Multi-micronutrient supplementation in HIV-infected South African children : effect on nutritional s tatus, diarrhoea and respiratory infections

Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and increased risk of diarrhoea and respiratory infections. Micronutrient deficiencies are common in HIV-infected children. The poor growth, diarrhoea and respiratory infections seen in HIV-infected children may be partly due to micronutrient deficiencies. The studies in this thesis had two main objectives: (1) to evaluate the effect of short-term (during hospitalization) and long-term (6 months) multi-micronutrient supplementation on episodes of diarrhoea and respiratory infections in HIV-infected children who are not yet on antiretroviral therapy (ART), and (2) to assess the effects of long-term multi-micronutrient supplementation on appetite and growth performance of HIV-infected who are not on ART. Methods and results: Four studies were conducted. Initially a cross-sectional study was performed in which the duration of hospitalization, weight, length, micronutrient status and appetite of HIV-infected children admitted with diarrhoea or pneumonia was compared with the results of HIV-uninfected children. Duration of hospitalization was 2.8 days (52%) longer in HIV-infected children. Appetite as measured by amount of test food eaten (g per kg body weight) was 26% poorer in HIV-infected children. Mean length-for-age Z-scores were lower in HIV-infected children; there was no difference in level of wasting. Subsequently multi-micronutrient supplementation studies were performed, one short-term and two long-term studies. The effect of supplementation on the duration of hospitalization in HIV-infected children with diarrhoea or pneumonia was assessed in the short-term study. One long-term study assessed the supplement’s impact on growth and frequency of episodes of diarrhoea and of pneumonia in HIV-infected children. The other evaluated the effect of the supplement on the appetite of these children. The supplement contained vitamins A, B complex, C, D, E and folic acid, and the minerals copper, iron, selenium and zinc at levels based on recommended dietary allowances. In the short-term supplementation study HIV-infected children aged 4-24 months who were hospitalized with pneumonia or diarrhoea received the supplement or a placebo until discharge from hospital. The duration of hospitalization was 1.7 days (19%) shorter in the supplement group. Long-term multi-micronutrient supplementation improved the weight-for-age and weight-for-height Z-scores of HIV-infected children aged 4-24 months by 0.4 over the 6-month period. There was no improvement in stunting. Children in the supplement group had substantially fewer episodes of respiratory symptoms per month than the placebo group (0.66 ± 0.51) per month vs (1.01 ± 0.67) (P P = 0.09). There was no effect on CD4 lymphocytes. Long-term supplementation with micronutrients had benefits on the appetite of HIV-infected children aged 6-24 months as well. Improvements in amount of test food eaten over the 6-month period were much higher among children who received the supplement (4.7 ± 14.7 g/kg body weight) than the changes in those who received the placebo (-1.4 ± 11.6 g/kg body weight). Conclusion: Multi-micronutrient supplementation reduces the duration of diarrhoea and of pneumonia and incidence of diarrhoea and of respiratory symptoms in HIV-infected children who are not yet on ART. Multi-micronutrient supplementation also improves appetite and weight in these children but not height. The results of these studies indicate that multi-micronutrient supplementation should be considered in HIV-infected infant and young children who have not commenced ART. </p

Nutrient supplementation for prevention of viral respiratory tract infections in healthy subjects:A systematic review and meta-analysis

It remains uncertain as to whether nutrient supplementation for the general population considered healthy could be useful in the prevention of RTIs, such as COVID-19. In this systematic review and meta-analysis, the evidence was evaluated for primary prevention of any viral respiratory tract infection (RTI) such as SARS-CoV-2, through supplementation of nutrients with a recognized role in immune function: multiple micronutrients, vitamin A, folic acid, vitamin B12, C, D, E, beta-carotene, zinc, iron and long-chain polyunsaturated fatty acids. The search produced 15,163 records of which 93 papers (based on 115 studies) met the inclusion criteria, resulting in 199,055 subjects (191,636 children and 7,419 adults) from 37 countries. Sixty-three studies were included in the meta-analyses, which was performed for children and adults separately. By stratifying the meta-analysis by world regions, only studies performed in Asia showed a significant but heterogeneous protective effect of zinc supplementation on RTIs (RR 0.86, 95% CI 0.7-0.96, I-2 = 79.1%, p = .000). Vitamin D supplementation in adults significantly decreased the incidence of RTI (RR 0.89, 95% CI 0.79-0.99, p = .272), particularly in North America (RR 0.82 95% CI 0.68-0.97), but not in Europe or Oceania. Supplementation of nutrients in the general population has either no or at most a very limited effect on prevention of RTIs. Zinc supplementation appears protective for children in Asia, whilst vitamin D may protect adults in the USA and Canada. In 10/115 (8.7%) studies post-hoc analyses based on stratification for nutritional status was performed. In only one study zinc supplementation was found to be more effective in children with low zinc serum as compared to children with normal zinc serum levels

