Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 48
Filtrar
1.
Front Public Health ; 8: 567900, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33240834

RESUMEN

Background: Multi-dimensional monitoring evaluation and learning strategies are needed to address the complex set of factors that affect early child development in marginalized populations, but few studies have explored their effectiveness. Objective: To compare improvement of health and development of children 0-3 years between intervention communities (IC) and control communities (CC) from peripheral settlements of Lima. Sequential interventions included: (1) home and community gardens, (2) conscious nutrition, and (3) parenting workshops following the International Child Development Program (ICDP). Methods: Interventions were delivered by community health promoters (CHPs) using a "step-by-step" learning system. Both IC and CC were monitored before the interventions began, at 8 and 12 months (n = 113 IC and 127 CC children). Data were collected on household characteristics, diet, food security, health indicators (history of diarrhea and respiratory infections, hemoglobin, intestinal parasites, anthropometry), caregiver-child interactions and stress, and achievement of Pan-American Health Organization age-specific developmental milestones. Stepwise multiple logistic regressions were used to determine if the interventions affected food insecurity, as well as motor, social/cognitive and language delays. Results: At baseline, 2.6% were categorized as "suspected developmental delay" and 14.2% were on "alert for development delay." Food insecurity, diarrhea and respiratory infections were lowered following the interventions. Through the "step-by-step" approach, caregivers in IC gained skills in gardening, conscious nutrition and parenting that reduced the risk of food insecurity [Adjusted Risk Ratio = 0.20 (95% CI: 0.08-0.51)] and language delay [0.39 (0.19-0.82)] but not motor or social/cognitive delay. Use of a multiple micronutrient supplement decreased the risk of motor delay [0.12 (0.03-0.56)], but more pets were associated with higher risk of motor [3.24 (1.47-7.14)] and social/cognitive delay [2.72 (1.33-5.55)], and of food insecurity [1.73 (1.13-2.66)]. Conclusion: The combined interventions delivered by CHPs helped to mitigate the impact of adversity on food insecurity and language delay. Additional improvements may have been detected if the interventions had continued for a longer time. Our results indicate that control of infections and pets may be needed to achieve measurable results for motor and social/cognitive development. Continuous monitoring facilitated adjusting implementation strategies and achieving positive developmental outcomes.

2.
Public Health Nutr ; : 1-13, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32885769

RESUMEN

OBJECTIVES: To explore impacts of a demonstration garden-based agricultural intervention on agricultural knowledge, practices and production, food security and preschool child diet diversity of subsistence farming households. DESIGN: Observational study of households new to the intervention or participating for 1 or 5 years. Variables measured were agricultural techniques learned from the intervention and used, agricultural production, household food insecurity (FIS) and child diet diversity (DDS), over one agricultural cycle (during land preparation, growing and harvest months). SETTING: Fifteen rural subsistence farming communities in Panama. PARTICIPANTS: Households participating in intervention (n 237) with minimum one preschool child. RESULTS: After 1 year, participants had more learned and applied techniques, more staple crops produced and lower FIS and higher DDS during land preparation and growing months compared with those new to the intervention. After 5 years, participants grew more maize, chickens and types of crops and had higher DDS during growing months and, where demonstration gardens persisted, used more learned techniques and children ate more vitamin A-rich foods. Variables associated with DDS varied seasonally: during land preparation, higher DDS was associated with higher household durable asset-based wealth; during growing months, with greater diversity of vegetables planted and lower FIS; during harvest, with older caregivers, caregivers working less in agriculture, more diverse crops and receiving food from demonstration gardens. CONCLUSIONS: The intervention improved food production, food security and diets. Sustained demonstration gardens were important for continued use of new agricultural techniques and improved diets.

3.
Front Public Health ; 8: 319, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32903835

RESUMEN

Background: In populations with a history of conflict, early identification of pregnant women who are at risk of adverse pregnancy outcomes is challenging, especially if sonography is not available. We evaluated the performance of symphysis-fundal height (SFH) for identification of high-risk pregnancies and investigated if food security and diet quality, clinical biomarkers, and stress were associated with SFH and two known indicators of maternal-fetal well-being, sonography-estimated fetal weight and amniotic fluid index (AFI). Methods: For this cross-sectional study, 61 women with high-risk pregnancies were recruited after referral to the obstetrics and gynecology unit at San José Hospital in Popayán, Colombia. Multiple stepwise linear and ordered logistic regressions were used to identify associations of SFH, sonography-estimated fetal weight and AFI classification with history of displacement, food insecurity, post-traumatic stress symptoms as well as biopsychosocial risk evaluated through the Colombian risk scale. Results: History of displacement was associated with lower SFH Z-scores, but higher hemoglobin, taking iron supplements and a higher diastolic blood pressure were associated with higher SFH Z-scores. SFH was also associated with AFI but not with sonography-estimated fetal weight. Stress indicators were associated with a higher AFI. In contrast family support, an element of the Colombian biopsychosocial risk assessment, was associated with a higher sonography-estimated fetal weight, whereas more hours of sleep/day were associated with lower sonography-estimated fetal weight. Conclusion: SFH was not only associated with biological factors known to affect maternal/fetal health but also with history of displacement, thus validating its use in conflict areas for pregnancy assessment. Associations of biopsychosocial stressors with maternal-fetal outcomes highlight the need for a systematic assessment of stress in pregnant women from conflict zones.

