Publications
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Baimukhambetova DV, Gorina AO, Rumyantsev MA, et al., 2021, Post-COVID condition in adults and children, Pulmonologiya, Vol: 31, Pages: 562-570, ISSN: 0869-0189
Despite the impressive progress in diagnosis and management of acute COVID-19, data regarding the consequences of this infection are just emerging. The World Health Organization has proposed the term post-COVID condition (PCC) to describe the wide range of sequelae of acute COVID-19. With more than 200 million confirmed cases of COVID-19, PCC may develop into a major problem for many years to come for the millions of COVID-19 survivors worldwide. Few studies were conducted in primary care, and very few studies have focused exclusively on children and adolescents. Objective. To review existing data on PCC. Analysis of manuscripts published in peer-reviewed journals and clinical protocols. PCC is characterized by a wide range of systemic, cardio-pulmonary, gastrointestinal, neurological, and psychosocial symptoms. Conclusion. Although PCC prevalence is difficult to estimate due to methodological limitations of the existing studies, there is no doubt that this problem is a significant healthcare burden. There is a need for further observational and interventional studies to establish optimal PCC prevention and management strategies.
O'Reilly D, Dorodnykh D, Avdeenko N, et al., 2021, Perspective: The Role of Human Breast-Milk Extracellular Vesicles in Child Health and Disease, ADVANCES IN NUTRITION, Vol: 12, Pages: 59-70, ISSN: 2161-8313
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- Citations: 18
Sigfrid L, Cevik M, Jesudason E, et al., 2021, What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol, BMJ OPEN, Vol: 11, ISSN: 2044-6055
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- Citations: 27
Schoos A-MM, Bullens D, Chawes BL, et al., 2020, Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy, FRONTIERS IN IMMUNOLOGY, Vol: 11, ISSN: 1664-3224
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- Citations: 37
Sim K, Mijakoski D, Stoleski S, et al., 2020, Outcomes for clinical trials of food allergy treatments, ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY, Vol: 125, Pages: 535-542, ISSN: 1081-1206
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- Citations: 10
Samuel TM, Zhou Q, Giuffrida F, et al., 2020, Nutritional and Non-nutritional Composition of Human Milk Is Modulated by Maternal, Infant, and Methodological Factors, FRONTIERS IN NUTRITION, Vol: 7, ISSN: 2296-861X
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- Citations: 58
Munblit D, Warner J, Tudor-Williams G, et al., 2020, Excessive media consumption about COVID-19 is associated with increased state anxiety: Outcomes of a large online survey in Russia, Journal of Medical Internet Research, Vol: 22, Pages: 1-18, ISSN: 1438-8871
Background: The coronavirus disease 2019 (COVID-19) pandemic has potentially had a negative impact on the mental health and well being of individuals and families. Anxiety levels and risk factors within particular populations are poorly described.Objectives: To evaluate confidence, understanding, trust and concerns and levels of anxiety during COVID-19 pandemic in general population and assess risk factors for increased anxiety.Methods: We launched a cross-sectional online survey a large Russian population between 6th and 15th April 2020 using multiple social media platforms. A set of questions targeted confidence, understanding, trust and concerns in respondents. State-Trait Anxiety Inventory (STAI) was used to measure anxiety. Multiple linear regressions were used to model predictors of COVID-19 related anxiety.Results: The survey was completed by 23,756 out of 53,966 unique visitors (44.0% response rate); 21,364 of who were residing in 62 areas of Russia. State anxiety (S-Anxiety) scores were higher than Trait anxiety (T-Anxiety) across all regions of Russia (median S-Anxiety score 52 [IQR 44-60]), exceeding published norms. Time spent following news on COVID-19 was strongly associated with an increased S-Anxiety adjusted for baseline anxiety level. One to two hours spent reading COVID news was associated with 5.46 (95%CI 5.03-5.90) point difference, 2-3 hours 7.06 (6.37-7.74) and more than three hours 8.65 (7.82-9.47), respectively; all compared to less than 30 minutes per day. Job loss during pandemic was another important factor associated with higher S-Anxiety scores (3.95 [3.31 – 4.58]).Despite survey respondents reporting high confidence in information regarding COVID-19, as well as understanding of healthcare guidance, they reported low overall trust in state and local authorities and perception of country readiness.Conclusions: Among Russian respondents from multiple social media platforms, there is evidence of higher levels of state-anxiety asso
Sigfrid L, Cevik M, Jesudason E, et al., 2020, What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? - A harmonised, global longitudinal observational study
