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. 2022 Sep 23:9:921213.
doi: 10.3389/fnut.2022.921213. eCollection 2022.

Association between infection and nutritional status among infants in a cohort study of vitamin A in western Kenya

Frederick K Grant  1 , Rose Wanjala  2 , Jan Low  2 , Carol Levin  3 , Donald C Cole  4 , Haile S Okuku  1 , Robert Ackatia-Armah  5 , Amy W Girard  6
Affiliations

Association between infection and nutritional status among infants in a cohort study of vitamin A in western Kenya

Frederick K Grant et al. Front Nutr. .

Abstract

Background: Infection is associated with impaired nutritional status, especially for infants younger than 5 years.

Objectives: We assessed the impact of infection indicated by both acute phase proteins (APP), C-reactive protein (CRP), and α-1-acid-glycoprotein (AGP), and as reported by maternal recall on the nutritional status of infants.

Materials and methods: A total of 505 pregnant women were enrolled in a nested longitudinal cohort study of vitamin A (VA). Data from 385 children are reported here. The incidence and severity of respiratory infection and diarrhea (previous 14 days) were assessed by maternal recall; infant/child feeding practices were collected. Infant weight, recumbent length, and heel-prick capillary blood were taken at 9 months postpartum. Indicators of the VA status [retinol binding protein (RBP)], iron status (Hb, ferritin), and subclinical inflammation APP, CRP (>5 mg/L), and AGP (>1 g/L) were determined. Impacts of infection on the infant nutritional status were estimated using logistic regression models.

Results: Infection prevalence, based on elevated CRP and AGP levels, was 36.7%. For diarrhea reported symptoms, 42.4% of infants at 9 months had no indication of infection as indicated by CRP and AGP; for acute respiratory reported symptoms, 42.6% had no indication of infection. There was a significant positive association with infection among VA-deficient (RBP < 0.83 μmol/L) infants based on maternal reported symptoms but not with iron deficiency (ferritin < 12 μg/L). The odds of having infection, based on increased CRP and AGP, in underweight infants was 3.7 times higher (OR: 3.7; 95% CI: 2.3, 4.5; P = 0.019). Infants with iron deficiency were less likely (OR: 0.40; 95% CI: 0.1, 0.7; P = 0.001) to have infection based on CRP and AGP, while infants with VA deficiency were five times more likely (OR: 5.06; 95% CI: 3.2, 7.1; P = 0.0001) to have infection.

Conclusion: Acute phase proteins are more useful in defining infection in a population than reported symptoms of illness. Not controlling for inflammation in a population while assessing the nutritional status might result in inaccurate prevalence estimation.

Keywords: infants; infection; inflammation; iron deficiency; vitamin A deficiency.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Numbers and reasons for loss to follow up for the 505 women enrolled in the cohort study of vitamin A (COVA) in western Kenya.
See this image and copyright information in PMC

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References

    1. Thurnham DI. Interactions between nutrition and immune function: using inflammation biomarkers to interpret micronutrient status. Proc Nutr Soc. (2014) 73:1–8. 10.1017/S0029665113003662 - DOI - PubMed
    1. Gruys E, Toussaint MJ, Niewold TA, Koopmans SJ. Acute phase reaction and acute phase proteins. J Zhejiang Univ Sci B. (2005) 6:1045–56. 10.1631/jzus.2005.B1045 - DOI - PMC - PubMed
    1. Northrop-Clewes CA. Interpreting indicators of iron status during an acute phase response–lessons from malaria and human immunodeficiency virus. Ann Clin Biochem. (2008) 45:18–32. 10.1258/acb.2007.007167 - DOI - PubMed
    1. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. (2003) 111:1805–12. 10.1172/JCI200318921 - DOI - PMC - PubMed
    1. Thurnham DI, Mburu AS, Mwaniki DL, De Wagt A. Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc. (2005) 64:502–9. 10.1079/PNS2005468 - DOI - PubMed