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Association of Nutritional Status with the Response to Infection with Leishmania chagasi

Outcomes of infection with Leishmania chagasi range from self-resolving infection to visceral leishmaniasis (VL). Risk factors determining development of disease are not totally understood, but probably include environmental influences and host genetics. We assessed whether nutrition influenced the outcome of Leishmania infection by comparing relatives of children with VL with either self-resolving Leishmania spp. infection or apparently uninfected households. We observed a decrease in body mass index (P < 0.0005) and mid-upper arm circumference for age (P = 0.022) z-scores for children with VL. Levels of vitamin A were lower in active children with VL as measured by serum retinol (P = 0.035) and the modified-relative-dose-response test (P = 0.009). Higher birth weight (P = 0.047) and albumin concentrations (P = 0.040) protected against disease. Increased breastfeeding time (P = 0.036) was associated with asymptomatic infection. The results indicate that modifiable nutritional aspects are associated with the outcome of Leishmania spp. infection in humans.

Received March 25, 2008. Accepted for publication May 30, 2008.

Acknowledgments: We thank Manoel Fernandes (Fundação Nacional de Saúde) for assistance during field work studies, Dr. Goreti Macedo (Biochemistry Engineering Department, Federal University of Rio Grande do Norte) for assistance and advice regarding high-performance liquid chromatography, and Dr. Daniela Martins, Glória Monteiro, and Olívia Souza for laboratory and field support.

Financial support: This study was supported by grant AI030639-15S1 from the National Institutes of Health. Selma M. B. Jeronimo is a researcher of the Conselho Nacional de Desenvolvimento Científico e Tecnológico. Bruna L. Lima Maciel was supported by a fellowship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

^* Address correspondence to Selma M. B. Jerônimo, Department of Biochemistry, Federal University of Rio Grande do Norte, CP 1624, Natal, Rio Grande do Norte, 59072-970, Brazil. E-mail: smbj{at}cb.ufrn.br

Authors’ addresses: Bruna L. Lima Maciel, José W. Queiroz, Juliana Galvão, Núbia N. Pontes, Roberto Dimenstein, and Selma M. B. Jerônimo, Department of Biochemistry, Federal University of Rio Grande do Norte, CP 1624, Natal, Rio Grande do Norte, 59072-970, Brazil, Tel/Fax: 55-84-3215-3428, E-mail: smbj{at}cb.ufrn.br. Hênio G. Lacerda, Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. Lúcia F. C. Pedrosa, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. Stephen E. McGowan, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242.