<jats:p>IntroductionVery little is known about possible clinical sequelae that may persist after resolution of the acute Coronavirus Disease 2019 (COVID-19). A recent longitudinal cohort from Italy including 143 patients recovered after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60 day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical ICU patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. Methods and analysisThis is an international open-access prospective, observational multi-site study. It will enrol patients following a diagnosis of COVID-19. Tier 1 is developed for following up patients day 28 post-discharge, additionally at 3 to 6 months intervals. This module can be used to identify sub-sets of patients experiencing specific symptomatology or syndromes for further follow up. A Tier 2 module will be developed for in-clinic, in-depth follow up. The primary aim is to characterise physical consequences in patients post-COVID-19. Secondary aim includes estimating the frequency of and risk factors for post-COVID- 19 medical sequalae, psychosocial consequences and post-COVID-19 mortality. A subset of patients will have sampling to characterize longer term antibody, innate and cell-mediated immune responses to SARS-CoV-2. Ethics and disseminationThis collaborative, open-access study aims to characterize the frequency of and risk factors for long-term consequences and characterise the immune response over time in patients following a diagnosis of COVID-19 and facilitate standardized and longitudinal data collection globally. The outcomes of this study will inform strategies to prevent long term consequences; inform clinical management, direct rehabilitation, and inform public health management to reduce overall mo
Stinson LF, Gay MCL, Koleva PT, et al., 2020, Human Milk From Atopic Mothers Has Lower Levels of Short Chain Fatty Acids, FRONTIERS IN IMMUNOLOGY, Vol: 11, ISSN: 1664-3224
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- Citations: 41
Brough HA, Kalayci O, Sediva A, et al., 2020, Managing childhood allergies and immunodeficiencies during respiratory virus epidemics - The 2020 COVID-19 pandemic: A statement from the EAACI-section on pediatrics, PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 31, Pages: 442-448, ISSN: 0905-6157
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- Citations: 81
Munblit D, Crawley H, Hyde R, et al., 2020, Health and nutrition claims for infant formula are poorly substantiated and potentially harmful, BMJ: British Medical Journal, Vol: 369, Pages: 1-8, ISSN: 0959-535X
Munblit D, Perkin MR, Palmer DJ, et al., 2020, Assessment of evidence about common infant symptoms and cow’s milk allergy, JAMA Pediatrics, Vol: 174, Pages: 599-608, ISSN: 2168-6203
Importance Sales of specialized formula for managing cow’s milk allergy (CMA) have increased, triggering concern that attribution of common infant symptoms, such as crying, vomiting, and rashes, to CMA may be leading to overdiagnosis, which could undermine breastfeeding.Objective To understand whether CMA guideline recommendations might promote CMA overdiagnosis or undermine breastfeeding.Evidence Review We reviewed recommendations made in CMA guidelines and critically appraised 2 key recommendations. First, we reviewed relevant literature summarizing whether maternal or infant dietary exclusion of cow’s milk is effective for managing common infant symptoms. Second, we reviewed published data on breastmilk composition and thresholds of reactivity in CMA to estimate the probability that cow’s milk protein in human breastmilk can trigger symptoms in infants with CMA. We also documented the level of commercial involvement in CMA guidelines.Findings We reviewed 9 CMA guidelines published from 2012 to 2019. Seven suggest considering CMA as a cause of common infant symptoms. Seven recommend strict maternal cow’s milk exclusion for managing common symptoms in breastfed infants. We found CMA proven by food challenge affects approximately 1% of infants, while troublesome crying, vomiting, or rashes are each reported in 15% to 20% of infants. We found clinical trials do not provide consistent support for using maternal or infant cow’s milk exclusion to manage common symptoms in infants without proven CMA. We estimated that for more than 99% infants with proven CMA, the breastmilk of a cow’s milk–consuming woman contains insufficient milk allergen to trigger an allergic reaction. Three CMA guidelines were directly supported by formula manufacturers or marketing consultants, and 81% of all guideline authors reported a conflict of interest with formula manufacturers.Conclusions and Relevance Recommendations to manage common infant s
Korsunskiy I, Blyuss O, Gordukova M, et al., 2020, Expanding TREC utility in primary immunodeficiency diseases diagnosis, Frontiers in Immunology, Vol: 11, ISSN: 1664-3224
Primary immunodeficiency diseases (PID) area heterogeneous group of disorders caused by genetic defects of the immune system, which manifest clinically as recurrent infections, autoimmune diseases or malignancies. Early detection of PID remains a challenge, particularly in older children with milder and less specific symptoms. This study aimed to assess TREC and KREC diagnostic ability in PID. Data from children assessed by clinical immunologists at Speransky Children's Hospital, Moscow, Russia with suspected immunodeficiencies were analyzed between May 2013 and August 2016. Peripheral blood samples were sent for TREC/KREC, flow cytometry (CD3, CD4, CD8 and CD19), IgA and IgG analysis. A total of 434 children [189 healthy, 97 with group I and II PID (combined T and B cell immunodeficiencies & well-defined syndromes with immunodeficiency) and 148 group III PID (predominantly antibody deficiencies)] were included. Area under the curve (AUC) for TREC in PID groups I and II diagnosis reached 0.82 (CI = 0.75–0.90), with best model providing sensitivity of 65% and specificity of 92%. Neither TREC, nor KREC had added value in PID group III diagnosis. In this study, the predictive value of TREC and KREC in PID diagnosis was examined. We found that the TREC had some diagnostic utility for groups I and II PID. Possibly, addition of TREC measurements to existing clinical diagnostic algorithms may improve their predictive value. Further investigations on a larger cohort are needed to evaluate TREC/KREC abilities to be used as diagnostic tools on a wider scale.
