Infant Feeding Practices, Dietary Adequacy, and Micronutrient Status Measures in the MAL-ED Study

Caulfield, Laura E.; Bose, Anuradha; Chandyo, Ram Krishna; Nesamvuni, C.; Moraes, Milena Lima de; Turab, Ali; Patil, CL; Mahfuz, Mustafa; Ambikapathi, Ramya; Ahmed, Tahmeed

doi:10.1093/cid/ciu421

Cited by 70 publications

(95 citation statements)

References 30 publications

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Section: Methodsmentioning

confidence: 99%

“…Infants were weighed and measured using standardized procedures at enrollment and every month thereafter 26 . Caregivers were queried biweekly regarding morbidity and feeding patterns 26 , 27 . Non-diarrheal stools were collected monthly and analyzed for a panel of bacterial, viral, and parasitic enteropathogens; diarrheal stools were similarly evaluated.…”

Section: Methodsmentioning

confidence: 99%

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Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort

Lee

McCormick

Seidman

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract.The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort

Lee

McCormick

Seidman

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…They also raised the question of whether perturbations in the functional development of the microbiota/microbiome were related to childhood undernutrition, the major cause of childhood deaths worldwide and a manifestation of a complex set of still poorly understood intra- and intergenerational factors, rather than food insecurity alone (Lazzerini et al, 2013; Caulfield et al, 2014; Richard et al, 2014). …”

Section: Defining Human Postnatal Development From a Microbial Perspementioning

confidence: 99%

“…In breastfed humans, the transition to formula feeding and family foods (complementary feeding practices) varies considerably in terms of which food types are consumed, the order of their presentation, and the duration of their consumption. Documenting which foods growing infants consume and in what quantities has required innovative approaches, particularly in low-income countries in which undernutrition is prevalent (Caulfield et al, 2014) (Figure 3). This makes it difficult to determine how the sequence and representation of various first foods affect maturation of the microbiota.…”

Section: The Impact Of First Foodsmentioning

confidence: 99%

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Cultivating Healthy Growth and Nutrition through the Gut Microbiota

Subramanian

Blanton

Frese

et al. 2015

Cell

149

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Microbiota assembly is perturbed in children with undernutrition, resulting in persistent microbiota immaturity that is not rescued by current nutritional interventions. Evidence is accumulating that this immaturity is causally related to the pathogenesis of undernutrition and its lingering sequelae. Preclinical models in which human gut communities are replicated in gnotobiotic mice have provided an opportunity to identify and predict the effects of different dietary ingredients on microbiota structure, expressed functions, and host biology. This capacity sets the stage for proof-of-concept tests designed to deliberately shape the developmental trajectory and configurations of microbiota in children representing different geographies, cultural traditions, and states of health. Developing these capabilities for microbial stewardship is timely given the global health burden of childhood undernutrition, the effects of changing eating practices brought about by globalization, and the realization that affordable nutritious foods need to be developed to enhance our capacity to cultivate healthier microbiota in populations at risk for poor nutrition.

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Food purchase patterns indicative of household food access insecurity, children’s dietary diversity and intake, and nutritional status using a newly developed and validated tool in the Peruvian Amazon

et al. 2018

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Food security, defined as the capacity to acquire preferred food at all times, can manifest in many dimensions. Following a mixed methods approach used in India and Burkina Faso, we developed a 58-item experience-based measure in the Peruvian Amazon, based on investigator observations, relevant literature, and pre-testing with community field workers. The tool encompasses seven dimensions of food security and included measures of (1) food purchases, frequency of purchase, and location of acquisition, (2) food expenses, (3) coping mechanisms, (4) preparation of leftover food, (5) food safety (refrigerator access), (6) fishing intensity and (7) selling food. The survey was piloted among 35 randomly selected families from the Malnutrition Enteric Disease (MAL-ED) birth cohort in Santa Clara, Peru and the surrounding communities. Subsequently, based on a focus group discussion, a pile-sorting exercise, and pilot results, we reduced the survey to 36 items to be collected monthly among 203 MAL-ED households from November 2013 to January 2015. Validity and reliability were then assessed using principal component analysis and exploratory factor analysis, revealing four groups of purchase and coping strategy behaviors: (1) Sweets and sugary items, (2) Less preferred, (3) More preferred, and (4) Minimum meal. Internal consistency of the final 22-item scale had an acceptable cutoff of Cronbach’s α of 0.73. Criterion and construct validity of the factor groups revealed there were: (1) food purchase patterns that were distinctive to quality and quantity aspects of the Household Food Insecurity Access scale, (2) unique correlations of child’s intake of fats, animal source protein, fiber and other micronutrients, (3) household purchase patterns from the “more preferred” group (fish, red meat) associated with child’s weight-for-age. Food purchase and frequency, and context-specific behaviors at the household level can be used as surrogates for dietary intake patterns and nutritional status among children. Food purchase and frequency measurement is a quick, objective, non-intrusive survey method that could be used as an indicator for acute changes in household food security status with appropriate pilot testing and validation.

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Infant Feeding Practices, Dietary Adequacy, and Micronutrient Status Measures in the MAL-ED Study

Cited by 70 publications

References 30 publications

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort

Cultivating Healthy Growth and Nutrition through the Gut Microbiota

Food purchase patterns indicative of household food access insecurity, children’s dietary diversity and intake, and nutritional status using a newly developed and validated tool in the Peruvian Amazon

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