Intestinal Parasites, Anemia and Nutritional Status in Young Children from Transitioning Western Amazon.

Young children are particularly vulnerable to the chronic sequelae of anemia, including poor nutritional status. The aim of this study was to assess intestinal parasitic-infections and nutritional status (anemia and linear growth) in preschool children living in contemporary Amazonian communities. A cross-sectional study measured children's intestinal parasites and hair-Hg (HHg)-biomarkers of fish consumption, hemoglobin levels, and growth (anthropometric Z-scores). Children came from traditional-living families (Itapuã), and tin-mining settlements (Bom Futuro) representing current transitioning populations. It covered 937 pre-school children (from 1 to 59 months of age) from traditional (247) and immigrant tin-mining families (688). There was a high prevalence of intestinal polyparasitic-infection in children from both communities, but mild anemia (hemoglobin concentrations) and moderate (chronic) malnutrition were more frequent in children from traditional families than in children from tin-mining settlers. Children from traditional families ate significantly more fish (HHg mean of 4.3 µg/g) than children from tin-mining families (HHg mean of 2.3 µg/g). Among traditional villagers, children showed a significant correlation (r = 0.2318; p = 0.0005) between hemoglobin concentrations and HHg concentrations. High rates of parasitic infection underlie the poverty and attendant health issues of young children in the Brazilian Amazon. The intestinal parasite burden affecting poor Amazonian children resulting from unsafe water, lack of sanitation and poor hygiene is the most urgent environmental health issue.

Data relating to maternal fish consumption, methylmercury exposure, and early child neurodevelopment in the traditional living of Western Amazonians.

This data paper includes information of a cohort organized to study the health, nutrition, and development of Amazonian children [1]. Child development were evaluated by trained nurses and psychologists with the Bayley Scales of Infant Development (at 24 months), the Stanford-Binet Intelligence Scale (at 60 months) and also with questionnaires administered by trained interviewers to the mothers. Maternal food questionnaires were used to estimate fish consumption and the associations between levels of prenatal and postnatal hair mercury (from mothers and children) and scores of neurodevelopment.

Distribution and availability of mercury and methylmercury in different waters from the Rio Madeira Basin, Amazon.

Waters from the Amazon Basin have distinct physicochemical characteristics that can be optically classified as "black", "clear" and "white". We studied the distribution of total-Hg (THg) and methyl-Hg (MeHg) in these waters and respective suspended solids, sediment, phytoplankton, zooplankton, and benthic macroinvertebrates (BM) in the Madeira River Basin. Compared with the other types of water, the more acidic "black" kind had the highest THg and MeHg concentrations. The trend (black > clear > white) occurred for the concentrations of THg and MeHg in sediments and in the biotic compartment (plankton, macroinvertebrates). Organic Hg accounted for a small percentage (0.6-0.4%) of the THg in sediments but was highest in water (17-15%). For plankton and BM, the biota sediment accumulation factor (BSAFs) of MeHg (53-125) were greater than those of THg (4.5-15); however, the BSAF trend according to water type (black > clear > white) was only significant for MeHg. Sediment THg is correlated with all forms of Hg in biotic and abiotic matrices. The results indicate that water acidity in the Amazon is an important chemical characteristic in assessing Hg contamination of sediments and bioaccumulation in the aquatic food web. The differences in the BSAFs between THg and MeHg support the use of this factor for evaluating the bioaccumulation potential of sediment-bound Hg. The results add information critical to assessing environmental and health risks related to Hg methylation and potential fish-MeHg contamination, especially in tropical aquatic environments.

Impact of organic mercury exposure and home delivery on neurodevelopment of Amazonian children.

In the transitioning Amazon, we addressed birth environment (home vs hospital) and associated perinatal organic-Hg exposures: methylmercury (MeHg) from maternal fish consumption and ethylmercury (EtHg) from pediatric Thimerosal-containing vaccines (TCVs) taken systematically during hospital delivery. We studied 365 children in relation to linear growth at 60 months and neurodevelopment (milestone achievements, Bayley Scale of Infant Development/BSID at 24 months, and Stanford-Binet intelligence tests at 60 months). Mothers delivered in hospitals vs those gave birth at home had significantly (p<0.0001) lower hair-Hg (HHg) concentrations (12.2 vs 23.9µg/g respectively) and shorter length of breastfeeding (8.5 vs 9.7 months respectively). Home-born children had significantly (p<0.0001) higher HHg (7.1µg/g) than hospital-born children (4.6µg/g). Hospital-born children also had significantly earlier (p<0.0001) hepatitis B vaccine than home-born children (1.5 vs 24.1days respectively) and higher (p<0.0001) exposures to total TCV-EtHg (75.8 vs 49.3µg respectively). Neither anthropometric indices nor neurodevelopment (except for fluid reasoning) were directly affected by birth environment. The percentage of hospital-born children with BSID (MDI or PDI) scores <80 was not significantly different from those born at home. In spite of the differences in HHg and EtHg levels between hospital-born and home-born children, no impact on neurodevelopment was observed.

