Dietary and anthropometric indicators of nutritional status in relation to Helicobacter pylori infection in a paediatric population.

It has been postulated that Helicobacter pylori infection could affect growth and appetite, consequently influencing body weight. Therefore, the association between H. pylori infection and the dietary and anthropometric indicators of nutritional status of a paediatric population were investigated. A total of 525 children (aged 4-16 years) who were referred to the gastroenterology unit of the Sor Maria Ludovica Children's Hospital from Buenos Aires, Argentina, were enrolled and completed an epidemiological questionnaire. H. pylori infection was diagnosed using the ¹³C-urea breath test (¹³C-UBT). Height and weight were assessed for calculation of anthropometric indicators. Energy and macronutrient intakes were estimated by 24 h dietary recall. Data analysis was performed using a χ² test, a Student's t test, a Mann-Whitney U test and linear and logistic regressions. The prevalence of H. pylori infection was 25·1 % (with a mean age of 10·1 (SD 3·1) years). A tendency towards lower energy, carbohydrate, protein and fat intakes was observed in infected patients; however, it was not associated with H. pylori infection in any of the evaluated age groups (4-8, 9-13 and 14-16 years). Underweight, stunting, overweight and obesity were also not associated with the infection. Although height-for-age and BMI-for-age Z scores tended to be lower in infected patients, the differences between H. pylori-positive and H. pylori-negative children were not statistically significant. In conclusion, H. pylori infection was not associated with dietary intake or with anthropometric indicators in the present population of children with gastrointestinal symptoms; however, an increased sample size would be needed to confirm the observed tendency towards lower dietary intake and lower anthropometric indicators of nutritional status in H. pylori-infected children.

Decreasing trend of Helicobacter pylori infection in children with gastrointestinal symptoms from Buenos Aires, Argentina.

BACKGROUND: Helicobacter pylori infection is declining in developed and developing countries. The aim of this study was to retrospectively evaluate over an 8-year period the rate of H. pylori infection in children with gastrointestinal symptoms from Buenos Aires, Argentina. MATERIALS AND METHODS: We reviewed the records of children referred from 2002 to 2009 to the gastroenterology unit of the Children Hospital "Superiora Sor Maria Ludovica" for evaluation of upper gastrointestinal signs and symptoms in which the (13) C-urea breath test was performed to diagnose H. pylori infection and a sociodemographic questionnaire was obtained. RESULTS: Records of a total of 1030 children and adolescents with a mean age of 9.99 years were included in the analysis. We found an H. pylori prevalence of 41.2% (95% CI, 36.9-46.0%) for the triennium 2002-2004, dropping to 26.0% (95% CI, 20.7-31.8%) in the triennium 2007-2009. CONCLUSION: Our results showed a significant decrease in H. pylori infection rates from children referred for upper gastrointestinal symptoms evaluation from 2002 to 2009, following the H. pylori epidemiologic trend reported in other countries.

Iron, zinc, and copper nutritional status in children infected with Helicobacter pylori.

OBJECTIVE: : Helicobacter pylori colonizes the gastric mucosa of about half of the world's population and it has been related to extragastrointestinal diseases. The present study sought to evaluate the association between H pylori infection and iron, zinc, and copper nutritional status in symptomatic children. PATIENTS AND METHODS: : A cross-sectional study was carried out in 395 children (4-16 years) with upper gastrointestinal symptoms, who were tested for H pylori infection by the C-urea breath test. Iron status was determined by hemoglobin, serum ferritin, and serum transferrin receptors. Copper and zinc serum concentrations were also evaluated. Epidemiological data, dietary assessment, and anthropometric indicators were analyzed as potential confounding factors. RESULTS: : Prevalence of H pylori infection was 24.3%. Anemia and iron deficiency (ID) were found in 12.0% and 14.3% of the H pylori-positive and 8.9% and 11.0% of the H pylori-negative children, respectively. There was no association between H pylori infection and anemia (odds ratio = 1.54 [95% confidence interval [CI] 0.73%-3.24%]) or ID (odds ratio = 1.35 [95% CI 0.67-2.70]). Crude beta coefficients showed that H pylori has no significant effect on hemoglobin, serum ferritin, serum transferrin receptors, copper, and zinc concentrations. However, adjusted results suggested that H pylori-infected children had an increase of 9.74 microg/dL (95% CI 2.12-17.37 microg/dL) in copper concentrations. CONCLUSIONS: : This study revealed that H pylori infection was not associated with iron deficiency, anemia, or zinc concentrations; however, a positive relation with copper status was found after adjusting for confounding factors. The contribution of H pylori infection to higher copper concentrations needs to be confirmed by additional studies.

