RESUMO
A randomised, double-blind, placebo-controlled trial was carried out among Mexico children aged 6-15 months to determine how household characteristics modify vitamin A and zinc supplementation efficacy on Ascaris lumbricoides, Giardia intestinalis and Entamoeba histolytica/E. dispar infection durations. Children assigned to receive vitamin A every 2 months, a daily zinc supplement, a combined vitamin A-zinc supplement or a placebo were followed for 1 year. Parametric hazard models were fit to infection durations stratified by personal and household factors. Children supplemented with vitamin A and zinc combined from households lacking piped water and children in all three treatment arms from households with dirt floors had longer G. intestinalis and A. lumbricoides infection durations than their counterparts, respectively. Shorter E. histolytica/E.dispar durations were found among zinc-supplemented children of mothers who had <6 years of education and no indoor bathrooms. Heterogeneity in supplementation efficacy among children may reflect differences in exposure risk and baseline immune responses.
Assuntos
Suplementos Nutricionais , Enteropatias Parasitárias/tratamento farmacológico , Vitamina A/administração & dosagem , Vitaminas/administração & dosagem , Zinco/administração & dosagem , Animais , Ascaríase/tratamento farmacológico , Ascaris lumbricoides/patogenicidade , Método Duplo-Cego , Características da Família , Fezes/parasitologia , Feminino , Giardia lamblia/patogenicidade , Giardíase/tratamento farmacológico , Habitação/normas , Humanos , Lactente , Masculino , México , Contagem de Ovos de Parasitas , Pais/educação , Estudos ProspectivosRESUMO
BACKGROUND: Micronutrient status may be a contributing factor to the development of childhood obesity in many industrializing countries passing the nutritional transition. The few studies investigating associations between serum concentrations of vitamin B and intake of B vitamins with adiposity, however, have reported inconsistent findings. OBJECTIVE: The aim of the study was to examine associations between serum vitamin B-12 and folate concentrations and intakes of B vitamins with body fat by using data on 1131 Mexican American children 8-15 y of age included in NHANES 2001-2004. METHODS: Children's body mass index (BMI), trunk fat mass (TrFM), and total body fat mass (TBFM) were used as body adiposity (BA) measures. Serum concentrations of folate and vitamin B-12 were measured in blood samples collected from children. Intake of B vitamins was collected according to 24-h dietary recall. Associations of BA with serum concentrations of vitamin B-12 and folate and intake of B vitamins were determined by using linear and multinomial regression models. RESULTS: Serum concentrations of vitamin B-12 and folate were inversely associated with BMI (ß: -2.68, P < 0.01; ß = -1.33, P < 0.01), TrFM (ß:-3.32, P < 0.01; ß: -0.14, P < 0.05), and TBFM (ß:-1.93, P < 0.01; ß: -3.19; P < 0.01). Higher serum concentrations of vitamin B-12 were associated with a reduced risk of obesity (OR: 0.48; 95% CI: 0.31, 0.77; P < 0.001). Thiamin and riboflavin intakes were inversely associated with BMI (ß:-1.35, P < 0.05; ß: -1.11, P < 0.05) and TrFM (ß:-1.26, P < 0.05; ß: -1.37, P < 0.05). CONCLUSION: Similar inverse associations between BA and status of both vitamin B-12 and folate and intake of thiamin and riboflavin suggest that these micronutrients may play a role in adipogenesis and risk of childhood obesity.