4.
Front Public Health ; 8: 86, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32292772

RESUMEN

Background: Ambulatory blood pressure is a potential tool for early detection of complications during pregnancy, but its utility in impoverished settings has not been assessed. This cross-sectional study aimed to determine whether maternal infections, nutrient deficiencies and inflammation (MINDI) were associated with four measures of maternal blood pressure (BP) and to determine their association with symphysis-fundal-height (SFH). Methods: Environmental and dietary factors, intake of iron and a multiple-nutrient supplement (MNS), markers of inflammation, protein, anemia, folate, vitamins B12, A and D status, and urogenital, skin, oral and intestinal nematode infections were measured in indigenous pregnant Panamanian women. Stepwise multiple linear and logistic regression models explored determinants of systolic and diastolic blood pressure (SBP, DBP), hypotension (SBP < 100 and DBP < 60), mean arterial pressure (MAP), elevated MAP (eMAP), and pulse pressure (PP). Associations of BP with intestinal nematodes and with SFH Z scores (≥16 wk) were also explored. Results: Despite absence of high SBP or DBP, 11.2% of women had eMAP. Furthermore, 24.1% had hypotension. Linear regression showed that hookworm infection was associated with higher SBP (P = 0.049), DBP (P = 0.046), and MAP (P = 0.016), whereas Ascaris was associated with lower DBP (P = 0.018) and MAP (P = 0.028). Trichomonas was also associated with lower SBP (P < 0.0001) and MAP (P = 0.009). The presence of Trichuris (OR: 6.7, 95% CI 1.0-44.5) and folic acid deficiency (OR: 6.9, 95% CI 1.4-33.8) were associated with increased odds of eMAP. The odds of low BP was higher in the presence of Ascaris (OR: 3.63 ± 2.28, P = 0.040), but odds were lowered by MNS (OR: 0.35 ± 0.11, P = 0.001), more intake of animal-source foods/wk (OR: 0.7, 95% CI 0.5-0.9) and by higher concentrations of IL-17 (OR: 0.87 ± 0.05, P = 0.016). Conclusion: MINDI were bi-directionally associated with blood pressure indicators. In this MINDI cohort, infections, nutrients and cytokines both raised, and lowered BP indices. The presence of eMAP identified pregnant women at risk of hypertension whereas low PP was associated with lower SFH. Therefore, MAP and PP may help in detecting women at risk of adverse pregnancy outcomes in settings with limited access to technology.

5.
J Nutr ; 149(9): 1651-1659, 2019 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-31187864

RESUMEN

BACKGROUND: Subclinical mastitis (SCM) is an inflammatory condition of the mammary gland, but its association with human milk composition and infant growth is not well described. OBJECTIVES: We investigated whether SCM, milk cytokines, and/or estimated intakes of milk minerals and trace elements were associated with infant anthropometry or growth velocity before 6 mo. METHODS: Breast milk was collected from Mam-Mayan mothers (n = 114) at both early (2-46 d) and established (4-6 mo) lactation. Concentrations of 9 elements (sodium, potassium, calcium, magnesium, copper, iron, manganese, selenium, zinc) analyzed by inductively-coupled plasma mass spectrometry were used to estimate infants' daily intakes. Concentrations of 4 cytokines were measured. Milk concentrations and infants' estimated elemental intakes and anthropometric measurements during early and established lactation were compared by SCM status. Multiple regression was used to identify factors associated with infant growth attainment (<46 d) for infant weight- (WAZ), length- (LAZ), and head circumference-for-age (HCAZ) and weight-for-length (WLZ) z scores and with growth velocity (expressed as Δ/d) from early to established lactation. RESULTS: SCM prevalence was higher in early (30%) than established (10%) lactation. Breast milk of SCM mothers had higher cytokine concentrations and higher magnesium in early and higher selenium concentrations in both early and established lactation (Padj < 0.0121). At day 46, regression models showed inverse associations of SCM with WLZ and IL-1ß with LAZ (Padj < 0.0150). In contrast, linear growth velocity was positively associated with IL-1ß measured in early lactation (Padj < 0.0124), whereas cranial growth velocity was positively associated with IL-8 measured during established lactation ( Padj < 0.0124). CONCLUSIONS: Despite a high prevalence of inadequate intakes, only infants' intake of milk magnesium during early lactation was associated with linear growth velocity in breastfed infants <6 mo. Evidence shows that SCM, breast-milk cytokines, and infants' estimated intakes of select elements are independently associated with growth attainment and growth velocity during lactation.


