Zinc deficiency in children with environmental enteropathy—development of new strategies: report from an expert workshop
01 Oct 2014-The American Journal of Clinical Nutrition (American Society for Nutrition)-Vol. 100, Iss: 4, pp 1198-1207
TL;DR: It was concluded that a reframing of the current recommendation is warranted with consideration of how to better optimize and deliver zinc and whether to provide a complementary public health primary prevention zinc strategy.
About: This article is published in The American Journal of Clinical Nutrition.The article was published on 2014-10-01 and is currently open access. It has received 31 citations till now. The article focuses on the topics: Zinc deficiency & Environmental enteropathy.
Citations
More filters
225 citations
TL;DR: Understanding the impact of malnutrition, particularly low micronutrient supply, on microbiota development, composition, and metabolism may help in implementing new strategies to overcome the deleterious effects of malnutrition on child development.
Abstract: There is increasing evidence that food is an important factor that influences and shapes the composition and configuration of the gut microbiota. Most studies have focused on macronutrients (fat, carbohydrate, protein) in particular and their effects on the gut microbiota. Although the microbiota can synthesize different water-soluble vitamins, the effects of vitamins synthesized within the microbiota on systemic vitamin status are unclear. Few studies exist on the shuttling of vitamins between the microbiota and intestine and the impact of luminal vitamins on the microbiota. Studying the interactions between vitamins and the microbiota may help to understand the effects of vitamins on the barrier function and immune system of the intestinal tract. Furthermore, understanding the impact of malnutrition, particularly low micronutrient supply, on microbiota development, composition, and metabolism may help in implementing new strategies to overcome the deleterious effects of malnutrition on child development. This article reviews data on the synthesis of different micronutrients and their effects on the human microbiota, and further discusses the consequences of malnutrition on microbiota composition.
172 citations
TL;DR: Various factors that have been identified or suggested as being involved in the differences of rotavirus vaccine effectiveness are reviewed here and recognition of these factors will help to achieve gradual worldwide improvement of rotvirusvaccine effectiveness.
Abstract: Rotaviruses are a major cause of acute gastroenteritis in infants and young children worldwide and in many other mammalian and avian host species. Since 2006, two live-attenuated rotavirus vaccines, Rotarix® and RotaTeq®, have been licensed in >100 countries and are applied as part of extended program of vaccination (EPI) schemes of childhood vaccinations. Whereas the vaccines have been highly effective in high-income countries, they were shown to be considerably less potent in low- and middle-income countries. Rotavirus-associated disease was still the cause of death in >200,000 children of <5 years of age worldwide in 2013, and the mortality is concentrated in countries of sub-Saharan Africa and S.E. Asia. Various factors that have been identified or suggested as being involved in the differences of rotavirus vaccine effectiveness are reviewed here. Recognition of these factors will help to achieve gradual worldwide improvement of rotavirus vaccine effectiveness.
95 citations
Cites background from "Zinc deficiency in children with en..."
...Zinc deficiency alters immune functions [48] and is known to be a contributing factor to severe diarrhea [49]....
[...]
...Environmental enteropathy (see below) perturbs zinc homeostasis in the gut [49]....
[...]
...Zinc deficiency is a major cause of childhood morbidity and mortality in low-income countries, in particular since it occurs in parallel with deficiencies of other micronutrients and animal proteins [49]....
[...]
TL;DR: Although many challenges remain in defeating EED, the global child health community must redouble their efforts to reduce EED in order to make substantive improvements in morbidity and mortality worldwide.
Abstract: Environmental enteric dysfunction (EED) has been recognised as an important contributing factor to physical and cognitive stunting, poor response to oral vaccines, limited resilience to acute infections and ultimately global childhood mortality. The aetiology of EED remains poorly defined but the epidemiology suggests a multifactorial combination of prenatal and early-life undernutrition and repeated infectious and/or toxic environmental insults due to unsanitary and unhygienic environments. Previous attempts at medical interventions to ameliorate EED have been unsatisfying. However, a new generation of imaging and '-omics' technologies hold promise for developing a new understanding of the pathophysiology of EED. A series of trials designed to decrease EED and stunting are taking novel approaches, including improvements in sanitation, hygiene and nutritional interventions. Although many challenges remain in defeating EED, the global child health community must redouble their efforts to reduce EED in order to make substantive improvements in morbidity and mortality worldwide.
40 citations
TL;DR: Young antibiotic-treated mice provide a new model of oral S. flexneri infection, with ZD promoting prolonged infection outcomes, and zinc supplementation increased weight gains and reduced intestinal inflammation and stool shedding in ZD infected mice.
Abstract: Shigella is one of the major enteric pathogens worldwide. We present a murine model of S. flexneri infection and investigate the role of zinc deficiency (ZD). C57BL/6 mice fed either standa...
35 citations
Cites background from "Zinc deficiency in children with en..."
...However, little is known about the mechanisms involved.(43,44) In this model, chronic infection outcomes, characterized by the persistent colonization and cytokine production findings, were observed in zinc-deficient mice exposed to S....
[...]
References
More filters
TL;DR: Understanding how the diet and nutritional status influence the composition and dynamic operations of the authors' gut microbial communities, and the innate and adaptive arms of the immune system, should help to address several pressing global health problems.
Abstract: Marked changes in socio-economic status, cultural traditions, population growth and agriculture are affecting diets worldwide. Understanding how our diet and nutritional status influence the composition and dynamic operations of our gut microbial communities, and the innate and adaptive arms of our immune system, represents an area of scientific need, opportunity and challenge. The insights gleaned should help to address several pressing global health problems.