Effects of Maternal Folate Levels and Prenatal Alcohol Exposure on Fetal Growth, Infant Outcomes and Later Development

Objectives Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASD), which include a broad range of cognitive, growth, behavior, and physical abnormalities. Early detection of the teratogenic effects of prenatal alcohol exposure is necessary to identify early interventions. The aim of this study is to identify the effects of prenatal alcohol exposure on growth and infant development, to determine if ultrasound imaging can be used as an early identification tool, and to determine if maternal folate supplementation can mitigate the detrimental effects on growth and infant development. Methods A prospective cohort study and randomized trial from 2008 to 2014 conducted in two sites of Western Ukraine was analyzed. A sample of pregnant women who reported moderate-to-heavy alcohol consumption during pregnancy, and a sample reporting little-to-no alcohol use during pregnancy participated in a comprehensive maternal interview and screening process. Women were further randomized into micronutrient supplementation groups. Standard ultrasound examinations during pregnancy including study specific brain growth measurements, along with blood and urine samples were obtained during follow-up visits. A biometric screening was conducted at birth, along with Bayley Scales of Infant Development-II Mental Development Index (MDI) and Psychomotor Development Index (PDI) assessments at 6 and 12 months of age. Results Estimated fetal weight (EFW), abdominal circumference (AC), biparietal diameter (BPD), transverse cerebellar diameter (TCD), occipitofrontal diameter (OFD), caval-calvarial distance (CCD), and orbital diameter (OD) were significantly reduced by alcohol exposure at third trimester ultrasound (p2(7)=18.044, p=0.012), AC at third trimester (X2(5)=17.955, p=0.003), and birth weight (X2(6)=75.058, p2(11)=63.051, p Conclusions Significant reductions in fetal growth measurements during third trimester ultrasound suggest that the effects of prenatal alcohol exposure may be detectable in late pregnancy. Significant associations between multivitamin supplementation and specific growth measurements suggest that micronutrient supplementation during pregnancy, including high doses of folate, may be an early intervention to reduce the harmful effects of prenatal alcohol exposure. Further studies are needed to identify the specific micronutrients producing these effects, and to assess the appropriate level of these micronutrients necessary to provide the greatest benefit without exceeding the safe limit

Effect of Vitamin A, Zinc and multivitamin supplementation on the nutritional status and retinol serum values in school-age children

Micronutrient deficiency or “Hidden Hunger” represents the most widespread form of malnutrition in the world. The aim of this study was to evaluate the effect of supplementation with Vitamin A as a single dose, Zinc and Vitamin A + Zinc on nutritional status, and on serum retinol and zinc levels in schoolchildren. A database total of 80 schoolchildren (girls = 47 and boys = 33) were evaluated about the effect of supplementation with vitamin A (VA), Zinc (Zn) and VA + Zn on nutritional anthropometric status, and on serum retinol and zinc values. Serum retinol concentrations were determined by HPLC, according to Bieri method, considering 30 μg/dL normal VA; serum zinc was analyzed by Flame Atomic Absorption Spectrometry, considering ≥0.72 μg/dL normal zinc and <0.72 μg/dL zinc deficiency (DZn). Data were analyzed using SAS program Statgraphics XVI, and a significant p < 0.05 was considered. The deficiency of the nutritional consumption of zinc was high in the students, contrary to the consumption of vitamin A which was normal. The observed prevalence of DVA was 6.25%, RDVA 23.75% and DZn 97.50%. The isolated or combined supplementation of vitamin A and Zinc contributes to the maintenance of the anthropometric state; however, they are ineffective in the cases of low consumption of these nutrients to reach optimum circulating values