Asunto(s)
Estatura , Peso Corporal , Lactancia Materna , Citocinas/análisis , Mastitis/etiología , Leche Humana/química , Minerales/análisis , Oligoelementos/análisis , Adulto , Femenino , Humanos , Lactante , Recién Nacido , Inflamación/etiología , Estudios Longitudinales
6.
Public Health Nutr ; 22(13): 2398-2407, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31122305

RESUMEN

OBJECTIVE: To determine if constraints on agricultural production were a novel construct in the Panama Food Security Questionnaire (FSQ) and to characterize agricultural and economic determinants of food insecurity during the planting, growing and harvesting time periods in subsistence farming communities. DESIGN: This longitudinal study followed households during land preparation, growing and harvest periods in one agricultural cycle. Agricultural production and economic variables were recorded and the Panama FSQ was administered. Exploratory factor analysis was used to verify construct validity of the FSQ. A food insecurity score (FIS), ranging from 0 to 42, was derived. Multiple regression analyses of FIS were conducted for each agricultural period. SETTING: Fifteen rural villages in Panama. PARTICIPANTS: Subsistence farming households (n 237). RESULTS: The FSQ contained four constructs: (i) ability to buy food; (ii) decreased amount/number of meals; (iii) feeling hungry; and (iv) lower agricultural production because of weather or lack of resources. Although most households were mildly food insecure in all time periods, determinants of food insecurity differed in each. Higher FIS was associated during land preparation with less rice and legumes planted and lower asset-based wealth; during growing months with less rice, more maize and pigeon peas planted and not selling produce; and during harvest with less rice planted, fewer chickens and lower income. CONCLUSIONS: Constraints on agriculture was a novel construct of the Panama FSQ. Different income-related variables emerged in each agricultural period. Planting staple foods and raising chickens were associated with food security, but some crop choices were associated with food insecurity.


Asunto(s)
Agricultura/estadística & datos numéricos , Abastecimiento de Alimentos/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adulto , Animales , Productos Agrícolas , Composición Familiar , Femenino , Humanos , Ganado , Estudios Longitudinales , Masculino , Panamá , Población Rural/estadística & datos numéricos
7.
Sci Rep ; 9(1): 4165, 2019 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-30862816

RESUMEN

Establishment of neural networks critical for memory and cognition begins during the perinatal period but studies on the impact of maternal infection are limited. Using a nematode parasite that remains in the maternal intestine, we tested our hypothesis that maternal infection during pregnancy and early lactation would alter perinatal brain gene expression, and that the anti-inflammatory nature of this parasite would promote synaptic plasticity and long-term potentiation. Brain gene expression was largely unaffected two days after birth, but in seven-day old pups, long-term potentiation and four related pathways essential for the development of synaptic plasticity, cognition and memory were up-regulated in pups of infected dams. Interestingly, our data suggest that a lowering of Th1 inflammatory processes may underscore the apparent beneficial impact of maternal intestinal infection on long-term potentiation.


Asunto(s)
Encéfalo/metabolismo , Enfermedades Gastrointestinales/genética , Potenciación a Largo Plazo/genética , Infecciones por Nematodos/genética , Regulación hacia Arriba/genética , Animales , Animales Recién Nacidos , Regulación hacia Abajo/genética , Femenino , Enfermedades Gastrointestinales/inmunología , Regulación del Desarrollo de la Expresión Génica , Ontología de Genes , Masculino , Ratones , Infecciones por Nematodos/inmunología , Embarazo , Mapas de Interacción de Proteínas/genética , Células TH1/inmunología , Células Th2/inmunología
8.
Matern Child Nutr ; 15(3): e12756, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30472802