2,158 citations
"Zinc deficiency in children with en..." refers background in this paper
...Alterations in the microbiome as found in EE may arise from a variety of causes including frequent enteric infections and probably contribute to intestinal dysfunction in affected children (30)....
[...]
Journal Article•
TL;DR: This chapter discusses zinc Nutrition, which focuses on dietary requirements and recommended intakes for zinc, and causes of zinc deficiency and groups at high risk.
Abstract: Chapter 1: Overview of Zinc Nutrition ............................................................................................................... S99 1.1 Biological functions of zinc ............................................................................................................................. S99 1.2 Tissue zinc distribution and reserves .............................................................................................................. S99 1.3 Zinc metabolism ........................................................................................................................................... S100 1.4 Importance of zinc for human health........................................................................................................... S101 1.5 Human zinc requirements............................................................................................................................. S105 1.5.1 Adult men ............................................................................................................................................. S106 1.5.2 Adult women......................................................................................................................................... S109 1.5.3 Children ................................................................................................................................................ S110 1.5.4 Pregnancy.............................................................................................................................................. S111 1.5.5 Lactation ............................................................................................................................................... S112 1.6 Dietary sources of zinc and suggested revisions of Recommended Daily Intakes .................................... S112 1.6.1 Dietary sources of zinc and factors affecting the proportion of zinc available for absorption ........ S112 1.6.2 Revised estimates of dietary requirements and recommended intakes for zinc ............................... S114 1.7 Zinc toxicity.................................................................................................................................................... S118 1.8 Causes of zinc deficiency and groups at high risk ....................................................................................... S121 1.9 Summary ........................................................................................................................................................ S123
1,280 citations
"Zinc deficiency in children with en..." refers background in this paper
...Therapeutic doses of zinc have traditionally been 10 or 20 mg/d depending on age, significantly in excess of daily intake and recommended requirements (w5–6 mg for young children) (5)....
[...]
...Deficiency itself is common, although its prevalence varies in different countries, as judged from differences in plasma zinc between populations (5)....
[...]
...Although plasma zinc ,40 mg/dL is 71% sensitive for clinical zinc deficiency (49), it is insensitive in an individual for early/marginal zinc depletion and does not correlate well with clinical status above this concentration (5)....
[...]
TL;DR: Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures.
980 citations
TL;DR: Knowledge about dietary factors that inhibit zinc absorption and about ways to overcome or remove these factors is essential when designing strategies to improve the zinc nutrition of vulnerable groups.
Abstract: Marginal zinc deficiency and suboptimal zinc status have been recognized in many groups of the population in both less developed and industrialized countries. Although the cause in some cases may be inadequate dietary intake of zinc, inhibitors of zinc absorption are most likely the most common causative factor. Phytate, which is present in staple foods like cereals, corn and rice, has a strong negative effect on zinc absorption from composite meals. Inositol hexaphosphates and pentaphosphates are the phytate forms that exert these negative effects, whereas the lower phosphates have no or little effect on zinc absorption. The removal or reduction of phytate by enzyme (phytase) treatment, precipitation methods, germination, fermentation or plant breeding/genetic engineering markedly improves zinc absorption. Iron can have a negative effect on zinc absorption, if given together in a supplement, whereas no effect is observed when the same amounts are present in a meal as fortificants. Cadmium, which is increasing in the environment, also inhibits zinc absorption. The amount of protein in a meal has a positive effect on zinc absorption, but individual proteins may act differently; e.g., casein has a modest inhibitory effect of zinc absorption compared with other protein sources. Amino acids, such as histidine and methionine, and other low-molecular-weight ions, such as EDTA and organic acids (e.g., citrate), are known to have a positive effect on zinc absorption and have been used for zinc supplements. Knowledge about dietary factors that inhibit zinc absorption and about ways to overcome or remove these factors is essential when designing strategies to improve the zinc nutrition of vulnerable groups.
888 citations
"Zinc deficiency in children with en..." refers background in this paper
...There is potential to use EDTA to compete with phytate (63, 67), but its value and safety in zinc nutrition have not been thoroughly evaluated....
[...]
...Phytate [inositol-6-phosphate (IP6)] is a strong ligand at IP4-6, but only binds weakly at IP2 (62, 63)....
[...]
01 Jan 2004
TL;DR: This chapter discusses dietary sources of zinc and factors affecting the proportion of zinc available for absorption in the diet, as well as causes of zinc deficiency and groups at high risk.
Abstract: Chapter 1: Overview of Zinc Nutrition S99 1.1 Biological functions of zinc S99 1.2 Tissue zinc distribution and reserves S99 1.3 Zinc metabolism S100 1.4 Importance of zinc for human health S101 1.5 Human zinc requirements S105 1.5.1 Adult men S106 1.5.2 Adult women S109 1.5.3 Children S110 1.5.4 Pregnancy S111 1.5.5 Lactation S112 1.6 Dietary sources of zinc and suggested revisions of Recommended Daily Intakes S112 1.6.1 Dietary sources of zinc and factors affecting the proportion of zinc available for absorption ........ S112 1.6.2 Revised estimates of dietary requirements and recommended intakes for zinc S114 1.7 Zinc toxicity S118 1.8 Causes of zinc deficiency and groups at high risk S121 1.9 Summary S123
768 citations