Helicobacter pylori is not associated with anaemia in Latin America: results from Argentina, Brazil, Bolivia, Cuba, Mexico and Venezuela.

OBJECTIVE: To investigate the association between Helicobacter pylori infection and anaemia. DESIGN: Six cross-sectional studies. H. pylori infection was assessed by the [13C]urea breath test using MS or IR analysis. Hb was measured for all countries. Ferritin and transferrin receptors were measured for Argentina, Bolivia, Mexico, and Venezuela. SETTING: Health services in Argentina, Brazil and Mexico or public schools in Bolivia, Cuba and Venezuela. SUBJECTS: In Argentina, 307 children aged 4-17 years referred to a gastroenterology unit; in Bolivia, 424 randomly selected schoolchildren aged 5-8 years; in Brazil, 1007 adults (157 men, 850 women) aged 18-45 years attending thirty-one primary health-care units; in Cuba, 996 randomly selected schoolchildren aged 6-14 years; in Mexico, seventy-one pregnant women in their first trimester attending public health clinics; in Venezuela, 418 children aged 4-13 years attending public schools. RESULTS: The lowest prevalence of H. pylori found was among children in Argentina (25.1%) and the highest in Bolivia (74.0%). In Bolivia, Cuba and Venezuela children showed similar prevalence of H. pylori infection as in Brazilian and Mexican adults (range 47.5% to 81.8%). Overall anaemia prevalence was 11.3% in Argentina, 15.4% in Bolivia, 20.6% in Brazil, 10.5% in Cuba and 8.9% in Venezuela. Adjusted analyses allowing for confounding variables showed no association between H. pylori colonization and anaemia in any study. Hb, ferritin and transferrin receptor levels were also not associated with H. pylori infection in any country. CONCLUSIONS: The present study showed no evidence to support the hypothesis that H. pylori contributes to anaemia in children, adolescents, adults or pregnant women in six Latin American countries.

Bioavailability studies of stabilized iron (II) sulfate by means of the prophylactic-preventive method.

The bioavailability of stabilized ferrous sulfate was studied by means of the prophylactic-preventive test in rats. For comparative purposes, ferrous sulfate was used as reference standard. The test was performed in male weaned rats during 3 weeks, which were randomized into three groups of ten animals each. A control group received a basal diet of low iron content while the other groups received the same diet added with iron at a dose of 15 mg/kg as FeSO4 7H2O and stabilized ferrous sulfate, respectively. Individual hemoglobin concentrations and weights were determined at the beginning and at the end of the study, and food intake was daily registered. Iron bioavailability (BioFe) of each source was calculated as the ratio between the amount of iron incorporated into hemoglobin during the treatment and the total iron intake per animal. A relative biological value was obtained as the ratio between the BioFe of stabilized ferrous sulfate and the reference standard given a value of 96%. Stabilized ferrous sulfate showed a high bioavailability, and when it is used to fortify dairy products as cheese and fluid milk in a dose of 15-20 mg of iron per kilogram, it behaved inertly in relation to the sensorial properties of the fortified food. These results suggest that this iron compound is a promising source to be use in food fortification.

Effect of iron deficiency anemia on the biodistribution of 99mTc radiopharmaceuticals.

