Incidence of severe acute malnutrition after treatment: A prospective matched cohort study in Sokoto, Nigeria.

Severe acute malnutrition (SAM) among children in Nigeria is tackled through the outpatient therapeutic programme (OTP) of the Community-based Management of Acute Malnutrition (CMAM) programme. CMAM is evidently effective in resolving SAM, but little evidence exists on the remaining risk of SAM relapse for children discharged as cured from the OTP. We aimed to measure and compare the 6-month incidence of SAM among OTP-cured and community control children and identify factors associated with SAM relapse. We conducted a prospective matched cohort study that tracked 553 OTP-cured and 526 control children in Sokoto State, Northern Nigeria. Outcomes and covariates were measured fortnightly in up to 12 home visits. We used multivariate Cox and accelerated failure time models to identify significant risk correlates, where the covariates to be tested for correlation with relapse were selected using domain knowledge and automatic feature selection methods. SAM incidence rates were 52 times higher in the OTP-cured cohort (0.204/100 child-days) than in the community control cohort (0.004/100 child-days). Children with lower mid-upper arm circumference at OTP admission, with lower height/length-for-age z-scores, whose household head did not work over the full year, who lived in an area previously affected by environmental shocks, who were female and who had diarrhoea before the visit had a significantly higher relapse risk. Our study shows that OTP-cured children remain at a significantly excess risk of SAM. To improve long-term health outcomes of these children, programmes adopting a CMAM approach should strengthen follow-up care and be integrated with other preventive services.

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries.

BACKGROUND: Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified. OBJECTIVES: We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA). METHODS: In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI). RESULTS: Fortified foods made modest contributions to measured iron intakes (0%-13% RNI); potential intakes if standards are met were generally higher (0%-65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%-125% and 88%-253% EAR, respectively); potential intakes were higher (53%-655% and 115%-377% EAR, respectively) and would exceed the tolerable upper intake level among 18%-56% of WRA for vitamin A in Nigeria and 1%-8% of WRA for iodine in Nigeria, Tanzania, and Uganda. CONCLUSIONS: Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.

A genome-wide search for type 2 diabetes susceptibility genes in West Africans: the Africa America Diabetes Mellitus (AADM) Study.

The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a proportionately greater genetic component. Through the Africa America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analysis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was observed in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes susceptibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these results should have considerable relevance to the study of type 2 diabetes in African Americans.

Occupational history and exposure and the risk of adult leukemia in Shanghai.

PURPOSE: Evaluation of the association of selected occupational exposures with leukemia risk. METHODS: Population-based case-control study of 486 leukemia subjects and 502 healthy controls residing in Shanghai from 1987 to 1989. Adjusted odds ratios (OR) were calculated for the association between occupational factors and leukemia risk. RESULTS: Significant increase in leukemia risk was observed in chemical manufacturing industry workers (OR=3.1, 95% CI=1.0-9.8). Increased risks for leukemia were observed from self-reported exposures to benzene (OR=1.7, 95% CI=1.1-2.6), radioactive materials (OR=3.7, 95% CI=1.3-10.2), synthetic fiber dust (OR=2.0, 95% CI=1.2-3.5), and toluene (OR=1.6, 95% CI=1.0-2.5). Dose-response relations of leukemia risk was observed with the duration of exposure to benzene (OR=3.3, 95% CI=1.6-6.9 for >or=15 years exposure; p for trend<0.01), radioactive materials (OR=5.2, 95% CI=1.1-24.7 for >or=15 years exposure; p for trend=0.02), paints (OR=2.3, 95% CI=1.2-4.7 for >or=15 years exposure; p for trend=0.09), and toluene (OR=2.9, 95% CI=1.3-6.7 for >or=15 years exposure; p for trend=0.02). CONCLUSIONS: Adult leukemia risk may be associated with working in the chemical industry, and exposure to benzene, synthetic fiber dust, radioactive materials, and toluene in the study population.

Is sickling trait associated with an increased risk for multiple myeloma?

