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Stable Isotope Techniques in the Development and Monitoring of Nutritional Interventions for Infants and Children with Malaria, TB and other Infectious Diseases
Closed for proposals
Project Type
Project Code
E43023CRP
1519Approved Date
Status
Start Date
Expected End Date
Completed Date
8 November 2015Description
Of the 10.6 million annual deaths of children under age 5, more than half were attributable to infectious disease, including 19% from acute respiratory infections, 17% from diarrhoeal diseases, and 8% from malaria, according to World Health Organization (WHO) 2000-2003 estimates. In at least half of these deaths, malnutrition was a contributing factor. Recent unexpected findings suggest that micronutrient supplementation in accordance with previously established guidelines may have adverse effects in regions where malaria is endemic, and more information is needed on the best way to manage nutritional deficiencies in such regions. Mortality from tuberculosis (TB) is on the increase, especially in association with HIV infection, and poverty, partly reflecting poor nutrition, is the strongest risk factor for childhood TB infection. A better understanding is needed for developing and evaluating appropriate nutritional care for infants and children in endemically infectious areas.
The overall goal of the proposed CRP is to contribute new information that will help to assess nutritional status and to measure micronutrient absorption to help improve nutritional care in young children at risk of infectious disease. Stable isotope techniques provide powerful tools that can produce valuable information on nutritional status, energy expenditure, and micronutrient absorption. Stable isotope methods can be used for examining the absorption of trace elements such as iron and zinc, to help define the best dose, chemical form(s), mode and timing of administration. In addition, stable isotope techniques allow sensitive assessment of nutritional status, such as body composition or the body vitamin A reserves.
The results generated within this CRP will contribute information on nutritional status and micronutrient absorption that can help improve nutritional management of infants and young children who are at high risk of infectious disease.
Objectives
To contribute new information that will help to assess nutritional status and to measure micronutrient absorption to help improve nutritional management of infants and young children who are at high risk of infectious disease.
Of the 10.6 million annual deaths of children under age 5, more than half were attributable to infectious disease, including 19% from acute respiratory infections, 17% from diarrhoeal diseases, and 8% from malaria, according to World Health Organization (WHO) 2000-2003 estimates. In at least half of these deaths, malnutrition was a contributing factor. Recent unexpected findings suggest that micronutrient supplementation in accordance with previously established guidelines may have adverse effects in regions where malaria is endemic, and more information is needed on the best way to manage nutritional deficiencies in such regions. Mortality from tuberculosis (TB) is on the increase, especially in association with HIV infection, and poverty, partly reflecting poor nutrition, is the strongest risk factor for childhood TB infection. A better understanding is needed for developing and evaluating appropriate nutritional care for infants and children in endemically infectious areas.
Specific objectives
To generate new information on the efficacy of interventions for improving the nutrition of infants and young children who are at high risk of infectious disease.
Impact
The CRP generated useful data to inform knowledge and practice on iron and zinc absorption in children prone to infectious diseases especially malaria and tuberculosis. The CRP contributed to knowledge on the use of stable isotope techniques to assess iron absorption, exchangeable zinc pool size (EZP) and fractional zinc absorption (FZA). Some of the key results were published in peer reviewed journals with wide readership. The results are from Malawi shoed that current practice of supplementing infants with iron after malaria episode has no adverse effect on iron absorption and should be continued. The CRP enhanced networking between contract holders from resource poor countries and experts from well established institutions. Results from Kenya were presented at the Bill and Melinda Gates Foundation sponsored "ZincTank-2" meeting in London, June 2013. Findings from Vietnam demonstrated that
providing 10mg supplemental zinc to children with TB for only 2 months increased their upper arm muscle mass and tended to increase their exchangeable zinc pool size without a change in plasma zinc levels. Investigation of the effect of higher dose of supplemental zinc given for a longer period was recommended.
Relevance
Infectious diseases including malaria, tuberculosis and others contribute over 10 million annual child deaths. Malnutrition underlies at least 45% of these and other deaths and increases the risk of dying from these diseases. An understanding of the inter-play between nutrition and infectious diseases is therefore important for prevention of child deaths and tackling of malnutrition in all it is forms. As outlined in the original objective, the data generated from this CRP is useful to help design nutritional care to reduce morbidity and mortality of infants and children from malaria, TB, and other infectious diseases. Evidence-based knowledge of the required nutrient amounts and interactions, chemical forms and modes of nutrient delivery, and the timing of nutritional support in relation to stages of recovery from infection, could help save the lives of hundreds of thousands of children annually.