Higher serum concentrations of DHEAS predict improved nutritional status in helminth-infected children, adolescents, and young adults in Leyte, the Philippines

Pubertal development and associated downmodulation of proinflammatory cytokines may predict improved nutritional status, independent of chronic parasite infections, in developing countries. We enrolled 731 individuals, aged 7-30 y, from Leyte, the Philippines, where helminth infections and nutritional morbidity are highly prevalent. The following data were collected: venous blood hemoglobin and serum concentrations of ferritin, dehydroepiandrosterone sulfate (DHEAS), C-reactive protein and proinflammatory cytokines (IL-1, IL-6, TNF-alpha, and soluble TNF receptor I); anthropometric measurements to calculate upper arm muscle area Z-score and sum of triceps and subscapular skinfolds Z-score; stool samples to determine Schistosoma japonicum and geohelminth egg counts; and responses to questionnaires assessing socio-economic status. In cross-sectional multilevel linear and logistic regression analyses adjusted for confounders, relations were assessed between 1) DHEAS and nutritional status, 2) DHEAS and proinflammatory cytokines, and 3) nutritional status and proinflammatory cytokines. Independent of age, socio-economic status, and helminth infections, increased levels of DHEAS were associated with improved nutritional status and decreased prevalence of non-iron deficiency anemia in both males and females. DHEAS showed dose-dependent inverse associations with C-reactive protein (P=0.08) and the production of IL-6 (P<0.0001). These inflammatory markers, in turn, were consistently associated with undernutrition and anemia. The results suggest that the puberty-associated rise in DHEAS downmodulates proinflammatory immune responses and thereby reduces undernutrition and anemia in a population experiencing a high burden of chronic helminth infections. This novel regulatory mechanism of inflammation-related nutritional morbidity emphasizes the importance of treating prepubescent children for helminth infections.     

Vitamin D status in children,adolescents, and young adults with Crohn disease

BACKGROUND: Crohn disease (CD) and vitamin D deficiency are associated with decreased bone mineralization. OBJECTIVE: We examined the prevalence of and risk factors for hypovitaminosis D in children, adolescents, and young adults with CD. DESIGN: Growth, clinical characteristics, vitamin D intake ( micro g/d), and bone mineral density (g/cm(2)) were measured in a cross-sectional study of 112 subjects (44 females) who had CD and were 5-22 y of age. Hypovitaminosis D was defined as a serum concentration of 25-hydroxyvitamin D [25(OH)D] < 38 nmol/L. RESULTS: The mean (+/- SD) serum concentration of 25(OH)D was 59.7 +/- 26.9 nmol/L, and 16% (95% CI: 9.3%, 23%) of the subjects had hypovitaminosis D. Hypovitaminosis D was most prevalent during the winter (31%; P = 0.02), among the African Americans (56%; P = 0.01), in the subjects with CD confined to the upper gastrointestinal tract (44%; P = 0.05), and in the subjects with a greater lifetime exposure to glucocorticoid therapy (23.7 +/- 13.5 compared with 17.5 +/- 12.2 mg/d; P = 0.05). There was no association between hypovitaminosis D and either bone mineral density (P = 0.10) or average dietary intake of vitamin D (4.6 +/- 3.6 micro g/d; P = 0.87). CONCLUSIONS: In this sample of pediatric patients with CD, hypovitaminosis D was common and was associated with the winter season, African American ethnicity, CD confined to the upper gastrointestinal tract, and magnitude of lifetime exposure to glucocorticoid therapy. The occurrence of these factors should prompt assessment of 25(OH)D status and clinical care optimized by supplementing subjects who have low serum concentrations. The physiologic relevance of ethnicity on 25(OH)D status in children with CD remains to be determined.     

