Navegando por Autor "Guerrant, Richard L."
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Artigo Assessment of environmental enteropathy in the MAL-ED cohort study: theoretical and analytic framework(Clinical Infectious Diseases, 2014-11) Maciel, Bruna Leal Lima; Kosek, Margaret; Guerrant, Richard L.; Kang, Gagandeep; Bhutta, Zulfiqar; Yori, Pablo Peñataro; Gratz, Jean; Gottlieb, Michael; Lang, Dennis; Lee, Gwenyth Oneill; Haque, Rashidul; Mason, J. Carl; Ahmed, Tahmeed; Lima, Aldo Ângelo Moreira; Petri, William A.; Houpt, Eric; Olortegui, Maribel Paredes; Seidman, Jessica Couvillion; Mduma, Estomih; Samie, Amidou; Babji, SudhirIndividuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerbated by undernutrition as well as being responsible for permanent growth deficits acquired in early childhood, vaccine failure, and loss of human potential. This article addresses the underlying theoretical and analytical frameworks informing the methodology proposed by the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study to define and quantify the burden of disease caused by EE within a multisite cohort. Additionally, we will discuss efforts to improve, standardize, and harmonize laboratory practices within the MAL-ED Network. These efforts will address current limitations in the understanding of EE and its burden on children in the developing worldArtigo Dietary intake from complementary feeding is associated with intestinal barrier function and environmental enteropathy in Brazilian children from the MAL-ED cohort study(British Journal of Nutrition, 2020-05) Maciel, Bruna Leal Lima; Costa, Priscila Nunes; Soares, Alberto Melo; Silva Filho, José Quirino da; Sousa Júnior, Francisco; Ambikapathi, Ramya; McQuade, Elizabeth T. Rogawski; Guerrant, Richard L.; Caulfield, Laura E.; Lima, Aldo Ângelo MoreiraA child’s diet contains nutrients and other substances that influence intestinal health. The present study aimed to evaluate the relations between complementary feeding, intestinal barrier function and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project cohort study. Habitual dietary intake from complementary feeding was estimated using seven 24-h dietary recalls, from 9 to 15 months of age. Intestinal barrier function was assessed using the lactulose–mannitol test (L–M), and EE was determined as a composite measure using faecal biomarkers concentrations – α-1-antitrypsin, myeloperoxidase (MPO) and neopterin (NEO) at 15 months of age. The nutrient adequacies explored the associations between dietary intake and the intestinal biomarkers. Children showed adequate nutrient intakes (with the exception of fibre), impaired intestinal barrier function and intestinal inflammation. There was a negative correlation between energy adequacy and L–M (ρ = −0·19, P < 0·05) and between folate adequacy and NEO concentrations (ρ = −0·21, P < 0·01). In addition, there was a positive correlation between thiamine adequacy and MPO concentration (ρ = 0·22, P < 0·01) and between Ca adequacy and NEO concentration (ρ = 0·23; P < 0·01). Multiple linear regression models showed that energy intakes were inversely associated with intestinal barrier function (β = −0·19, P = 0·02), and fibre intake was inversely associated with the EE scores (β = −0·20, P = 0·04). Findings suggest that dietary intake from complementary feeding is associated with decreased intestinal barrier function and EE in childrenArtigo Disease surveillance methods used in the 8-site MAL-ED cohort study(Clinical Infectious Diseases, 2014-11) Maciel, Bruna Leal Lima; Richard, Stephanie Ann; Barrett, Leah J.; Guerrant, Richard L.; Checkley, William; Miller, Mark AndrewDescribing the early life associations between infectious disease episodes and growth, cognitive development, and vaccine response in the first 2 years of life is one of the primary goals of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study. To collect high-resolution data during a critical early period of development, field staff visit each study participant at their house twice weekly from birth to 2 years of age to collect daily reported illness and treatment data from caregivers. Detailed infectious disease histories will not only allow us to relate the overall burden of infectious disease with the primary outcomes of the study, but will also allow us to describe the ages at which infectious diseases have the greatest effect on child health. In addition, twice-weekly visits allow for sample collection when diarrhea episodes are identified. This article describes the methods used to collect illness and treatment history data and discusses the a priori definitions of diarrhea and acute lower respiratory illness episodesArtigo Geography, population, demography, socioeconomic, anthropometry, and environmental status in the MAL-ED Cohort and case-control study sites in Fortaleza, Ceará, Brazil(Clinical Infectious Diseases, 2014-11) Maciel, Bruna Leal Lima; Lima, Aldo Ângelo Moreira; Oriá, Reinaldo Barreto; Soares, Alberto Melo; Silva Filho, José Quirino da; Sousa, Francisco de; Abreu, Cláudia B.; Bindá, Alexandre Havt; Lima, Ila Fernanda Nunes; Quetz, Josiane da Silva; Moraes, Milena; Costa, Hilda Pinheiro da; Leite, Álvaro Madeiro; Lima, Noélia Leal; Mota, Francsco Sulivan Bastos; Moura, Alessandra Di; Scharf, Rebecca; Barret, Leah; Guerrant, Richard L.The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort in the study’s Fortaleza, Brazil, catchment area has a population of approximately 82 300 inhabitants. Most of the households (87%) have access to clean water, 98% have electricity, and 69% have access to improved toilet/sanitation. Most childbirths occur at the hospital, and the under-5 mortality rate is 20 per 1000 live births. The MAL-ED case-control study population, identified through the Institute for the Promotion of Nutrition and Human Development (IPREDE), serves 600 000 inhabitants from areas totaling about 42% of the city of Fortaleza. IPREDE receives referrals from throughout the state of Ceará for infant nutrition, and provides services including teaching activities and the training of graduate students and health professionals, while supporting research projects on child nutrition and health. In this article, we describe the geographic, demographic, socioeconomic, anthropometric, and environmental status of the MAL-ED cohort and case-control study populations in Fortaleza, BrazilArtigo Higher energy and zinc Intakes from complementary feeding are associated with decreased risk of undernutrition in children from South America, Africa, and Asia(Journal of Nutrition, 2020-09) Maciel, Bruna Leal Lima; Costa, Priscila Nunes; Silva Filho, José Quirino da; Ribeiro, Samilly A.; Rodrigues, Francisco Adelvane de Paulo; Soares, Alberto Melo; Sousa Júnior, Francisco; Ambikapathi, Ramya; McQuade, Elizabeth T. Rogawski; Kosek, Margaret; Ahmed, Tahmee; Bessong, Pascal; Kang, Gangadeep; Shresthra, Sanjaya; Mduma, Estomih; Bayo, Eliwaza; Guerrant, Richard L.; Caulfield, Laura E.; Lima, Aldo Ângelo MoreiraBackground: Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide. Objectives: This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and stunting. Methods: Usual nutrient intakes from complementary feeding were determined by 24-h recalls collected when infants were 9–24 mo of age in communities from 7 low- and middle-income countries: Brazil (n = 169), Peru (n = 199), South Africa (n = 221), Tanzania (n = 210), Bangladesh (n = 208), India (n = 227), and Nepal (n = 229), totaling 1463 children and 22,282 food recalls. Intakes were corrected for within- and between-person variance and energy intake. Multivariable regression models were constructed to determine nutrient intakes associated with the development of underweight, wasting, and stunting at 12, 18, and 24 mo of age. Results: Children with malnutrition presented significantly lower intakes of energy and zinc at 12, 18, and 24 mo of age, ranging from −16.4% to −25.9% for energy and −2.3% to −48.8% for zinc. Higher energy intakes decreased the risk of underweight at 12 [adjusted odds ratio (AOR): 0.90; 95% CI: 0.84, 0.96] and 24 mo (AOR: 0.91; 95% CI: 0.86, 0.96), and wasting at 18 (AOR: 0.91; 95% CI: 0.83, 0.99) and 24 mo (AOR: 0.83; 95% CI: 0.74, 0.92). Higher zinc intakes decreased the risk of underweight (AOR: 0.12; 95% CI: 0.03, 0.55) and wasting (AOR: 0.19; 95% CI: 0.04, 0.92) at 12 mo, and wasting (AOR: 0.05; 95% CI: 0.00, 0.76) at 24 mo. Conclusions: Higher intakes of energy and zinc in complementary feeding were associated with decreased risk of undernutrition in the studied children. Data suggest these are characteristics to be improved in children’s complementary feeding across countriesArtigo Infant feeding practices and determinant variables for early complementary feeding in the first 8 months of life: results from the brazilian MAL-ED cohort site(Public Health Nutrition, 2018-04) Maciel, Bruna Leal Lima; Moraes, M.L.; Soares, Alberto Melo; Cruz, I.F.S.; Andrade, Maria I. R. de; Silva Filho, José Quirino da; Sousa Júnior, Francisco; Costa, Priscila Nunes; Abreu, C. B.; Ambikapathi, Ramya; Guerrant, Richard L.; Caulfield, Laura E.; Lima, Aldo Ângelo MoreiraObjective: The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community. Design: A birth cohort was conducted (n 233), with data collection twice weekly, allowing close observation of breast-feeding, complementary feeding introduction and description of the WHO core indicators on infant and young child feeding. Infant feeding practices were related to socio-economic status (SES), assessed by Water/ sanitation, wealth measured by a set of eight Assets, Maternal education and monthly household Income (WAMI index). Two logistic regression models were constructed to evaluate risk factors associated with early complementary feeding. Results: Based on twice weekly follow-up, 65 % of the children received exclusive breast-feeding in the first month of life and 5 % in the sixth month. Complementary feeding was offered in the first month: 29 % of the children received water, 15 % infant formulas, 13 % other milks and 9·4 % grain-derived foods. At 6 months, dietary diversity and minimum acceptable diet were both 47% and these increased to 69 % at 8 months. No breast-feeding within the first hour of birth was a risk factor for the early introduction of water (adjusted OR=4·68; 95 % CI 1·33, 16·47) and low WAMI index a risk factor for the early introduction of other milks (adjusted OR=0·00; 95 % CI 0·00, 0·02). Conclusions: Data suggest local policies should promote: (i) early breast-feeding initiation; (ii) SES, considering maternal education, income and household conditions; (iii) timely introduction of complementary feeding; and (iv) dietary diversity