Nutritional and Health-Related Environmental Studies (NAHRES)

Stable isotope technique to assess human milk intake in infants living in contaminated areas

Background

Death of young children in impoverished countries is commonly associated with the vicious cycle of malnutrition exacerbating infection, which in turn exacerbates malnutrition. Of the 10.6 million annual deaths of children under age 5, 19% are from acute respiratory infections including tuberculosis (TB), 17% from diarrhoeal diseases, and 8% from malaria; malaria alone accounts for 18% of such deaths in Africa. In at least one out of two of these deaths, malnutrition is a contributing factor (1).

Nutrition and infection interact in complex ways that are not yet fully understood. Anabolic energy and related nutrients are required to activate and propagate cells and synthesize an array of molecules involved in the immune response, and the energy cost of immunity may further impair the fitness of the host (2).

Although infection may generally tend to increase nutrient requirements, a competition may occur between the child host and the infectious agent for some nutrients. Such competition may help explain the apparent adverse effects of iron and folic acid supplementation of young children in a recent study in Pemba, Tanzania, a malaria endemic region (3). As a result of this study, the WHO recommended that universal iron supplementation should not be implemented in regions where malaria is endemic without screening to confirm that the individual child is iron deficient (4). The WHO statement also recommended research on safer ways to deliver absorbable iron to children to reduce iron deficiency anaemia without additional infectious risk. The WHO further called for research on other micronutrients, especially zinc, which may modify iron uptake or utilization. Zinc supplementation has been shown to reduce both the severity and duration of diarrhoea in children and is recommended in the clinical management of diarrhoea (5-6).

TB affects nutritional status, and malnutrition increases the likelihood that latent TB will develop into active disease (7). Mortality from TB is on the increase, especially in association with HIV infection. Poverty, partly reflecting poor nutrition, is the strongest risk factor for childhood TB infection. Anti-TB drug treatment usually improves nutrition, possibly improving appetite and food intake, reducing energy and nutrient needs, and improving metabolic efficiency. But changes in body composition may be limited to increases in fat rather than muscle mass, and more information is needed about the best nutritional support to improve body composition during and after pharmaceutical treatment.

Using stable isotope techniques, this CRP will contribute experimental evidence to help design nutritional care to reduce morbidity and mortality of infants and children from malaria, TB, and other infectious diseases. 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.


Objective
Overall objective
  • The overall objective is to contribute to development or monitoring of practices for improving the nutrition of infants and young children at high risk of infectious diseases such as malaria and tuberculosis.
Specific objectives
  • Evaluate the absorption of micronutrients such as iron and zinc to help define the dose, chemical form, mode and timing of oral administration for prevention or treatment of nutrient deficiencies without exacerbating infectious conditions.
  • Evaluate the body composition, energy expenditure, and vitamin A reserves of children with infectious diseases, to contribute to the development or monitoring of best practices for nutritional management.
Expected research outputs
  • New data on procedures for the effective and safe administration of micronutrients such as iron and zinc to infants and children at risk of infectious diseases.
  • New data on the usefulness of nutritional interventions for improving lean body mass, energy utilization, and vitamin A reserves of infants and children susceptible to infectious diseases.
  • Publications in the form of scientific reports and peer-reviewed papers.
Expected Research Outcomes

To contribute to improved management of the nutrition of infants and young children at high risk of infectious diseases.

Proposal submission forms

Research institutions in Member States interested in participating in this CRP are invited to submit proposals directly to the Research Contracts Administration Section (NACA) of the International Atomic Energy Agency:
Official.Mail@iaea.org or to Ms Janet R. Hunt: Ja.Hunt@iaea.org. The forms can be downloaded from http://www-crp.iaea.org/html/forms.html. For more information about research contracts and research agreements, please visit our web-site: http://www-crp.iaea.org/html/faqs.html.

Deadline for submission of proposals

Proposals must be received no later than 1 August 2009. Transmission via Email is acceptable if all required signatures are scanned.

For additional information, please contact:
Janet Hunt, Nutrition Specialist
Nutritional and Health-Related Environmental Studies Section
Division of Human Health
International Atomic Energy Agency (IAEA)
Wagramer Strasse 5
A-1400 Vienna Austria
Phone: + 43 1 2600 21680 or 21681
Fax: + 43 1 26007
Ja.Hunt@iaea.org


References
  1. WORLD HEALTH ORGANIZATION, World Health Report: Make every mother and child count, WHO, Geneva (2005).
  2. SCHAIBLE, U.E., KAUFMAN, S.H.E., Malnutrition and Infection: Complex Mechanisms and Global Impacts, PLoS Med 4(5) (e115) (2007) 0806-12.
  3. SAZAWAL, S., BLACK, R.E., RAMSAN, M., CHWAYA, H.M., et al., Effects of routine prophylactic supplementation with iron and folic on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial, The Lancet 367 (2006) 9505.
  4. WORLD HEALTH ORGANIZATION, Conclusions and recommendations of the WHO Consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas, Food Nutr. Bull. 28(4) (2007) S621-7.
  5. WORLD HEALTH ORGANIZATION, Dept. of Child and Adolescent Health and Development/UNICEF Clinical management of acute diarrhoea: WHO/UNICEF joint statement [WHO/FCH/CAH/04.7; UNICEF/PD/Diarrhoea/01], Geneva (2004).
  6. LAZZERINI, M., RONFANI, L., Oral zinc for treating diarrhoea in children, Cochrane Database Syst. Rev. 16(3) (2008) CD005436.
  7. AFRICA’S HEALTH IN 2010 PROJECT/ACADEMY FOR EDUCATION DEVELOPMENT (AED), Nutrition and Tuberculosis: A review of the literature and considerations for TB control programs. United States Agency for International Development (USAID) (2008).