Assuntos
Adiposidade , Ácido Fólico/sangue , Americanos Mexicanos , Riboflavina/sangue , Tiamina/sangue , Vitamina B 12/sangue , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Ácido Fólico/administração & dosagem , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/epidemiologia , Humanos , Modelos Lineares , Masculino , Rememoração Mental , Micronutrientes/administração & dosagem , Micronutrientes/sangue , Micronutrientes/deficiência , Análise Multivariada , Inquéritos Nutricionais , Obesidade Infantil/sangue , Obesidade Infantil/epidemiologia , Riboflavina/administração & dosagem , Deficiência de Riboflavina/sangue , Deficiência de Riboflavina/epidemiologia , Tiamina/administração & dosagem , Deficiência de Tiamina/sangue , Deficiência de Tiamina/epidemiologia , Vitamina B 12/administração & dosagem , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/epidemiologiaRESUMO
Mexican-American children have a high prevalence of overweight/obesity. Micronutrient deficiencies may be contributing to the development of greater adiposity in these children. This study investigated the relations between adiposity and serum concentrations of carotenoids, retinol, and vitamin E among Mexican-American children 8-15 y of age included in the 2001-2004 U.S. NHANES. Associations of the outcomes of children's body mass index (BMI), truncal fat mass (TrFM), and total body fat mass (TBFM) with serum concentrations of α-carotene, cis-ß-carotene, trans-ß-carotene, retinol, and α-tocopherol were determined by using linear, quantile, and multinomial regression models. BMI was inversely associated with serum concentrations of α-carotene (ß = -0.88, P < 0.05), trans-ß-carotene (ß = -2.21, P < 0.01), cis-ß-carotene (ß = -2.10, P < 0.01), and α-tocopherol adjusted for total cholesterol ratio (ß = -3.66, P < 0.01), respectively. Similar inverse associations were found with TrFM and TBFM. Higher cis-ß-carotene and α-tocopherol serum concentrations were associated with reduced probability of overweight (OR: 0.57; 95% CI: 0.37, 0.89; P < 0.05; and OR: 0.56; 95% CI: 0.37, 0.86; P < 0.05; respectively) and obesity (OR: 0.39; 95% CI: 0.26, 0.58; P < 0.01; and OR: 0.38; 95% CI: 0.24, 0.60; P < 0.01; respectively). Higher retinol serum concentrations were associated with increased probability of overweight and obesity (OR: 2.01; 95% CI: 1.26, 3.22; P < 0.01; and OR: 2.90; 95% CI: 1.65, 5.09; P < 0.01; respectively). Significant inverse associations were found between serum concentrations of carotenoids and vitamin E and adiposity among Mexican-American children, but serum retinol concentrations were positively associated with adiposity. Future research is needed to understand the causes and consequences of micronutrient status on adiposity and comorbidities.
Assuntos
Adiposidade , Carotenoides/sangue , Obesidade/complicações , Sobrepeso/complicações , Deficiência de Vitamina E/complicações , Vitamina E/sangue , Gordura Abdominal/patologia , Adolescente , Biomarcadores/sangue , Índice de Massa Corporal , Carotenoides/deficiência , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Americanos Mexicanos , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/etiologia , Obesidade/patologia , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Sobrepeso/patologia , Prevalência , Estados Unidos/epidemiologia , Vitamina A/efeitos adversos , Vitamina A/sangue , Deficiência de Vitamina E/sangueRESUMO
Vitamin A supplementation is associated with divergent clinical norovirus (NoV) outcomes in Mexican children. Fecal cytokine concentrations following NoV genogroup infections among 127 Mexican children 5-15 mo old enrolled in a randomized, double-blind, placebo-controlled, vitamin A supplementation trial were determined to clarify the role the gut immune response plays in these associations. Stools collected from supplemented children [20,000 IU retinol (3.3 IU = 1 µg retinol) for children < 12 mo of age; 45,000 iu for children ≥ 12 mo] or children in the placebo group were screened for NoV genogroups I (GI) and II (GII). Monocyte chemoattractant protein-1 (MCP-1), TNFα, IL-5, IL-6, IL-8, IL-4, IFNγ, and IL-10 fecal concentrations were also determined. Differences in cytokine levels between the 2 groups following GI and GII infections were determined using ordered logistic regression models. MCP-1 and IL-8 levels were greater among GI- and GII-infected children, respectively, compared with uninfected children, whereas IL-5 levels were greater following both genogroup infections. MCP-1, IL-8, and IL-6 fecal levels were reduced among supplemented children with GII-associated diarrhea compared with the placebo group. Vitamin A-supplemented, GII-infected children had reduced MCP-1 and TNFα levels compared with GII-infected children in the placebo group (P-interaction = 0.02 and 0.03, respectively). Supplemented children with GI-associated diarrhea had higher TNFα and IL-4 levels compared with children in the placebo group with diarrhea (P-interaction = 0.02 and 0.02, respectively). The divergent effects of supplementation on NoV outcomes may result from the different effects vitamin A has on the genogroup-specific immune responses.
