Interactions Of Malnutrition Research Articles

The association and interactions of malnutrition, micronutrients, and drug therapy in the management of tuberculosis

Tuberculosis is an infectious lung disease that is the leading cause of death worldwide. Globally, over 3,500 people lose their lives to tuberculosis each day – totalling 1.3 million deaths each year. Mycobacterium tuberculosis is the acid-fast bacteria that causes tuberculosis. Fever, coughing, exhaustion, and weight loss are among the symptoms that patients with tuberculosis display. Tuberculosis is transmitted from person to person by inhaling airborne droplets. Immune compromised individuals are at high risk for developing tuberculosis. Direct microscopy of sputum smears and solid media cultures are used as tuberculosis diagnostic techniques. The global effort to combat tuberculosis has so far saved an estimated 75 million lives since 2000. The present review focuses on the association between malnutrition and tuberculosis, micronutrient status, and drugs used in tuberculosis therapy. The greatest risk factor for TB is malnutrition, which weakens immunity by lowering the cells' ability to fight off infections. Many micronutrients are useful in controlling tuberculosis and boosting the host's immunity. These include copper, zinc, selenium, iron, vitamin A, vitamin C, vitamin D, vitamin B6, and vitamin E. Furthermore, the longevity of patients in intensive care units (ICUs) depends on their micronutrient status. Several medications, such as isoniazid, ethambutol, rifabutin, levofloxacin, amikacin, streptomycin, and capreomycin, are used to treat tuberculosis for a certain period of time. Anti-tuberculosis medications can cause vitamin B6 deficiency, arthralgias, gastrointestinal issues, hepatotoxic effects, and allergic reactions as adverse effects. The United Nations Sustainable Development Goals (SDGs) aimed to end the global tuberculosis epidemic by 2023 but more work remains to be done.

Assessing development across cultures: Invariance of the Bayley-III Scales Across Seven International MAL-ED sites.

The Bayley's Scales of Infant and Toddler Development-Third Edition (Bayley-III) were used to measure the development of 24-month-old children (N = 1,452) in the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study (an international, multisite study on many aspects of child development). This study examined the factor structure and measurement equivalence/invariance of Bayley-III scores across 7 international research sites located in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, and South Africa. Exploratory and confirmatory factor analyses were used to identify the factor structure of Bayley-III scores. Subsequently, reliability analyses and item response theory analyses were applied, and invariance was examined using multiple-indicator, multiple-cause modeling. The findings supported the validity, but not invariance, of Bayley-III language scores at all seven sites and of the cognitive and motor scores at six sites. These findings provide support for the use of scores for research purposes, but mean comparison between sites is not recommended. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Determinants of early child development in rural Tanzania

BackgroundIt has been estimated that more than 200 million children under the age of five do not reach their full potential in cognitive development. Much of what we know about brain development is based on research from high-income countries. There is limited evidence on the determinants of early child development in low-income countries, especially rural sub-Saharan Africa. The present study aimed to identify the determinants of cognitive development in children living in villages surrounding Haydom, a rural area in north-central Tanzania.MethodsThis cohort study is part of the MAL-ED (The Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development) multi-country consortium studying risk factors for ill health and poor development in children. Descriptive analysis and linear regression analyses were performed. Associations between nutritional status, socio-economic status, and home environment at 6 months of age and cognitive outcomes at 15 months of age were studied. The third edition of the Bayley Scales for Infant and Toddler Development was used to assess cognitive, language and motor development.ResultsThere were 262 children enrolled into the study, and this present analysis included the 137 children with data for 15-month Bayley scores. Univariate regression analysis, weight-for-age and weight-for-length z-scores at 6 months were significantly associated with 15-month Bayley gross motor score, but not with other 15-month Bayley scores. Length-for-age z-scores at 6 months were not significantly associated with 15-month Bayley scores. The socio-economic status, measured by a set of assets and monthly income was significantly associated with 15-month Bayley cognitive score, but not with language, motor, nor total 15-month Bayley scores. Other socio-economic variables were not significantly associated with 15-month Bayley scores. No significant associations were found between the home environment and 15-month Bayley scores. In multivariate regression analyses we found higher Bayley scores for girls and higher Bayley scores in families with more assets. Adjusted R-squared of this model was 8%.ConclusionWe conclude that poverty is associated with a slower cognitive development in children and malnutrition is associated with slower gross motor development. This information should encourage authorities and other stakeholders to invest in improved welfare and nutrition programmes for children from early infancy.

Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth.

To investigate the relationship between faecal contamination in child play spaces, enteric infections, environmental enteropathy (EE) and impaired growth among young children. A prospective cohort study was conducted of 203 children 6-30months of age in rural Bangladesh. Stool samples were analysed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia intestinalis and Cryptosporidium spp. Four faecal markers of intestinal inflammation were also measured: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Child growth was measured at baseline and 9months after enrolment. E.coli was measured in soil in child play spaces. Forty-seven percent of study children had three or more enteric pathogens in their stool. Thirty five percent (71/203) of children had Shigella, 30% (61/203) had ETEC, 73% (148/203) had C.jejuni, 79% (160/203) had Giardia intestinalis and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9-month follow-up (OR: 2.01, 95% CI: 1.02, 3.93). Children with Giardia intestinalis had significantly higher E.coli counts in the soil collected from their play spaces (OR: 1.23, 95% CI: 1.02, 1.48). Enteric infections were significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children.

Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition

ObjectivesDeficits in weight gain and linear growth are seen frequently among children in areas where malnutrition and recurrent infections are common. Although both inflammation and malnutrition can result in growth hormone (GH) resistance, the interrelationships of infection, inflammation, and growth deficits in developing areas remain unclear. The aim of this study was to evaluate relationships between low levels of systemic inflammation, growth factors, and anthropometry in a case–control cohort of underweight and normal weight children in northern Brazil. MethodsWe evaluated data from 147 children ages 6 to 24 mo evaluated in the MAL-ED (Interactions of Malnutrition and Enteric Disease) case–control study following recruitment from a nutrition clinic for impoverished families in Fortaleza, Brazil. We used nonparametric tests and linear regression to evaluate relationships between current symptoms of infections (assessed by questionnaire), systemic inflammation (assessed by high-sensitivity C-reactive protein [hsCRP]), the GH insulin-like growth factor-1 (IGF-1) axis, and measures of anthropometry. All models were adjusted for age and sex. ResultsChildren with recent symptoms of diarrhea, cough, and fever (compared with those without symptoms) had higher hsCRP levels; those with recent diarrhea and fever also had lower IGF-1 and higher GH levels. Stool myeloperoxidase was positively associated with serum hsCRP. hsCRP was in turn positively associated with GH and negatively associated with IGF-1 and IGF-binding protein-3 (IGFBP-3), suggesting a state of GH resistance. After adjustment for hsCRP, IGF-1 and IGFBP-3 were positively and GH was negatively associated with Z scores for height and weight. ConclusionsInfection and inflammation were linked to evidence of GH resistance, whereas levels of GH, IGF-1, and IGFBP-3 were associated with growth indices independent of hsCRP. These data implicate complex interrelationships between infection, nutritional status, GH axis, and linear growth in children from a developing area.

P-167 Serum Derived Bovine Immunoglobulin Enhances Overall Survival of Clostridium Difficile Associated Disease Accentuated by Malnutrition

The morbidity, mortality and financial costs of Clostridium difficile infection (CDI) have increased dramatically over the past decade. The primary virulence factors are toxins A and B. Risk factors for CDI include antibiotics, ages over 65, inflammatory bowel disease, gastrointestinal surgery and malnutrition. Serum-derived bovine immunoglobulin (SBI) is predominantly IgG and has been shown to bind and neutralize toxins A and B in vitro. Based on these results, we hypothesized that SBI would reduce mortality in an in vivo mouse model of CDI. Mice on a 5% protein (low, 25% of protein requirement by N.R.C.) or 20% protein (normal) diet were provided 40 mg/day SBI or hydrolyzed collagen (HC) in drinking water/oral gavage for the entire study. On day -5 a cocktail of antibiotics was orally administered for 3 days followed by parenteral clindamycin on day -1. Mice were challenged with 105 CFU C. difficile on day 0 and treated with vancomycin from days 0–4. Kaplan-Meier survival curves were generated. Overall, mice administered SBI had a significant reduction in CDI-associated mortality compared to HC-treated mice (P = 0.002). While the difference in survival when comparing SBI and HC in normal protein diets was not significant (P = 0.13), mice fed a low protein diet and SBI were substantially protected against mortality as shown in Figure 1 (P = 0.005). These results indicate that SBI is particularly effective at reducing CDI mortality in a state of malnutrition. Future studies will focus on how SBI and the interaction of malnutrition, affect colonization and resistance of C. difficile.

