Fortified complementary foods with or without alpha-amylase treatment increase hemoglobin but do not reduce breast milk intake of 9-mo-old Zambian infants.

BACKGROUND: Malnutrition in late infancy in developing countries may result from poor-quality complementary foods that displace breast milk. OBJECTIVE: The objective of the study was to assess the effects of fortified complementary blends of different energy densities on growth, hemoglobin concentrations, and breast milk intake of 9-mo-old Zambian infants. DESIGN: Infants were randomly assigned at 6 mo of age to receive for 3 mo a fortified blend of maize, beans, bambaranuts, and groundnuts [Chilenje Baby Mix (CBM); energy density: 68 kcal/100 g; n = 37] or a similar blend with alpha-amylase (CBMA; energy density: 106 kcal/100 g; n = 44). Cross-sectional data were obtained at 9 mo for a control group of infants (n = 69) not given the diets. Breast milk intake was measured by using the dose-to-the-mother deuterium dilution technique. RESULTS: No differences in weight or length z scores, all of which were within normal ranges, were seen between groups at 9 mo. Percentage fat mass was significantly (P = 0.01) greater in the infants in both the CBM (23.2 +/- 2.7%) and CBMA (23.4 +/- 2.5%) groups than in the control group (21.6 +/- 2.6%). Hemoglobin concentrations were significantly (P = 0.03) greater in both intervention groups (CBM group: 104 +/- 12 g/L: CBMA group: 103 +/- 12 g/L) than in the control group (98 +/- 14 g/L). Breast milk intake was not significantly (P = 0.87) different between groups (CBM group: 614 +/- 271 g/d; CBMA group: 635 +/- 193 g/d; control group: 653 +/- 221 g/d). CONCLUSIONS: The study foods improved hemoglobin concentrations without reducing breast milk intake and may be used to improve the nutritional status of infants in developing countries.

Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study.

BACKGROUND: HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We aimed to measure predictors of treatment failure and the cause of non-responsive pneumonia in children admitted to hospital with severe pneumonia in Durban, South Africa. METHODS: We investigated 358 children aged 1-59 months who presented with WHO-defined severe or very severe pneumonia. Children were recruited irrespective of HIV status and started on a standard antimicrobial regimen of benzylpenicillin and gentamicin. All infants also received high-dose trimethoprim-sulfamethoxazole. The primary outcome measure was treatment failure at 48 h. FINDINGS: 242 (68%) children were HIV infected, 41 (12%) HIV exposed, uninfected, and 75 (21%) HIV uninfected. Failure to respond by 48 h was predicted by age under 1 year (adjusted odds ratio 6.38, 95% CI 2.72-14.91, p<0.0001), very severe disease (2.47, 1.17-5.24, p=0.0181), HIV status (HIV infected 10.3, 3.26-32.51; HIV exposed, uninfected 6.02, 1.55-23.38; p=0.0003), and polymicrobial disease (one organism 2.06, 1.05-4.05; two organisms 10.75, 4.38-26.36; p<0.0001) on logistic regression analysis. All children with three organisms failed treatment. 72/110 treatment failures had at least two organisms isolated. Three of nine HIV-exposed, uninfected infants, 29/74 HIV-infected, but no HIV-uninfected infants who failed study therapy had Pneumocystis jirovecii pneumonia. INTERPRETATION: For children younger than 1 year, the WHO guidelines are inadequate and need to be revised since both HIV-infected and HIV-exposed, uninfected infants had more treatment failures than did HIV-uninfected infants. Polymicrobial disease is an important reason for treatment failure, and we need to identify rapid low-cost diagnostic methods to assist clinicians.

Effect of multiple micronutrient supplementation during pregnancy on inflammatory markers in Nepalese women.

BACKGROUND: Multiple micronutrient supplementation of Nepalese women during pregnancy is associated with a significant increase in birth weight. OBJECTIVE: We tested the hypothesis that improved birth weight in infants of mothers supplemented with micronutrients is associated with a decrease in inflammatory responses and an increase in the production of T helper 1 cells and T helper 2 cells. DESIGN: The study was embedded in a randomized controlled trial of 15 micronutrients, compared with iron-folate supplementation (control), given during pregnancy with the aim of increasing birth weight. Blood samples were collected at 32 wk of gestation, 12-20 wk after supplementation began, for the measurement of inflammatory markers. Breast-milk samples were collected 1 mo after delivery for the measurement of the ratio of milk sodium to potassium (milk Na:K). In an opportunistically selected subgroup of 70 women, mitogen-stimulated cytokine production was measured ex vivo in whole blood. RESULTS: Blood eosinophils; plasma concentrations of the acute phase reactants C-reactive protein, alpha(1)-acid glycoprotein (AGP), neopterin, and ferritin; milk Na:K; and the production of interleukin (IL) 10, IL-4, interferon gamma, and tumor necrosis factor alpha in whole blood did not differ significantly between the supplemented and control groups. Plasma C-reactive protein and AGP were higher in women who had a preterm delivery, and AGP was higher in women who delivered a low-birth-weight term infant than in women who delivered a normal-birth-weight term infant. CONCLUSIONS: The results indicate an association between systemic inflammation in late pregnancy and compromised delivery outcome in Nepalese women but do not support the hypothesis that multiple micronutrient supplementation changes cytokine production or inflammatory markers.

