[The effect of spiruline during nutritional rehabilitation: systematic review]. / Supplémentation en spiruline dans le cadre de la réhabilitation nutritionnelle: revue systématique.

BACKGROUND: To evaluate the impact of spiruline on nutritional rehabilitation. DATA SOURCES: Systematic search in medical and scientific databases (Medline, Cochrane, Embase) and other specific databases (PhD theses, reports...). METHODS: We selected studies in which spiruline was used as supplementation in malnourished patients, irrespective of the form and dose of spiruline and in controlled trials or not. Two persons made the selection separately. Nutritional status was estimated by anthropometric and biological measures. RESULTS: Thirty-one references were identified and seven studies were retained for this review; three randomized controlled and four non-controlled trials. Spiruline had a positive impact on weight in all studies. In non-controlled trials, the other parameters: arm circumference, height, albumin, prealbumin, protein and hemoglobin improved after spiruline supplementation. For these studies, methodology was the main drawback. None of the studies retained for analysis were double-blinded clinical trials and all involved small samples. Four of them did not have a control group for comparison. CONCLUSION: The impact of spiruline was positive for most of the considered variables. However, the studies taken into account in this review are of poor-methodological quality. A randomized, a large-sized double-blind controlled clinical trial with a longer follow-up should be conducted to improve current knowledge on the potential impact of spiruline on nutritional rehabilitation.

Quinine disposition in globally malnourished children with cerebral malaria.

BACKGROUND: Both malnutrition and malaria affect drug disposition and are frequent among children in the tropics. We assessed their respective influence on quinine distribution. METHODS: Forty children were divided into 4 groups: children with normal nutritional status without (group 1) or with (group 2) cerebral malaria, and malnourished children without (group 3) or with (group 4) cerebral malaria. All children received an infusion of 8 mg/kg of a combination solution of cinchona alkaloids that contained 96.1% quinine, 2.5% quinidine, 0.68% cinchonine, and 0.67% cinchonidine (corresponding to 4.7 mg/kg quinine base). The children with malaria then received repeated infusions every 8 hours for 3 days. Pharmacokinetic profiles of plasma and erythrocyte quinine were determined during the first 8 hours, together with quinine protein binding. Additional measurements of plasma quinine concentrations were used to simulate quinine concentrations profiles in children with malaria with and without malnutrition. Clinical recovery and parasitemia clearance times were determined in the children with malaria. RESULTS: Compared with control children, malaria and malnutrition increased plasma concentrations of quinine and reduced both the volume of distribution and the total plasma clearance. Simultaneously, alglycoprotein plasma concentrations and protein-bound fraction of the drug were increased. Erythrocyte quinine concentrations correlated strongly with free plasma quinine but not with the extent of parasitemia. Similar effective and nontoxic quinine concentration profiles were obtained in malaria with and without malnutrition. CONCLUSIONS: Severe global malnutrition and cerebral malaria have a similar effect on quinine pharmacokinetics in children. Moderate malnutrition does not potentiate cerebral malaria-mediated modifications of quinine disposition. These results suggest that current parenteral quinine regimens can be used, unmodified, to treat children with both malaria and malnutrition.

Effect of iron supplementation on the iron status of pregnant women: consequences for newborns.

We studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants. The subjects were 197 pregnant women selected at 28 wk +/- 21 d of gestation at a mother-and-child health center in Niamey, Niger. Ninety-nine women received 100 mg elemental Fe/d throughout the remainder of their pregnancies and 98 received placebo. The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group. Three months after delivery, the prevalence of anemia was significantly higher in the placebo group. At delivery, there were no differences between the two groups in cord blood iron variables. Three months after delivery, serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group. Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group.

Consequences of Schistosoma haematobium infection on the iron status of schoolchildren in Niger.

The relationship between iron status and degree of infection by Schistosoma haematobium was studied in 174 schoolchildren from Niger in an area endemic for urinary schistosomiasis. Iron deficiency was defined by a combination of three reliable indicators: a low serum ferritin level combined with a low transferrin saturation, a high erythrocyte protoporphyrin level, or both. Hematuria and proteinuria were found in 76.4% and 79.9% of the children, respectively, while 95.4% excreted eggs (geometric mean egg count of 31.5 eggs per 10 ml of urine). Anemia was observed in 59.7% of the subjects. The prevalence of iron deficiency was 47.1%. Anemia was associated with iron deficiency in 57.7% of the cases. The hemoglobin level and transferrin saturation decreased significantly when the degree of hematuria increased, while prevalence of anemia and prevalence of iron deficiency increased significantly. The hemoglobin level and the hematocrit were negatively correlated with egg count, while prevalence of anemia increased with increasing egg count. This inverse relationship between degree of infection by S. haematobium and iron status shows a deleterious consequence of urinary schistosomiasis on nutrition and hematopoietic status, which should be considered in the design of nutrition intervention programs.