The distribution of colloids and labeled cells in organs is influenced by their intrinsic properties and by the state of the investigated subject. Iron deficiency remains an unsolved nutritional problem all over the world; one of its severe consequences is anemia. Because iron metabolism principally takes place in the liver, spleen, bone marrow, skeletal muscle and blood, we studied the effect of iron deficiency anemia on the biodistribution of 99mTc phytate, 99mTc gelatin colloid and 99mTc RBC (red blood cells labeled with 99mTc). Our results show that iron deficiency anemia modifies the pattern of biodistribution of the two colloids assayed. However, this behavior is different for both of them. This work contributes to studies that kinetically and statistically establish that iron deficiency anemia induces a significant inversion in the spleen-liver activity relationship when centellographic studies are performed with colloids such as 99mTc phytate.

Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children.

OBJECTIVE: Current recommendations for treatment of Helicobacter pylori infection include a proton pump inhibitor in combination with two antibiotics. We evaluated the potential activity of a probiotic food as an adjuvant to antibiotic triple therapy for eradication of H. pylori infection in children from Buenos Aires, Argentina. METHODS: Sixty-five children who tested positive for H. pylori, as diagnosed by (13)C-urea breath test and endoscopy, were included in this study. Patients were randomized to receive 1-wk triple therapy plus probiotic food (treated group) or milk placebo (control) that was administered for 3 mo. Probiotic food consisted of 250 mL of a commercial yogurt containing Bifidobacterium animalis and Lactobacillus casei (10(7) colony-forming units/mL). Post-treatment urea breath test controls were performed 1 and 3 mo after the end of triple therapy. RESULTS: We found no significant differences in H. pylori eradication rates (ERs) at 1 and 3 mo between the treated group (ER = 45.5% and 42.4%) and the control group (ER = 37.5% and 40.6%). Relative risks between groups were 0.87 (95% confidence interval 0.58-1.32, P = 0.345) in the first month and 0.97 (95% confidence interval 0.64-1.46, P = 0.542) in the third month. CONCLUSIONS: We could not demonstrate an adjuvant effect of the studied probiotic food to triple therapy in the eradication of H. pylori infection in children in Buenos Aires, Argentina. However, we found lower ERs than those reported for the same therapeutic scheme in developed countries, indicating that bacterial resistance and alternative therapeutic strategies should be studied.

Factors associated with H. pylori epidemiology in symptomatic children in Buenos Aires, Argentina.

AIM: To determine prevalence of H pylori infection in symptomatic children in Buenos Aires, Argentina, and to investigate factors associated with H pylori positivity. METHODS: A total of 395 children with upper gastrointestinal symptoms referred to the Gastroenterology Unit of the Children Hospital "Sor Maria Ludovica" were evaluated for the presence of H pylori by the (13)C-Urea Breath Test ((13)C-UBT). A questionnaire was applied to the recruited population. RESULTS: Prevalence of H pylori infection was 40.0% in this population (mean age 9.97 +/- 3.1 years). The factors associated with H pylori positivity were number of siblings (P < 0.001), presence of pet cats (P = 0.03) and birds (P = 0.04) in the household, and antecedents of gastritis among family members (P = 0.01). After multivariate analysis, number of siblings [Odds ratio (OR) = 1.39; 95% CI, 1.20-1.61] and contact with pet cats (OR = 1.76; 95% CI, 1.00-3.09) remained as variables associated with H pylori infection. CONCLUSION: The prevalence of H pylori infection in children with upper gastrointestinal symptoms in Argentina was similar to that reported in developed countries. Children from families with a higher crowding index and presence of pet cats have a higher risk of being colonized with H pylori.

Circulating blood volume determination using electronic spin resonance spectroscopy.

There have been numerous methods proposed to measure the circulating blood volume (CBV). Nevertheless, none of them have been massively and routinely accepted in clinical diagnosis. This study describes a simple and rapid method, on a rabbit model, using the dilution of autologous red cells labeled with a nitroxide radical (Iodoacetamide-TEMPO), which can be detected by electronic spin resonance (ESR) spectroscopy. Blood samples were withdrawn and re-injected using the ears' marginal veins. The average CBV measured by the new method/body weight (CBV(IAT)/BW) was 59 +/- 7 mL/kg (n = 33). Simultaneously, blood volume determinations using the nitroxide radical and (51)Cr (CBV(Cr)) were performed. In the plot of the difference between the methods (CBV(IAT) - CBV(Cr)) against the average (CBV(IAT) + CBV(Cr))/2, the mean of the bias was -1.1 +/- 6.9 mL and the limits of agreement (mean difference +/-2 SD) were -14.9 and 12.7 mL. Lin's concordance correlation coefficient p(c) = 0.988. Thus, both methods are in close agreement. The development of a new method that allows a correct estimation of the CBV without using radioactivity, avoiding blood manipulation, and decreasing the possibility of blood contamination with similar accuracy and precision of that of the "gold standard method" is an innovative proposal.

