A double-blind, randomized clinical trial was conducted to determine the effects of prevention of zinc deficiency on cognitive and sensorimotor development during infancy. At 6 mo of age, infants ...were randomly assigned to be administered a daily liquid supplement containing 10 mg/d of zinc (zinc sulfate), 10 mg/d of iron (ferrous sulfate), and 0.5 mg/d of copper (copper oxide), or an identical daily liquid supplement containing only 10 mg/d of iron and 0.5 mg/d of copper. Various controls were implemented to ensure adherence to the supplement protocol. A battery of developmental assessments was administered from 6 to 18 mo of age that included a visual habituation/recognition memory task augmented with heart rate at 6, 9, and 12 mo of age; the Bayley Scales of Infant Development, 2nd edition (BSID2) at 6, 12, and 18 mo; the A-not-B error task at 9 and 12 mo; and free-play attention tasks at 12 and 18 mo. Only infants supplemented with zinc had the normative decline in look duration from 6 to 12 mo during habituation and a normative decline in shifting between objects on free-play multiple-object attention tasks from 12 to 18 mo of age. The 2 groups did not differ on any of the psychophysiologic indices, the BSID2, or the A-not-B error task. The findings are consistent with zinc supplementation supporting a profile of normative information processing and active attentional profiles during the first 2 y of life. This trial was registered at clinicaltrials.gov as NCT00589264.
Objective. To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno. Materials and methods. ...Cross-sectional study in children aged 6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation. Results. The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt). Conclusions. Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.
Objetivos. Objetivos. Caracterizar el estado del hierro y proponer factores de ajuste de hemoglobina por altitud, en niños de 6 a 8 meses de Lima, Arequipa, Cusco y Puno. Materiales y métodos. Estudio transversal en niños de 6 a 8 meses de edad en cuatro ciudades, se midió hemoglobina y otros biomarcadores de hierro, Proteína C reactiva (PCR), entre otros. Para estimar la ecuación de ajuste, se aplicó una regresión exponencial y excluimos a los niños con deficiencia de hierro (DH) y/o inflamación. Resultados. Las proporciones de DH fueron mayores en Puno y Arequipa, mientras que la inflamación no superó el 19% en ninguna de las ciudades. La hemoglobina mostró un incremento exponencial a mayor altitud. La ecuación de ajuste fue: 10,34249 x (1,00007 ^ Alt). Conclusiones. Los niños residentes en Arequipa y Puno mostraron mayores proporciones de DH y menores reservas de hierro; además el aumento de la hemoglobina por altitud fue exponencial evidenciando la necesidad de ajustar la hemoglobina en altura.
This study builds on a previous study by this group in which 6-11-month-old Peruvian infants who were fed bovine milk fat globule membrane (MFGM) containing complementary food had significantly fewer ...episodes of infection-related bloody diarrhea relative to those consuming a control food (skim milk powder). Micronutrient deficiencies including zinc deficiency were prevalent in this study population. To understand the mechanism behind the health benefits of consuming MFGM, the serum metabolome and cytokine levels, as markers for systemic immune responses, were evaluated using
H nuclear magnetic resonance-based metabolomics and a multiplex system, respectively. Combined with data on micronutrient status and anthropometry, a comparative analysis was performed. Supplementation with MFGM tended to improve micronutrient status, energy metabolism, and growth reflected as increased levels of circulating amino acids and weight gain, particularly in female infants compared to controls. Decreased levels of the microbial choline metabolite trimethylamine-
-oxide in the MFGM-supplemented group (both male and female infants) suggest a functional perturbation in the intestinal microbiota. A cytokine shift toward a less T helper type 1 response was observed in those receiving the MFGM supplement, which was mainly attributed to decreases in interleukin-2 levels. Our findings suggest that consumption of MFGM with complementary food may reverse the metabolic abnormalities found in marginally nourished infants, thereby improving metabolic regulation, which may lead to enhanced immunity.
Tools to assess intake among children in Latin America are limited. We developed and assessed the reproducibility and validity of a semi-quantitative food frequency questionnaire (FFQ) administered ...to children, adolescents, and their caregivers in Lima, Peru. We conducted 24-h diet recalls (DRs) and focus groups to develop a locally-tailored FFQ prototype for children aged 0-14 years. To validate the FFQ, we administered two FFQs and three DRs to children and/or their caregivers (
= 120) over six months. We examined FFQ reproducibility by quartile agreement and Pearson correlation coefficients, and validity by quartile agreement and correlation with DRs. For reproducibility, quartile agreement ranged from 60-77% with correlations highest for vitamins A and C (0.31). Age-adjusted correlations for the mean DR and the second-administered FFQ were highest in the 0-7 age group, in which the majority of caregivers completed the FFQ on behalf of the child (total fat; 0.67) and in the 8-14 age group, in which both the child and caregiver completed the FFQ together (calcium, niacin; 0.54); correlations were <0.10 for most nutrients in the 8-14 age group in which the caregiver completed the FFQ on the child's behalf. The FFQ was reproducible and the first developed and validated to assess various nutrients in children and adolescents in Peru.