RESUMEN

Infant growth faltering occurs in breastfed infants <6 months of age. The possibility that maternal health status contributes to this growth faltering is underexplored. We investigated whether (a) subclinical mastitis (SCM), an asymptomatic inflammation of the breast, (b) maternal intestinal nematode and protozoan infections, indicators of faecal-oral contamination, or (c) poor breastfeeding practices increased the odds of stunting (length-for-age z-score < -2SD), underweight (weight-for-age z-score < -2SD), or low head circumference (head circumference-for-age z-score < -2SD) in breastfed infants in rural indigenous communities in Guatemala. Mother-infant dyads (n = 105) were subdivided into those with and without SCM (milk Na:K ratio > 0.6). Maternal and infant anthropometry were measured at the time of breast milk collection. Maternal stool samples were examined for the presence of intestinal nematodes and protozoa. Questionnaires were used to characterize breastfeeding practices (exclusivity and frequency) and support, hygiene (latrine use and household faucet), and infant diarrhoea. SCM occurred in 14% of women and was associated with increased odds of infant stunting (odds ratio [OR] = 4.3; confidence interval [CI] [1.1, 15.8]), underweight (OR = 9.2; CI [1.8, 48.0]), and low head circumference (OR = 15.9; CI [2.6, 96.9]). Maternal pathogenic protozoa and nematodes were uncommon (<4%), but nonpathogenic protozoa were common (e.g., Entamoeba coli [39%]). Entamoeba coli increased the likelihood (OR = 3.3; CI [1.02, 10.6]) of low head circumference, whereas higher breastfeeding frequency lowered its odds (OR = 0.74, CI [0.56, 0.97]). Prevention of SCM may improve early infant growth, but public health measures that increase breastfeeding frequency and reduce faecal-oral contamination may be required to minimize low head circumference.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Trastornos del Crecimiento , Higiene , Mastitis , Adolescente , Adulto , Infecciones Asintomáticas , Estudios Transversales , Femenino , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Guatemala/epidemiología , Humanos , Lactante , Recién Nacido , Parasitosis Intestinales/complicaciones , Parasitosis Intestinales/epidemiología , Mastitis/complicaciones , Mastitis/epidemiología , Delgadez , Adulto Joven
9.
J Trace Elem Med Biol ; 50: 139-145, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30262271

RESUMEN

Amniotic fluid (AF), which is swallowed by the developing fetus, contains minerals and trace elements, but their association with fetal growth has not been explored. Our objectives were to assess (1) whether concentrations of AF minerals and trace elements were associated with changes in 5 fetal ultrasound measurements (estimated weight, bi-parietal diameter, head circumference, abdominal circumference, femur length) between 16-20 and 32-36 wks gestation and (2) whether a prenatal supplement was associated with concentrations of AF minerals and trace elements or the 5 fetal ultrasound measurements. We measured, using inductively coupled plasma-mass spectrometry (ICP-MS), 15 minerals and trace elements (aluminum, arsenic, calcium, chromium, copper, iron, lead, magnesium, nickel, potassium, rubidium, selenium, silver strontium, zinc) in amniotic fluid collected from 176 pregnant women undergoing age-related amniocentesis for genetic testing (15.7 ±â€¯1.1 wks). AF mineral concentrations, prenatal supplement use, and determinants of ultrasound measurements during early and late pregnancy were used in models to assess their impact on change in fetal ultrasound measurements. Positive associations were identified for change in bi-parietal diameter with AF calcium, for change in head circumference with AF copper and nickel, and for change in femur length with AF selenium. Arsenic was negatively associated with estimated fetal weight, and this relationship was modified by prenatal supplement use. Additionally, AF chromium concentrations were lower in women taking prenatal supplements. In conclusion, AF minerals were associated with fetal ultrasound indices, supporting a biological role for calcium, copper, nickel and selenium in promoting in-utero fetal growth. Evidence of a mineral-vitamin interaction between arsenic and folic acid in prenatal supplements and mineral-mineral interaction between iron and chromium would suggest that attention be paid to mineral and trace element formulation of prenatal supplements.


Asunto(s)
Líquido Amniótico/metabolismo , Minerales/metabolismo , Oligoelementos/metabolismo , Suplementos Dietéticos , Femenino , Desarrollo Fetal/fisiología , Humanos , Embarazo
10.
J Trace Elem Med Biol ; 46: 55-61, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29413111

RESUMEN

The possibility that either subclinical mastitis (SCM), an inflammatory condition of the breast, or elevations in breast milk proinflammatory cytokines alter breast milk mineral and trace element composition in humans has not been investigated. In this cross-sectional study, breast milk samples (n=108) were collected from Guatemalan Mam-Mayan mothers at one of three stages of lactation (transitional, early and established), and categorized as SCM (Na:K >0.6) or non-SCM (Na:K ≤0.6). Milk concentrations of 12 minerals (calcium, copper, iron, magnesium, manganese, phosphorus, potassium, rubidium, selenium, sodium, strontium, and zinc) and 4 proinflammatory cytokines (IL-1ß, IL-6, IL-8, TNF-α) were measured by inductively coupled plasma mass spectrometry (ICP-MS), Lachat analyzer or Luminex multiplex bead cytokine assay. SCM was more prevalent during transitional (30%) than early (15.6%) and established (8.9%) lactation. Analysis of variance revealed that breast milk minerals differed by stage of lactation and SCM status. Breast milk minerals with the exception of magnesium were lower in established lactation, whereas SCM was associated with higher selenium and lower phosphorus. Regression models that controlled for lactation stage also confirmed that SCM was associated with lower milk phosphorus and higher milk selenium concentrations. Furthermore, cytokine concentrations were independently associated with several mineral concentrations: IL-1ß with higher phosphorus and iron, IL-6 with higher calcium, magnesium, copper and manganese, IL-8 with higher calcium and zinc, and TNF-α with lower iron and manganese. We conclude that milk mineral and trace element concentrations are affected not only by the presence of SCM but also by proinflammatory cytokines in breast milk.


