Navegando por Autor "Kosek, Margaret N."
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Artigo How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight-site MAL-ED birth cohort study(Maternal and Child Nutrition, 2016-08) Maciel, Bruna Leal Lima; Ambikapathi, Ramya; Kosek, Margaret N.; Lee, Gwenyth O.; Mahopo, Cloupas; Patil, Crystal L.; Turab, Ali; Islam, M. Munirul; Ulak, Manjeswori; Bose, Anuradha; Olortegui, Maribel Paredes; Pendergast, Laura L.; Murray-Kolb, Laura E.; Lang, Dennis; Mccormick, Benjamin J. J.; Caulfield, Laura E.The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non-breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non-EBF days may occur, EBF can be re-initiated for extended periods. We compared breastfeeding metrics in the MAL-ED study; infants’ breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice-weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non-EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re-initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studiesArtigo Intestinal permeability and inflammation mediate the association between nutrient density of complementary foods and biochemical measures of micronutrient status in young children: results from the mal-ed study(American Journal of Clinical Nutrition, 2019-10) Maciel, Bruna Leal Lima; McCormick, Benjamin J. J.; Murray-Kolb, Laura E.; Lee, Gwenyth O.; Schulze, Kerry J.; Ross, A. Catharine; Bauck, Aubrey; Lima, Aldo Ângelo Moreira; Kosek, Margaret N.; Seidman, Jessica C.; Ambikapathi, Ramya; Bose, Anuradha; John, Sushil; Kang, Gagandeep; Turab, Ali; Mduma, Estomih; Bessong, Pascal; Shrestra, Sanjaya; Ahmed, Tahmeed; Mahfuz, MustafaBackground: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Methods: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1- antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network. Results: A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations. Conclusions: EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED. Am J Clin Nutr 2019;110:1015–1025Artigo Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED: an eight-country cohort study(American Journal of Tropical Medicine and Hygiene, 2018-03) Maciel, Bruna Leal Lima; Petri, William; Bhutta, Zulfiqar; Bessong, Pascal; McCormick, Benjamin J. J.; Caulfield, Laura E.; Mduma, Estomih; Turab, Ali; Richard, Stephanie Ann; Mahfuz, Mustafa; Rasmussen, Zeba; Seidman, Jessica Couvillion; Chandyo, Ram Krishna; Rogawski, Elizabeth T.; Bose, Anuradha; Kosek, Margaret N.Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95% confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23, 95% CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0–6 months was protective against diarrhea (0–2 months: RR 0.39, 95% CI 0.32, 0.49; 3–5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3–5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention