Giardiasis as a predictor of childhood malnutrition in Orang Asli children in Malaysia

Al-Mekhlafi, Hesham M.; Azlin, M.; Aini, U. Nor; A, Shaik; Sa’iah, A.; Fatmah, M. S.; Ismail, Munirah; Firdaus, M. S. Ahmad; Aisah, M. Y.; Rozlida, A.R.; Norhayati, M

doi:10.1016/j.trstmh.2005.02.006

Cited by 99 publications

(67 citation statements)

References 11 publications

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“…This could indicate that infection transmission occurs during intermediate childhood, perhaps when children normally play in very close contact. This result was in agreement with a study of a rural community in Malaysia, which reported higher association among two to six year-old children 3 .…”

Section: Discussionsupporting

confidence: 93%

“…However, it is common for acute symptomatic individuals to present with diarrhea or clinical manifestations of malabsorption. Malabsorption of fat, D-xylose, vitamin A and vitamin B12 have been reported associated with this infection 3,12,34,47 . Chronic giardiasis in children is generally associated with clinical manifestations of failure to thrive 1,9,48,53 .…”

Section: Introductionmentioning

confidence: 92%

“…Although the etiology of growth failure is multifactorial, malnutrition and repeated infections in children have been documented as causative agents, among which G. intestinalis is a hallmark cause 16 . Diarrhea, poor sanitation, housing and socioeconomic conditions are factors that contribute to the high prevalence of this parasite 2,3,4,10,46,52 . Moreover, these are nonfood factors that can also be involved in growth failure 2,4,5 .…”

Section: Introductionmentioning

confidence: 99%

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Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006

Botero-Garcés

García-Montoya

Grisales-Patiño

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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SUMMARYGiardia intestinalis infection is prevalent throughout the world and widely distributed in developing countries. In general, children display serious consequences to their state of health, including slow height-weight development; therefore, the main aim of this study was to determine the association between Giardia infection and the nutritional status of children who participate in the program of complementary feeding (Mejoramiento Alimentario y Nutricional de Antioquia (MANA) -Instituto Colombiano de Bienestar Familiar (ICBF)). A cross-sectional study examining the association of giardiasis with nutritional status was conducted. A total of 2035 children aged eight months to six years-old were studied. Data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and stool samples. Analysis of the results showed that 27.6% of children were infected with G. intestinalis, while 8.1% and 1.9% were mildly and significantly underweight, respectively, and 14.1% presented stunting. Giardiasis was statistically identified as a strong predictor of stunting in this study population.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006

Botero-Garcés

García-Montoya

Grisales-Patiño

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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“…Previous studies among Aboriginal children in Selangor, Malaysia, reported a higher prevalence of low serum retinol concentration and significant wasting among children infected with G. duodealis than in uninfected children. 16,33 Similarly, previous studies from Thailand and Mexico found that Giardia -infected children were more likely to be vitamin A-deficient and had lower concentrations of serum retinol than Giardia -free children. 31,32 Furthermore, a case of VAD phrynoderma (a rare form of follicular hyperkeratosis associated with deficiencies in vitamins A or C or essential fatty acids) has been reported to be associated with chronic giardiasis in a six-year-old boy in France.…”

mentioning

confidence: 79%

Giardiasis and Poor Vitamin A Status among Aboriginal School Children in Rural Malaysia

