Graduate student in Dr. Ken Brown's Lab Studies Optimal Supplement Level for Stunted Children in Ecuador

Sara Wuehler, a Ph.D. student in Dr. Ken Brown's lab, conducted a benefit-risk study in Ecuador to determine the optimal dose of zinc supplements for 1-3 year old stunted children. Changes in growth and biochemical markers of zinc status were the major outcomes assessed during the six months of intervention.

Sara Wuehler conducted the study in three provinces of Ecuador, including the coastal rain forest and both rural (Latacunga) and urban (Quito) sites in the Andean highlands. The purposes of the study were to: 1) define the minimum safe and effective dose of zinc supplementation for young children at risk of zinc deficiency, and 2) determine whether copper should be given along with zinc. After baseline censusing and anthropometric assessment, stunted children are treated for anemia and randomly assigned to treatment with daily, masked supplements containing 0, 3, 7 or 10 mg of zinc, or 10 mg of zinc with 0.5 mg copper. The children were then visited 3-5 times per week by a community health worker to supervise supplementation and record morbidity histories. Clinical exams and dietary, anthropometric, and biochemical assessments are repeated at intervals. Biochemical analyses include plasma zinc and copper, ceruloplasmin, ferritin, HDL and total cholesterol, hemoglobin and erythrocyte SOD. Metallothionein mRNA and certain zinc transporters are being measured in a sub-population. To date, 467 children have been enrolled, and 204 have completed the study. An additional 150-200 children will be enrolled before the study is completed.

Program in International & Community Nutrition Student Conducts Zinc Study in Peru

Joanne Arsenault, a graduate student working with Dr. Kenneth Brown in the Program in International & Community Nutrition, carried out a study in Peru to examine the effect of zinc, given either as a liquid supplement or as a fortified-cereal, on infant growth, morbidity, body composition, energy intake, and hormones that affect appetite.

Zinc administered in liquid supplements has been shown to have positive effects on growth and morbidity in children in developing countries. However, little is known about the health effects of additional zinc provided by a zinc-fortified food. In this study, infants enrolled at 6-8 months of age receive a liquid multivitamin supplement and iron-fortified, wheat-based cereal every day for 6 months. One-third of the infants receive zinc in the liquid supplement, one-third receive zinc in the cereal, and the remainder do not receive added zinc. The infants are visited 2-3 times per week in their homes by study personnel who monitor morbidity symptoms and consumption of the cereal and liquid supplement. Information on dietary intake is obtained by 12-hour observation and weighing of all foods consumed. The infants’ weight and length are measured and blood samples are collected at various timepoints. In a sub-group of infants, body composition and hormones affecting appetite are being measured. Approximately 260 children will have completed the study by November 2004.

Dr. Kathryn Dewey Studies Growth Patterns of Youngsters

A UC Davis nutritionist who specializes in the health of mothers and children is part of a global research team working to develop better growth charts to monitor the health and development of young children. Dr. Kathryn Dewey recently directed the only United States research site for a worldwide research project, coordinated by the World Health Organization, to revise growth charts for children under the age of 5 years.

Previous research by Dewey and other nutritionists suggests that current growth charts, used to gauge whether children are growing appropriately, don't accurately reflect the growth patterns of breast-fed children. Dewey's team collected data on the growth of some 700 children in the Davis area, which will be used in revising the World Health Organization growth charts.

"At certain ages, breast-fed babies tend to grow more slowly than do formula-fed children," said Dewey. "The concern is that health professionals might mistake this slower growth for a failure to thrive and recommend that the mother switch to formula."

Research has shown that breast milk is effective in warding off illnesses such as ear infections and diarrhea, and helps boost mental development. Dewey has been researching maternal and infant nutrition for more than 15 years. Her work includes studies on infant growth and nutrition, the impact of nutrition and exercise on nursing moms, breastfeeding and post-childbirth weight loss in mothers, and growth problems in infants and children in developing countries.

Drs. Kenneth Brown and Marjorie Haskell of the UC Davis Program in International & Community Nutrition study night blindness in pregnant Nepalese women

The Program in International & Community Nutrition at the University of California at Davis has received a three-year grant from the Bill & Melinda Gates Foundation. Dr. Kenneth Brown, director of the program, and researcher Dr. Marjorie Haskell used the funding to study several treatments for night blindness in pregnant Nepalese women.