Assuntos
Infecções por Caliciviridae/prevenção & controle , Quimiocinas/análise , Citocinas/análise , Interações Hospedeiro-Patógeno , Intestinos/imunologia , Norovirus/fisiologia , Vitamina A/uso terapêutico , Imunidade Adaptativa , Infecções por Caliciviridae/imunologia , Quimiocinas/imunologia , Citocinas/imunologia , Suplementos Nutricionais , Método Duplo-Cego , Fezes/química , Fezes/microbiologia , Feminino , Gastroenterite/imunologia , Gastroenterite/prevenção & controle , Humanos , Imunidade Inata , Imunomodulação , Lactente , Intestinos/microbiologia , Masculino , México , Norovirus/classificação , Norovirus/imunologia , Norovirus/isolamento & purificação , Deficiência de Vitamina A/imunologia , Deficiência de Vitamina A/prevenção & controleRESUMO
BACKGROUND: The efficacy of vitamin A supplementation on diarrheal disease morbidity may reflect the divergent effects that supplementation has on pathogen-specific immune responses and pathogen-specific outcomes. OBJECTIVE: We examined how vitamin A supplementation modified associations between gut-cytokine immune responses and the resolution of different diarrheal pathogen infections. DESIGN: Stools collected from 127 Mexican children who were 5-15 mo old and enrolled in a randomized, placebo-controlled vitamin A supplementation trial were screened for enteropathogenic Escherichia coli (EPEC), enterotoxigenic E. coli (ETEC), and Giardia lamblia. Fecal concentrations of interleukin (IL)-6, IL-8, IL-4, IL-5, IL-10, monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were measured by using an enzyme-linked immunosorbent assay. Hazard models that incorporated categorized cytokine variables (ie, nondetectable, less than the median of detectable concentrations, and at least the median of detectable concentrations) were fit to the length of pathogen infections stratified by treatment group. RESULTS: Vitamin A-supplemented children with fecal MCP-1 or IL-8 concentrations less than the median of detectable concentrations and IL-10 concentrations of at least median concentrations had longer durations of EPEC infection than did children in the placebo group. In supplemented children, detectable fecal TNF-α or IL-6 concentrations were associated with shorter ETEC infection durations, whereas MCP-1 concentrations of at least the median were associated with longer infection durations. Children in this group who had IL-4, IL-5, or IFN-γ concentrations of at least median detectable concentrations had shorter durations of G. lamblia infection. CONCLUSION: The effect of supplementation on associations between fecal cytokine concentrations and pathogen infection resolution depends on the role of inflammatory immune responses in resolving specific pathogen infections.
Assuntos
Diarreia Infantil/tratamento farmacológico , Diarreia Infantil/imunologia , Suplementos Nutricionais , Infecções por Enterobacteriaceae/tratamento farmacológico , Enterobacteriaceae/isolamento & purificação , Imunidade/efeitos dos fármacos , Vitamina A/uso terapêutico , Imunidade Adaptativa/efeitos dos fármacos , Citocinas/análise , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli Enteropatogênica/efeitos dos fármacos , Escherichia coli Enteropatogênica/isolamento & purificação , Escherichia coli Enterotoxigênica/efeitos dos fármacos , Escherichia coli Enterotoxigênica/isolamento & purificação , Fezes/química , Fezes/microbiologia , Feminino , Giardia lamblia/efeitos dos fármacos , Giardia lamblia/isolamento & purificação , Humanos , Imunidade Inata/efeitos dos fármacos , Imunidade nas Mucosas/efeitos dos fármacos , Lactente , Masculino , México , Modelos de Riscos ProporcionaisRESUMO
The identification of immune response mechanisms that contribute to the control of diarrheal disease in developing countries remains an important priority. We addressed the role of fecal chemokines and cytokines in the resolution of diarrheal Escherichia coli and Giardia lamblia infections. Stools collected from 127 Mexican children 5 to 15 months of age enrolled in a randomized, double-blind, placebo-controlled, vitamin A supplementation trial were screened for enteropathogenic Escherichia coli (EPEC), enterotoxigenic E. coli (ETEC), and Giardia lamblia. Fecal concentrations of tumor necrosis factor alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1), interleukin-4 (IL-4), IL-5, IL-6, IL-8, IL-10, and interferon-gamma (IFN-gamma) were determined. Hazard models incorporating cytokine variables were fit to durations of asymptomatic and symptomatic pathogen infections, controlling for treatment group. Increased levels of TNF-alpha and IL-6 were associated with decreased durations of EPEC infection and increased ETEC durations. Increased IL-4 and IFN-gamma levels were associated with decreased and increased durations, respectively, of both EPEC and ETEC infections. Increased IL-10 levels were associated with increased and decreased durations of asymptomatic and symptomatic EPEC infections, respectively, and increased durations of both asymptomatic and symptomatic ETEC infections. Increased levels of MCP-1, IFN-gamma, IL-4, and IL-5 were associated with increased G. lamblia infection duration, while increased IL-8 levels were associated with decreased durations. Differences in proinflammatory and Treg cytokine levels are associated with differences in the resolution of inflammatory and noninflammatory pathogen infections.