Association of Nutritional Status with the Response to Infection with Leishmania chagasi

Abstract

Outcomes of infection with Leishmania chagasi range from self-resolving infection to visceral leishmaniasis (VL). Risk factors determining development of disease are not totally understood, but probably include environmental influences and host genetics. We assessed whether nutrition influenced the outcome of Leishmania infection by comparing relatives of children with VL with either self-resolving Leishmania spp. infection or apparently uninfected households. We observed a decrease in body mass index (P < 0.0005) and mid-upper arm circumference for age (P = 0.022) z-scores for children with VL. Levels of vitamin A were lower in active children with VL as measured by serum retinol (P = 0.035) and the modified-relative-dose-response test (P = 0.009). Higher birth weight (P = 0.047) and albumin concentrations (P = 0.040) protected against disease. Increased breastfeeding time (P = 0.036) was associated with asymptomatic infection. The results indicate that modifiable nutritional aspects are associated with the outcome of Leishmania spp. infection in humans.

Biochemical and nutritional evaluation of patients with visceral leishmaniasis before and after treatment with leishmanicidal drugs

“…Taking into account these results, the pre-treatment patients also exhibited normal BMI values, as malnutrition is considered a BMI below 18.5kg/m 2 . Contrary to our fi ndings, one study reported that children with active VL had lower BMI values than healed children and uninfected children; additionally, children that breastfeed for longer period of time have asymptomatic VL, while children with lower birth weight are more likely to develop VL, which shows that nutritional status plays a crucial role in the pathogenesis of visceral leishmaniasis 22 . Thus, we can conclude that patients with active VL showed no difference in weight compared to the post-treatment patients and the controls and, therefore displayed no difference in BMI, percentage of lean mass and fat mass.…”

“…The infectious process is usually followed by hypercatabolism, which is aggravated by anorexia, resulting in the loss and the consequent depletion of the body's nutrient reserves, thereby causing great changes in the metabolism of the host 21 . Some studies have reported differences in body mass index (BMI), glucose, triglycerides and lipoproteins in patients with active VL [22][23][24] . Studies performed on patients with VL showed high triglyceride levels and low high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol levels 25,26 .…”

Immune response to Leishmania (Leishmania) chagasi infection is reduced in malnourished BALB/c mice

“…By using data from the same study, Cerf et al (1987) concluded that a child with moderate or severe malnutrition had about a 9-fold increased risk of developing VL compared to a well-nourished child. More recently, Maciel et al (2008) assessed whether nutritional status influenced the outcome of Leishmania infection by comparing relatives of children with VL with either self-resolving Leishmania spp infection or apparently uninfected households. The authors observed decreases in the body mass index and mid-upper arm circumference by age z-scores for children with VL.…”

Identification of Risk Areas for Visceral Leishmaniasis in Teresina, Piaui State, Brazil

“…Third, although from the public health perspective the control of symptomatic cases is a priority, the non-use of markers for infection prevents the demarcation of transmission foci because more infections occur than cases of the disease [35][36][37][38] and the evolution from asymptomatic infected status to symptomatic status is mediated by genetic and nutritional factors. [39][40][41] Finally, as mentioned, this study is based on secondary data available in SINAN. Thus, although VL is a serious disease subject to mandatory reporting (and the treatment of which is only provided by government health services), the available data are based on passive case detection, and one cannot rule out the possibility of case underreporting.…”