Associação entre nutrientes da alimentação complementar, função da barreira intestinal e enteropatia ambiental em crianças da coorte brasileira do estudo MAL-ED

Abstract

Nutrition during the complementary feeding period provides nutrients and dietary compounds that influence intestinal health. This study aimed to investigate the association between nutrient intake of complementary food and intestinal barrier function in infants under two years of age. A prospective longitudinal study included 233 children aged 9 to 15 months from the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, carried out in Fortaleza-CE. The dietary intake of complementary food was estimated based on 24-hour dietary recall (24HR), collected monthly from 9 to 15 months of age. The usual nutrient intake was adjusted by intrapersonal variance and energy. Nutritional adequacy of the energy, fiber, and macronutrients dietary intake was evaluated by the ratio between the value consumed and the recommended one. For the micronutrient adequacy of diet, the mean adequacy ratio (MAR) was constructed from the nutrient adequacy ratios (NAR) calculated for vitamins (vitamin A, thiamine and folate) and minerals (iron, zinc, and calcium). The evaluation of intestinal barrier function was determined by the lactulose/mannitol urinary ratio (L:M). Myeloperoxidase (MPO), neopterin (NEO) and alpha-1-antitrypsin (AAT) concentrations were measured in stool samples to indicate gut immunity and permeability. As an indicator of environmental enteropathy (EE), the EE score was calculated, based on the categorization of the three fecal biomarkers concentrations (MPO, NEO, AAT) distributions. To investigate the association between energy and nutrient intake and intestinal biomarkers multiple linear regressions were used. Nutritional adequacy was high for all evaluated nutrients, except for the fiber intake adequacy. All biomarkers exhibited high values, indicating a compromised intestinal barrier function and the presence of intestinal inflammation among the infants evaluated. 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). However, a positive correlation between thiamine adequacy and MPO concentration (ρ = 0.22, p <0.01) and between calcium adequacy and NEO concentration (ρ = 0.23; p < 0.01). The results from the regression models showed that higher energy intake was associated with a lower L: M ratio (β = -0.19, p = 0.02) and that higher fiber intake was associated with lower intestinal inflammation (β = -0.20, p = 0.04). In conclusion, the infants showed nutrient intakes higher than the recommended dietary allowance (on the exception of fiber), impaired intestinal barrier function and intestinal inflammation. The higher energetic and fiber intakes were associated with a better intestinal barrier function and lower intestinal inflammation, respectively.