Al-Mekhlafi¹,

Surin²,

Sallam³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract.A cross-sectional study was carried out on 241 primary schoolchildren in Pahang, Malaysia to update their vitamin A status and to investigate the association of poor vitamin A status with their health and socioeconomic factors. All children were screened for intestinal parasitic infections. Blood samples were collected and vitamin A status was assessed. Socioeconomic data were collected by using pre-tested questionnaires. The results showed that 66 (27.4%) children had low serum retinol levels (< 0.70 μmol/L). Giardiasis and severe ascariasis were significantly associated with low serum retinol levels ( P = 0.004 and P = 0.018, respectively). Logistic regression confirmed the significant association of giardiasis with low serum retinol (odds ratio = 2.7, 95% confidence interval = 1.3-5.5). In conclusion, vitamin A deficiency is still a public health problem in rural Malaysia. Vitamin A supplementation and treatment of intestinal parasitic infections should be distributed periodically to these children to improve their health and nutritional status. 18 Iintensity of infection was graded as heavy, moderate, or light according to criteria proposed by the World Health Organization.19 Scores for intensity of infections were given to each soil-transmitted helminth species (light = 1, mild = 2, and severe = 3) and mixed infections with a worm score ≥ 5 were included in the analysis. Samples were also examined for Giardia duodenalis trophozoites or cysts by using the trichrome staining technique.Assessment of vitamin A status. Approximately 2-3 mL of venous blood were collected from each participant into tubes for biochemical analysis. Blood was left at room temperature to ensure clot formation. The tubes were then centrifuged at 3,000 rpm for 10 minutes to obtain serum that was stored at -20°C until further analysis. Serum retinol concentrations were determined using a reverse-phase high performance liquid chromatography (LC-10AD; Shimadzu, Kyoto, Japan) as described. 16,20 One hundred microliters of ethanol containing retinyl acetate as an internal standard was added to 100 μL of serum. Refiltered petroleum ether (RPE) (500 μL) was added and the mixture was mixed with a vortex mixer for 1 minute and centrifuged at 5,000 rpm for 10 minutes. A 150-μL sample from the refiltered petroleum ether layer was transferred into a clean test tube and evaporated. The extract was dissolved in 200 μL of ethanol. Eighty microliters of this mixture was injected into the high performance liquid chromatography apparatus. Methanol:water (95:5 [v/v]) was used as the mobile phase and all-trans retinol was used as the standard. For quality control, 20% of the samples were randomly selected and examined in duplicate. Serum retinol was measured in picomoles per liter.Use of serum retinol to assess vitamin A status may be influenced by inflammation and reductions in plasma retinol, which have been described during the acute phase of a wide range of infections. 21 The design of this study did not consider the inflammatory status of the...

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“…Supporting the notion that there is an impact on developmental delay, early childhood giardiasis is associated with persistent diarrhea (5), which is a major risk factor for childhood stunting (height-for-age Z score [HAZ] of less than -2) (6). While in some studies stool carriage of G. lamblia is a strong predictor of either wasting or stunting (7)(8)(9), other studies of equal validity demonstrate no association between giardiasis and childhood growth (10). While Goto et.…”

Section: Introductionmentioning

confidence: 99%

Persistent G. lamblia impairs growth in a murine malnutrition model

Bartelt¹,

Roche²,

Kolling³

et al. 2013

J. Clin. Invest.

119

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Giardia lamblia infections are nearly universal among children in low-income countries and are syndemic with the triumvirate of malnutrition, diarrhea, and developmental growth delays. Amidst the morass of early childhood enteropathogen exposures in these populations, G. lamblia-specific associations with persistent diarrhea, cognitive deficits, stunting, and nutrient deficiencies have demonstrated conflicting results, placing endemic pediatric giardiasis in a state of equipoise. Many infections in endemic settings appear to be asymptomatic/ subclinical, further contributing to uncertainty regarding a causal link between G. lamblia infection and developmental delay. We used G. lamblia H3 cyst infection in a weaned mouse model of malnutrition to demonstrate that persistent giardiasis leads to epithelial cell apoptosis and crypt hyperplasia. Infection was associated with a Th2-biased inflammatory response and impaired growth. Malnutrition accentuated the severity of these growth decrements. Faltering malnourished mice exhibited impaired compensatory responses following infection and demonstrated an absence of crypt hyperplasia and subsequently blunted villus architecture. Concomitantly, severe malnutrition prevented increases in B220 + cells in the lamina propria as well as mucosal Il4 and Il5 mRNA in response to infection. These findings add insight into the potential role of G. lamblia as a "stunting" pathogen and suggest that, similarly, malnourished children may be at increased risk of G. lambliapotentiated growth decrements.

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Giardiasis as a predictor of childhood malnutrition in Orang Asli children in Malaysia

Cited by 99 publications

References 11 publications

Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006

Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006

Giardiasis and Poor Vitamin A Status among Aboriginal School Children in Rural Malaysia

Persistent G. lamblia impairs growth in a murine malnutrition model

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