Relación entre microbiota intestinal, epigenética y exposoma en la salud materno infantil / Relation between intestinal microbiota, epigenetics and exposome in mother-child health

Introducción: El exposoma, la epigenética y la microbiota de un individuo son categorías que se interrelacionan y pueden contribuir a una mejor comprensión del proceso salud enfermedad. Objetivo: Exponer la relación entre las categorías mencionadas con enfoque biopsicosocial. Métodos: Búsqueda bibliográfica en Medline, Pubmed, Scielo, LILACS y Cochrane en los últimos cinco años en idioma inglés y español, sobre la relación entre nutrición y aparición de enfermedades, el eje intestino cerebro, la correspondencia entre epigenética y el exposoma y la microbiota intestinal y su relación con algunas afecciones. Resultados: La alimentación adecuada de la madre, en calidad y cantidad, es un seguro de salud para la vida futura del hombre. El eje intestino cerebro puede afectarse por factores de riesgo, de ahí la importancia de regular su funcionamiento para la prevención de enfermedades como la depresión, síndrome de ansiedad, sobrepeso, y otras. El 10 por ciento del riesgo de padecer enfermedades crónicas puede deberse a factores genéticos pero se desconoce que muchas exposiciones humanas al ambiente, podrían iniciar procesos de enfermedad en el futuro. El exposoma es una herramienta útil para evaluar factores de riesgo de enfermedades generadas por el medio ambiente: exposición a productos químicos y contaminantes; el estilo de vida, el nivel socioeconómico y el entorno social de un individuo. Consideraciones finales: La ruptura del equilibrio entre la microbiota intestinal, la epigenética y el exposoma está relacionada con la etiopatogenia de diversas enfermedades, con las características individuales del ser humano y su relación con el medio ambiente(AU)

Introduction: Exposome, epigenetics and microbiota of an individual are categories that are interrelated and can contribute to a better understanding of the health-sickness process. Objective: To deepen the comprehensive analysis of the mentioned categories with a biopsychosocial approach. Methods: A bibliographic search in Medline, Pubmed, Scielo, LILACS and Cochrane databases was made in the last five years in English and Spanish, on the relation between nutrition and diseases onset, the intestine-brain axis, the correspondence between epigenetics and the exposome, and intestinal microbiota and its relation with some conditions. Results: The proper feeding of the mother in quality and quantity is a health insurance for the future life of a person. The intestine -brain axis can be affected by risk factors, hence the importance of regulating its functioning for the prevention of diseases such as depression, anxiety syndrome, overweight, and others. 10 percent of the risk of chronic diseases may be due to genetic factors but it is unknown that many human exposures to the environment could initiate disease processes in the future. The exposome is a useful tool to evaluate risk factors for diseases generated by the environment: exposure to chemicals and contaminants, lifestyle, socioeconomic status and social environment of an individual. Final considerations: The rupture of the equilibrium between intestinal microbiota, epigenetics and exposome is related to the etiopathogenesis of various diseases, with the individual characteristics of human beings and their relationship with the environment(AU)

A methodologic framework for modeling and assessing biomarkers of environmental enteropathy as predictors of growth in infants: an example from a Peruvian birth cohort.

