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
Year: 2019
Type: article
Abstract: 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.
DOI: 10.1093/ajcn/nqz151
Authors: Benjamin JJ McCormick, Laura E Murray-Kolb, Gwenyth O Lee, Kerry J Schulze, A Catharine Ross, Aubrey Bauck, Aldo AM Lima, Bruna LL Maciel, Margaret N Kosek, Jessica C Seidman, Ramya Ambikapathi, Anuradha Bose, Sushil John, Gagandeep Kang, Ali Turab, Estomih Mduma, Pascal Bessong, Sanjaya K Shrestra, Tahmeed Ahmed, Mustafa Mahfuz, Maribel Paredes Olortegui, Zulfiqar Bhutta, Laura E Caulfield
Institutions: National Institutes of Health, Fogarty International Center, Pennsylvania State University, Johns Hopkins University, Universidade Federal do Ceará, Universidade Federal do Rio Grande do Norte, Christian Medical College, Vellore, Aga Khan University, Haydom Lutheran Hospital, University of Venda, Armed Forces Research Institute of Medical Science, International Centre for Diarrhoeal Disease Research, Prisma, Duke University, Foundation for the National Institutes of Health, Tribhuvan University, Institute of Medicine
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,342
Funders: Foundation for the National Institutes of Health, Duke University, Johns Hopkins University, Pennsylvania State University, University of Virginia, University of Illinois System, Temple University, Universitetet i Bergen, Christian Medical College, Vellore, University of Venda, Haukeland Universitetssjukehus, National Institutes of Health, University of Illinois at Urbana-Champaign, Fogarty International Center, Eunice Kennedy Shriver National Institute of Child Health and Human Development
OpenAlex ID: W2964708338