Prevalence of Helicobacter pylori infection and associated factors among adults in Southern Brazil: a population-based cross-sectional study.

BACKGROUND: Helicobacter pylori (Hp) infection is associated with several upper gastrointestinal disorders. Local data on the epidemiology of the infection are scarce in Brazil. The purpose of this study is to measure the prevalence rate and to explore the associated factors among the adult population living in Pelotas, a southern Brazilian city. METHODS: This was a population-based cross-sectional study. Through a multi-stage sampling method all individuals 20 years and over living at the selected households at the urban area of the city were interviewed regarding past and current socio-economic indicators; demographic characteristics; nutritional and behavioural habits; and history of upper gastrointestinal symptoms.Hp infection was ascertained through the 13C-UBT. Due to the high prevalence, data were analysed through robust Poisson regression. All analyses took into account the family clustering of the data. RESULTS: Among 563 eligible individuals, 363 agreed to perform the 13C-UBT (refusal rate of 35.5%). Refusals were associated with female sex, consumption of mate drinking, and presence of upper gastrointestinal symptoms. The prevalence rate of H. pylori infection was 63.4% (95%CI 59.3%-69.3%). In crude analyses, prevalence was associated with increasing age, non-white skin colour, lower current family income, lower education level, higher size of the family, low socio-economic conditions in childhood, higher number of siblings and attendance to day-care centres in childhood, and presence of dyspeptic symptoms. In adjusted analysis the level of education of the father was inversely associated with the infection, whereas number of siblings and attendance to day-care centre in childhood were directly associated with it. Non-white skin colour remained significantly associated with increased prevalence even after allowing for past and current socio-economic characteristics, age and sex. Compared to non-symptomatic individuals, those reporting dyspeptic symptoms presented a higher prevalence of the infection even after allowing for current and past socio-economic conditions, ethnicity, age, and sex. CONCLUSION: Hp infection is as common among adults in southern Brazil as it is in other developing countries. Socio-economic conditions in childhood besides ethnicity and presence of dyspeptic symptoms were the factors significantly associated with the infection.

Quality control validation for exogenous natural surfactant labeled with 99mTc.

OBJECTIVE: Exogenous natural surfactant (ENS) labeled with 99mTc shows an elevated lung specificity allowing the acquisition of high-quality images for ventilation scintigraphy. METHODS: The methods for 99mTc-ENS quality control (physical properties, pH determination, radiochemical studies, and biologic studies) were evaluated and validated. RESULTS: The physical properties of the nonradioactive precursor and of the radiopharmaceutical were analyzed as general descriptors of the product. The pH of the radiopharmaceutical was determined by using pH test papers, a method described and validated in the United States Pharmacopeia. Chromatographic studies performed using the acetone/Whatman-1 paper system were validated as a method to evaluate the radiochemical purity of the 99mTc-ENS. Biodistribution studies on rats after intratracheal administration were validated as a method to estimate the radiopharmaceutical biodistribution in humans. CONCLUSION: The proposed method for 99mTc-ENS quality control studies and stability studies was evaluated and validated following international standards.

Fortification strategies to combat zinc and iron deficiency.

Food fortification is an important strategy to combat iron and zinc deficiency. This review covers the basic concepts of food fortification, as well as its advantages and disadvantages. The main characteristics of the most common zinc and iron compounds used in this procedure are also analyzed.

The role of zinc in the growth and development of children.

This review concerns the importance of zinc in growth, development, and cognitive function in children and the deleterious consequences of its deficiency on children's health. Possible strategies to overcome zinc deficiency and the results of some supplementation trials are discussed.