Background: Environmental enteropathy (EE) impairs the gut's absorptive capacity and immune function and causes decelerations in statural growth that manifest gradually over time.Objective: To illustrate an approach for assessing emerging biomarkers of EE, we separately assessed the associations between 3 such markers and subsequent nutritional status.Design: Stool samples were routinely collected between January 2010 and November 2014 from a cohort of 303 Peruvian infants and analyzed for concentrations of the biomarkers α-1-antitrypsin (AAT), myeloperoxidase, and neopterin. For each marker, a mixed-effects linear regression model was fitted for length-for-age z scores (LAZs) obtained from anthropometric assessments that incorporated covariate predictors, polynomial terms for age, and product interaction terms to test associations over varying lag lengths. The biomarkers' contribution to the models was assessed with the use of the likelihood ratio test and partial R2 statistics.Results: Test statistics for the combined inclusion of the 4-model terms that involved the biomarker were highly statistically significant for AAT (28.71; P < 0.0001) and myeloperoxidase (62.79; P < 0.0001) over a 3-mo lag and moderately so for neopterin (13.97; P = 0.0074). AAT and myeloperoxidase seemed to interact strongly with age, with the magnitude and direction of the effect varying considerably over the first 3 y of life. The largest proportion of the variance explained by any biomarker (2.8%) and the largest difference in LAZ predicted between the 5th and 95th percentile (0.25) was by myeloperoxidase over a 2-mo lag.Conclusions: Of the 3 fecal biomarkers studied, 2 that related to intestinal function-AAT and myeloperoxidase-were associated with small but highly statistically significant differences in future statural growth trajectories in infants in this cohort, lending further evidence to the EE hypothesis that increased gut permeability and inflammation adversely affects subsequent nutritional status. This association exhibited a complex interaction with age. This trial was registered at clinicaltrials.gov as NCT02441426.

Environmental enteropathy is associated with cardiometabolic risk factors in Peruvian children.

Environmental enteropathy (EE) is a syndrome of altered small intestine structure and function hypothesized to be common among individuals lacking access to improved water and sanitation. There are plausible biological mechanisms, both inflammatory and non-inflammatory, by which EE may alter the cardiometabolic profile. Here, we test the hypothesis that EE is associated with the cardiometabolic profile among young children living in an environment of intense enteropathogen exposure. In total, 156 children participating in the Peruvian cohort of a multicenter study on childhood infectious diseases, growth and development were contacted at 3-5 years of age. The urinary lactulose:mannitol ratio, and plasma antibody to endotoxin core were determined in order to assess intestinal permeability and bacterial translocation. Blood pressure, anthropometry, fasting plasma glucose, insulin, and cholesterol and apolipoprotein profiles were also assessed. Extant cohort data were also used to relate biomarkers of EE during the first 18 months of life to early child cardiometabolic profile. Lower intestinal surface area, as assessed by percent mannitol excretion, was associated with lower apolipoprotein-AI and lower high-density lipoprotein concentrations. Lower intestinal surface area was also associated with greater blood pressure. Inflammation at 7 months of age was associated with higher blood pressure in later childhood. This study supports the potential for a relationship between EE and the cardiometabolic profile.

Geophagy Is Associated with Growth Faltering in Children in Rural Bangladesh.

OBJECTIVE: To determine the relationship between geophagy (mouthing of dirt, sand, clay, or mud) and growth faltering in young children. STUDY DESIGN: We examined linear growth as height and weight standardized by age and sex, and weight standardized by height, in a cohort of children aged 6-36 months in rural Mirzapur, Bangladesh. We determined geophagy behavior at baseline through caregiver report. Anthropometric measurements were assessed at baseline and at a 1-year follow-up. RESULTS: We found that among children not stunted at baseline, those with caregiver-reported geophagy at baseline grew less over 1 year compared with their peers, with a difference in the change of standardized height for age and sex of -0.31 (95% CI, -0.61 to -0.01). CONCLUSION: These findings show that caregiver-reported geophagy was associated with growth faltering in a pediatric population in rural Bangladesh. Future studies are needed to learn more about this exposure pathway and its relevance to child growth.

Assessment of environmental enteropathy in the MAL-ED cohort study: theoretical and analytic framework.

Individuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerbated by undernutrition as well as being responsible for permanent growth deficits acquired in early childhood, vaccine failure, and loss of human potential. This article addresses the underlying theoretical and analytical frameworks informing the methodology proposed by the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study to define and quantify the burden of disease caused by EE within a multisite cohort. Additionally, we will discuss efforts to improve, standardize, and harmonize laboratory practices within the MAL-ED Network. These efforts will address current limitations in the understanding of EE and its burden on children in the developing world.