PIP: The relationship between iron status and degree of infection by Schistosoma haematobium was examined in 174 schoolchildren from Niger in an area endemic for urinary schistosomiasis. Iron deficiency was defined by a combination of 3 reliable indicators: a low serum ferritin level combined with a low transferrin saturation, a high erythrocyte protoporphyrin level, or both. Hematuria and proteinuria were seen in 76.4% and 79.9% of the children, respectively, while 95.4% excreted eggs (geometric mean egg count of 31.5 eggs/10 ml of urine). Anemia was seen in 59.7% of the subjects. The prevalence of iron deficiency was 47.1%. Anemia was associated with iron deficiency in 57.7% of the cases. Hemoglobin level and transferrin saturation decreased significantly when the degree of hematuria increased, while prevalence of anemia and iron deficiency increased significantly. The hemoglobin level and hematocrit were negatively correlated with egg count, while anemia prevalence increased with increasing egg count. This inverse relationship between degree of infection by s. haematobium and iron status shows a deleterious consequence of urinary schistosomiasis on nutrition and hematopoietic status, which should be considered in the design of nutrition intervention programs.

Iron status in Nigerian mothers and their newborns.

An evaluation of iron status was carried out on 364 Nigerian pregnant women from Niamey at delivery and in cord blood from their newborns. Anemia, defined as a low hematocrit value, was observed in 46% of pregnant women. Iron deficiency, recognized by a combination of, at least, 2 abnormal values in the 3 independent indicators measured (serum ferritin level, erythrocyte protoporphyrin concentration and transferrin saturation) was present in 47.8% of pregnant women. Anemia was associated with iron deficiency in 60.1% of cases in anemic mothers. A correlation between maternal and newborn iron indicators was found. This study points out the necessity for developing strategies in Sahelian countries to combat iron deficiency during pregnancy by specific measures in combination with more general interventions.

[Study of two goitrous endemic areas in Niger: Belley-Koira and Tiguey-Tallawal]. / Etude de deux foyers d'endémie goitreuse au Niger: Belley-Koira et Tiguey-Tallawal.

The present work reports the clinical and laboratory findings in two endemic areas in Niger: Tiguey-Tallawal and Belley-Koira. The goitrous subjects (n = 293), mainly children and adolescents, have clinical evidence of euthyroidism but with biological criteria of hypothyroidism in 25% of cases as shown by the decrease of the total serum T4 and the increase of serum TSH. Iodine deficiency intake evaluated by the determination of urinary iodine in single urine specimens is the permissive and main factor for goiter endemicity = 14 +/- 7 micrograms/l in Belley-Koira (n = 99), 26 +/- 23 micrograms/l in Tiguey (n = 155) and 25 +/- 19 micrograms/l in Tallawal (n = 95). The single intramuscular injection of iodized oil (240 mg of iodine) constitutes an extremely effective way of correcting iodine deficiency: decrease of volume or disappearance of goiter among 291 subjects out of 362 i.e. 80%, twelve months after the injection. The diffuse goiter, more numerous (n = 270) than nodular goiter (n = 92) are corrected with more efficiency (85% versus 50%). We also noted that non goitrous subjects living in these two endemic areas show a severe iodine deficiency (urinary iodine: 33 +/- 18 mu/l; n = 70 = 76) while those living in non endemic areas present a moderate or a low iodine deficiency, respectively in Niamey (urinary iodine: 48 +/- 36 micrograms/l; n = 200) and in Tamou (urinary iodine: 80 +/- 29 micrograms/l; n = 69). Severe, moderate and low iodine deficiency seem to be correlated with nutritional habits: mil in endemic areas, mil and meat in Niamey and mil, meat, milk and fish in Tamou. The nutriments eaten in Niger have a low iodine level except ewe milk: salt (270 to 7100 micrograms/kg), woman milk (40 +/- 21 micrograms/l) cow milk (22 micrograms/l) goat milk (50 micrograms/l), ewe milk (294 micrograms/l). Salt consumption, evaluated by the determination of urinary chloride, is adequate. Prophylaxis by iodinated salt should be well accepted. No other factors than iodine deficiency in the etiology of endemic goiter, mainly nutritional (goitrogens or protein-calorie malnutrition) can be evoked to explain clinical and biochemical discrepancies between subjects living in the same morbid territory.