Traditional living in the Amazon: Extended breastfeeding, fish consumption, mercury exposure and neurodevelopment.

BACKGROUND: Features of traditional living in the Amazon Basin (high fish consumption and long breastfeeding) are likely to expose children to Mercury (Hg). AIM: To study neurodevelopment in 690 children in relation to prolonged breastfeeding and mercury exposure. SUBJECTS AND METHODS: Three groups of breastfeeding children were formed: Group 1 (breastfed for 6 months), Group 2 (7-12 months) and Group 3 (extending up to 24 months). Neurodevelopment was assessed as age of walking, age of talking and the Bayley Scales of Infant Development-BSID. Mercury exposure was assessed from Thimerosal-containing vaccines and fish consumption from hair Hg (HHg). RESULTS AND CONCLUSIONS: HHg increased in children and decreased in mothers at 24 months. Frequency of fish consumption was significantly correlated with maternal HHg at birth (Spearman's r = 0.8583; p = 0.0001); likewise, there was a significant correlation between duration of breastfeeding and children's HHg (Spearman's r = 0.15; p = 0.0018). Extended breastfeeding did not influence the Mental Development Index-MDI or Psychomotor Development Index-PDI, but maternal education and HHg (marker of fish consumption) interacted positively and significantly with both. Frequency of maternal fish consumption and education had a positive association with BSID scores; it is speculated that maternal education and nutrients in fish have an opposing effect on Hg exposure.

Neurodevelopment of Amazonian children exposed to ethylmercury (from Thimerosal in vaccines) and methylmercury (from fish).

Few studies have addressed co-occurring methylmercury (MeHg) from maternal origin and ethylmercury (EtHg) from Thimerosal-containing vaccines (TCVs) during infant's neurodevelopment. We studied children (n=1139) from the Western Amazon based on combined (low, intermediate, and high) exposure to chronic MeHg from fish consumption and acute TCV- EtHg. Neurodevelopment outcomes were age of walking and age of talking, and the Bayley Scale of Infant Development (BSID). The Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) were measured at six and 24 months of age. Median hair-Hg (HHg) at birth was 6.4µgg(-1) in mothers, and 1.94µgg(-1) in newborns; total (pregnancy and infancy) EtHg exposure ranged from 0 to 187.5µg. The combined (MeHg+EtHg) exposure showed significant differences for MDI but not for PDI; however, there was a significant decrease in both MDI and PDI scores at 24 months. The increase in BSID delays (scores <80) between six and 24 months was not discernible with regards to EtHg or MeHg exposure. We found a statistically significant increase in neurodevelopmental (BSID) delays related to the combined exposure to Hg (MeHg>EtHg). Neurodevelopment delays due to low-doses of organic mercury (albeit undiscernible) are not predictable but can be avoided by choosing low-Hg fish and providing Thimerosal-free vaccines.

Neurodevelopment outcomes in children exposed to organic mercury from multiple sources in a tin-ore mine environment in Brazil.