Blyuss O, Zaikin A, Cherepanova V, et al., 2020, Development of PancRISK, a urine biomarker-based risk score for stratified screening of pancreatic cancer patients, BRITISH JOURNAL OF CANCER, Vol: 122, Pages: 692-696, ISSN: 0007-0920
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- Citations: 23
Levina DM, Korsunskiy IA, Munblit DB, 2020, Oral food challenges in clinical practice: a missing element of food allergy diagnosis in Russia, Russian Journal of Allergy, Vol: 17, Pages: 19-29, ISSN: 1810-8830
Food allergy is one of the most prevalent allergic conditions, causing reduction in patient quality of life. It is linked with high levels of anxiety due to potential life-threatening reactions, and high economic burden for a healthcare system. Food allergy affects approximately 5 to 10% of children around the world. In Russian Federation the diagnosis of food allergy is primarily based on clinical history, laboratory test results, examination and elimination of suspected food. Meanwhile oral food challenge (OFC) is considered a “gold standard” of food allergy diagnosis by most of professional bodies nationally and internationally. OFC is a diagnostic procedure involving administration of a causative allergen in gradually increasing amount under a close medical supervision. The method is safe, highly specific and sensitive and is widely used around the world for more than45 years. The main goals of OFC include food allergy diagnosis and presence of tolerance evaluation, which may result in diet expansion. OFC may also help establishing both, reaction severity and dose needed to elicit reaction, which may further assist with alleviation of patients’ anxiety. In this paper we discuss existing approaches to the diagnosis of food allergy in Russian Federation and review available recommendations on OFC outlined in international guidelines.
Bulanov N, Blyuss OB, Munblit DB, et al., 2020, Venn diagrams and probability in clinical research, Sechenov Medical Journal, Vol: 11, Pages: 5-14, ISSN: 2218-7332
Statistics is the science dealing with the collecting, summarizing and interpreting of associations in research data, and has a leading role in medical research. This article is an introductory publication in a series devoted to biomedical statistics. The aim of this article is to acquaint the readers with the basic concepts of Venn diagrams, probability and set theory, which are required to further understand descriptive and inferential statistics. First, we discuss the applications of Venn diagrams in current clinical research. Then we discuss the definitions of sample space, events, basic set operations (union and intersection) and their implementation in the classical approach to probability theory. All examples are introduced with Venn diagrams to illustrate the cases.
DunnGalvin A, Treneva M, Pampura A, et al., 2020, Quality of life associated with maternal anxiety disorder in Russian children and adolescents with food allergy, PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 31, Pages: 78-84, ISSN: 0905-6157
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- Citations: 9
Michelen M, Cheng V, Manoharan L, et al., 2020, What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review., F1000Res, Vol: 9
Although the majority of people with Covid-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for months after the acute phase of the illness. These symptoms include, among others, fatigue, problems breathing, lack of smell and taste, headaches, and depression and anxiety. It is also clear the virus has lasting fluctuating multiorgan sequelae, including affecting not only the respiratory system but also the heart, liver, and nervous system. We present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and characteristics of post-acute COVID-19. The living systematic review will be updated regularly, approximately every 6 months, as new evidence emerges. We will include studies that follow up at least 100 people with Covid-19 at 12 or more weeks post Covid-19 onset, with no restrictions regarding country, setting, or language. We will use descriptive statistics and, for outcomes reported in two or more studies, we will use meta-analyses to estimate prevalence with 95% confidence intervals (CIs) using the exact method. Heterogeneity between estimates will be assessed using the I2 statistic. Our findings will also be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from Covid-19. The protocol has been registered with PROSPERO ( CRD42020211131, 25/09/2020).
