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Keshan disease is a potentially fatal cardiomyopathy in humans. Selenium deficiency, T-2 toxin, and myocarditis virus are thought to be the major factors contributing to Keshan disease. But the relationship among these three factors is poorly described. This study aims to explore whether selenium deficiency aggravates T-2 toxin-induced cardiomyocyte injury and its underlying mechanism. Cardiomyocytes were isolated from neonatal rat and cultured at the physiological (2.0 μM) or lower concentrations of selenium with different concentrations of T-2 toxin. Our results showed that selenium deficiencies aggravated T-2 toxin-induced cardiomyocyte injury in a concentration-dependent manner as demonstrated by MTT bioassay, LDH activity, reactive oxygen species levels and caspase 3 protein expressions. T-2 toxin treatment significantly increased mRNA expressions for stress proteins GRP78 and CHOP in cardiomyocytes compared with the control. Selenium deficiencies further promoted GRP78, CHOP and p-eIF2α expressions. Knockdown of CHOP by the specific small interfering RNA eliminated the effect of selenium deficiencies on T-2 toxin-induced injury. It could be concluded that selenium deficiency aggravates T-2 toxin-induced cardiomyocyte injury through initiating more aggressive endoplasmic reticulum stress., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Impressive strides are being made in the understanding of trace element metabolism and function. This is underscored by the many contributions in these proceedings. However, not so impressive are: i) the precise recognition of mild trace element deficiencies and how to establish their functional consequences, possibly confounded by concurrent trace element inadequacies, are difficult to assess, ii) approaches to the quantitative determination of requirements for trace elements remain unsatisfactory and archaic, in so many ways, iii) our understanding of the extent of the biological basis for the variation in requirements among apparently similar individuals is poor, and iv) much needs to be learned about the quantitative extent to which genetic, epigenetic and dietary factors interact to determine the nutritional phenotype. Some ideas are presented as to how we might embrace, in the context of a reconstructive approach, the exciting new knowledge and related techniques emerging during the postgenome era and develop new paradigms for assessing trace element needs and status, and for establishing effective nutrient intake under different conditions of complex genotype-environment interactions. Metabolites are functional cellular entities and I also urge a vigorous application of metabolomics and of metabolic profiling that is closely linked with genomics, proteomics, trace element kinetics and system analysis, as components of the new integrative paradigm. We need to understand the system and its strategy, not only the molecular details of its component parts and its individual controls. An interdisciplinary research and teaching enterprise will be necessary to best achieve this aim. All of this is related to our common goal to promote, through expanded biological knowledge and its effective application, the enhanced role of trace elements for human well-being.

Objective: To review the literature addressing the care of neonatal skin., Data Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization., Study Selection: Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review., Data Extraction: Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown., Data Synthesis: Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity., Conclusions: This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Objective: To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y., Design: Cross sectional study., Study Setting: Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India., Participants: The study included 1094 all children under 6 y of age, from two randomly selected urban slums., Methods: Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group., Results: Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased., Conclusions: Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.

Background: Thiamine deficiency (beriberi) is common in some parts of southeast Asia. Acute thiamine deficiency can mimic many complications of malaria, such as encephalopathy and lactic acidosis. We examined the incidence of thiamine deficiency in adults admitted to hospital with malaria in Thailand., Methods: For this prospective study, we recruited consecutive patients with malaria or other febrile illness who presented to Paholpolpayuhasena Hospital, Kanchanaburi, Thailand, between May and July, 1992. We used the activation coefficient (alpha) for transketolase activity in erythrocytes to measure thiamine deficiency (defined as alpha>1.31) in patients with severe and uncomplicated malaria and in controls (patients' relatives and healthy volunteers). To exclude the possibility of interference in the assays, transketolase activity was also measured in erythrocytes used to culture parasites., Findings: 12 (52%) of 23 patients with severe malaria and ten (19%) of 54 patients with uncomplicated malaria had alpha values above the normal range (p<0.0001 and p=0.0014, respectively, compared with controls), which indicated severe thiamine deficiency. Thiamine deficiency was more severe in patients with cerebral malaria than in those with uncomplicated malaria and the controls (p=0.008)., Interpretation: In adults admitted to hospital in Thailand, thiamine deficiency commonly complicates acute falciparum malaria, particularly in severe infections, and could contribute to dysfunction of the central nervous system.