Vitamin D status in adolescents and young adults with HIV infection

BACKGROUND: Vitamin D status affects immune function and thus may affect the progress of HIV infection. OBJECTIVES: Our goals were to assess vitamin D intake and status in subjects with HIV infection and in matched control subjects and to determine whether HIV infection was associated with vitamin D insufficiency. DESIGN: Plasma 25-hydroxyvitamin D [25(OH)D] concentrations and vitamin D intake were measured in a cross-sectional study of members of the Reaching for Excellence in Adolescent Health (REACH) cohort. RESULTS: The subjects were aged 14-23 y; 74% were female, and 72% were black. Mean (+/-SE) vitamin D intake from food was 30% greater (P = 0.023) in HIV-positive subjects (295 +/- 18 IU/d; n = 237) than in HIV-negative subjects (227 +/- 26 IU/d; n = 121). The prevalence of vitamin D supplement use was 29% (104 of 358 subjects) and did not differ significantly by HIV status (P = 0.87). Mean plasma 25(OH)D did not differ significantly (P = 0.62) between the HIV-positive (20.3 +/- 1.1 nmol/L; n = 238) and HIV-negative (19.3 +/- 1.7 nmol/L; n = 121) subjects, nor was HIV status a significant predictor of plasma 25(OH)D when multiple regression analysis was used to adjust for other variables. The prevalence of vitamin D insufficiency [plasma 25(OH)D < or = 37.5 nmol/L] in the subjects was 87% (312 of 359 subjects). CONCLUSIONS: HIV infection did not influence vitamin D status. The prevalence of vitamin D insufficiency in both HIV-positive and HIV-negative REACH subjects was high, perhaps because these disadvantaged, largely urban youth have limited sun exposure.     

Glutathione, glutathione peroxidase, and selenium status in HIV-positive and HIV-negative adolescents and young adults

BACKGROUND: Antioxidant nutrient deficiencies may hasten the progression of HIV disease by impairing antioxidant defenses. OBJECTIVE: The objective of the study was to determine whether HIV infection is associated with poor selenium status and low antioxidant protection by glutathione and glutathione peroxidase (GPX). DESIGN: In a cross-sectional study of 365 HIV-positive and HIV-negative adolescents and young adults, we examined the relation of plasma selenium, whole-blood glutathione, and whole-blood GPX to HIV status, disease severity, immune activation, and oxidative damage. RESULTS: Selenium deficiency (plasma selenium < 0.070 microg/mL) was not seen in any subjects, and plasma selenium in 244 HIV-positive subjects (0.120 +/- 0.0013 microg/mL) did not differ significantly (P = 0.071) from that in 121 HIV-negative subjects (0.125 +/- 0.0020 microg/mL) . However, multiple regression analysis after adjustment for covariates showed a significant (P = 0.002) negative association between HIV-associated immune activation (plasma neopterin) and plasma selenium concentrations. GPX activity was highest in HIV-positive subjects taking antiretroviral therapy (median: 14.2; 25th, 75th percentiles: 11.1, 18.7 U/mL; n = 130), intermediate in HIV-positive subjects not taking antiretroviral therapy (11.8; 9.4, 15.1 U/mL; n = 114), and lowest in HIV-negative subjects (10.6; 8.6, 12.7 U/mL; n = 121; P < 0.05 for all comparisons). GPX was also positively associated with malondialdehyde, a marker of oxidative damage. CONCLUSIONS: Subjects had adequate selenium status, although HIV-related immune activation was associated with lower plasma selenium concentrations. GPX activity appears to have been induced by the oxidative stress associated with HIV infection and use of antiretroviral therapy. Thus, young, well-nourished subjects can mount a compensatory antioxidant response to HIV infection.     

Calcium supplementation trials and bone mass development in children, adolescents, and young adults

The development of bone mass during childhood through young adulthood is an important determinant of bone health later in life, and calcium is the major building block. Most randomized, double-blind, placebo-controlled trials of calcium supplementation have been done in girls; however, calcium supplementation in boys has been investigated in recent studies. Positive short-term effects on bone measures during growth has been shown in boys and girls, particularly in weight-bearing appendicular bone, although the lifelong effect is not certain.     

间断口服铁剂改善儿童贫血及铁储备状态的研究

【目的】探讨不同口服铁剂补充方式改善儿童贫血及铁储备状态的作用。【方法】共107名营养性缺铁性贫血患儿随机分为常规量每日口服铁剂治疗组(A组),两日间隔口服铁剂治疗组(B组)以及每周间隔口服铁剂治疗组(C组)。测定三组患儿治疗前后血红蛋白(hemoglobing,HB)、红细胞平均容积(mean corpuscular volume,MCV)、红细胞平均血红蛋白量(mean corpuscular hemoglobin,MCH)和红细胞平均血红蛋白浓度(mean corpuscular hemoglobinconcentration,MCHC)、血清铁蛋白(serumferritin,SF)、可溶性转铁蛋白受体(soluble transferrin receptor,sTfR)水平及TfR-F指数。【结果】治疗后各组HB、MCV、MCH、MCHC以及SF均显著升高(P<0.05)而sTfR和TfR-F指数则明显降低(P<0.05),但组间无差异(P>0.05)。贫血改善率也无组间差异(P>0.05),但B组和C组的副反应发生率显著低于A组(P<0.05)。【结论】间断口服铁剂治疗缺铁性贫血副作用小,服药次数...     