Munblit D, Perkin MR, Palmer DJ, et al., 2019, Attributing common infant symptoms to cow’s milk allergy, JAMA Pediatrics, ISSN: 2168-6203
Background: Sales of specialised formula for managing cow’s milk allergy (CMA) have increased, triggering concern that attribution of common infant symptoms such as crying, vomiting and rashes to CMA may be leading to overdiagnosis, which could undermine breastfeeding. Objective: To understand whether CMA guideline recommendations might promote CMA over diagnosis or undermine breastfeeding. Methods: We reviewed recommendations made in CMA guidelines and critically appraised two key recommendations. First, we reviewed relevant literature 36summarisingwhether maternal or infant dietary exclusion of cow’s milk is effective for managing common infant symptoms. Second, we reviewedpublished data on breastmilk compositionand thresholds of reactivity in CMA,to estimate the probability that cow’s milk protein in human breastmilk can trigger symptoms in infantswith CMA. We also documentedthe level of commercial involvement in CMA guidelines. Findings: We reviewed nineCMA guidelinespublished from2012-19. Seven suggest consideringCMA as a cause ofcommon infant symptoms.Seven recommend strict maternal cow’s milk exclusion for managing common symptoms in breastfed infants. We found CMA proven by food challenge affects ~1% of infants, while troublesome crying, vomiting orrashesare each reported in 15-20% of infants. We found clinical trials don’t provide consistent support for usingmaternal or infant cow’s milk exclusion to manage common symptoms in infants without proven CMA. We estimated that for >99% infantswith proven CMA the breastmilk of a cow’s milk consuming woman contains insufficient milk allergen to trigger an allergic reaction. Three CMA guidelines were directly supported by formula manufacturers or marketing consultants and 81% of all guideline authors reported aconflict of interest with formula manufacturers. Conclusions: Recommendations to manage common infant symptoms as CMA are not evidence-based, especially in breastfe
Blyuss O, Cheung KY, Chen J, et al., 2019, Statistical approaches in the studies assessing associations between human milk immune composition and allergic diseases: A scoping review, Nutrients, Vol: 11, Pages: 1-15, ISSN: 2072-6643
A growing number of studies are focusing on the associations between human milk (HM) immunological composition and allergic diseases. This scoping review aims to identify statistical methods applied in the field and highlight pitfalls and unmet needs. A comprehensive literature search in MEDLINE and Embase retrieved 13,607 unique records. Following title/abstract screening, 29 studies met the selection criteria and were included in this review. We found that definitions of colostrum and mature milk varied across the studies. A total of 17 out of 29 (59%) studies collected samples longitudinally, but only 12% of these used serial (longitudinal) analyses. Multivariable analysis was used in 45% of the studies, but statistical approaches to modelling varied largely across the studies. Types of variables included as potential confounding factors differed considerably between models. Discrimination analysis was absent from all studies and only a single study reported classification measures. Outcomes of this scoping review highlight lack of standardization, both in data collection and handling, which remains one of the main challenges in the field. Improved standardization could be obtained by a consensus group of researchers and clinicians that could recommend appropriate methods to be applied in future prospective studies, as well as already existing datasets.