Factors influencing breast milk HIV RNA viral load among Zambian women.

In a longitudinal cohort study we investigated factors contributing to breast milk HIV RNA viral load among lactating women in Lusaka, Zambia. Detailed data from 135 HIV-infected women were collected by questionnaires concerning postpartum maternal and infant health and infant feeding practice. Maternal blood was collected during pregnancy and at 6 weeks postpartum. Milk samples collected from each breast at 10 days and 6 weeks postpartum plus a subset collected at other time points were analyzed for HIV RNA viral load. Increased milk viral load was associated in univariate analyses with maternal symptoms of poor health, raised plasma alpha(1)-acid glycoprotein (AGP) at week 6, raised milk sodium/potassium (Na/K) ratio, postpartum need for antibiotics, preterm delivery, and low birth weight infants. In a multiple regression 49% of variability in mean milk viral load was explained by milk Na/K ratio and need for antibiotics, with borderline contributions from plasma AGP and plasma viral load. Maternal blood hemoglobin or receipt of iron supplements and infant feeding variables such as changing the infant's diet by moving from exclusive to nonexclusive breastfeeding or adding solid foods were not associated with milk viral load. Thus maternal health was the main factor contributing to milk viral load. The lack of effect of feeding practices on milk viral load and the previously determined association of poor maternal health with reduced duration of exclusive breastfeeding in this cohort suggest the relation between exclusive breastfeeding and decreased HIV transmission may be secondary to poor maternal health.

Lack of association between the nasopharyngeal carriage of Streptococcus pneumoniae and Staphylococcus aureus in HIV-1-infected South African children.

We investigated the nasopharyngeal carriage of Streptococcus pneumoniae and Staphylococcus aureus in 355 children hospitalized with severe pneumonia. Of the children, 239 (67.3%) were human immunodeficiency virus (HIV)-1 positive; 169 (47.6%) carried S. pneumoniae, 91 (25.6%) carried S. aureus, and 33 (9.3%) carried both. S. pneumoniae carriage was not related to HIV-1 status. The HIV-1-positive children had a significantly higher rate of S. aureus carriage than did the HIV-1-negative children (31.4% vs. 13.8%; P<.001). The rate of S. aureus carriage in the HIV-1-negative S. pneumoniae carriers was significantly lower than that in the noncarriers (5.5% vs. 21.3%; P=.013), but the rate of S. aureus carriage in the HIV-1-positive S. pneumoniae carriers was not significantly lower than that in the noncarriers (26.3% vs. 36.0%; P=.11). We did not find a negative association between S. pneumoniae and S. aureus carriage in HIV-1-positive hospitalized children with severe pneumonia.

Impact of zinc deficiency on vibrio cholerae enterotoxin-stimulated water and electrolyte transport in animal model.

The effect of zinc deficiency on the function of the intestine to absorb water and electrolytes was studied in animal models, stimulated by Vibrio cholerae enterotoxin. Sprague-Dawley rats, used in the study, were divided into four groups: Zinc-deficient, ad libitum zinc-fed control, zinc weight-matched control, and zinc-deficient acutely-repleted. 14C-labelled polyethylene glycol solution was used for measuring the absorption capacity of the small intestine. Significantly lower absorption of water and sodium per cm of the intestine was observed in the zinc-deficient animals compared to the ad libitum zinc-fed control animals (p < 0.01). An improved absorption capacity was equally observed in the zinc-deficient acutely-repleted animals and ad libitum zinc-fed control group. The zinc-deficient animals showed four times greater cholera toxin-induced net secretions of water and sodium compared to the ad libitum zinc-fed group (p < 0.01), while a 40% reduction was observed in the zinc-deficient acutely-repleted group. The results suggest that zinc deficiency is associated with reduced absorption of water and electrolytes and increased secretion of the same stimulated by cholera toxin.

Xanthophyll and hydrocarbon carotenoid patterns differ in plasma and breast milk of women supplemented with red palm oil during pregnancy and lactation.