Asunto(s)
Citocinas/metabolismo , Mastitis/metabolismo , Leche Humana/metabolismo , Minerales/metabolismo , Oligoelementos/metabolismo , Adolescente , Adulto , Lactancia Materna , Estudios Transversales , Femenino , Guatemala , Humanos , Lactancia , Evaluación Nutricional , Análisis de Componente Principal , Adulto Joven
11.
Int J Parasitol ; 48(1): 51-58, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28903026

RESUMEN

Maternal dietary protein deficiency and gastrointestinal nematode infection during early pregnancy have negative impacts on both maternal placental gene expression and fetal growth in the mouse. Here we used next-generation RNA sequencing to test our hypothesis that maternal protein deficiency and/or nematode infection also alter the expression of genes in the developing fetal brain. Outbred pregnant CD1 mice were used in a 2×2 design with two levels of dietary protein (24% versus 6%) and two levels of infection (repeated sham versus Heligmosomoides bakeri beginning at gestation day 5). Pregnant dams were euthanized on gestation day 18 to harvest the whole fetal brain. Four fetal brains from each treatment group were analyzed using RNA Hi-Seq sequencing and the differential expression of genes was determined by the edgeR package using NetworkAnalyst. In response to maternal H. bakeri infection, 96 genes (88 up-regulated and eight down-regulated) were differentially expressed in the fetal brain. Differentially expressed genes were involved in metabolic processes, developmental processes and the immune system according to the PANTHER classification system. Among the important biological functions identified, several up-regulated genes have known neurological functions including neuro-development (Gdf15, Ing4), neural differentiation (miRNA let-7), synaptic plasticity (via suppression of NF-κß), neuro-inflammation (S100A8, S100A9) and glucose metabolism (Tnnt1, Atf3). However, in response to maternal protein deficiency, brain-specific serine protease (Prss22) was the only up-regulated gene and only one gene (Dynlt1a) responded to the interaction of maternal nematode infection and protein deficiency. In conclusion, maternal exposure to GI nematode infection from day 5 to 18 of pregnancy may influence developmental programming of the fetal brain.


Asunto(s)
Encéfalo/metabolismo , Enfermedades Fetales/genética , Herencia Materna , Complicaciones del Embarazo/genética , Deficiencia de Proteína/embriología , Trichostrongyloidea/fisiología , Tricostrongiloidiasis/parasitología , Animales , Encéfalo/embriología , Encéfalo/parasitología , Proteínas Portadoras/genética , Proteínas Portadoras/metabolismo , Femenino , Desarrollo Fetal , Enfermedades Fetales/metabolismo , Enfermedades Fetales/parasitología , Enfermedades Fetales/fisiopatología , Factor 15 de Diferenciación de Crecimiento/genética , Factor 15 de Diferenciación de Crecimiento/metabolismo , Masculino , Ratones , MicroARNs/genética , MicroARNs/metabolismo , Embarazo , Complicaciones del Embarazo/metabolismo , Complicaciones del Embarazo/parasitología , Deficiencia de Proteína/genética , Deficiencia de Proteína/metabolismo , Deficiencia de Proteína/parasitología , Trichostrongyloidea/genética , Trichostrongyloidea/aislamiento & purificación , Tricostrongiloidiasis/embriología , Tricostrongiloidiasis/genética , Tricostrongiloidiasis/metabolismo , Troponina T/genética , Troponina T/metabolismo , Proteínas Supresoras de Tumor/genética , Proteínas Supresoras de Tumor/metabolismo
12.
Infect Dis Poverty ; 6(1): 94, 2017 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-28571565

RESUMEN

BACKGROUND: The usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common. METHODS: This cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B12, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies. RESULTS: CRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP. CONCLUSIONS: Infections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.


Asunto(s)
Avitaminosis/epidemiología , Proteína C-Reactiva/metabolismo , Enfermedades Transmisibles/epidemiología , Adolescente , Adulto , Avitaminosis/etiología , Enfermedades Transmisibles/etiología , Estudios Transversales , Femenino , Humanos , Indios Centroamericanos/estadística & datos numéricos , Lactancia , Panamá/epidemiología , Embarazo , Adulto Joven
13.
J Nutr ; 146(10): 2067-2074, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27558578