Khaleva E, Gridneva Z, Geddes DT, et al., 2019, Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review, Clinical and Experimental Allergy, Vol: 49, Pages: 1201-1213, ISSN: 0954-7894
BACKGROUND: Human milk (HM) transforming growth factor beta (TGF-β) is critical for inflammation regulation and oral tolerance promotion. Previous reports suggested that variations in HM TGF-β levels are associated with allergic outcomes. OBJECTIVE: We undertook a systematic review (PROSPERO 2017 CRD42017069920) to reassess the evidence on the relationships between HM TGF-β and allergic outcomes in children. METHODS: Electronic bibliographic databases (MEDLINE, EMBASE, Cochrane Library) were systematically searched. Two independent reviewers screened reference lists, extracted the data and assessed risk of bias using the National Institute for Clinical Excellence methodological checklist. RESULTS: A total of 21 studies were identified. Sixteen studies assessed relationships between HM TGF-β and risk of eczema; 14, allergic sensitisation; 9, wheezing/asthma; 6, food allergy; 3, allergic rhinitis/conjunctivitis. Five cohorts (5/18, 28%) reported a protective effect of TGF-β1, while 3 (3/10, 30%) suggested increased risk of allergic outcomes development and 1 (1/10, 10%), a protective effect of TGF-β2 on eczema. Meta-analysis was not possible due to significant heterogeneity in methodology, age of outcome assessment and differing statistical approaches. 71% (15/21) of studies carried a high risk of bias. CONCLUSION AND CLINICAL RELEVANCE: In contrast with previous findings we did not find strong evidence of associations between HM TGF-β and allergic outcomes. Differences in studies' methodology and outcomes do not allow unconditional rejection or acceptance of the hypothesis that HM TGF-β influences the risk of allergy development. Future studies on diverse populations employing standardised methods, accurate phenotyping of outcomes and evaluation of the effect of TGF-β in combination with other HM immune markers, microbiome and oligosaccharides are required.
Galvin DA, Lindsley S, Patel N, et al., 2019, Validation of food allergy quality of life short forms (FAQLQ-10) for parents, children and teens, Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI), Publisher: WILEY, Pages: 95-96, ISSN: 0105-4538
Boix-Amorós A, Collado MC, Van't Land B, et al., 2019, Reviewing the evidence on breast milk composition and immunological outcomes., Nutr Rev
A large number of biologically active components have been found in human milk (HM), and in both human and animal models, studies have provided some evidence suggesting that HM composition can be altered by maternal exposures, subsequently influencing health outcomes for the breastfed child. Evidence varies from the research studies on whether breastfeeding protects the offspring from noncommunicable diseases, including those associated with immunological dysfunction. It has been hypothesized that the conflicting evidence results from HM composition variations, which contain many immune active molecules, oligosaccharides, lactoferrin, and lysozyme in differing concentrations, along with a diverse microbiome. Determining the components that influence infant health outcomes in terms of both short- and long-term sequelae is complicated by a lack of understanding of the environmental factors that modify HM constituents and thereby offspring outcomes. Variations in HM immune and microbial composition (and the differing infantile responses) may in part explain the controversies that are evidenced in studies that aim to evaluate the prevalence of allergy by prolonged and exclusive breastfeeding. HM is a "mixture" of immune active factors, oligosaccharides, and microbes, which all may influence early immunological outcomes. This comprehensive review provides an in-depth overview of existing evidence on the studied relationships between maternal exposures, HM composition, vaccine responses, and immunological outcomes.
Munblit D, Verhasselt V, Warner JO, 2019, Editorial: human milk composition and health outcomes in children, Frontiers in Pediatrics, Vol: 7, Pages: 1-3, ISSN: 2296-2360
Colicino S, Munblit D, Minelli C, et al., 2019, Validation of childhood asthma predictive tools: A systematic review, Clinical and Experimental Allergy, Vol: 49, Pages: 410-418, ISSN: 0954-7894
BACKGROUND: There is uncertainty about the clinical usefulness of currently available asthma predictive tools. Validation of predictive tools in different populations and clinical settings is an essential requirement for the assessment of their predictive performance, reproducibility and generalizability. We aimed to critically appraise asthma predictive tools which have been validated in external studies. METHODS: We searched MEDLINE and EMBASE (1946-2017) for all available childhood asthma prediction models and focused on externally validated predictive tools alongside the studies in which they were originally developed. We excluded non-English and non-original studies. PROSPERO registration number is CRD42016035727. RESULTS: From 946 screened papers, eight were included in the review. Statistical approaches for creation of prediction tools included chi-square tests, logistic regression models and the least absolute shrinkage and selection operator. Predictive models were developed and validated in general and high-risk populations. Only three prediction tools were externally validated: the Asthma Predictive Index, the PIAMA and the Leicester asthma prediction tool. A variety of predictors has been tested, but no studies examined the same combination. There was heterogeneity in definition of the primary outcome among development and validation studies, and no objective measurements were used for asthma diagnosis. The performance of tools varied at different ages of outcome assessment. We observed a discrepancy between the development and validation studies in the tools' predictive performance in terms of sensitivity and positive predictive values. CONCLUSIONS: Validated asthma predictive tools, reviewed in this paper, provided poor predictive accuracy with performance variation in sensitivity and positive predictive value.
