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Stable Isotope Techniques to Design Effective Food Fortification Strategies in Settings with High H. Pylori Infection
Closed for proposals
Project Type
Project Code
E43025CRP
1771Approved Date
Start Date
Expected End Date
Completed Date
19 November 2019Description
H. pylori infection is the most common bacterial infection in humans with particularly high prevalence in developing countries. Acquisition takes place in early childhood and persists life-long. Most individuals are asymptomatic, however, there is evidence that gastric acid output is reduced which affects the solubility of essential micronutrients and limits their absorption. Limited absorption of non- water-soluble compounds might compromise the effectiveness of food fortification programs, because these programs often use iron and zinc compounds that are soluble in diluted acid, but not in water. Thus, in particular, in the context of high rates of infectious diseases and malnutrition, H. pylori infection presents an additional burden to vulnerable population groups. The proposed CRP will evaluate the effect of H. pylori infection on gastric acid secretion and on iron and zinc absorption from different fortification compounds. The [13C] Urea Breath Test will be used for the diagnosis of H. pylori infection and stable isotope techniques will be used to provide information on absorption of iron and zinc from compounds with different physical and chemical properties. Study participants with diagnosed H. pylori infection will be treated thereafter. Results will be disseminated to different stakeholders, including policy makers. The overall goal of the proposed CRP is to contribute evidence of how H. pylori infection affects iron and zinc absorption from fortification compounds in asymptomatic individuals in developing countries. This will assist public health policy makers in designing effective food fortification strategies using bioavailable compounds to address micronutrient deficiencies. In general, food fortification with iron and zinc is highly cost effective and of particular importance to developing countries, where the degree of micronutrient deficiency is high.
Objectives
The overall objective is to contribute new information on the effect of H. pylori infection on iron and zinc absorption from different food fortification compounds in asymptomatic individuals in developing countries.
Specific objectives
Explore possibilities to develop a non-invasive test using stable isotopes to measure gastric acid secretion.
Generate new data on the link between H. pylori infection and iron and zinc absorption from fortification compounds in asymptomatic individuals.
Generate new data on the protective role of maternal breastfeeding on morbidity and H. pylori infection.
Generate new data on the role of H. pylori gastric colonization in hormonal modulation of food intake and its consequences on nutritional status.
Impact
Though the clinical significance of H. pylori infection in children remains largely unknown, there is a clear link with iron stores. Results from this CRP suggest that H. pylori infection may limit the efficacy of any oral iron supplementation due to modified gastric secretion. New data on H. pylori infection, gastric acid secretion and iron status in children and women were generated across Africa, Asia and Latin America. The CRP enabled capacity building including training at Masters and PhD level and was a platform for north-south information exchange. The CRP also contributed to information of the choice of the form of iron for food fortification to address anaemia among children and women of reproductive age. Lastly the CRP confirmed that children who are mixed fed from a very young age tend to gain more weight in the form of body fat, a situation that can potentially increase their risk for later disease in adolescence and adulthood. Results have already been published in three peer reviewed papers which have a potential to inform policy and practice.
Relevance
H. pylori infection is the most common bacterial infection in humans and its prevalence is much higher in developing countries (around 80-90% among adults) than in developed countries (<40%). Transmission occurs in the family setting and acquisition takes place in early childhood and persists life-long in most infected subjects. Studies have shown that high H. pylori prevalence is associated with a variety of risk factors including low socio-economic status, low education level, poor sanitation, rural residence, and birth in a developing country. Prior to this CRP, there was insufficient data on how H. pylori infection impacts nutrient uptake and utilisation, especially the absorption of micronutrients such as iron and zinc. Additionally, the impact of food-based interventions such as fortification on nutritional status of mothers and children in high H. pylori prevalence settings was unknown. The CRP results suggest that treatment of H. pylori with antibiotics can greatly improve micronutrient absorption and iron stores, especially that of iron. However, the results confirm that the effect of H. pylori infection on iron and zinc absorption is not uniform; it likely depends on the H. pylori strain and the location of the infection.