Brain growth and development are critically dependent on several micronutrients. During early development cellular activity may be sensitive to micronutrient deficiencies, however the evidence from ...human studies is equivocal. The objective of this study was to examine the long-term cognitive and social-emotional effects of multiple micronutrient supplementation compared with iron supplementation alone, administered during infancy. This study was a follow-up to an initial randomized, double-blind controlled trial (RCT) in 2010 in which 902 infants, aged 6-17 months, from Lima, Peru, were given daily supplements of either iron (Fe) or multiple micronutrients (MMN) including zinc (451 in each group). The supplementation period for both groups was six months. In 2012, a subsample of 184 children from the original cohort (now aged 36-48 months) was randomly selected to participate in a follow-up trial and was assessed for intelligence, working memory, inhibition, and executive function. The tests showed no significant differences between the supplementation groups though there were some gender differences, with girls displaying higher scores than boys across both groups on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) Verbal IQ sentences subtest, the Day-Night cognitive test and on the Brief Infant-Toddler Social Emotional Assessment (BITSEA) social competency, and boys scoring higher than girls in problem behaviour. The results indicate that MMN supplementation had no long term additional effects on cognitive function compared with iron supplementation alone. The timing of supplement administration for maximum impact on a child's cognitive development requires further investigation.
Objective To test whether zinc supplementation during pregnancy would reduce infant morbidity rates. Study design A double-blind, randomized controlled trial of prenatal zinc supplementation was ...conducted from 1995 to 1997 in a periurban slum of Lima, Peru. Participants were randomly assigned to receive daily supplementation with zinc (15 mg zinc + 60 mg iron + 250 μg folic acid) or placebo (60 iron + 250 μg folic acid) from 10 to 24 weeks gestation until 1 month postpartum. Anthropometry was measured monthly from birth through age 12 months, and morbidity and dietary intake were measured weekly from 6 to 12 months (n = 421). Results The average percentage of observation days with diarrhea among infants prenatally treated with zinc (5.8%) was reduced compared with infants in the control group (7.7%) ( P = .01). Prenatal zinc supplementation reduced the likelihood of an infant experiencing diarrheal episodes of acute diarrhea lasting longer than 7 days (OR 0.66, 95% CI 0.43, 0.99, P = .04) and mucus in the stool (OR 0.65 95% CI 0.46, 0.92, P = .01) adjusting for infant age, breastfeeding, season, and hygiene and sanitation covariates. No treatment effects on respiratory illnesses, fever, or skin conditions were detected. Conclusions Improving prenatal zinc nutrition protected against diarrheal morbidity in infant offspring through 12 months of age.
To set up a global system for monitoring maternal and perinatal health in 54 countries worldwide.
The WHO Global Survey for Monitoring Maternal and Perinatal Health was implemented through a network ...of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas.
The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 125 institutions in seven African countries and 119 institutions in eight Latin American countries participated.
This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.
Abstract Objective We describe the levels and patterns of change in red blood cell (RBC) metallothionein (MT) during pregnancy and the neonate and relate RBCMT to other indicators of zinc and iron ...status. Methods As part of a double-masked controlled trial of prenatal zinc supplementation among 242 Peruvian pregnant women, we determined RBCMT at enrollment (10–16 wk), at 28 and 36 wk of gestation, and in the cord blood at delivery in 158 women (86 who received daily supplements containing 60 mg of iron and 250 μg of folic acid and 72 whose supplements also contained 25 mg of zinc). In addition, we measured plasma and urinary zinc concentrations, hemoglobin and serum ferritin, and, on a limited sample, RBC zinc and placental MT. Results RBCMT increased during pregnancy, and levels in the cord blood approximated maternal values at 36 wk. Only RBC zinc at 36 wk differed by supplement type ( P < 0.05). Increases in RBCMT over pregnancy were, however, related to early pregnancy RBC zinc and inversely with the decline in plasma zinc from baseline to 36 wk of gestation. Conclusion Changes in RBCMT throughout pregnancy were consistent with the hypothesized role of MT in regulating zinc homeostasis. RBCMT appears to not be responsive during pregnancy to changes in zinc status achieved with supplements.
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