Postpartum depressive symptoms across time and place: Structural invariance of the Self-Reporting Questionnaire among women from the international, multi-site MAL-ED study

BackgroundThe Self-Reporting Questionnaire (SRQ) is a screening instrument that has been shown to be an effective measure of depression in postpartum women and is widely used in developing nations. MethodsThe SRQ was administered to 2028 mothers from eight nations at two time points: one and six months postpartum. All data were obtained from the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study. The sample included women from MAL-ED sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. This study examined three aspects of validity of SRQ scores including (a) structural validity, (b) cross-cultural invariance, and (c) invariance over time. ResultsA 16-item, one-factor structure with items reflecting somatic symptoms removed was deemed to be superior to the original structure in this postpartum population. Although differential item functioning (DIF) across sites was evident the one-factor model was a good fit to the data from seven sites, and the structure was invariant across the one- and six-month time points. LimitationsFindings are based on data from self-report scales. No information about the clinical status of the participants was available. ConclusionsOverall, findings support the validity of a modified model of the SRQ among postpartum women. Somatic symptoms (e.g., headaches, not sleeping well) may not reflect internalizing problems in a postpartum population. Implications for researchers and practitioners are discussed.

The Interaction of Malnutrition and Neurologic Disability in Africa

Malnutrition and neurodisability are both major public health problems in Africa. This review highlights key areas where they interact. This happens throughout life and starts with maternal malnutrition affecting fetal neurodevelopment with both immediate (eg, folate deficiency causing neural tube defects) and lifelong implications (eg, impaired cognitive function). Maternal malnutrition can also increase the risk of perinatal problems, including birth asphyxia, a major cause of neurologic damage and cerebral palsy. Macronutrient malnutrition can both cause and be caused by neurodisability. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirement. Specific micronutrient deficiencies can also lead to neurodisability, for example, blindness (vitamin A), intractable epilepsy (vitamin B6), and cognitive impairment (iodine and iron). Toxin ingestion (eg, from poorly processed cassava) can cause neurodisability including a peripheral polyneuropathy and a spastic paraparesis. We conclude that there is an urgent need for nutrition and disability programs to work more closely together.

Association of malnutrition with amebiasis

Observation of a cohort of preschool children in Dhaka, Bangladesh, is beginning to reveal the contributions of environment, host, and parasite to amebiasis. Reviewed here are the associations and interactions of malnutrition, IgA and interferon-gamma, human leukocyte antigen alleles, and parasite genotypes to the outcome of infection. Future efforts aimed at understanding the mechanisms of these effects are described.

Interactions of malnutrition and immune impairment, with specific reference to immunity against parasites.

KEY POINTS Clinical malnutrition is a heterogenous group of disorders including macronutrient deficiencies leading to body cell mass depletion and micronutrient deficiencies, and these often coexist with infectious and inflammatory processes and environmental problems.There is good evidence that specific micronutrients influence immunity, particularly zinc and vitamin A. Iron may have both beneficial and deleterious effects depending on circumstances.There is surprisingly slender good evidence that immunity to parasites is dependent on macronutrient intake or body composition.

Parasitic infection and chronic energy deficiency in adults

Interactions between infection and nutrition have been well recognized for several years now since they contribute directly to the health of individuals and communities. Malnourished individuals are specially prone to developing infections while infections themselves can lead to profound changes in the nutritional status of the individual. Health workers in developing countries in the tropics have long recognized the mutually aggravating interactions of malnutrition and infection. The importance of this synergistic relationship between infection and nu-tritional status has been studied extensively in the case of young children. The nutritional status of a young child is a critical determinant of both c morbidity and mortality resulting from a wide range of infections: bacterial, viral, or parasitic. Chandra (1983), in his review on the relationship of nutrition, immunity and infection has categorized the wide range of infectious agents (bacterial, viral, fungal and parasitic) into those that are definitely, variably or minimally influenced by the nutritional status of the child.

