Impact of lysine-fortified wheat flour on morbidity and immunologic variables among members of rural families in northwest Syria

Background. Previous studies have shown an effect of lysine fortification on nutrition and immunity of poor men, women, and children consuming a predominantly wheat-based diet. Objective. To examine the lysine value of diets and the effect of lysine fortification on functional protein status, anthropometry, and morbidity of men, women, and children in rural Syria. Methods. At baseline of a two-phase study using 7-day household food intake inventories (n = 98), nutrient availabilities per adult male equivalent were estimated. In the intervention phase, a 16-week double-blind trial, households (n = 106) were randomly assigned to control and lysine groups. Hematologic and anthropometric data were collected from men (n = 69; 31 control, 38 lysine), women (n = 99; 51 control, 48 lysine), and children (n = 69; 37 control, 32 lysine) at baseline, 12 weeks, and 16 weeks. Total CD3 T lymphocytes as well as T lymphocytes bearing the receptors CD4, CD8, and CD56, IgM, IgG, IgA, complement C3, C-reactive protein, serum albumin, prealbumin, transferrin, retinol-binding protein, hemoglobin, and hepatitis B surface antigen were determined. Health status and flour usage were monitored. Paired- and independent-sample t-tests and chi-square tests were performed. Results. Mean nutrient availability per adult equivalent was 2,650 ± 806 kcal, 70.1 ± 26.4 g protein, 65 ± 14percent cereal protein, and 41.9 ± 0.8 mg lysine per gram of protein. Complement C3 was significantly higher in men receiving lysine than in controls (p .05). Among women, there were significant differences between the control and lysine groups in diarrhea period prevalence (total number of diarrheal episodes during the period of intervention divided by the total number of observations), (20 in the control group, 6 in the lysine group; p = .014), the mean number of days ill (0.4 ± 0.7, control, 0.14 ± 0.4, lysine, p = 0.03), and the number of diarrheal episodes per person per year (1.39 in the control group, 0.47 in the lysine group). No other significant differences between the lysine and the control groups were observed. Conclusions. Lysine fortification of wheat flour demonstrated a positive effect on diarrheal morbidity in women. The effect could be attributed to an improvement in protein utilization but possibly also to a direct effect of lysine in gastrointestinal tract. Studies in populations with higher diarrheal prevalence and significant dietary lysine deficiency are needed to determine whether the reported effects on diarrheal prevalence are replicable and whether they are pharmacological or nutritional. It would be particularly desirable to study the effect of lysine on diarrhea in preschool children, who have much higher morbidity and mortality rates from this disease than school-age children or adults. © 2008, The United Nations University.

BABA N, 1994, ECOL FOOD NUTR, V32, P247; BATTLE WM, 1980, DIGEST DIS SCI, V25, P647, DOI 10.1007-BF01308322; BRESSANI R, 1963, J NUTR, V81, P339; BRESSANI R, 1958, J NUTR, V66, P501; BRESSANI R, 1963, J NUTR, V79, P333; BRESSANI R, 1960, J NUTR, V70, P176; BRESSANI R, 1963, J NUTR, V80, P80; BRICKER M, 1945, J NUTR, V38, P269; Dixon J.A., 2001, FARMING SYSTEMS POVE; *FAO WHO UN U, 1985, EN PROT REQ; *FAO WHO UN U, 2004, EN PROT REQ REP JOIN; FAO-WHO, 1991, REP JOINT FAO WHO EX; FIORAMONTI J, 1980, BRIT J NUTR, V43, P155, DOI 10.1079-BJN19800074; Ghosh S, 2004, ECOL FOOD NUTR, V43, P107, DOI 10.1080-03670240490280267; GHOSH S, 2004, THESIS U MASSACHUSET; Gibson RS, 2005, PRINCIPLES NUTR ASSE; Grosh M., 2000, DESIGNING HOUSEHOLD; HOFFMAN WILLIAM S., 1949, JOUR NUTRITION, V38, P331; Hussain Tajammal, 2004, Food and Nutrition Bulletin, V25, P114; KIELMANN AA, 1976, B WORLD HEALTH ORGAN, V54, P477; Mearadji B, 2001, DIGEST DIS SCI, V46, P38, DOI 10.1023-A:1005649506525; MOKBEL M, 1986, 18 INT CTR AGR RES D; Pellet P. L., 1988, Increasing small ruminant productivity in semi-arid areas. Proceedings of a workshop held at the International Center for Agricultural Research in the Dry Areas, Aleppo, Syria, 30 November to 3 December 1987., P3; Pellett Peter L., 1996, Food and Nutrition Bulletin, V17, P204; PELLETT PL, 1970, FOOD TABLES MIDDLE E; SCRIMSHAW NS, 1958, J NUTR, V66, P458; SCRIMSHAW NS, 1969, AMINO ACID FORTIFICA; Smriga M, 2003, P NATL ACAD SCI USA, V100, P15370, DOI 10.1073-pnas.2436556100; Smriga M, 2002, J NUTR, V132, P3744; SOUMI G, 1991, SUPPLEMENTAL IRRIGAT, P497; STENE L, 1998, EUR J CLIN NUTR, V76, pS93; Turrini A, 2001, EUR J CLIN NUTR, V55, P571, DOI 10.1038-sj.ejcn.1601185; *UN INT CHILDR EM, 1996, MULT IND CLUST SURV; *US DEP HHS, 2005, GUID IND FDA STAFF R; *WORLD BANK, REACH RUR POOR RUR D; YOUNG VR, 1994, AM J CLIN NUTR, V59, p1203S; YOUNG VR, 1989, AM J CLIN NUTR, V50, P80; ZHAO W, 2004, FOOD NUTR BULL, V252, P123

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