Peshko D, Kulbachinskaya E, Korsunskiy I, et al., 2019, Health-Related Quality of Life in Children and Adults with Primary Immunodeficiencies: A Systematic Review and Meta-Analysis, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 7, Pages: 1929-+, ISSN: 2213-2198
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- Citations: 23
Munblit D, DunnGalvin A, 2019, An examination of Quality of Life and General Anxiety Disorder in Parents, Children and Teens in Russia, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB58-AB58, ISSN: 0091-6749
Korsunskiy I, Blyuss O, Gordukova M, et al., 2019, TREC and KREC Levels as a Predictors of Lymphocyte Subpopulations Measured by Flow Cytometry, FRONTIERS IN PHYSIOLOGY, Vol: 9, ISSN: 1664-042X
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- Citations: 8
Saso A, Blyuss O, Munblit D, et al., 2019, Breast milk cytokines and early growth in Gambian infants, Frontiers in Pediatrics, Vol: 6, ISSN: 2296-2360
Background: Breast milk provides nutrition for infants but also delivers other bioactive factors that have key protective and developmental benefits. In particular, cytokines are thought to play a role in immunomodulation, although little is known about their impact on health outcomes in early life.Objective: The purpose of this pilot study was to evaluate the relationship between cytokines in breast milk and infant growth outcomes in a low-income setting.Methods: 100 mother-infant pairs were followed up to 2–3 months postpartum as part of a prospective longitudinal cohort study in urban Gambia, West Africa. The concentrations of 9 pro-inflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL-13, IFN-γ, TNFα), IGF-1 and TGFβ2 were measured in colostrum within 12 h of birth and in breast milk at the final visit, scheduled between day 60 and 89 postpartum. Infant weight was recorded and converted to weight-for-age Z-scores (WAZ) at the same time points. Growth outcomes were defined in our study as (a) change in WAZ between birth and final visit (b) WAZ at final visit. Linear regression analysis was used to determine the ability of colostrum and breast milk cytokine concentrations to predict growth outcomes up to 2–3 months postpartum.Results: Gambian infants demonstrated growth faltering across the first 2–3 months postpartum. There was no significant relationship between cytokines in colostrum and subsequent change in WAZ between birth and the final visit, in either unadjusted or adjusted models. However, cytokines in mature breast milk, TNFα, IFNγ, IL1β, IL2, IL4, and IL6, were weak negative predictors of WAZ scores at the final visit, in unadjusted models (p < 0.05). When adjusted for maternal anemia (as a proxy for maternal nutrition), TNFα and IL6 remained significant predictors (p < 0.05).Conclusions: Variations in breast milk cytokine levels do not play a substantial role in the growth
Munblit D, Abrol P, Sheth S, et al., 2018, Levels of growth factors and IgA in colostrum of women from Burundi and Italy, Nutrients, Vol: 10, ISSN: 2072-6643
Colostrum is produced in the first days postpartum. It is a known source of immune mediators for a newborn within the first week of life. Although it is still unclear if colostrum composition varies between populations, recent data suggest differences. Hepatocyte growth factor (HGF); transforming growth factor-β (TGF-β) 1, 2, and 3; and immunoglobulin A (IgA) are key immunological components of colostrum that stimulate neonatal gastrointestinal and immune system development. We aimed to investigate the differences in the concentration between immune markers in the colostrum of mothers living in Burundi and Italy, and to identify the factors associated with differences. In this cross-sectional birth cohort study, a total of 99 colostrum samples from Burundian (n = 23) and Italian (n = 76) women were collected at 0 to 6 days postpartum. A clinical chemistry analyser was used for IgA quantification and electro-chemiluminescence, for HGF and TGFβ1-3 assessment. A univariate analysis and multivariate linear regression model were used for statistical testing. The concentrations of TGF-β2 (p = 0.01) and IgA (p < 0.01) were significantly higher in the colostrum from the women residing in Burundi than in Italy, both in a univariate analysis and upon the adjustment for confounding factors. A similar trend is seen for HGF, reaching statistical significance upon a multivariate analysis. We found a moderate to strong positive correlation between the TGF-β isoforms and IgA concentration in both countries (p < 0.01), with stronger concentration in the colostrum from Burundi. The results of this study are in support of previous data, suggesting that concentration of the immune active molecules is higher in the human milk of women residing in developing countries. However, with a small sample size, caution must be applied, as the findings require further confirmation. Future work should also be focused on other factors (e.g., lipid and microbial compos
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