Methylmercury (from fresh-water fish) and ethylmercury [from thimerosal-containing vaccines (TCVs)] are the most prevalent source of neurotoxic exposure during early life in families consuming fish and using these vaccines. But children living in Amazonian mining environments are exposed to additional toxic metals in waste materials. We studied mercury (Hg) exposure and neurodevelopment in 294 children (105 boys and 189 girls) from Bom Futuro (Rondonia, Brazil), the epicenter of a tin-ore open-pit mine. Hair-Hg (HHg) concentrations and total ethylmercury (from TCVs) were taken from infants and respective mothers during pregnancy. We used bivariate analysis to determine the effect of sex and linear mixed models to assess the association of prenatal and postnatal organic Hg exposures with children's Bayley Scales of Infant Development (BSID) as psychomotor developmental index and mental developmental index (MDI) at 6 and 24 months of age as well as milestones achievements (age of walking and age of talking). Significant differences between boys and girls were observed for both MDI score (p = 0.0073) and MDI score (p = 0.0288) at 6 months but not at 24 months. Regression analysis showed that only in boys was there a significant interaction between MDI score with family income (ß = 0.288, p = 0.018) and with birth weight (ß = -0.216, p = 0.036) at 6 months; at 24 months, however, only boys showed a significant association of both MDI score (ß = -0.222, p = 0.045) and MDI score (ß = -0.222, p = 0.045) with neonatal HHg. In boys, age of walking was associated with HHg (ß = 0.188, p = 0.019) and breastfeeding (ß = -0.282, p = 0.000), whereas for girls, age of walking was only associated with breastfeeding (ß = -0.275, p = 0.001). In this mining environment, with only a weak association for prenatal Hg exposure, there was a significant sex difference in neurodevelopment, with boys showing more sensitivity related to BSID delays.

Perinatal multiple exposure to neurotoxic (lead, methylmercury, ethylmercury, and aluminum) substances and neurodevelopment at six and 24 months of age.

We studied neurodevelopment in infants from two communities. Children living in the vicinity of tin-ore kilns and smelters - TOKS; n = 51) were compared to children from a fishing village (Itapuã; n = 45). Mean hair-Hg (HHg) concentrations were significantly higher in Itapuã children which received significantly (p = 0.0000001) less mean ethylmercury (88.6 µg) from Thimerosal-containing vaccines (TCV) than the TOKS children (120 µg). Breast-milk Pb concentrations were significantly higher in the TOKS mothers (p = 0.000017; 10.04 vs. 3.9 µg L(-1)). Bayley mental development index (MDI) and psychomotor development index (PDI) were statistically significant (respectively p < 0.0000001, p = 0.000007) lower for the TOKS children only at 24 months of age. Multivariate regression analysis showed that MDI was negatively affected by breast-milk Pb and by HHg. PDI was positively affected by breastfeeding and negatively affected by ethylmercury. Milestone achievements were negatively affected by breast-milk Pb (age of walking) and by HHg (age of talking).

Mercury transfer during pregnancy and breastfeeding: hair mercury concentrations as biomarker.

UNLABELLED: Hair mercury (HHg) concentration is a biomarker of exposure that is widely used to assess environmental contamination by fish methylmercury and neurodevelopment in children. In the Rio Madeira basin (Brazilian Amazon), total HHg concentrations in 649 mother-infant pairs were measured at birth (prenatal exposure) and after 6 months of exclusive breastfeeding; these mother-infant pairs were from high fish-eating communities (urban, n = 232; rural, n = 35; and Riverine, n = 262) and low fish-eating tin-miner settlers (n = 120). Differences in kinetics were seen between Hg exposure from fish consumption and environmental exposure to a tin-ore mining environment. Overall maternal HHg concentrations (at childbirth and after 6 months of lactation) were higher than those of infant HHg. However, the relative change in HHg after 6 months of lactation showed that mothers decreased HHg while infants increased HHg. The relative change showed a consistently higher increase for girls than boys with a statistical significance only in high fish-eating mothers. The correlation coefficients between maternal and newborn hair were high and statistically significant for mothers living in urban (r = 0.66, p < 0.001), rural (r = 0.89, p < 0.001), and Riverine (r = 0.89, p < 0.001) communities not for tin miner settlers (r = 0.07, p = 0.427). After 6 months of exclusive breastfeeding, correlation coefficients showed high correlation coefficients and statistical significance for all groups (urban, r = 0.73, p < 0.001; rural, r = 0.88, p < 0.001; Riverine, r = 0.91, p < 0.001) except for Tin miners (r = -0.07, p = 0.428). A linear model analysis was used to assess the longitudinal associations of maternal total HHg and total HHg at birth (0 days) and 6 months of age in exclusively breastfed infants. Regression analysis significantly predicted HHg in newborn from maternal HHg for high fish-eating maternal-infant pairs. CONCLUSION: The concentration of mercury accumulated in newborn tissues (in utero and during breastfeeding) relevant to both, maternal sources and infant exposure, can be reliably assessed from maternal hair.

Fish consumption during pregnancy, mercury transfer, and birth weight along the Madeira River Basin in Amazonia.