A nutrition survey was performed in 1990 among children 6 through 35 mo of age living in Palestinian refugee camps in Syria, Jordan, the West Bank, Gaza Strip and Lebanon. Overall, 67% [95% confidence interval (CI): 66, 68] were anemic (hemoglobin <110 g/L), ranging from 54% in the West Bank to 75% in Syria. The following factors were significantly associated with anemia in one or more of three age groups (6-11.9, 12-23.9 and 24-35.9 mo) by logistic regression: living in Syria, Lebanon, or Gaza [with prevalence odds ratios (POR) in the range of 1.4-2.6 depending on the age group and area, relative to children living in Jordan]; never having been breast-fed (POR = 1.7); male sex (POR = 1.2); maternal illiteracy (POR = 1.4 relative to those with >/=6 y of education); having a recent (within 2 wk) or current episode of fever or diarrhea; and stunting. Recent or current illness and stunting interacted in two age groups with the general trend of stunted children with recent or current illness having high POR. Early childhood anemia is associated with factors reflecting poor socioeconomic status and recent diarrheal and febrile illnesses in Palestinian refugee camps.

Vitamin B-12 status was evaluated in 113 Guatemalan women and their infants at 3 mo of lactation. Plasma vitamin B-12 was deficient or low in 46.7% of the mothers, and holotranscobalamin II (holo TC II) concentrations were low in 32.3%, which may indicate vitamin B-12 malabsorption. Only 9% had deficient or low plasma folate. Breast milk vitamin B-12 was low in 31%, and negatively correlated with infant urinary methylmalonic acid (UMMA, r = -0.22, P < 0.05, n = 88); UMMA was elevated in 12.2% of the infants, indicating vitamin B-12 deficiency. Mothers of the infants with elevated UMMA had significantly lower concentrations of vitamin B-12 in their breast milk compared with mothers of infants with normal UMMA concentrations (410.7 +/- 247.7 vs. 705.3 +/- 487.5 pmol/L, P = 0.05, n = 87). Mean maternal dietary intake of vitamin B-12 was significantly correlated with plasma vitamin B-12 (r = 0.20, P = 0. 05, n = 94) and was the main determinant of plasma vitamin B-12 in a linear regression model. Determinants of maternal holo TC II concentrations included dietary intake of vitamin B-12 and Giardia lamblia infection. There were no statistically significant determinants of infant UMMA concentrations. We conclude that vitamin B-12 deficiency is highly prevalent in these lactating women and is associated with depletion of the vitamin in their infants. The cause of the maternal deficiency is unknown, but malabsorption exacerbated by low dietary intake of the vitamin is a possibility.

Background: Factors that influence shedding of HIV-1 infected cells in cervical and vaginal secretions may be important determinants of sexual and vertical transmission of the virus. We investigated whether hormonal contraceptive use, vitamin A deficiency, and other variables were risk factors for cervical and vaginal shedding of HIV-infected cells., Methods: Between December, 1994, and April, 1996, women who attended a municipal sexually transmitted diseases (STDs) clinic in Mombasa, Kenya, and had previously tested positive for HIV-1, were invited to take part in our cross-sectional study. Cervical and vaginal secretions from 318 women were evaluated for the presence of HIV-1 infected cells by PCR amplification of gag DNA sequences., Findings: HIV-1 infected cells were detected in 51% of endocervical and 14% of vaginal-swab specimens. Both cervical and vaginal shedding of HIV-1 infected cells were highly associated with CD4 lymphocyte depletion (p = 0.00001 and p = 0.003, respectively). After adjustment for CD4 count, cervical proviral shedding was significantly associated with use of depot medroxyprogesterone acetate (odds ratio 2.9, 95% CI 1.5-5.7), and with use of low-dose and high-dose oral contraceptive pills (3.8, 1.4-9.9 and 12.3, 1.5-101, respectively). Vitamin A deficiency was highly predictive of vaginal HIV-1 DNA shedding. After adjustment for CD4 count, severe vitamin A deficiency, moderate deficiency, and low normal vitamin A status were associated with 12.9, 8.0, and 4.9-fold increased odds of vaginal shedding, respectively. Gonococcal cervicitis (3.1, 1.1-9.8) and vaginal candidiasis (2.6, 1.2-5.4) were also correlated with significant increases in HIV-1 DNA detection, but Chlamydia trachomatis and Trichomonas vaginalis were not., Interpretation: Our study documents several novel correlates of HIV-1 shedding in cervical and vaginal secretions, most notably hormonal contraceptive use and vitamin A deficiency. These factors may be important determinants of sexual or vertical transmission of HIV-1 and are of public health importance because they are easily modified by simple interventions.

Unlabelled: Vitamin A deficiency is a major cause of morbidity, mortality and blindness among children. Although vitamin A deficiency is known to affect many children in developing countries, the magnitude of the problem in the South Pacific region is unclear., Methods: Five cross-sectional surveys for vitamin A deficiency were conducted between 1989 and 1992 in the Republic of Kiribati, Tuvalu, the Republic of Vanuatu, Solomon Islands and the Cook Islands., Results: In total, 10,673 children between the ages of 6 and 72 months were examined for clinical signs of vitamin A deficiency (nightblindness and xerophthalmia). The prevalence of xerophthalmia was 14.76% in the Republic of Kiribati, 1.55% in Solomon Islands, 0.59% in the Cook Islands, 0.28% in Tuvalu, and 0.11% in Vanuatu. The most common clinical findings were Bitot's spots followed by nightblindness. Xerophthalmia were more common among boys (Kiribati P < 0.001, Solomon Islands P = 0.03) and tended to occur in older preschool children (P < 0.0001)., Conclusions: These studies suggest that vitamin A deficiency is a public health problem in the Republic of Kiribati and Solomon Islands.

