More than half of all annual deaths in children under age five are attributable to infectious disease. In 2013, 6.3 million children under five years died, with diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria comprising the top five causes of death. Iron deficiency was the leading cause of disability in this age group (Global Burden of Disease Study, 2013; Lancet 2015;385). In at least half of these deaths, malnutrition was a contributing factor. Recent unexpected findings suggest that iron supplementation in accordance with previously established guidelines may have adverse effects in regions where malaria is endemic, and more information is needed on the best way to manage nutritional deficiencies in such regions. Mortality from tuberculosis (TB) is on the increase, especially in association with HIV infection, and poverty, partly reflecting poor nutrition, is the strongest risk factor for childhood TB infection. An understanding of the interplay between nutrition and infectious diseases is therefore important for prevention of child deaths and tackling of malnutrition in all its forms as well as for developing and evaluating appropriate nutritional care. Evidence-based knowledge of the required nutrient amounts and interactions, chemical forms and modes of nutrient delivery, and the timing of nutritional support in relation to stages of recovery from infection, could help save the lives of hundreds of thousands of children annually.
The aim of this Coordinated Research Project’s (CRP) was to contribute new information that will help to assess nutritional status and to measure micronutrient absorption to help improve nutritional management of infants and young children who are at high risk of infectious disease.
Useful data on iron and zinc absorption in children prone to infectious diseases, especially malaria and tuberculosis, was generated and informed nutritional care. The CRP also contributed to knowledge on the use of stable isotope techniques to assess iron absorption, exchangeable zinc pool size (EZP) and fractional zinc absorption (FZA). Results from Malawi showed that the current practice of supplementing infants with iron after a malaria episode has no adverse effect on iron absorption and should be continued. Findings from Vietnam demonstrated that providing 10mg of supplemental zinc to children with TB for only two months increased their upper arm muscle mass and tended to increase their exchangeable zinc pool size without showing a change in plasma zinc levels. Investigation of the effect of a higher dose of supplemental zinc given for a longer period was recommended. In Kenya, the CRP evaluated the effect of micronutrient powders (MNP) with and without iron on zinc absorption from local foods (six months of age).
Results showed that iron in MNP did not negatively affect zinc absorption, suggesting a potential to increase zinc amounts in MNPs to strengthen the immune response in vulnerable populations. These results from Kenya were presented at the Bill and Melinda Gates Foundation sponsored "ZincTank-2" meeting in London in June 2013. The CRP enhanced networking between contract holders from resource poor countries and experts from well-established institutions.
Researchers from Bangladesh, Burkina Faso, Kenya, Malawi, Pakistan, Vietnam, the United Kingdom, Switzerland, the United Republic of Tanzania and the United States of America participated in the CRP.
For more information, please see the CRP description:
http://www.dgdingfa.net/projects/crp/e43023
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