UNLABELLED: Birth weight can be a predictor of maternal health issues related to nutrition and environmental contaminants. Total hair mercury (HHg) concentration was studied as an indicator of both fish consumption and methylmercury exposure in mothers (and newborns) living in selected low income areas of the Madeira River basin, Amazonia, Brazil. This cohort study (n = 1,433) consisted of traditional riverines (n = 396), riverines who had moved to urban (n = 676) and rural (n = 67) settings, and tin miner settlers (n = 294). Median maternal HHg was significantly different (p = 0.00001) between riverine (12.1 µg·g-1), rural (7.82 µg·g-1), urban (5.4 µg·g-1), and tin miner (4.5 µg·g-1) groups studied. The same trend (of medians) was observed for newborns' HHg which also showed significant differences between riverine (3.0 µg·g-1), rural (2.0 µg·g-1), urban (1.5 µg·g-1), and tin miner (0.8 µg·g-1) groups. The correlation between maternal and newborn HHg was statistically significant in the riverine (r = 0.8952; p = 0.0001), urban (r = 0.6744; p = 0.0001), and rural (r = 0.8416; p = 0.0001) groups but not in the mother-infant pairs in the tin miner group (r = 0.0638; p = 0.2752). Birth weight was significantly different among groups but did not show a pattern consistent with that of fish consumption (and HHg). A multiple regression analysis showed that only family income and gestational age had a significant impact on birth weight. CONCLUSIONS: Maternal HHg is an important biomarker of maternal fish consumption and of methylmercury exposure during pregnancy. However, in these Amazonian groups, only maternal education and gestational age seemed to affect birth weight positively.

Fish consumption by traditional subsistence villagers of the Rio Madeira (Amazon): impact on hair mercury.

BACKGROUND: Subsistence ribeirinhos of the Amazon Basin depend on fish for their principal source of protein, but fish availability changes with seasonal high and low waters. AIM: To assess taxa and quantity of fish consumed and estimate attendant exposure to methyl-Hg in a traditional subsistence high fish-eating community of the Amazon Basin. SUBJECTS AND METHODS: 120 villagers in 18 households were followed for 6 months (August to February) for weighed portions of fish consumed. RESULTS: Mean daily per capita fish consumption was high (406 g/day) with fish meals ranging from 4 to 14 times/week and an integrated yearly consumption of 148.2 kg/person. Median total-Hg concentrations in fish ranged from 0.011 to 0.409 ppm; six of the more consumed fish species comprised more than 50% of the fish consumed. The villagers mean hair-Hg concentration was high (17.4 +/- 11.5 microg/g), with both inter- and intra-household variation despite similar high fish consumption; only 7% showed hair-Hg concentrations < 5 microg/g, but 75% had hair-Hg levels above 10 microg/g. Maternal hair-Hg was significantly correlated with respective children's hair-Hg (Spearman r = 0.5390; p < 0.0001). The high daily fish intake of these villagers is predominantly of species with much lower Hg concentrations. CONCLUSION: In Amazonian lifestyle of ribeirinho communities traditional fish consumption is high and depends on available species; fish is also the principal via of meHg exposure and attendant hair-Hg concentrations.

Prenatal and postnatal mercury exposure, breastfeeding and neurodevelopment during the first 5 years.

OBJECTIVE: We evaluated the association between infant hair-Hg and Gesell schedules (GS). BACKGROUND: Longitudinal assessment of prenatal and postnatal Hg exposure during the first 60 months. METHODS: We used hair-Hg as a marker of postnatal Hg exposure (inorganic and methyl-Hg from breast milk, and ethyl-Hg from thimerosal) and GS measured at 6, 36, and 60 months. RESULTS: Hair-Hg at 6 months responded to events related to Hg exposure and breastfeeding. However, most neurodevelopment delays observed at 6 months were overcome with infant growth; at 60 months 87% of children showed adequate GS (>85). Length of lactation and hair-Hg were each significantly correlated with GS, but in opposite ways: length of lactation was positive and significantly correlated with all GS at 60 months; hair-Hg concentrations were negative and significantly correlated with GS at 6 months (r=-0.333; P=0.002) and 60 months (r=-0.803; P=0.010), but not at 36 months. Multiple regression models showed that the GS outcome at 60 months depended on GS at 36 months that in turn was influenced by infants' developmental and Hg exposure variables. GS at 6 months was significantly influenced by prenatal (maternal and infant hair-Hg at birth) and postnatal Hg exposure at 6 months. CONCLUSIONS: Until there is more refined approach to recognize children sensitive to Hg exposure, and in situations of uncertainty (EtHg exposure), the neurodevelopment benefit of breastfeeding should be recommended.

