Navegando por Autor "Kosek, Margaret"

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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, Sudhir
Individuals 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 world
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 Moreira
Background: 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 countries
Methods of analysis of enteropathogen infection in the MAL-ED cohort study
(Clinical Infectious Diseases, 2014-11) Maciel, Bruna Leal Lima; Platts-Mills, James Alexander; McCormick, Benjamin J. J.; Kosek, Margaret; Pan, William K.; Checkley, William; Houpt, Eric Robert
Studies of diarrheal etiology in low- and middle-income countries have typically focused on children presenting with severe symptoms to health centers and thus are best equipped to describe the pathogens capable of leading to severe diarrheal disease. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study was designed to evaluate, via intensive community surveillance, the hypothesis that repeated exposure to enteropathogens has a detrimental effect on growth, vaccine response, and cognitive development, which are the primary outcome measures for this study. In the setting of multiple outcomes of interest, a longitudinal cohort design was chosen. Because many or even the majority of enteric infections are asymptomatic, the collection of asymptomatic surveillance stools was a critical element. However, capturing diarrheal stools additionally allowed for the determination of the principle causes of diarrhea at the community level as well as for a comparison between those enteropathogens associated with diarrhea and those that are associated with poor growth, diminished vaccine response, and impaired cognitive development. Here, we discuss the analytical methods proposed for the MAL-ED study to determine the principal causes of diarrhea at the community level and describe the complex interplay between recurrent exposure to enteropathogens and these critical long-term outcomes

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Navegando por Autor "Kosek, Margaret"