Bioavailability of microencapsulated ferrous sulfate in powdered milk produced from fortified fluid milk: a prophylactic study in rats.

OBJECTIVE: We investigated the iron bioavailability of microencapsulated ferrous sulfate (SFE-171) in a diet based on powdered milk by using the prophylactic method in rats. METHODS: The SFE-171 was added into fluid milk and industrially processed into powdered milk, which was then mixed in our laboratory with a normalized diet (17.2 +/- 2.1 mg Fe/kg). A reference standard diet using ferrous sulfate as iron-fortifying source (19.8 p+/- 2.9 mg Fe/kg) and a control diet without added iron (4.6 +/- 0.8 mg Fe/kg) were prepared in the laboratory in a similar way. These diets were administered to different groups of weaning rats for 28 d as the only solid nourishment. The iron bioavailability of the different sources was calculated as the relation between the mass of iron incorporated into hemoglobin during the treatment and the total iron intake per animal. RESULTS: The iron bioavailability values of SFE-171 and ferrous sulfate in the fortified diets were 41.6 +/- 6.6% and 42.6 +/- 4.2%, respectively; these results were significantly higher (P < 0.01) than the iron bioavailability of the control diet (28.8 +/- 8.1%). CONCLUSION: These results showed that iron-fortified powdered milk can be produced from fluid milk fortified with SFE-171. The bioavailability of SFE-171 in this rat model was not altered by the manufacturing process.

Iron deficiency: causes, consequences, and strategies to overcome this nutritional problem.

Iron deficiency and anemia affect a substantial portion of the world's population, provoking severe health problems to the people suffering these conditions, as well as important economic losses to the regions in which this nutritional deficiency is significant. In this work, the principal causes and consequences produced by this deficiency are discussed, as well as the different strategies that can be applied in order to prevent and solve this nutritional problem.

Current knowledge of iron metabolism.

Iron plays many roles in human physiology. In this article, we summarize the basic and current knowledge of this essential micronutrient on human metabolism.

Stabilized ferrous gluconate as iron source for food fortification: bioavailability and toxicity studies in rats.

The iron bioavailability and acute oral toxicity in rats of a ferrous gluconate compound stabilized with glycine (SFG), designed for food fortification, was studied in this work by means of the prophylactic method and the Wilcoxon method, respectively. For the former studies, SFG was homogeneously added to a basal diet of low iron content, reaching a final iron concentration of 20.1 +/- 2.4 mg Fe/kg diet. A reference standard diet using ferrous sulfate as an iron-fortifying source (19.0 +/- 2.1 mg Fe/kg diet) and a control diet without iron additions (9.3 +/- 1.4 mg Fe/kg diet) were prepared in the laboratory in a similar way. These diets were administered to three different groups of weaning rats during 23 d as the only type of solid nourishment. The iron bioavailability of SFG was calculated as the relationship between the mass of iron incorporated into hemoglobin during the treatment and the total iron intake per animal. This parameter resulted in 36.6 +/- 6.2% for SFG, whereas a value of 35.4 +/- 8.0% was obtained for ferrous sulfate. The acute toxicological studies were performed in two groups of 70 female and 70 male Sprague-Dawley rats that were administered increasing doses of iron from SFG. The LD50 values of 1775 and 1831 mg SFG/kg body wt were obtained for female and male rats, respectively, evidencing that SFG can be considered as a safe compound from a toxicological point of view.

Bioavailability of Petit-Suisse cheese as food vehicle for iron fortification estimated by the prophylactic method.

Microencapsulated ferrous sulfate (SFE-171) and ferric orthophosphate in Petit-Suisse cheese were examined for iron bioavailability by the prophylactic method. The iron sources were industrially added to different samples of Petit-Suisse cheese, which were mixed with other food components in our laboratory before use. A reference standard diet inclusive of nonmicroencapsulated ferrous sulfate and a control diet low in iron content were prepared in the laboratory. The final iron content in the fortified diets was approximately 15 mg Fe/kg diet. These diets were administered to weaning rats for 23 days. The iron bioavailability was evaluated as the ratio of iron incorporated into hemoglobin to oral iron intake, thereby being estimated as 62.6 +/- 8.8% for ferrous sulfate and 59.2 +/- 10.6% for SFE-171, which were significantly effective at p < 0.01 compared to 43.4 +/- 10.5% for ferric orthophosphate. It thus turned out that SFE-171 was stable through industrial processing with Petit-Suisse cheese as the food vehicle and served as an iron fortifier equal to ferrous sulfate in bioavailability.