Currently limited information exists on how maternal supplementation with provitamin A carotenoids might influence the carotenoid pattern in breast milk during lactation. This study was designed to investigate the effect of maternal red palm oil supplementation ( approximately 12 g/d) throughout the 3rd trimester of pregnancy and the first 3 mo postpartum on carotenoid pattern in both plasma and breast milk. Plasma and breast milk alpha- and beta-carotene concentrations increased in response to red palm oil supplementation and were different (P < 0.001) from the control group at both 1 and 3 mo postpartum. Plasma lutein and zeaxanthin concentrations were reduced (P < 0.001) from pregnancy to 1 mo postpartum and remained stable until 3 mo postpartum. However, breast milk lutein concentrations, expressed per gram of milk fat, increased (P < 0.05) in both groups from 1 to 3 mo postpartum. The results of this study show that there are proportionally more hydrocarbon carotenoids such as alpha- and beta-carotene in plasma than in breast milk, whereas xanthophylls, such as lutein and zeaxanthin, are proportionally more prevalent in breast milk. More importantly, red palm oil supplementation increases the milk concentrations of provitamin A carotenes without decreasing the milk concentrations of xanthophylls. In summary, this study demonstrates that a regulated uptake of polar carotenoids into breast milk exists and that supplementation with alpha- and beta-carotene does not negatively affect this transfer. The mechanisms behind this transport are not fully understood and merit further study.

Plasma levels of retinol, carotenoids, and tocopherols in relation to dietary pattern among pregnant Tanzanian women.

In Tanzania, as in other developing countries, dietary intake of nutrients in pregnant women is marginal or lower than the recommended intakes and therefore these women are at high risk for deficiencies. Our aim was to evaluate the relationship between diet and plasma levels of retinol, carotenoids, and alpha-tocopherol in the third trimester of pregnancy. Ninety pregnant women aged between 18 and 45 years were equally recruited from three villages. Seven-day food frequency data was collected by questionnaire. Plasma levels of retinol, carotenoids, and tocopherols were assessed by high-performance liquid chromatography (HPLC). Results indicated that cooked green leafy vegetables constituted the major source of provitamin A carotenoids, with low intake of yellow/orange fruits and preformed vitamin A. Lutein, lycopene, and beta-carotene were the predominant carotenoids in the plasma with mean values of 1.61, 0.84, and 0.63 mumol/L, respectively. There was no significant correlation between frequencies of vegetable consumption and either plasma retinol or carotenoids. However, increased consumption of green leafy vegetables with oil, which increases bioavailability, was correlated with high plasma retinol levels (p = 0.03). Low retinol levels (< or = 0.70 mumol/L) were present in 26% of women. The mean plasma retinol concentration was 0.89 mumol/L and 63% of the women had values below 1.05 mumol/L. The mean plasma alpha-tocopherol concentration was 15.4 mumol/L and women with plasma retinol concentration > 1.05 mumol/L had significantly higher mean alpha-tocopherol than women with plasma retinol concentration < or = 0.70 mumol/L (p < or = 0.01). Twenty-four percent of the women were anemic (hemoglobin: Hb < 110 g/L) and the mean Hb value was 116.3 g/L.

Health and health care-seeking behavior of adolescents in urban and rural China.

A cross-sectional survey was conducted among 13-18-year-old adolescents in Zhejiang Province, China. Morbidities showed few urban/rural differences. Concerns were mainly related to academic pressure. Respondents were eager users of health services; 73% were taking regular medication, but 52% had never attended a dentist.

Subclinical mastitis among HIV-infected and uninfected Zimbabwean women participating in a multimicronutrient supplementation trial.

Subclinical mastitis, defined as raised milk sodium/potassium (Na/K) ratio is common and associated with poor infant growth and increased mother-to-child HIV transmission. In 1996-97, we conducted a randomized controlled trial of multiple micronutrient supplementation, at recommended daily allowance levels, from 22 to 35 weeks gestation until 3 months post-partum, on the prevalence and severity of subclinical mastitis among 84 HIV-infected and 83 HIV-uninfected lactating Zimbabwean women and on their infants' growth. Spot milk samples collected before 4.5 months post-partum were analysed for Na/K ratio by flame photometry. There was no significant difference in prevalence of subclinical mastitis between HIV-infected and HIV-uninfected women. After controlling for infant age at time of sampling, micronutrient-supplemented HIV-infected women had non-significantly (P = 0.08) lower geometric mean Na/K ratio (0.43, 95% CI 0.35-0.51) than HIV-infected women given placebo (0.51, 95% CI 0.42-0.61). Micronutrient supplementation had no effect on the prevalence of subclinical mastitis among HIV-uninfected women (odds ratio [OR] = 1.26, 95% CI 0.45-3.51, P = 0.80) but induced a borderline decrease in prevalence (OR = 2.82, 95% CI 0.96-8.26, P = 0.07) among HIV-infected women. Infant weight between 1.5 and 4.5 months was lower in women with higher milk Na/K ratio. Thus, the importance of subclinical mastitis for infant growth suggests that further investigations to decrease the condition, perhaps using higher micronutrient doses, are warranted.