Approximately 10 percent of pregnant women in remote regions of Nepal suffer from night blindness and are 7 1/2 times more likely to die of pregnancy-related complications than other women. The work done by Brown and Haskell will help counteract vitamin A and other nutrient deficiencies associated with night blindness. The purpose of this study is to assess the efficacy of food-based strategies for reversing symptoms of nightblindness and improving vitamin A status in pregnant, nightblind Nepalese women. Food-based approaches may be the only safe and logistically feasible approach for reversing symptoms of nightblindness and improving vitamin A status in these women.

Specifically, they are evaluating the efficacy of locally available vitamin A-rich foods (amaranth leaves, carrots, or goat liver) or vitamin A-fortified Ultra-riceTM for reversing symptoms of nightblindness and improving vitamin A status in pregnant, nightblind Nepalese women. Participants receive a food source of vitamin A and a placebo capsule, or a non-vitamin A containing food with a vitamin A capsule containing the same amount of vitamin A provided by the vitamin A-rich foods (0.85 mg RE). The foods and capsules are provided 6 days/wk, for a period of six weeks. The project took place in the district of Saptari in the eastern Terai area of Nepal. The foods are prepared at the field facility daily, packaged into individual thermoses and delivered to the women by teams of transporters and motivators who travel to the womens' homes by motorcycle. Participants visited the field clinic weekly for dark-adaptation testing and for assessment of recent dietary intake and morbidity. Blood samples and anthropometric measurements were obtained at the first and final clinic visits (wks 1 and 7). Final mean dark adaptation scores (pupillary thresholds) and biochemical indicators of micronutrient status will be compared across treatment groups to evaluate the efficacy of the various dietary treatments for reversing symptoms of nightblindness and improving maternal vitamin A and micronutrient status.

An obstetrical approach to reduce infant iron deficiency and anemia in Mexico

Graduate student Camila Chaparro and Dr. Kathryn Dewey investigate an obstetrical approach to reduce infant iron deficiency and anemia, which can affect up to 50% of children in developing countries by one year of age. The timing of clamping of the umbilical cord at delivery has an important effect on a newborn's blood iron.

Previous work done by Dr. Dewey and co-investigators in Guatemala showed positive effects of delayed clamping on iron status of infants at 2 months of age. However, it was not known whether this was a short-lived effect or whether this improved iron status would persist until later in infancy.

The study in Mexico, which is done in collaboration with the National Institute of Public Health of Mexico and a large obstetric hospital in Mexico City, enrolled 476 normal-weight, term infants and their mothers, who were randomly assigned to have immediate or late clamping of the umbilical cord. They were followed through 6 months of age, with information on the infant's diet, morbidity and growth collected at three time points, and hematological and iron status measured at the beginning and end of the study. Preliminary results show that late clamping significantly improved the iron status of infants at 6 months of age, especially benefiting infants who had not received any iron fortified formulas, and infants born to iron deficient mothers.

Because of the high prevalence of iron deficiency and anemia in infants and children and the detrimental effects of anemia on child development, interventions to prevent iron deficiency and anemia are a high priority. Delayed cord clamping is an especially appealing option because it can be easily implemented at birth at essentially no cost.

Study completed in Ghana by UC Davis researchers shows that infants who consumed a fat-based nutrient supplement from 6 to 12 months of age showed no deficit in growth or motor development

Recent graduate of the UC Davis Graduate Group in Nutritional Biology Ph.D. Program, Dr. Seth Adu-Afarwuah and Nutrition Department faculty member Dr. Kathryn Dewey have completed a study in Ghana that showed that infants who consumed Nutributter, a fat-based nutrient supplement, showed no deficit in either growth rate or gross motor development compared to international standards.

In Ghana, UC Davis researchers conducted a randomized controlled trial of ~400 infants in 4 groups. One group received 20 g/day (108 kcal/day) of a fat-based nutrient supplement called "Nutributter", added daily to complementary foods given to children between 6 and 12 months of age. Results for this group were compared with those for groups who received daily a multiple micronutrient powder, a crushable multiple micronutrient tablet, or no intervention during the same period. Iron status and prevalence of anemia were improved in all three of the intervention groups, but only in the Nutributter group was there an impact on growth. In that group, there was no faltering in length gain between 6 and 12 months, whereas in the other groups there was the typical decline in relative length-for-age compared to WHO growth standards that one sees in most developing country populations.

The statistical analysis suggested that the effect on growth was largely due to the essential fatty acids provided by the Nutributter, not to increased calories. Motor development of the infants was assessed at 12 months. In the non-intervention control group, only 25% of the infants were able to walk independently at that age, which is half of what would be expected in a healthy population (50% should be walking at 12 months) and indicative of developmental delay in the general population. In all three intervention groups, there was a significant improvement in this outcome, but the percentage able to walk at 12 months was higher in the Nutributter group (49%) than in the two groups that received the micronutrient powder (39%) or tablet (36%). Thus, the Nutributter group showed no deficit in either growth or gross motor development compared to international standards, which is a remarkable outcome.