Epidemiology and infection in famine and disasters

Despite advances in health care in the tropics, and the inputs of international and voluntary organisations, famine and disaster continue to cause major devastation in many developing countries. In the aftermath of acute disasters such as earthquakes or cyclones and in chronic post-famine relief camps, mortality rates may be 20–30 times greater than those in ‘normal’ years [1]. The interaction of malnutrition, crowding, poor environmental sanitation, and changes in host parasite relationships due to migration or environmental change, result in communicable diseases playing a major role in excess morbidity and mortality.

Interaction of malnutrition and difluoromethylornithine-induced intestinal mucosal damage: degree of severity and subsequent recovery.

The interaction between malnutrition and exposure to a mucosal damaging agent, difluoromethylornithine (DFMO), was examined by monitoring the small-intestinal changes in weanling rats. Malnutrition as induced by the expanded-litter method resulted in severe reduction in body weights in the expanded litters as compared to normal litters. Subsequent treatment of malnourished and well-nourished pups with DFMO for 7 days resulted in decreases in small-intestinal weights and enzyme contents. A 2 factors (well-nourished and malnourished) by 2 factors (DFMO-treated and nontreated) analysis of variance showed no interaction between malnutrition and DFMO treatment in terms of food intake, total mucosal protein, and contents of enterokinase, leucine aminopeptidase and sucrase. Very slight and insignificant interactions (p less than or equal to 0.2) were found for body weights, intestinal weights and total DNA content. Only one parameter studied, the maltase content, showed significant interaction between malnutrition and DFMO treatment (p less than 0.05). Three weeks after the withdrawal of DFMO, essentially all the changes caused by DFMO recovered. But those changes caused by malnutrition did not, such that the malnourished group, whether treated with DFMO or not, still remained significantly less than the control group in their small-intestinal parameters. Analysis of variance showed no interaction between malnutrition and DFMO treatment in the recovery phase. The results suggest that malnutrition is a more important factor in determining the intestinal damage and that malnutrition in the immediate postnatal period does not increase the sensitivity of the small intestine to the damaging effect of DFMO.

The Narangwal Nutrition Study: a summary review.

Between April 1968 and May 1973 the department of International Health of The Johns Hopkins University carried out investigations into the interactions of malnutrition and infection and their effects on preschool child growth, morbidity and mortality in 10 villages of Punjab, North India. Base line surveys before the introduction of services revealed a high prevalence of malnutrition and undernutrition and infectious disease morbidity, as well as lack of accessibility, underutilization and poor population coverage of governmental health services. Study villages were selected in separate clusters and allocated to a control group and three service groups in which nutrition care and medical care were provided singly and in combination by auxiliary health workers resident in each village. Outcome effects were measured through means of longitudinal and cross-sectional surveys. Service inputs and service costs were similarly monitored. Results showed significant improvement of growth (weight and height) and hemoglobin levels of children. Perinatal mortality was reduced by nutrition supplementation to pregnant women. Medical care significantly reduced postneonatal and 1 to 3 mortality, and decreased illness duration of all six conditions examined in this paper. The auxiliary health worker capably managed more than 90% of health needs on her own and referred the rest safely to the physician. Analysis of cost per child death averted showed that cost-effectiveness declined with increasing age of the child. Prenatal nutrition care to pregnant women was most cost-effective in preventing perinatal deaths followed by medical care for infants, and then medical care for the 1 to 3 year age group. The relevance of the field research to national or international endeavors to solve present health problems of developing nations and the timeliness of projects such as the Narangwal Nutrition Study is also evaluated.

Interaction of malnutrition and infection. A neglected clinical concept

Interaction of malnutrition and infection. A neglected clinical concept

Interaction of Malnutrition and Infection

The interaction of malnutrition and infection is the leading cause of morbidity and mortality in the so-called developing nations and among the poorer communities of the affluent nations. 1,2 Infections are more abundant, of longer duration, and more severe in malnourished as compared to well-nourished populations. 2,3 The most dramatic expressions of this interaction is the precipitation of kwashiorkor by measles and the exceedingly high case fatality of measles in malnourished children. 4 Less dramatic is the chronic and wide-spread coexistence of moderate malnutrition and commonplace but abundant respiratory, intestinal, and skin infections. 1,5 The problem of synergism of malnutrition and infection is only recently being appreciated in this country, not only in disadvantaged communities but in the context of the hospitalized patient, debilitated nutritionally from a variety of chronic diseases, particularly malignancy, gastrointestinal disorder, and, sometimes, drastic but life-saving treatments. Protein-calorie malnutrition (PCM) in all degrees is now being