RESUMEN

BACKGROUND: Breast milk is the recommended source of nutrients for infant growth, but its adequacy to meet infants' mineral and trace element needs is unknown. OBJECTIVES: We used breast-milk mineral and trace element concentrations of Guatemalan mothers at 3 lactation stages to estimate total daily intakes and to determine whether intakes were associated with early infant growth. METHODS: In this cross-sectional study, breast-milk samples were collected from Mam-Mayan mothers during transitional (5-17 d, n = 56), early (18-46 d, n = 75), and established (4-6 mo, n = 103) lactation; z scores for weight (WAZ), length (LAZ), and head circumference (HCAZ) were measured. Concentrations of 11 minerals (calcium, potassium, magnesium, sodium, copper, iron, manganese, rubidium, selenium, strontium, and zinc) were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). WHO equations were used to calculate the estimated energy requirement, which was divided by the energy density of breast milk to estimate daily milk volume, and this number was multiplied by breast-milk mineral concentrations to estimate intakes. Principal component analyses identified clusters of minerals; principal components (PCs) were used in regression analyses for anthropometric outcomes. RESULTS: Estimated breast-milk intakes during established lactation were insufficient to compensate for the lower milk sodium, copper, manganese, and zinc concentrations in male infants and the lower sodium, iron and manganese concentrations in female infants. Estimated intakes of calcium, magnesium, potassium, sodium, and selenium were below the Institute of Medicine Adequate Intake for both sexes at all 3 stages of lactation. In early lactation, multiple linear regressions showed that PC1 (calcium, magnesium, potassium, rubidium, and strontium intakes) was positively associated with WAZ, LAZ, and HCAZ. In established lactation, the same PC with sodium added was positively associated with all 3 anthropometric outcomes; a second PC (PC2: zinc, copper, and selenium intakes) was associated with WAZ and LAZ but not HCAZ. CONCLUSIONS: Breast milk may be inadequate in selected minerals and trace elements where higher estimated intakes were associated with greater infant growth.


Asunto(s)
Fenómenos Fisiológicos Nutricionales del Lactante , Leche Humana/química , Oligoelementos/análisis , Peso Corporal , Lactancia Materna , Estudios Transversales , Femenino , Guatemala , Humanos , Lactante , Lactancia , Modelos Lineales , Masculino , Evaluación Nutricional , Necesidades Nutricionales , Análisis de Componente Principal , Oligoelementos/administración & dosificación , Oligoelementos/deficiencia , Organización Mundial de la Salud
14.
Parasitology ; 143(8): 1043-54, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27000494

RESUMEN

This longitudinal study explored whether aspects of subsistence agriculture were associated with presence and intensity of Ascaris and hookworm in preschool children in rural Panama. Questionnaires were used to collect data on household socio-demographics, child exposure to agriculture and household agricultural practices. Stool samples were collected from children (6 months-5 years) at 3 time points, with albendazole administered after each to clear infections, resulting in 1 baseline and 2 reinfection measures. A novel Agricultural Activity Index (AAI) was developed using principal components analysis to measure the intensity of household agricultural practices. Zero-inflated negative binomial regression models revealed baseline hookworm egg counts were higher if children went to the agricultural plot and if the plot was smaller. Baseline and reinfection Ascaris egg counts were higher if children went to the plot and households had higher AAI, and higher at baseline if the plot was smaller. Caregiver time in the plot was negatively associated with baseline Ascaris egg counts, but positively associated with baseline hookworm and Ascaris reinfection egg counts. Children who spent more time playing around the home were less likely to be infected with Ascaris at baseline. We conclude that preschool child exposure to subsistence agriculture increased Ascaris and hookworm intensity.


Asunto(s)
Albendazol/administración & dosificación , Ancylostomatoidea/fisiología , Antihelmínticos/administración & dosificación , Ascariasis/transmisión , Ascaris/fisiología , Infecciones por Uncinaria/transmisión , Agricultura , Animales , Ascariasis/tratamiento farmacológico , Ascariasis/parasitología , Preescolar , Demografía , Composición Familiar , Heces/parasitología , Femenino , Infecciones por Uncinaria/tratamiento farmacológico , Infecciones por Uncinaria/parasitología , Humanos , Estudios Longitudinales , Masculino , Panamá , Recuento de Huevos de Parásitos , Población Rural , Suelo/parasitología , Encuestas y Cuestionarios
15.
Int J Parasitol ; 46(2): 97-104, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26475213

RESUMEN

Intestinal nematode infection and dietary protein deficiency are common during pregnancy and both have been shown to impair fetal growth in humans, livestock and laboratory animals. The placenta has been linked to fetal growth but its role in mediating the response to maternal infection and protein deficiency is not understood. We used microarrays to test the hypothesis that maternal intestinal nematode infection and protein deficiency alter the expression of placental genes related to fetal growth. Placentas were obtained on day 18 of pregnancy from CD-1 mice fed protein sufficient (24%) or protein deficiency (6%) isoenergetic diets and either uninfected or infected with Heligmosomoides bakeri. Gene expression was analysed using the Affymetrix GeneChip 2.0 ST mouse array (n=3/experimental group). Differentially expressed genes were identified using two-way ANOVA (P<0.02, fold-change >1.25) and pathway analyses were performed using DAVID software. Expression changes for selected genes were confirmed using qPCR. Heligmosomoides bakeri infection down-regulated 109 transcripts, including genes related to oxidative phosphorylation, and up-regulated 214 transcripts, including genes involved in ATP binding and hemopoiesis. Up-regulation of hemopoiesis genes may explain increased placental mass previously reported in H. bakeri-infected mice. Protein deficiency down-regulated 141 annotated transcripts, including genes involved in cell motility and endopeptidase activity, and up-regulated 131 annotated transcripts, including genes related to hemopoiesis. A statistical interaction was detected for 248 transcripts, including several genes with known functions in fetal growth. Notably, expression of the gene Irs1 (insulin receptor substrate) was lower in infected dams but only when they were fed a protein sufficient diet. Also, expression of several genes, including Igf1r (insulin-like growth factor-1 receptor) and Prl (prolactin) was up-regulated by infection in protein deficiency dams and down-regulated by protein deficiency in uninfected dams. Our results highlight that expression of placental genes involved in fetal growth is influenced by the interaction between protein deficiency and H. bakeri infection.


