Effects on maternal macronutrient intake towards human milk’s fatty acids composition

While fatty acids found in human milk account for half of the energy consumed by exclusively breastfed infants, fatty acids such as monounsaturated fatty acids (MUFA) and long chain polyunsaturated fatty acids (LC-PUFA) plays critical roles in infant growth. Fatty acids components in human milk are vary widely accordance to the maternal diet during lactation but has not been sufficiently studied. The objective of this paper was to determine the correlation between maternal macronutrient intake with human milk’s fatty acids composition among exclusively breastfeeding mothers. A total of N=36 lactating mothers were recruited based on convenience sampling basis from Dengkil, Selangor and Kuantan, Pahang. A 24-hour dietary recall (24HR) was used to capture mother’s dietary intake in the past 24 hours. The human milk sample was collected in the next day morning after the diet recall and stored before proceeded to another fatty acids extraction and transesterification process namely Blight and Dyer method. The composition of fatty acids methyl esters was analyzed and quantified by a gas chromatography (Agilent 7890A), equipped with a flame ionization detector (FID) and Agilent Chromatography Workstation software. As overall, the most abundance fatty acids found was SFA ranged (81.90 to 97.7 %) followed with MUFA (2.3 to 18.1%), but PUFA was below detection limit (BDL). Result also indicated that palmitic, stearic, and oleic acids were the three major types of fatty acids determined from human milk. Correlational study also determined that, there was no significant correlation between the human milk’s SFA and MUFA with the same dietary intake and another macronutrient like carbohydrate and protein. Even though there was no significant correlation determined for the most composition, various pattern of correlation was found in the study. Human milk’s SFA only had a positive correlation with dietary carbohydrate but negative with the rest. Different pattern also showed for human milk’s MUFA which only negatively correlate with carbohydrate and fats while positive for the rest. Thus, overall, this fat composition is known to have higher variation in terms of concentration of its components compared to another macronutrient even within the same population. Aside from geographical considerations, maternal nationality and age have a substantial impact on the fatty acid composition of human milk

Distribution of lipid-soluble vitamin intake among exclusively breastfeeding mothers and its correlation with human milk’s fatty acids

The lipid composition such as fatty acids and fat-soluble vitamins is the second-most abundant composition of human milk providing dietary energy to infants. Micronutrient dietary intake such as vitamin A, D, E, K and C by breastfeeding mothers plays an important role in regulating the quality of human milk for optimum infant health and growth. The objective of this paper is to determine the distribution and correlation of maternal micronutrient intake of lipid-soluble vitamin and vitamin C towards fatty acids composition in human milk of exclusively breastfeeding mothers. A total of N=36 nursing women were recruited from Dengkil, Selangor, and Kuantan, Pahang, using a convenience sample method. A 24-hour dietary recall (24HR) was performed to collect thorough information on all foods and beverages ingested in the previous 24 hours by the respondent. The data on micronutrients intake per mother was tabulated using Nutritionist Pro. (NP) software. Following the diet recall, the human sample was collected in the next morning and subjected to fatty acid extraction and transesterification using the Blight and Dyer method. The composition of fatty acids methyl esters was analyzed and quantified by a gas chromatography (Agilent 7890A), equipped with a flame ionization detector (FID) and Agilent Chromatography Workstation software. The highest mean of intake occurred during the fifth to sixth months with, 1067.37±629.66 μg RE/day for vitamin A, during the first two months with, 0.89±0.84 μg RE/day of vitamin D, 5.85±2.49 mg/day while during the fifth to sixth months with, 17.28±11.74 μg /day of Vitamin E and at the first two months of lactation period with, 91.60±55.26 mg per day for vitamin C. Despite the fact that there was no significant correlation between vitamin intake and the fatty acid content of human milk, the study discovered a variety of patterns of correlation. Saturated fatty acids (SFA) in human milk were only positively correlated with vitamin D and C, while monounsaturated fatty acids (MUFA) were positively correlated with vitamin A, E, and K and negatively correlated with the rest. As a result, the fatty acid composition of human milk is less dependent on micronutrient dietary intake and more dependent on De-Novo synthesis in the mammary gland

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use