Browsing by Author "Moore, S.E."
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Item Antenatal multiple micronutrient supplementation: call to action for change in recommendation(ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 2019-11-05) Ahmed, S.; Bourassa, M.W.; Osendarp, S.J.M; Adu-Afarwuah, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, J.; Klemm, R.; Kraemer, K.; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L-A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.We appreciate the comments by Devakumar et al .1 and agree that there are still some unanswered questions regarding the long‐term impact of multiple micronutrient supplementation (MMS) during pregnancy. However, in their assessment, Devakumar and colleagues ignore the significant benefits shown in the individual patient data (IPD) meta‐analysis, which strongly influenced our task force's conclusions. Rather, their comments focus only on the birth size data from the Cochrane reviews.2, 3 In the IPD meta‐analysis, which included data from nearly 113,000 pregnancies, the authors found that, in addition to reducing the risk of low birthweight, MMS significantly reduces the risk of preterm birth (RR = 0.93 (0.87–0.98), random effects).2 The Cochrane review also states that MMS “probably led to a slight reduction in preterm births” on the basis of data from 91,425 participants with moderate quality evidence (RR = 0.95 (0.90–1.01)Item Key genetic variants associated with variation of milk oligosaccharides from diverse human populations(Elsevier, 2021) Williams, J.E.; McGuire, M.K.; Meehan, C.L.; McGuire, M.A.; Brooker, S.L.; Kamau-Mbuthia, E.W.; Kamundia, E.W.; Mbugua, S.; Moore, S.E.; Prentice, A.M.; Otoo, G.E.; Rodríguez, J.M.; Pareja, R.G.; Foster, J.A.; Sellen, D.W.; Kita, D.G.; Neibergs, H.L.; Murdoch, B.M.Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P < 4.23−9 to P < 4.5−70) gene with seven HMO and provide evidence of balancing selection for FUT2. Although polymorphisms in FUT3 were also associated with variation in lacto-N-fucopentaose II and difucosyllacto-N-tetrose, we found little evidence of selection on FUT3. To our knowledge, this is the first report of the use of genome-wide association analyses on HMO.Item Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries(Annals of the New York Academy of Sciences, 2019-05-27) Adu-Afarwuah, S.; Bourassa, M.W.; Osendarp, S.J.M.; Ahmed, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, j; Klemm, R.; Kraemer, k; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L.A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.Item Setting research priorities on multiple micronutrient supplementation in pregnancy(ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 2019-11-06) Adu-Afarwuah, S.; Gomes, F.; Bourassa, M.W.; Ajello, C.; Bhutta, Z.A.; Black, R.; Catarino, E.; Chowdhury, R.; Dalmiya, N.; Dwarkanath, P.; Engle-Stone, R.; Gernand, A.D.; Goudet, S.; Hoddinott, J.; Kæstel, P.; Manger, M.S.; McDonald, C.M.; Mehta, S.; Moore, S.E.; Neufeld, L.M.; Osendarp, S.; Ramachandran, P.; Rasmussen, K.M.; Stewart, C.; Sudfeld, C.; West, K.; Bergeron, G.Prenatal micronutrient deficiencies are associated with negative maternal and birth outcomes. Multiple micronutrient supplementation (MMS) during pregnancy is a cost-effective intervention to reduce these adverse outcomes. However, important knowledge gaps remain in the implementation of MMS interventions. The Child Health and Nutrition Research Initiative (CHNRI) methodology was applied to inform the direction of research and investments needed to support the implementation of MMS interventions for pregnant women in low- and middleincome countries (LMIC). Following CHNRImethodology guidelines, a group of international experts in nutrition andmaternal health provided and ranked the research questions thatmost urgently need to be resolved for prenatal MMS interventions to be successfully implemented. Seventy-three research questions were received, analyzed, and reorganized, resulting in 35 consolidated research questions. These were scored against four criteria, yielding a priority ranking where the top 10 research options focused on strategies to increase antenatal care attendance and MMSadherence, methods needed to identify populationsmore likely to benefit fromMMS interventions and some discovery issues (e.g., potential benefit of extending MMS through lactation). This exercise prioritized 35 discrete research questions that merit serious consideration for the potential of MMS during pregnancy to be optimized in LMIC.Item Variation in Human Milk Composition Is Related to