Asunto(s)
Regulación del Desarrollo de la Expresión Génica , Parasitosis Intestinales/metabolismo , Infecciones por Nematodos/metabolismo , Placenta/metabolismo , Deficiencia de Proteína/metabolismo , Animales , Femenino , Parasitosis Intestinales/genética , Ratones , Infecciones por Nematodos/genética , Análisis de Secuencia por Matrices de Oligonucleótidos , Embarazo , Deficiencia de Proteína/genética
16.
Food Nutr Bull ; 36(4): 415-40, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26481796

RESUMEN

BACKGROUND: The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together. OBJECTIVES: To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother-infant dyads. METHODS: Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored. RESULTS: Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts. CONCLUSIONS: The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother-infant dyad.


Asunto(s)
Lactancia , Fenómenos Fisiologicos Nutricionales Maternos , Complicaciones del Embarazo/epidemiología , Población Rural , Adulto , Estudios Transversales , Dieta , Violencia Doméstica/estadística & datos numéricos , Femenino , Abastecimiento de Alimentos , Trastornos del Crecimiento/epidemiología , Guatemala/epidemiología , Humanos , Lactante , Mortalidad Infantil , Trastornos de la Nutrición del Lactante/epidemiología , Recién Nacido , Lactancia/fisiología , Lactancia/psicología , Estudios Longitudinales , Periodo Posparto , Embarazo , Complicaciones del Embarazo/fisiopatología , Complicaciones del Embarazo/psicología , Complicaciones Infecciosas del Embarazo/epidemiología , Estrés Psicológico/complicaciones , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios
17.
Parasitology ; 142(12): 1543-54, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26302902

RESUMEN

This study explored whether the yard environment and child hygiene and play behaviours were associated with presence and intensity of Ascaris and hookworm in preschool children and with eggs and larvae in soil. Data were collected using questionnaires, a visual survey of the yard, soil samples and fecal samples collected at baseline and following re-infection. The presence of eggs/larvae in soil was associated negatively with water storage (eggs) but positively with dogs (eggs) and distance from home to latrine (larvae). Baseline and re-infection prevalences were: hookworm (28.0%, 3.4%); Ascaris (16.9%, 9.5%); Trichuris (0.9%, 0.7%). Zero-inflated negative binomial regression models revealed a higher baseline hookworm infection if yards had eggs or larvae, more vegetation or garbage, and if the child played with soil. Baseline Ascaris was associated with dirt floor, dogs, exposed soil in yard, open defecation and with less time playing outdoors, whereas Ascaris re-infection was associated with water storage, vegetation cover and garbage near the home and not playing with animals. Our results show complex interactions between infection, the yard environment and child behaviours, and indicate that transmission would be reduced if latrines were closer to the home, and if open defecation and water spillage were reduced.


Asunto(s)
Ancylostomatoidea/aislamiento & purificación , Ascariasis/transmisión , Ascaris/aislamiento & purificación , Infecciones por Uncinaria/transmisión , Animales , Ascariasis/epidemiología , Ascariasis/parasitología , Niño , Preescolar , Perros , Ambiente , Heces/parasitología , Femenino , Infecciones por Uncinaria/parasitología , Humanos , Higiene , Larva , Masculino , Panamá/epidemiología , Prevalencia , Población Rural , Suelo/parasitología
18.
Public Health Nutr ; 18(10): 1737-45, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26017476

RESUMEN

OBJECTIVE: Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49.8%), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1.5 months of life among Guatemalan infants. DESIGN: As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <-2 using WHO growth standards. SETTING: Eight rural, indigenous Mam-Mayan villages (n 200, 100% of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27% of Mayan indigenous origin), Guatemala. SUBJECTS: Three hundred and six newborns with a median age of 19 d. RESULTS: The median rural HAZ was -1.56 and prevalence of stunting was 38%; the respective urban values were -1.41 and 25%. Linear regression revealed no relationship between infant age and HAZ (r = 0.101, r(2) = 0.010, P = 0.077). Maternal height explained 3% of the variability in HAZ (r = 0.171, r(2) = 0.029, P = 0.003). CONCLUSIONS: Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.