The prevalence of night blindness during pregnancy and lactation was assessed in a sample of 426 women living in the rural terai of Nepal. These women were also examined for ocular signs of vitamin A deficiency. Among 241 lactating women, 16.2% reported experiencing night blindness at some time during the pregnancy that produced the infant they were now breast-feeding. Among 185 pregnant women, 8.1% reported being night-blind at the time of the interview. The odds of night blindness in the current pregnancy were six times greater for women who reported night blindness in their previous pregnancy. Night-blind women were more likely to come from households with lower socioeconomic status. Teenage women and those over the age of 30 were at highest risk, particularly those of higher parity within these age groups. Vitamin A deficiency, for which night blindness is a marker, seems to be a problem in this population of pregnant and lactating women, with potential health consequences for women and their infants.

The virtual elimination of vitamin A deficiency and all its consequences is high on the political agenda as a solvable public health problem by the end of the decade. Five to six times more children in the developing world are likely to be subclinically than clinically deficient. Subclinical deficiency can be detected by newer methodological approaches. Subclinically deficient children are at increased risk of severe and fatal infections. The problem at a population level is avoidable by the appropriate selection and application of a mix of available interventions. Countries are challenged to assess, analyze and take actions to incorporate nutrition concerns into development planning to attain end-of-decade goals.

Although the association between nutritional status and mortality risk is obvious for extreme malnutrition, the issue is not so clear for mild to moderate undernutrition. We have investigated this association in children of 0-5 years in the rural area of Bwamanda, Zaire, where an integrated development project, with good medical facilities, has operated for 20 years. A random cluster sample of 5167 children was taken; newborn infants and immigrants were included at six quarterly survey rounds from October, 1989, until February, 1991. All surveys included clinical and anthropometric assessment of nutritional status. Deaths were recorded up to April, 1992; there were 246 deaths. Marasmus, kwashiorkor, and other causes of death were defined by the verbal autopsy method and checked against medical records kept at the central hospital and the peripheral dispensaries. As expected, we found an increased risk of death in severe malnutrition. When deaths directly attributed to marasmus or kwashiorkor were excluded, mild to moderate stunting or wasting were not associated with higher mortality in the short term (within 3 months of the previous study round) or in the long term (from 3-30 months after study entry). The commonest causes of death were malaria and anaemia. Extreme marasmus and kwashiorkor caused 16% of deaths, and are important causes of death even in this favoured area with an integrated development project. Nutritional interventions should be targeted more selectively so that children with moderate malnutrition can be protected from progression to marasmus or kwashiorkor.

Pyridinoline (PYD) and deoxypyridinoline (DPD) are cross-linking aminoacids of collagen that are located mainly in bone and cartilage. When bone matrix is resorbed these cross-links are quantitatively excreted in the urine and therefore represent specific markers. We have measured the urinary excretion rate of PYD and DPD in 46 severely malnourished boys to assess their skeletal turnover and to relate this to their subsequent rate of growth. The children were aged 13 months (SD 6), and height-for-age was -3.6 (1.6) Z-score, and weight-for-height was -2.4 (0.8) Z-score. PYD excretion when malnourished and after "recovery" was 11.2 (4.6) nmol h-1m-2 and 32.2 (10.8) nmol h-1m-2 and DPD excretion was 2.6 (1.3) nmol h-1m-2 and 7.5 (3.0) nmol h-1m-2, respectively. The ratio of the two cross-links did not change with recovery. These data show that cartilage and bone turnover is much lower in the malnourished than in the recovered child. There was no difference in the degree of depression of turnover between the children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain during recovery was significantly related to cross-link excretion, age, and weight-for-height on admission. These three factors accounted for 44% of the variance in the height velocity of the children. PYD and DPD excretion rate could be used to assess therapeutic interventions designed to alleviate stunting.

The present study determined the effect of duration of feeding and dietary levels of rapeseed flours on growth, outcome of gestation and lactation and blood trace element content of rats. In the first two experiments, female rats were fed either casein or rapeseed flour diets during gestation and lactation, or prior to and during gestation. In the last two experiments, weanling male rats were fed for 4 weeks either casein or rapeseed flour diets with or without added zinc. Feeding rapeseed flours prior to and/or during gestation caused a reduction in weight gains and food consumption but did not affect the number or weight of the pups born. Plasma zinc levels were low in the mother rats at parturition and plasma zinc and iron levels were low in weanling rats after 4 weeks of feeding the rapeseed diets. Adding 300 ppm zinc to the diet prevented the decrease in food consumption, weight gains and plasma zinc levels in the weanling rats. It is concluded that the recommended levels of trace elements in the rat diet are inadequate for the purpose of bioassay and toxicological evaluation or rapeseed preparations. In order that the nutritional potenital of new protein sources be correctly evaluated, guidelines for adequacy of mineral in such diets should be determined.

