M Slupsky
- Departments of Nutrition/Food Science & Technology, University of California Davis, California, CA 95616-5270, USA.
| | - Elloise du Toit
- Division of Medical Microbiology, University of Cape Town, Cape Town, Rondebosch 7701, South Africa.
| | - Merete Eggesbo
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo N-0213, Norway.
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI 48208, USA.
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI 48208, USA.
| | - Naoki Shimojo
- Department of Pediatrics, Chiba University, Chiba 260-8677, Japan.
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, University of Sydney, Sydney, NSW 2145, Australia.
| | - Susan L Prescott
- School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia.
- ORIGINS Project, Telethon Kids Institute, Perth Children's Hospital, Perth, WA 6009, Australia.
| | - Daniel Munblit
- Department of Paediatrics, Imperial College London, London W2 1NY, UK.
- Faculty of Pediatrics, Sechenov University, Moscow 119991, Russia.
| | - Donna T Geddes
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia.
| | - Anita L Kozyrskyj
- Departments of Pediatrics/Obstetrics & Gynecology, School of Public Health, University of Alberta, Edmonton, Alberta AB T6G 1C9, Canada.
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49
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Forbes JD, Azad MB, Vehling L, Tun HM, Konya TB, Guttman DS, Field CJ, Lefebvre D, Sears MR, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Subbarao P, Scott JA, Kozyrskyj AL. Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices With Gut Microbiota and Risk of Overweight in the First Year of Life. JAMA Pediatr 2018; 172:e181161. [PMID: 29868719 PMCID: PMC6137517 DOI: 10.1001/jamapediatrics.2018.1161] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The effect of neonatal and infant feeding practices on childhood obesity is unclear. The gut microbiome is strongly influenced by feeding practices and has been linked to obesity. OBJECTIVE To characterize the association between breastfeeding, microbiota, and risk of overweight during infancy, accounting for the type and timing of supplementary feeding. DESIGN, SETTING, AND PARTICIPANTS In this study of a subset of 1087 infants from the prospective CHILD pregnancy cohort, mothers were recruited between January 1, 2009, and December 31, 2012. Statistical analysis was performed from February 1 to December 20, 2017. MAIN OUTCOMES AND MEASURES Feeding was reported by mothers and documented from hospital records. Fecal microbiota at 3 to 4 months (from 996 infants) and/or 12 months (from 821 infants) were characterized by 16S ribosomal RNA sequencing. Infants with a weight for length exceeding the 85th percentile were considered to be at risk for overweight. RESULTS There were 1087 infants in the study (507 girls and 580 boys); at 3 months, 579 of 1077 (53.8%) were exclusively breastfed according to maternal report. Infants who were exclusively formula fed at 3 months had an increased risk of overweight in covariate-adjusted models (53 of 159 [33.3%] vs 74 of 386 [19.2%]; adjusted odds ratio, 2.04; 95% CI, 1.25-3.32). This association was attenuated (adjusted odds ratio, 1.33; 95% CI, 0.79-2.24) after further adjustment for microbiota features characteristic of formula feeding at 3 to 4 months, including higher overall richness and enrichment of Lachnospiraceae. A total of 179 of 579 infants who were exclusively breastfed (30.9%) received formula as neonates; this brief supplementation was associated with lower relative abundance of Bifidobacteriaceae and higher relative abundance of Enterobacteriaceae at 3 to 4 months but did not influence the risk of overweight. At 12 months, microbiota profiles differed significantly according to feeding practices at 6 months; among partially breastfed infants, formula supplementation was associated with a profile similar to that of nonbreastfed infants (higher diversity and enrichment of Bacteroidaceae), whereas the introduction of complementary foods without formula was associated with a profile more similar to that of exclusively breastfed infants (lower diversity and enrichment of Bifidobacteriaceae and Veillonellaceae). Microbiota profiles at 3 months were more strongly associated with risk of overweight than were microbiota profiles at 12 months. CONCLUSIONS AND RELEVANCE Breastfeeding may be protective against overweight, and gut microbiota may contribute to this effect. Formula feeding appears to stimulate changes in microbiota that are associated with overweight, whereas other complementary foods do not. Subtle microbiota differences emerge after brief exposure to formula in the hospital. These results identify important areas for future research and distinguish early infancy as a critical period when transient gut dysbiosis may lead to increased risk of overweight.
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Affiliation(s)
- Jessica D. Forbes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada,Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Meghan B. Azad
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorena Vehling
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hein M. Tun
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore B. Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David S. Guttman
- Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Catherine J. Field
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Allan B. Becker
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada,Child and Family Research Institute, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Theo J. Moraes
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Entz R, Rai U, Rycroft J, Chari RS, Kozyrskyj AL. Regional Caesarean Delivery Practices, the Maternal-Infant Microbiome, and Risk for Asthma. J Obstet Gynaecol Can 2018; 40:1061-1065. [PMID: 29887361 DOI: 10.1016/j.jogc.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/14/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Rebecca Entz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Usha Rai
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Jordan Rycroft
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Radha S Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Anita L Kozyrskyj
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB.
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