Differences in Milk and Infant Fecal Microbial Communities(MDPI, 2021) Pace, R.M.; Williams, J.E.; Robertson, B.; Lackey, K.A.; Meehan, C.L.; Price, W.J.; Foster, J.A.; Sellen, D.W.; Kamau-Mbuthia, E.W.; Kamundia, E.W.; Mbugua, S.; Moore, S.E.; Prentice, A.M.; Kita, D.G.; Kvist, L.J.; Otoo, G.E.; Ruiz, L.; Rodríguez, J.M.; Pareja, R.G.; McGuire, M.A.; Bode, L.; McGuire, M.K.Previously published data from our group and others demonstrate that human milk oligosaccharide (HMOs), as well as milk and infant fecal microbial profiles, vary by geography. However, little is known about the geographical variation of other milk-borne factors, such as lactose and protein, as well as the associations among these factors and microbial community structures in milk and infant feces. Here, we characterized and contrasted concentrations of milk-borne lactose, protein, and HMOs, and examined their associations with milk and infant fecal microbiomes in samples collected in 11 geographically diverse sites. Although geographical site was strongly associated with milk and infant fecal microbiomes, both sample types assorted into a smaller number of community state types based on shared microbial profiles. Similar to HMOs, concentrations of lactose and protein also varied by geography. Concentrations of HMOs, lactose, and protein were associated with differences in the microbial community structures of milk and infant feces and in the abundance of specific taxa. Taken together, these data suggest that the composition of human milk, even when produced by relatively healthy women, differs based on geographical boundaries and that concentrations of HMOs, lactose, and protein in milk are related to variation in milk and infant fecal microbial communities.Item What's normal? Microbiomes in human milk and infant feces are related to each other but vary geographically: The inspire study(Frontiers in Nutrition, 2019-03-27) Otoo, G.E.; Lackey, K.A.; Williams, J.E.; Meehan, C.L.; Zachek, J.A.; Benda, E.D.; Price, W.J.; Foster, J.A.; Sellen, D.W.; Kamau-Mbuthia, E.W.; Kamundia, E.W.; Mbugua, S.; Moore, S.E.; Prentice, A.M.; Gindola, D.K.; Kvist, L.J.; García-Carral, C.; Jiménez, E.; Ruiz, L.; Rodríguez, J.M.; Pareja, R.G.; Bode, L.; McGuire, M.A.; McGuire, M.K.Background: Microbial communities in human milk and those in feces from breastfed infants vary within and across populations. However, few researchers have conducted cross-cultural comparisons between populations, and little is known about whether certain "core" taxa occur normally within or between populations and whether variation in milk microbiome is related to variation in infant fecal microbiome. The purpose of this study was to describe microbiomes of milk produced by relatively healthy women living at diverse international sites and compare these to the fecal microbiomes of their relatively healthy infants. Methods: We analyzed milk (n = 394) and infant feces (n = 377) collected from mother/infant dyads living in 11 international sites (2 each in Ethiopia, The Gambia, and the US; 1 each in Ghana, Kenya, Peru, Spain, and Sweden). The V1-V3 region of the bacterial 16S rRNA gene was sequenced to characterize and compare microbial communities within and among cohorts. Results: Core genera in feces were Streptococcus, Escherichia/Shigella, and Veillonella, and in milk were Streptococcus and Staphylococcus, although substantial variability existed within and across cohorts. For instance, relative abundance of Lactobacillus was highest in feces from rural Ethiopia and The Gambia, and lowest in feces from Peru, Spain, Sweden, and the US; Rhizobium was relatively more abundant in milk produced by women in rural Ethiopia than all other cohorts. Bacterial diversity also varied among cohorts. For example, Shannon diversity was higher in feces from Kenya than Ghana and US-California, and higher in rural Ethiopian than Ghana, Peru, Spain, Sweden, and US-California. There were limited associations between individual genera in milk and feces, but community-level analyses suggest strong, positive associations between the complex communities in these sample types. Conclusions: Our data provide additional evidence of within- and among-population differences in milk and infant fecal bacterial community membership and diversity and support for a relationship between the bacterial communities in milk and those of the recipient infant's feces. Additional research is needed to understand environmental, behavioral, and genetic factors driving this variation and association, as well as its significance for acute and chronic maternal and infant health.