In a cross-sectional study, children 0-6 yr of age from eight different population groups in Africa and Asia were examined. Clinical assessment defined 8750 children as being well nourished and 194 as having marasmus. Height, weight, arm circumference (AC), and triceps skinfold thickness were measured; the latter two measurements and the clinical assessment were done by the same observer. Based on data from normal children, local growth curves were computed for each group. Each child's growth was expressed in standard deviation scores (SDS) of his own group. On the basis of the results of a discriminant analysis, all variables were ranked by their decreasing power to discriminate between normal and marasmic children. For 83% of the children one measurement (AC/age) is sufficient to classify them definitely; for the others several variables are needed. This strategy yields an overall sensitivity of 80%, a specificity of 97%, and a positive predictive value of 38%.

In Arsi and Bale regions of Ethiopia we found an area in which vitamin A deficiency is hyperendemic and linked to monocrop grain farming. The prevalence of mild xerophthalmia is higher in villages than settlements and higher in settlements than towns (p less than 0.001 for both). The prevalence of mild xerophthalmia is higher in males than females (p = 0.03) and the difference cannot be explained by ecological factors. Nutritional status, length of weaning, severe diseases, and intake of food with low-vitamin A content are factors associated with vitamin A deficiency. Length of weaning and severe diseases play a more important role than nutritional status in this study. The prevalence of diarrhea and respiratory diseases was twice as high in children with xerophthalmia than in children without (p less than 0.001 and less than 0.02, respectively). The incidence of measles was higher in children with vitamin A deficiency than in children without, relative risk 4.7 (p = 0.01).

To evaluate the effect of copper deficiency on growth in humans we performed a prospective case-control study in 11 infants identified as Cu deficient based on low plasma Cu (less than 70 micrograms/dL [11.0 mumol/L]) and low ceruloplasmin (less than 200 mg/L). Growth was evaluated with anthropometric indices 1 mo before and 1 mo after onset of Cu supplementation of 80 micrograms.kg-1.d-1. Plasma Cu and ceruloplasmin rose significantly after 1 mo of supplementation. Weight-for-age and weight-for-length indices increased significantly after supplementation only in the Cu-deficient group. Daily energy intake was significantly higher in the Cu-deficient group after supplementation than it was in the control group. Daily weight gain after supplementation increased significantly in the Cu-deficient group and the value for daily weight gain after supplementation was significantly higher than that of the control group for the equivalent amount of time. Cu supplementation improves the growth of Cu-deficient infants recovering from malnutrition.

The aim of this study was to determine the incidence of lactose malabsorption in healthy, adult Australian Aborigines. Malabsorption of lactose was measured in 45 full-blood Aboriginal subjects and 37 non-Aboriginal, multiracial controls using the breath hydrogen method. Eighty-four percent of the Aboriginal subjects were found to be lactose malabsorbers and 64% developed abdominal pain or diarrhea. In the control subjects, 20% were found to be lactose malabsorbers and all of these developed symptoms of diarrhea. The results provide strong evidence that Australian Aborigines, in common with most human adults, are lactase deficient.

Preschool-age rural Indonesian children were reexamined every 3 mo for 18 mo. An average of 3228 were free of xerophthalmia at the examination initiating each of the six, 3-mo follow-up intervals. Children with respiratory disease and/or a recent history of diarrhea at the start of an interval developed xerophthalmia by the end of the interval at more than twice the rate of their healthier peers (p less than 0.05) independent of anthropometric status. It appears that vitamin A deficiency and infections, especially diarrhea and respiratory disease, can establish a vicious cycle that induces and perpetuates ocular and systemic disease.

In 1988, an outbreak of beri-beri occurred in The Gambia during the rainy season. At least 140 people were affected, and 22 died. A clear response to thiamine was observed in 8 patients who were in hospital, and the outbreak resolved after distribution of thiamine in the community. Gradual replacement of traditional cereals with imported milled rice may have increased susceptibility to beri-beri.

Over 1500 preschool urban Indian children were followed weekly for morbidity from 12 to 18 mo. Examination for mild xerophthalmia (Bitot's spots and night blindness) was done initially and at 6 and 12 mo. Children with mild xerophthalmia at the start of a 6-mo interval developed respiratory disease in the interval twice as often as children with normal eyes at the start of the interval. No association was found between mild xerophthalmia and incidence of diarrhea.