Assessment of micronutrient status in pregnant Malawian women before and after treatment for moderate malnutrition

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies. Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions. Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B12, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC \u3e20.6 cm and Results: Baseline micronutrient concentrations indicated high rates of deficiency in zinc (29-39%) and albumin (37-46%), and marginal status of retinol (26-37%) and vitamin D (31-32%). Adjusted mean changes in vitamin B12 concentrations from week 0 to week 10 were -17.1, -36.1, and -52.9 pg/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in vitamin D concentrations from week 0 to week 10 were 6.1, 3.1, and 1.7 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in folate concentrations from week 0 to week 10 were 2.2, 1.7, and 4.0 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.37 for effect of treatment; p=0.06 for the interaction effect of time*treatment). Changes in ferritin, zinc, albumin, retinol, and CRP were not significantly different between treatment groups. Conclusions: Deficiencies in zinc and albumin, and marginal status of vitamin D and retinol, are common among this population of moderately malnourished pregnant Malawian women. Significant changes in vitamin D and vitamin B12were observed from week 0 to week 10, with the RUSF group having the greatest improvements compared to the CSB-UNIMMAP and CSB-IFA treatments

Vitamin A status of HIV-infected adults in South Africa

Introduction: Several studies in developed countries such as the USA have reported low serum or plasma vitamin A levels in adults with HIV disease. Limited data suggests that HIV-infected adults from developing countries show even lower vitamin A levels. Factors that contribute to a low vitamin A status include a poor intake, malabsorption and repeated episodes of infections resulting in a decreased hepatic mobilisation of vitamin A during the acute phase response, an accelerated utilisation of vitamin A or increased urinary losses of vitamin A. Aim: To determine the vitamin A status of HIV-infected adults without major active opportunistic infections with WHO clinical stages 1 to 4 HIV-infection. Methods: One hundred and thirty-two HIV-positive patients were included in a cross-sectional study at the outpatient clinic at Groote Schuur Hospital. Exclusion criteria included current use of multivitamin or vitamin A supplements, pregnancy, pyrexia (> 38 °C) and patients who had received TB treatment for less than 12 weeks. We obtained data on demographic characteristics, weight and height, CD4 lymphocyte levels, CD4:CD8 ratio, full blood count and plasma levels of retinal, retinal-binding protein, zinc and CRP. Results: The sample consisted of 51, 48 and 33 patients with WHO Stage 1/2, 3 and 4 HIV-infection, respectively. The proportion of patients with borderline vitamin A levels ( 100 mg/l. Seventy seven percent (39/51) of patients with early disease had CRP levels 40 mg/l. The median retinal level of patients with CRP levels> 40 mg/l (n=7) was 16.8 μg/l versus 27.3 μg/l and 30.2 μg/l in the other two categories (p < 0.05). A similar relationship between CRP and plasma zinc levels was observed, although not significant (p < 0.1). Multivariate analysis revealed that a borderline retinal status was independently associated with a 3-fold increase (95%CI: 2-5.6) in the risk of having stage 4 disease or AIDS after adjusting for CD4 lymphocyte count or the CD4:CD8 ratio, haemoglobin, plasma zinc and body weight. Conclusions: Patients with advanced disease are more likely to have a borderline vitamin A status in the absence of opportunistic infections. The majority of patients with symptomatic disease had mildly raised CRP levels, possibly reflecting HIV-viral activity. CRP levels were associated with low retinal levels only in a small number of subjects, possibly indicating the presence of underlying infection, despite the clinical review of our data. Although our data indicates an independent relationship between retinal levels and advanced disease, the cross-sectional design precludes causal inferences about this association

