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A cluster-randomized trial of water, sanitation, handwashing and nutritional interventions on stress and epigenetic programming.
Lin, Audrie; Mertens, Andrew N; Rahman, Md Ziaur; Tan, Sophia T; Il'yasova, Dora; Spasojevic, Ivan; Ali, Shahjahan; Stewart, Christine P; Fernald, Lia C H; Kim, Lisa; Yan, Liying; Meyer, Ann; Karim, Md Rabiul; Shahriar, Sunny; Shuman, Gabrielle; Arnold, Benjamin F; Hubbard, Alan E; Famida, Syeda L; Akther, Salma; Hossen, Md Saheen; Mutsuddi, Palash; Shoab, Abul K; Shalev, Idan; Rahman, Mahbubur; Unicomb, Leanne; Heaney, Christopher D; Kariger, Patricia; Colford, John M; Luby, Stephen P; Granger, Douglas A.
Affiliation
  • Lin A; Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA. audrielin@ucsc.edu.
  • Mertens AN; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Rahman MZ; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Tan ST; Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
  • Il'yasova D; Department of Medicine, Duke University, Durham, NC, USA.
  • Spasojevic I; Department of Medicine, Duke University, Durham, NC, USA.
  • Ali S; PK/PD Core Laboratory, Duke Cancer Institute, Durham, NC, USA.
  • Stewart CP; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Fernald LCH; Institute for Global Nutrition, University of California Davis, Davis, CA, USA.
  • Kim L; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Yan L; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Meyer A; EpigenDx Inc., Hopkinton, MA, USA.
  • Karim MR; EpigenDx Inc., Hopkinton, MA, USA.
  • Shahriar S; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Shuman G; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Arnold BF; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Hubbard AE; Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
  • Famida SL; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Akther S; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Hossen MS; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Mutsuddi P; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Shoab AK; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Shalev I; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Rahman M; Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA.
  • Unicomb L; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Heaney CD; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
  • Kariger P; Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA.
  • Colford JM; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Luby SP; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
  • Granger DA; Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
Nat Commun ; 15(1): 3572, 2024 Apr 26.
Article in En | MEDLINE | ID: mdl-38670986
ABSTRACT
A regulated stress response is essential for healthy child growth and development trajectories. We conducted a cluster-randomized trial in rural Bangladesh (funded by the Bill & Melinda Gates Foundation, ClinicalTrials.gov NCT01590095) to assess the effects of an integrated nutritional, water, sanitation, and handwashing intervention on child health. We previously reported on the primary outcomes of the trial, linear growth and caregiver-reported diarrhea. Here, we assessed additional prespecified

outcomes:

physiological stress response, oxidative stress, and DNA methylation (N = 759, ages 1-2 years). Eight neighboring pregnant women were grouped into a study cluster. Eight geographically adjacent clusters were block-randomized into the control or the combined nutrition, water, sanitation, and handwashing (N + WSH) intervention group (receiving nutritional counseling and lipid-based nutrient supplements, chlorinated drinking water, upgraded sanitation, and handwashing with soap). Participants and data collectors were not masked, but analyses were masked. There were 358 children (68 clusters) in the control group and 401 children (63 clusters) in the intervention group. We measured four F2-isoprostanes isomers (iPF(2α)-III; 2,3-dinor-iPF(2α)-III; iPF(2α)-VI; 8,12-iso-iPF(2α)-VI), salivary alpha-amylase and cortisol, and methylation of the glucocorticoid receptor (NR3C1) exon 1F promoter including the NGFI-A binding site. Compared with control, the N + WSH group had lower concentrations of F2-isoprostanes isomers (differences ranging from -0.16 to -0.19 log ng/mg of creatinine, P < 0.01), elevated post-stressor cortisol (0.24 log µg/dl; P < 0.01), higher cortisol residualized gain scores (0.06 µg/dl; P = 0.023), and decreased methylation of the NGFI-A binding site (-0.04; P = 0.037). The N + WSH intervention enhanced adaptive responses of the physiological stress system in early childhood.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sanitation / Hand Disinfection / DNA Methylation / Epigenesis, Genetic Limits: Adult / Child, preschool / Female / Humans / Infant / Male / Pregnancy Country/Region as subject: Asia Language: En Journal: Nat Commun Journal subject: BIOLOGIA / CIENCIA Year: 2024 Document type: Article Affiliation country: United States Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sanitation / Hand Disinfection / DNA Methylation / Epigenesis, Genetic Limits: Adult / Child, preschool / Female / Humans / Infant / Male / Pregnancy Country/Region as subject: Asia Language: En Journal: Nat Commun Journal subject: BIOLOGIA / CIENCIA Year: 2024 Document type: Article Affiliation country: United States Country of publication: United kingdom