title: The effects of micronutrient-fortified complementary/replacement food on intestinal permeability and systemic markers of inflammation among maternally HIV-exposed and unexposed Zambian infants.
abstract: The present randomised trial investigated the effects of feeding Zambian infants from 6 to 18 months old either a richly or basal micronutrient-fortified complementary/replacement food on gut integrity and systemic inflammation. Blood samples were obtained from all infants (n 743) at 6 and 18 months for the assessment of serum C-reactive protein (CRP) and α1-acid glycoprotein (AGP). A subsample of 502 infants, selected from the main cohort to include a larger proportion of infants with HIV-positive mothers, was assigned to lactulose/mannitol gut permeability tests. Lactulose:mannitol (L:M) ratio analyses were adjusted for baseline urinary L:M ratio, socio-economic status, mother's education, season of birth and baseline stunting, and stratified by maternal antenatal HIV status, child's sex, concurrent breast-feeding status and anaemia at baseline. There was no significant difference in geometric mean L:M ratio between the richly fortified and basal-fortified porridge arms at 12 months (0·47 (95 % CI 0·41, 0·55) v. 0·41 (95 % CI 0·34, 0·49); P = 0·16 adjusted). At 18 months, the richly fortified porridge group had a significantly higher geometric mean L:M ratio than the basal-fortified group (0·23 (95 % CI 0·19, 0·28) v. 0·15 (95 % CI 0·12, 0·19); P = 0·02 adjusted). This effect was evident for all stratifications, significantly among boys (P = 0·04), among the infants of HIV-negative mothers (P = 0·01), among the infants of HIV-negative mothers not concurrently breast-fed (P = 0·01) and among those who were not anaemic at baseline (P = 0·03). CRP, but not AGP, was positively associated with L:M ratio, but there were no significant effects of the diet on either CRP or AGP. In conclusion, a richly fortified complementary/replacement food did not benefit and may have worsened intestinal permeability.
authors: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. anne.mullen@kcl.ac.uk
authors: Anne
authors: A
authors: Mullen
authors: Laura
authors: L
authors: Gosset
authors: Natasha
authors: N
authors: Larke
authors: Daniela
authors: D
authors: Manno
authors: Molly
authors: M
authors: Chisenga
authors: Lackson
authors: L
authors: Kasonka
authors: Suzanne
authors: S
authors: Filteau
mesh_terms: D000740:Anemia / Q000150:complications; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D005527:Food, Fortified / Q000032:analysis; D006679:HIV Seropositivity / Q000151:congenital / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000032:analysis; D007408:Intestinal Absorption; D007422:Intestines / Q000276:immunology / Q000503:physiopathology; D007792:Lactulose / Q000378:metabolism / Q000652:urine; D059012:Lost to Follow-Up; D008286:Malabsorption Syndromes / Q000150:complications / Q000178:diet therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008353:Mannitol / Q000378:metabolism / Q000652:urine; D018977:Micronutrients / Q000627:therapeutic use*; D010539:Permeability; D012727:Sex Characteristics; D015024:Zambia
chemical_list: D018977:Micronutrients; D008353:Mannitol; D007792:Lactulose; D002097:C-Reactive Protein