Zinc and iron interactions evaluated between different mineral sources in different nutritional matrixes.

We compared the absorption of BioZn, SFE-171, SO4Fe (reference standard) and SO4Zn (reference standard) alone or in combination in water and in an infant dessert. When mineral interactions were evaluated, zinc and iron were administered in a 1:1 molar relation. There 160 rats divided in 16 groups of 10 animals each which received: SO(4)65Zn, Bio65Zn, SO(4)65Zn + SO4Fe, Bio65Zn + SFE-171, SO(4)59Fe, 59SFE-171, SO(4)59Fe + SO4Zn and 59SFE-171 + BioZn either in water or an infant dessert. The results showed that BioZn has bioavailability similar to SO4Zn both in water (23.36 +/- 3.14% vs. 21.48 +/- 6.03%. respectively) and in an infant dessert (19.89 +/- 3.27% vs. 18.31 +/- 4.76%, respectively). When these zinc compounds were administered with iron no statistical difference of zinc absorption was found (Bio65Zn + SFE-171 in water 22.70 +/- 6.30%, Bio65Zn + SFE-171 in the infant dessert 18.07 +/- 5.89%, SO(4)65Zn + SO4Fe in water 24.67 +/- 5.70% and SO(4)65Zn + SO4Fe in the infant desert 20.56 +/- 5.20%). For iron, the absorption of 59SFE-171 in water was higher (p < .01) than SO(4)59Fe in water and 59SFE-171 + BioZn in water (32.35 +/- 8.32% vs. 26.27 +/- 8.83% vs. 23.69 +/- 8.37%, respectively). Iron absorption from SO(4)59Fe in water was higher (p < .01) than SO(4)59Fe + SO4Zn in water (26.27 +/- 8.83% vs. 20.21 +/- 8.72%, respectively). Iron absorption in the infant dessert was higher (p < .01) for 59SFE-171 + BioZn than SO(4)59Fe, 59SFE-171 and SO(4)59Fe + SO4Zn (22.81 +/- 6.97% vs. 16.12 +/- 6.14% vs. 16.90 +/- 6.23% vs. 15.04 +/- 6.25%, respectively). Statistical differences (p < .01) were found between iron absorption from 59SFE-171 in water and the infant dessert (32.35 +/- 8.32% vs. 16.90 +/- 6.23%, respectively) and for SO(4)59Fe (26.27 +/- 8.83% vs. 16.12 +/- 6.14% respectively). Zinc and iron interactions evaluated in a 1:1 molar relation of the minerals were observed only for iron absorption in water but not in infant dessert. No negative effect was found for zinc absorption neither in water nor in infant dessert.

Evidence of Helicobacter sp. in dental plaque of captive dolphins (Tursiops gephyreus).

Gastrointestinal lesions have been extensively reported in wild and captive marine mammals. However, their etiology remains unclear. In humans and other animals, chronic gastritis and peptic ulcers have been associated with Helicobacter sp. Therefore, the aim of our study was to investigate the presence of Helicobacter sp. in the gastric juice, dental plaque, and saliva of marine mammals living in a controlled environment. Five dolphins (Tursiops gephyreus), one killer whale (Orcinus orca), one false killer whale (Pseudorca crassidens), three sea lions (Otaria flavescens), two elephant seals (Mirounga leonina), and two fur seals (Arctocephalus australis) were studied. Saliva, dental plaque, and gastric juice samples were examined for Helicobacter sp. using polymerase chain reaction. None of the gastric juice or saliva samples were positive for Helicobacter sp. However, Helicobacter sp. DNA was detected in dental plaque from two dolphins, suggesting the oral cavity might be a reservoir of this bacterium.