Apolipoprotein E4 influences growth and cognitive responses to micronutrient supplementation in shantytown children from northeast Brazil

Abstract

Objective: Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children.

Methods: A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children.

Results: Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9%. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence.

Conclusions: During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.

Trial registration: ClinicalTrials.gov NCT00133406.

Figure 1

The gel electrophoresis banding patterns used to genotype amplified DNA of study subjects digested with the HhaI restriction enzyme were as follows: (Column 1) 50-basepair DNA ladder; (Column 4) APOE2,3 genotype; (Column 5) APOE3,3 genotype; (Column 6) APOE3,4 genotype; (Column 7) APOE4,4 genotype; (Column 8) 100-basepair DNA ladder.

Figure 2

Scatter plots indicating significant positive Pearson correlations between the changes in anthropometric indicators over 4 months and cognitive testing in the APOE4(+) population receiving glutamine supplementation: (A) ΔHAZ* (t₄-t₀) vs. WRAML-delayed verbal learning (n = 21); (B) ΔWAZ* (t₄-t₀) vs. TONI-3-IQ (n = 21); and (C) ΔWHZ* (t₄-t₀) vs. TONI-3-IQ (n = 21). *HAZ = height-for-age z-scores, WAZ = weight-for-age z-scores, WHZ = weight-for-height z-scores.