Seropersistence and booster response following vaccination with FSME-IMMUN in children,adolescents, and young adults

BackgroundTick-borne encephalitis (TBE) is a viral disease that can have a severe clinical course and considerable long-term morbidity. As no curative treatment exists, vaccination is the primary means of prevention. Long-term antibody seropersistence 2–5 years after the 3-dose primary immunization and 3–10 years after first booster was evaluated, as well as booster responses in children, adolescents and young adults.MethodsSubjects who participated in these phase 4 prospective, open-label follow-up studies received all vaccinations with FSME-IMMUN. After 3-dose primary immunization, subjects were followed for 2–5 years. Overall, 205 out of 358 subjects (57%) received the first booster and 179 of these subjects (87%) enrolled in a further 10-year follow-up. Antibody seropersistence was assessed annually. Subjects with a TBE antibody titer below a pre-specified cut-off at the yearly blood draw received a booster. Seropositivity rates and geometric mean fold rises (GMFRs) were assessed.ResultsIn children who received their 3-dose primary immunization between 1 and 15 years of age, the seropositivity rate 5 years after the 3rd dose was 84.9% by NT and 72.0% by ELISA. One month post-first booster, all subjects were seropositive by NT and 98.5% by ELISA. Response to first booster by GMFR ranged from 3.7 to 11.4. At 5 years post-first booster, seropositivity was 99.4% by NT and 97.5% by ELISA, and at 10 years, was 90.3% by NT and 87.7% by ELISA. Although seropositivity rates differed between age groups, all subjects (100%) who received a second booster responded with a robust increase of TBEV antibodies.DiscussionLong-lasting seropersistence of TBEV antibodies after the 3-dose primary immunization and first booster was demonstrated as well as a competent immune memory response in those who received a first or second booster at any time during the 15-year follow-up. Therefore, an extension of FSME-IMMUN booster interval up to 10 years after the 3-dose primary immunization seems warranted.ClinicalTrials.gov Identifier: NCT00894686.     

Trends in diabetes prevalence among American Indian and Alaska native children,adolescents, and young adults

OBJECTIVES: This study determined trends in diabetes prevalence among young American Indians and Alaska Natives. METHODS: American Indian and Alaska Native children (< 15 years), adolescents (15-19 years), and young adults (20-34 years) with diabetes were identified from the Indian Health Service (IHS) outpatient database. The population living within IHS contract health service delivery areas was determined from census data. RESULTS: From 1990 to 1998, the total number of young American Indians and Alaska Natives with diagnosed diabetes increased by 71% (4534 to 7736); prevalence increased by 46% (6.4 per 1000 to 9.3 per 1000 population). Increases in prevalence were greater among adolescents and among young men. CONCLUSIONS: Diabetes should be considered a major public health problem among young American Indians and Alaska Natives.     

Immunogenicity of a meningococcal serogroup C conjugate vaccine in HIV-infected children, adolescents, and young adults