Retinol Levels in Hashimoto's Thyroiditis

Hashimoto’s thyroiditis (HT) is one of the most common autoimmune diseases in the United States. Previous studies have proven that HT patients often have low vitamin D levels and benefit from vitamin D supplementation to help manage their autoimmune disease. Research is currently underway to investigate vitamin A’s benefits in the management of autoimmune diseases. Both of these vitamins have immune-modulating properties, and both affect thyroid function. This dissertation aims to establish whether HT patients had lower retinol (vitamin A) levels than participants that did not have HT. Data regarding retinol levels and thyroid function markers were gathered from a database of results from a small study conducted at Health Matters Clinic, in Northeast Arkansas. The study participants were sorted into two groups: HT and non-HT, and then 26 participants were randomly selected for each group. The HT group had participants that were positive for either or both thyroperoxidase and thyroglobulin antibodies, and that were not on thyroid medications such as levothyroxine. The non-HT group had participants that did not have thyroid autoantibodies, and did not have any other known autoimmune disease and had normal Thyroid Stimulating Hormone (TSH) levels. An independent sample t-test for differences in retinol levels was performed, as well as Pearson’s correlation for retinol and TSH and retinol and the anti-thyroid antibodies. The results revealed no statistical differences in retinol levels between the groups and no correlation between retinol and the level of thyroid antibodies. Retinol’s tight homeostatic control, which maintains steady serum levels regardless of liver reserve status, can explain the lack of statistical difference in retinol levels between the groups. A positive correlation was found between retinol and TSH levels (high TSH with high retinol), which may indicate some novel mechanism of retinol’s effect on the thyroid or retinol’s involvement in the etiology of HT, therefore, needs to be validated with more data. In conclusion, serum retinol levels do not appear to correlate with HT; in particular, serum retinol levels appear not to be decreased in patients with HT. At the same time, our data seem to indicate some involvement of retinol, or its signaling pathway, in thyroid disorders

Micronutrient status and effects of supplementation in anemic pregnant women in China

Background Iron deficiency anemia (IDA) is a major nutrition related problem in China, especially affecting pregnant women,like in most developing countries. Deficiencies of vitamins also play an important role, such that iron, retinol and riboflavin deficiencies tend to coexist in anemic pregnant women. However, vitamin and/or mineral supplements are not routinely used by pregnant women at or below low income levels. Besides being an essential trace element, iron plays a central role in oxygen radical generation, whereas susceptibility during pregnancy is elevated. There is evidence that both iron deficiency and excess may result in free radical damage. Objectives Based on this background, objectives of this thesis were to investigate the current prevalence of anemia among pregnant women in different sites of China, and todescribe the micronutrient status of anemic and non-anemic pregnant women in China. In addition, in anemic pregnant women, the effect of retinol and riboflavin supplementation on top of iron plus folic acid on anemia and changes in hematological status wasassessed. Also oxidative stress and erythrocyte membrane fluidity were evaluated. Finally, we compared the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA) and ferrous sulfate on hemoglobin (Hb), iron bioavailability and oxidative stress. Subjects and Methods A total of 6413 women in their third trimester of pregnancy were recruited from five rural areas in China (years 2000~2003) for screening anemia or iron deficiency. A random subset was selected for measuring micronutrient status. In three supplementation trials, effects of iron, folic acid, retinol and riboflavin were assessed among anemic pregnant women. Outcomes included hematological status, micronutrient status and parameters of oxidative stress. Samples of fasting blood were collected from subjects before and at the end of the interventions for measurements. Results The overall prevalence of anemia was 58.6%, ranging between 48.1%~70.5% in the five areas. Serum concentrations of micronutrients were significantly lower in anemic women than non-anemic women. After the 2-mo intervention, the increase of Hb concentration in the group, supplemented with iron and folic acid combined with retinol and riboflavin, was 5.4g/L greater than in the group with iron and folic acid only (p Conclusion and recommendations Deficiency of iron and micronutrients in combination appears to contribute to the high prevalence of anemia in pregnant women in rural China. Supplementation with iron, particularly in combination with vitamins improved hematologic status as well as oxidative stress. NaFeEDTA performed better than ferrous sulfate. Multi-micronutrient supplementation may be worthwhile for pregnant women in rural China. Further studies on food-based or supplement-based approaches are warranted to decrease anemia of Chinese pregnant women in the third trimester. </p

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia.</p> <p>Methods</p> <p>In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.</p> <p>Results</p> <p>After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).</p> <p>Conclusion</p> <p>The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.</p