Intestinal permeability and inflammation mediate the association between nutrient density of complementary foods and biochemical measures of micronutrient status in young children: results from the MAL-ED study.
diet
environmental enteropathy
inflammation
intestinal barrier function
micronutrient status
Journal
The American journal of clinical nutrition
ISSN: 1938-3207
Titre abrégé: Am J Clin Nutr
Pays: United States
ID NLM: 0376027
Informations de publication
Date de publication:
01 10 2019
01 10 2019
Historique:
received:
03
12
2018
accepted:
24
06
2019
entrez:
1
10
2019
pubmed:
1
10
2019
medline:
24
3
2020
Statut:
ppublish
Résumé
Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network. A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations. EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.
Sections du résumé
BACKGROUND
Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation.
OBJECTIVE
We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status.
METHODS
Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network.
RESULTS
A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations.
CONCLUSIONS
EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.
Identifiants
pubmed: 31565748
pii: S0002-9165(22)01276-X
doi: 10.1093/ajcn/nqz151
pmc: PMC6766446
doi:
Substances chimiques
Biomarkers
0
Micronutrients
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1015-1025Subventions
Organisme : NICHD NIH HHS
ID : R01 HD066982
Pays : United States
Investigateurs
Angel Mendez Acosta
(AM)
Rosa Rios de Burga
(RR)
Cesar Banda Chavez
(CB)
Julian Torres Flores
(JT)
Maribel Paredes Olotegui
(MP)
Silvia Rengifo Pinedo
(SR)
Mery Siguas Salas
(MS)
Dixner Rengifo Trigoso
(DR)
Angel Orbe Vasquez
(AO)
Imran Ahmed
(I)
Didar Alam
(D)
Asad Ali
(A)
Zulfiqar A Bhutta
(ZA)
Shahida Qureshi
(S)
Muneera Rasheed
(M)
Sajid Soofi
(S)
Ali Turab
(A)
Anita K M Zaidi
(AKM)
Ladaporn Bodhidatta
(L)
Carl J Mason
(CJ)
Sudhir Babji
(S)
Anuradha Bose
(A)
Ajila T George
(AT)
Dinesh Hariraju
(D)
M Steffi Jennifer
(MS)
Sushil John
(S)
Shiny Kaki
(S)
Gagandeep Kang
(G)
Priyadarshani Karunakaran
(P)
Beena Koshy
(B)
Robin P Lazarus
(RP)
Jayaprakash Muliyil
(J)
Mohan Venkata Raghava
(MV)
Sophy Raju
(S)
Anup Ramachandran
(A)
Rakhi Ramadas
(R)
Karthikeyan Ramanujam
(K)
Anuradha Bose
(A)
Reeba Roshan
(R)
Srujan L Sharma
(SL)
Shanmuga Sundaram E
(S)
Rahul J Thomas
(RJ)
William K Pan
(WK)
Ramya Ambikapathi
(R)
J Daniel Carreon
(JD)
Vivek Charu
(V)
Viyada Doan
(V)
Jhanelle Graham
(J)
Christel Hoest
(C)
Stacey Knobler
(S)
Dennis R Lang
(DR)
Benjamin J J McCormick
(BJJ)
Monica McGrath
(M)
Mark A Miller
(MA)
Archana Mohale
(A)
Gaurvika Nayyar
(G)
Stephanie Psaki
(S)
Zeba Rasmussen
(Z)
Stephanie A Richard
(SA)
Jessica C Seidman
(JC)
Vivian Wang
(V)
Rebecca Blank
(R)
Michael Gottlieb
(M)
Karen H Tountas
(KH)
Caroline Amour
(C)
Eliwaza Bayyo
(E)
Estomih R Mduma
(ER)
Regisiana Mvungi
(R)
Rosemary Nshama
(R)
John Pascal
(J)
Buliga Mujaga Swema
(BM)
Ladislaus Yarrot
(L)
Tahmeed Ahmed
(T)
A M Shamsir Ahmed
(AMS)
Rashidul Haque
(R)
Iqbal Hossain
(I)
Munirul Islam
(M)
Mustafa Mahfuz
(M)
Dinesh Mondal
(D)
Fahmida Tofail
(F)
Ram Krishna Chandyo
(RK)
Prakash Sunder Shrestha
(PS)
Rita Shrestha
(R)
Manjeswori Ulak
(M)
Aubrey Bauck
(A)
Robert E Black
(RE)
Laura E Caulfield
(LE)
William Checkley
(W)
Margaret N Kosek
(MN)
Gwenyth Lee
(G)
Kerry Schulze
(K)
Pablo Peñataro Yori
(PP)
Laura E Murray-Kolb
(LE)
A Catharine Ross
(AC)
Barbara Schaefer
(B)
Suzanne Simons
(S)
Laura Pendergast
(L)
Cláudia B Abreu
(CB)
Hilda Costa
(H)
Alessandra Di Moura
(AD)
José Quirino Filho
(JQ)
Alexandre Havt
(A)
Álvaro M Leite
(ÁM)
Aldo A M Lima
(AAM)
Noélia L Lima
(NL)
Ila F Lima
(IF)
Bruna L L Maciel
(BLL)
Pedro H Q S Medeiros
(PHQS)
Milena Moraes
(M)
Francisco S Mota
(FS)
Reinaldo B Oriá
(RB)
Josiane Quetz
(J)
Alberto M Soares
(AM)
Rosa M S Mota
(RMS)
Crystal L Patil
(CL)
Pascal Bessong
(P)
Cloupas Mahopo
(C)
Angelina Maphula
(A)
Emanuel Nyathi
(E)
Amidou Samie
(A)
Leah Barrett
(L)
Rebecca Dillingham
(R)
Jean Gratz
(J)
Richard L Guerrant
(RL)
Eric Houpt
(E)
William A Petri
(WA)
James Platts-Mills
(J)
Rebecca Scharf
(R)
Binob Shrestha
(B)
Sanjaya Kumar Shrestha
(SK)
Tor Strand
(T)
Erling Svensen
(E)
Informations de copyright
Copyright © American Society for Nutrition 2019.
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