Children and adolescents infected with HIV typically have a lower response to immunization than do those in the general population. In most developed countries, meningococcal serogroup C conjugate vaccine is one of the recommended vaccines for such individuals. However, there have been no studies evaluating the antibody response to this vaccine in HIV-infected children, adolescents or young adults. In this study, we evaluated that response using serum bactericidal antibody (SBA) and enzyme-linked immunosorbent assay, comparing HIV-infected with non-HIV-infected patients, as well as analysing the occurrence of side effects. In non-responders, we assessed the antibody response to revaccination. This clinical trial involved 92 patients between 10 and 20 years of age: 43 HIV-infected patients (HIV+ group) and 49 non-HIV-infected patients (HIV- group). After one dose of the vaccine, 72.1% of the HIV+ group patients and 100% of the HIV- group patients were considered protected. Of the HIV+ group patients who received a second dose of the vaccine, only 40% acquired protection. Overall, 81.4% of the HIV+ group patients acquired protection (after one or two doses of the vaccine). Side effects occurred in 16.3% and 44% of the HIV+ group and HIV- group patients, respectively. Therefore, the meningococcal serogroup C conjugate vaccine proved to be safe and effective for use in HIV-infected children, adolescents, and young adults, although their antibody response was weaker than that shown by non-HIV-infected patients. This indicates the need to discuss changes to the immunization schedule for children, adolescents, and young adults infected with HIV, in order to ensure more effective protection against meningococcal disease.     

Cystic fibrosis in adolescents and young adults

Advances in knowledge and medical science have resulted in an increased life span and quality of life of patients with cystic fibrosis (CF). The median age of survival for CF patients is 32.3 years of age and patients 18 years of age or older now constitute one third of the total patients with CF. Because of these advances, a new patient population has emerged: the adolescents and young adults with CF. Adolescence is normally a time of great cognitive, social and developmental changes. Adolescents with CF not only have to deal with the normal changes expected, but also have to deal with the transition of assuming responsibility for their care from the parents and transitioning their care from a pediatric to an adult care team. Moreover, many of these young adults have to deal with the impact of the progressive deterioration of their CF disease. This review discusses issues of significance to this emerging patient population, including medical care, issues of disability, and psychosocial and other medical conditions associated with an increased life expectancy.     

成人缺铁性贫血调查分析

目的缺铁性贫血(iron deficiency anemia,IDA)是最常见的贫血,严重影响着人类的健康。本研究通过对IDA患者的病例进行分析,总结其人口学特征、病因和实验室检查情况,为IDA预防和诊治提供参考依据。方法选取2014-04-01-2017-04-01齐齐哈尔市第一医院收治的494例成人IDA患者为调查对象,收集患者临床资料进行回顾分析,分析成人IDA患者人口学特征、病因及实验室检查结果。结果 494例成人IDA患者中,男134例(27.1%),女360例(72.9%);年龄18～45岁171例(34.6%),45～60岁188例(38.1%),60岁135例(27.3%);城镇人口居多,为299例(60.5%),农村人口为195例(39.5%)。男性以胃肠道疾病为主要病因,女性以月经多为主要病因,老年患者胃肠道恶性肿瘤比例较高。实验室检查结果显示,血小板数增多检出率为55.3%,红细胞平均体积与血小板数量呈负相关,r=-0.211,P0.001;骨髓巨核细胞增多检出率高,为89.1%,骨髓增生明显活跃的检出率随贫血程度加重呈上升趋势,P=0.002。结论成人IDA患者主要以胃肠道疾病和女性月经过多为主要病因,对于成人男性患者及非月经增多所致的女性患者,尤其针对中老年患者,胃肠镜检查对确定IDA病因十分重要。对血小板增多的IDA患者临床医生需注意鉴别。     

Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children

In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.     

Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children

Although iron deficiency is the most common single-nutrient deficiency in infants and children, other deficiencies may develop concurrently, including zinc deficiency. In previous studies, we used home-fortification with "Sprinkles," single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods, to successfully treat anemia. This mode of micronutrient delivery is amenable to the delivery of other micronutrients. However, the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions. Thus, we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants, compared with Sprinkles formulated with iron alone. We studied 304 anemic infants (mean age 10.3 +/- 2.5 mo; hemoglobin 87.4 +/- 8.4 g/L) in rural Ghana. A combined supplementation group (FeZn) received daily Sprinkles containing 80 mg iron and 10 mg zinc; a comparison group (Fe) received Sprinkles (80 mg iron) without zinc for 2 mo. The rate of recovery from anemia was higher in the Fe group compared with the FeZn group (74.8 vs. 62.9%; P = 0.048). The plasma zinc concentration decreased significantly in both groups (P < 0.05). A significant decline in the height for age Z-score was observed in the FeZn group (P = 0.0011), but there was no change in the Fe group. These results suggest that in a controlled setting, home-fortification using micronutrient Sprinkles with iron, or iron and zinc, was very successful in treating anemia; however, this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population.