Maternal fish consumption in the nutrition transition of the Amazon Basin: growth of exclusively breastfed infants during the first 5 years.

BACKGROUND: Changes in fish-eating habits due to rapid urbanization in Western Amazon was used as model to investigate whether maternal fish-intake rate impacts on children's weight and height during the first 5 years. AIM: The study examined the growth of 82 breastfed children, and maternal fish consumption (hair mercury concentrations, HHg) during pregnancy and lactation. SUBJECTS AND METHODS: Fish consumption in mothers and children was estimated through HHg. The children were measured and weighed at birth and at 6 (exclusive breastfeeding), 36 and 60 months. RESULTS: Fish consumption rate (HHg) had no significant impact on children's growth at the specified ages (p = 0.35). After 6 months of exclusive breastfeeding, children had the highest proportion of Z-scores <-1 SD; however, weaning (with extended breastfeeding) had a substantial impact in moving up the attained growth at 3 years. The duration of breastfeeding was significantly correlated with attained Z-scores for weight-for-age (r = 0.26; p = 0.02) and weight-for-height (r = 0.22; p = 0.04) but not for height-for-age. At 3 years most children had improved Z-scores (>-1 SD) for height-for-age (70/82), weight-for-age (74/82) and weight-for-height (74/82). At 5 years, all but one child attained Z-scores >-1. CONCLUSION: The apparently good nutritional status of subjects is more likely due to a well balanced diet composition than to only one dietary protein source--fish.

Principal component analysis and discrimination of variables associated with pre- and post-natal exposure to mercury.

The variance of variables associated with neurodevelopment at 180 days, pre-natal variables (Hg in placenta, blood and hair) and post-natal Hg exposure (including Thimerosal-containing vaccines, TCV) were examined in 82 exclusively breastfed infants using principal component analysis (PCA). This multivariate method was applied to identify hierarchy and sets of interrelated variables. The PCA yielded a two-factor solution, explaining 92% of variance and summarizing most of the relevant information in the dataset matrix: the first component represented birth weight and vaccine (first doses of Hepatitis B and DTP) variability and explained 57% of variance; the second component represented a gradient of neurodevelopment (Gesell scores) and explained 35% of variance. The third component explained only 3% of the remaining 8% variance. Beside CNS priming by breastfeeding, infant development (birth weight) and time of immunization with TCV should be considered in epidemiological studies. PCA can classify sets of variables related to vaccination and neuromotor development schedules, clearly discriminating between earlier and later TCV exposures of exclusively breastfed infants. In conclusion, the incommensurable concept of the chance of toxic risk caused by TCV-EtHg exposure against the proven benefit of immunization is in no way disputed here. However, infant neurodevelopmental (ND) disorders linked to Thimerosal-Hg stands in need of proof, but PCA points to the possibility of identifying exposure risk variables associated with ND schedules.

Time of perinatal immunization, thimerosal exposure and neurodevelopment at 6 months in breastfed infants.

AIM: Brazilian newborns immunized with hepatitis-B (thimerosal containing vaccine, TCV) receive the first dose within 24 h if delivered in public hospitals, but at a later time if born in private hospitals. We compared neurodevelopment (ND) in infants born in a state hospital (immunized within 24 h) and in privately run hospitals (immunized 2-4 days postnatally). METHODS: We used the Gesell Developmental Schedules in 82 healthy exclusively breastfed infants at 6 months to assess motor skills, language development, comprehension capacity and social skills. RESULTS: Compared to the group immunized 2-4 days after hospital discharge, the group immunized within 24 h showed no significant difference in ND delays. Despite the variation in gestational age (range 36-42 weeks) and TCV-ethylmercury (EtHg) dose (5.7-11.3 microg Hg/kg b.w.) at birth, time of exposure to TCV showed no significant association with ND. Gesell Developmental Score was not significantly correlated with total parenteral EtHg/unit of body mass neither with the relative increase in hair-Hg (as an additional challenge to prenatal Hg exposure). CONCLUSION: In breastfed infants, differences in early exposure to TCV-EtHg cannot portend clinical neurodevelopment delays at 6 months. We speculate that breastfeeding remains a significant strategy to improve central nervous system protection of infants facing early exposure challenges.