In the US, multiple myeloma (MM) rates have been disproportionately higher in states with high proportions of African Americans. Understanding this disparity may assist in developing new control/prevention strategies for MM. Most of the known associated risk factors for MM are occupational and/or environmental. A possible chromosomal link between sickle cell disease and leukemia, a hematologic malignancy like MM, has been described. Interleukin-6 (IL-6) has been reported to be central to the pathogenesis of MM, inducing proliferation and inhibiting apoptosis in neoplastic plasma cells. IL-6 levels are also increased in healthy sickle cell disease patients. This role of IL-6 in the pathophysiology of MM and sickle cell disease makes it pertinent to ask whether persons with abnormal sickling erythrocytes are more at risk of developing MM than persons with no abnormal sickling erythrocytes. Abrogating the IL-6 signaling pathway will be of therapeutic interest for both MM and sickle cell disease.

Challenges unique to the design of a comprehensive questionnaire assessing breast cancer risk factors among women in sub-Saharan Africa.

We assessed the efficacy of a pilot questionnaire designed to elicit information about external risk factors for breast cancer in sub-Saharan African women. Preliminary analysis identified areas of the questionnaire and interviewing process that required modification, as well as socioeconomic factors that contribute to reduced participation among these understudied populations.

Genetic polymorphisms in uridine diphospho-glucuronosyltransferase 1A1 (UGT1A1) and risk of breast cancer.

Uridine diphospho-glucuronosyltransferase 1A1 (UGT1A1) is involved in catalyzing estrogen, the hormone that plays a central role in the etiology of breast cancer. A common polymorphism [A(TA)6TAA (allele *1) to A(TA)7TAA change (allele *28)] in the TATA-box of the promoter region of the UGT1A1 gene has been reported to be associated with a reduced transcription of this gene. We investigated the association of this polymorphism with the risk of breast cancer among 1047 breast cancer cases and 1083 community controls in the Shanghai Breast Cancer Study, a population-based case-control study. Approximately same proportion of cases (12.5%) and controls (13.0%) carried the variant allele *28 in the Chinese population (p = 0.32). When stratified by age, carrying the *28 allele was associated with an increased risk of breast cancer among women aged less than 40 years (odds ratio [OR] = 1.7; 95% CI = 1.0-2.7) but not among women 40 years old and over (OR = 0.8; 0.7-1.1). Only a few women were homozygous for the *28 allele, precluding a detailed gene-dose association analysis. Additional analyses showed that, the elevated risk associated with the UGT1A1 *28 allele among young women was primarily seen in women who had a later menarche, short menstrual years, absence of family history of breast cancer, low waist-to-hip ratio, or low body-mass index. These results suggested that the *28 allele in the UGT1A1 gene may be associated with an increased risk for breast cancer among Chinese women under age 40. No significant associations were observed with *28 allele and breast cancer risk by estrogen receptor/progesterone receptor status.

Agreement of job-exposure matrix (JEM) assessed exposure and self-reported exposure among adult leukemia patients and controls in Shanghai.

BACKGROUND: Estimating a person's history of occupational exposure in case-control studies is difficult. METHODS: Percent agreement between selected self-reported occupational exposures and job-exposure matrix (JEM) exposure assessment for all participants and various subgroups of a population-based case-control interview study of 486 leukemia subjects and 502 healthy controls in Shanghai was evaluated. RESULTS: With JEM as the "gold standard," the sensitivities for self-reported exposures ranged from 0.75 to 0.98. However, that for pesticide exposure was 0.44 in subjects >51 years old. Self-reported exposures specificities ranged from 0.87 to 0.99. Agreement between self-reported exposures and JEM assessment was good (kappa coefficients [kappa]: 0.48-0.84). Variations in agreement for benzene exposure between males and females as well as between the direct interview and surrogate interview subgroups were observed. CONCLUSIONS: The levels of agreement between self-report and JEM in this study suggest that self-reported exposures are a suitable method for assessing occupational exposures in this population.