Asunto(s)
Estatura/etnología , Desarrollo Fetal , Retardo del Crecimiento Fetal/epidemiología , Trastornos del Crecimiento/epidemiología , Indios Centroamericanos , Desnutrición/epidemiología , Fenómenos Fisiologicos Nutricionales Maternos , Estudios Transversales , Femenino , Retardo del Crecimiento Fetal/etnología , Crecimiento , Trastornos del Crecimiento/etnología , Guatemala/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Desnutrición/etnología , Madres , Prevalencia , Población Rural , Factores Socioeconómicos , Población Urbana
19.
Am J Trop Med Hyg ; 92(6): 1100-10, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25825387

RESUMEN

Interrelationships among bacteria, protozoa, helminths, and ectoparasites were explored in a cross-sectional survey of 213 pregnant and 99 lactating indigenous women. Prevalences in pregnancy and lactation, respectively, were: vaginitis (89.2%; 46.8%), vaginal trichomoniasis (75.3%; 91.1%), bacterial vaginosis (BV; 60.6%; 63.3%), hookworm (56.6%; 47.8%), asymptomatic bacteriuria/urinary tract infection (AB/UTI; 56.2%; 36.2%), cervicitis (33.3%; 6.3%), vaginal yeast (24.9%; 11.4%), Ascaris (32.5%; 17.4%), vaginal diplococci (20.4%; 31.6%), caries (19.7%; 18.2%), scabies (17.4%; 8.1%), and Trichuris (12.5%; 8.7%). Multiple regressions revealed positive associations during pregnancy (trichomoniasis and AB/UTI; diplococci and Ascaris) and lactation (yeast and scabies). Negative associations were detected in pregnancy (BV and trichomoniasis; hookworm and diplococci) and lactation (BV and yeast). Vaginal Lactobacillus reduced odds of diplococci in pregnancy and lactation, but increased Ascaris eggs per gram (epg) and odds of trichomoniasis in pregnancy and yeast in lactation. These associations raised a concern that treatment of one condition may increase the risk of another.


Asunto(s)
Enfermedades Urogenitales Femeninas/epidemiología , Indios Centroamericanos/estadística & datos numéricos , Parasitosis Intestinales/epidemiología , Enfermedades Intestinales/epidemiología , Enfermedades de la Boca/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Enfermedades Cutáneas Infecciosas/epidemiología , Adolescente , Adulto , Estudios Transversales , Heces/parasitología , Femenino , Humanos , Enfermedades Intestinales/complicaciones , Parasitosis Intestinales/complicaciones , Lactancia , Enfermedades de la Boca/complicaciones , Enfermedades de la Boca/microbiología , Panamá/epidemiología , Embarazo , Complicaciones Parasitarias del Embarazo/epidemiología , Prevalencia , Enfermedades Cutáneas Infecciosas/complicaciones , Frotis Vaginal , Adulto Joven
20.
J Hum Lact ; 31(1): 172-84, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25583316

RESUMEN

BACKGROUND: Among indigenous Mam-Mayan women, breastfeeding practices may be intertwined with cultural influences during the early postpartum period. OBJECTIVES: Our study explored whether beliefs regarding transmission of emotions through breast milk, the feeding of agüitas or temascal (traditional sauna) use were associated with achievement of the World Health Organization infant feeding recommendations and if these cultural practices served as moderators of the relationship between optimal breastfeeding practices and infant anthropometry. METHODS: We recruited 190 mother-infant dyads at infant age < 46 days. Data on breastfeeding and cultural practices were collected via questionnaire. Infant length, weight, and head circumference were measured and z scores were calculated. Multiple linear and logistic regression analyses were used to examine determinants of initiation of breastfeeding within 1 hour, breastfeeding frequency, breastfeeding exclusivity, and infant weight-for-age z score (WAZ). RESULTS: Mothers who delivered at the traditional midwife's house (odds ratio [OR] = 2.5) and those who did not believe in the transmission of susto (fright) through breast milk (OR = 2.4) were more likely to initiate breastfeeding within 1 hour postpartum. Higher breastfeeding frequency was observed among mothers who spent more time in the temascal. Initiating early breastfeeding within 1 hour postpartum was the sole infant feeding practice positively associated with exclusive breastfeeding and WAZ. CONCLUSIONS: Our investigation in the Western Highlands of Guatemala has highlighted the link between cultural practices and beliefs during lactation, breastfeeding practices and infant growth. Public health practitioners need to understand how local cultural practices influence early initiation of breastfeeding to promote adequate infant weight.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Características Culturales , Adolescente , Adulto , Lactancia Materna/etnología , Estudios Transversales , Femenino , Guatemala , Servicios de Salud del Indígena , Humanos , Indios Sudamericanos , Recién Nacido , Servicios de Salud Materno-Infantil , Grupos de Población , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...