Using the premarital examination for population-based surveillance for HIV in China: a pilot study.

All couples attending the premarital examination at four selected sites in Zhejiang and Yunnan provinces in China were included in this study. Blood from 9952 individuals was tested for HIV-1 using a gelatin particle agglutination technique. There were no HIV-positive individuals in Zhejiang. In Yunnan, 28 of 3742 individuals were positive, a prevalence of 0.75%. The premarital examination should be used for voluntary counselling and testing and anonymous surveillance for HIV in high prevalence areas.

Breastmilk RNA viral load in HIV-infected South African women: effects of subclinical mastitis and infant feeding.

OBJECTIVE: To investigate determinants of breastmilk RNA viral load among HIV-infected South African women, with particular attention to infant feeding mode and subclinical mastitis. DESIGN: Observational, longitudinal study. METHODS: Information on current infant feeding practice and a spot milk sample from each breast were obtained from 145 HIV-infected lactating women at 1, 6 and 14 weeks postpartum. The sodium/potassium (Na+/K+) ratio in milk was taken as an indicator of subclinical mastitis. The association between milk RNA viral load and maternal and infant characteristics was investigated using uni- and multivariate models. RESULTS: Milk viral load was below the limit of detection of the HIV RNA assay (< 200 copies/ml) in 63/185 (34.1%), 73/193 (37.8%) and 68/160 (42.5%) of samples at 1, 6 and 14 weeks, respectively. Multivariate models predicted between 13 and 26% of variability in milk viral load in the first 14 weeks. Low blood CD4 cell count (< 200 x 10(6) cells/l) during pregnancy and raised milk Na+/K+ ratio were significantly associated with raised milk RNA viral load at all times, but there were no consistent associations between infant feeding mode and RNA viral load in milk. There was a non-significant trend for the six infants known to be infected postnatally, compared with the 88 infants who remained uninfected, to have been exposed to breastmilk of higher viral load at each time point. CONCLUSIONS: Breast milk HIV RNA viral load in the first 14 weeks of life varied; high levels were associated with subclinical mastitis and severe maternal immunosuppression. Multivariate models had limited predictive value for milk RNA viral load, illustrating the multiple contributors to viral load.

Disparities in economic development in Eastern China: impact on nutritional status of adolescents.

OBJECTIVE: To compare the effects of disparities in economic development in urban and rural Eastern China on the nutritional status of adolescents. DESIGN: A cross-sectional survey consisting of self-completion questionnaires, anthropometry and haemoglobin measurement. SETTING: Twelve middle schools in an urban and a rural area of Zhejiang Province: Hangzhou, the capital, and Chunan, a poor mountainous area. SUBJECTS: Some 4835 young adolescents (predominant age range 13-16 years). RESULTS: The mean body mass index (BMI) was significantly higher in urban Hangzhou (P = 0.01) Overweight affected 3.6% overall; adjusted odds ratios (ORs) showed male sex (OR 2.1, 95% confidence interval (CI) 1.1-3.4) and urban residence (OR 9.1, 95% CI 3.7-22) to be the most important risk factors. The prevalence of underweight was 18%, with no significant urban-rural difference. Predictors of underweight were male sex (OR 1.5, 95% CI 1.1-2.0) and low household income (OR, 1.3, 95% CI 1.1-1.5). Mean haemoglobin was significantly lower in the rural area. Anaemia was more common in girls, 51% compared with 21% of the boys, but rural residence was not an independent risk factor. Rural students exercised more and had a less varied diet than their urban counterparts. Around one-third of the respondents consumed dietary supplements on a regular basis. CONCLUSIONS: These results suggest that in urban areas of Eastern China a dual picture is emerging with the problems of excess (overweight and obesity) coexisting with underweight and anaemia. In rural areas the problems of relative nutritional deprivation predominate, but the long-term consequences of such marginal underweight and anaemia are not clear.

Vitamina A e retardo de crescimento intra-uterino / Vitamin A and intrauterine growth retardation

Objetivos: Comparar os níveis de vitamina A nos sangues materno e do cordäo umbilical de 356 mäes que geraram bebês com retardo de crescimento intra-uterino (RCIU) e 356 mäes que geraram bebês adequados para a idade gestacional (AIG), identificar a possível associaçäo entre os níveis de vitamina A e o RCIU e a correlaçäo entre os níveis de vitamina A nos sangues materno e do cordäo. Materiais e Métodos: As mäes incluídas no estudo foram recrutadas de 4 hospitais de Campinas, SP, onde em média 1350 bebês nascem ao mês. Os recém-nascidos foram classificados como tendo RCIU de acordo com a classificaçäo de Lubchenco e a gestacional foi avaliada pelo método de Capurro. A concentraçäo plasmática de vitamina A foi determinada pelo método de "high performance liquid chromatography" (HPLC)...