Results from the study were recently published in an article in the American Journal of Clinical Nutrition titled "Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development." Dr. Adu-Afarwuah now works as aNutrition Specialist with UNICEF-Ghana, supporting the UNICEF Nutrition Officers in the planning and implementation of nutrition intervention activities in Ghana. His research interests include the development and evaluation of low cost interventions to improve nutrition and health of infants and children in low income populations.

Graduate Student Patrice Armstrong and Dr. Charles Stephensen Study the Effects of Genes and Diet on Inflamation-mediated Heart Disease Risk Among African-Americans

Graduate student Patrice Armstrong and Dr. Charles Stephensen are studying the effects of genes and diet on inflammation-mediated heart disease risk among African-Americans. The body’s inflammatory response relies upon signal molecules such as leukotrienes, prostaglandins, and cytokines. Increased inflammation from these signals raises heart disease risk.

The project, funded by the National Center for Complementary and Alternative Medicine, is a collaboration between UC Davis, the USDA’s Western Human Nutrition Research Center, and researchers in Sacramento and Oakland.

The team is studying 5-lipoxygenase, a gene in the leukotriene biosynthesis pathway. Several variant forms of the 5-lipoxygenase gene are found in human populations. Some variants confer increased heart disease risk relative to the most common form of the gene, whereas others are associated with decreased risk. In addition, the 5-lipoxygenase gene is nutritionally responsive: its activity can be changed by changes in dietary fatty acid composition.

The research team is screening healthy African-American adults, aged 20 to 59, to see which variants of the 5-lipoxygenase gene are found in this population. The team hypothesizes that high-risk gene variants are common among African-Americans, and may contribute to their high rates of heart disease.

After screening, subjects with six variants of the 5-lipoxygenase gene that confer different levels of heart disease risk are being recruited for the study’s nutrition intervention. During the intervention, subjects consume an omega 3 fatty acid supplement (fish oil) or a placebo for 6 weeks. Omega 3 fatty acids have known anti-inflammatory effects, including reducing activity of the 5-lipoxygenase gene. The researchers are measuring a variety of inflammatory markers and heart disease risk factors both before and after the treatment. They anticipate that people with the gene variants that confer higher risk of heart disease may experience the greatest reductions in inflammation and thus benefit most from consuming fish oil supplements. If this hypothesis is correct, the study’s results could eventually be used to design individually-tailored diet plans aimed at preventing heart disease.

UC Davis Nutritional Biology Graduate Group Student Andrew Hall Studies Maternal Health and Pregnancy Outcomes Among Rural Vietnamese Women

Women in rural areas of Vietnam often suffer from poor nutrition, underweight and anemia. When they become pregnant, these women are at high risk for inadequate weight gain, complications of pregnancy, and unfavorable birth outcomes.

UC Davis Nutritional Biology Ph.D. student Andrew Hall and Research Professor Dr. Janet King are developing a low-cost nutrition intervention designed to improve maternal health and pregnancy outcomes among rural Vietnamese women. Their study will recruit approximately 500 women of childbearing age from 21 communes in rural Vietnam.

During the two-year study, women in control communes will receive nutrition education, while those in treatment communes will receive nutrition education and a daily food supplement. The supplement will consist of locally available animal-source foods such as chicken eggs, small shrimp, field crabs, and small fish. Animal-source foods are rich in nutrients needed for fetal development, including iron, zinc, vitamin A, and vitamin B12. However, in rural Vietnam, social and economic obstacles and dietary taboos observed during pregnancy often limit women’s consumption of these foods.

The foods will be prepared by study cooks according to local tastes, and will be eaten by subjects at the study center. Some women will receive food supplements throughout the study, beginning before they become pregnant. Others will start receiving the supplements in the second trimester of pregnancy, the time when local customs dictate dietary changes for expectant mothers.

The research team anticipates that maternal health and infant birth weight and health will be improved more by the daily food supplement than by nutrition education alone. Because prior studies have shown strong effects of maternal nutrient status at conception on the offspring’s future health, they also expect that improving women’s diets before pregnancy will have greater benefits than waiting until pregnancy to initiate dietary changes. The researchers hope their findings will be used to develop sustainable, locally sourced, low-cost nutrition interventions that will improve maternal and child health in Vietnam and other developing countries.