Joann Mcdermid

Understanding mature breastmilk immunology may benefit infants chronically exposed to infectious pathogens in resource-limited regions. This prospective rural/semi-rural Tanzanian cohort of women (n = 102 at delivery; 38% HIV-positive) and their infants (n = 102) investigated breastmilk, maternal and infant serum immunoglobulins (IgA/IgG1-4/IgM) an...

Early identification of individuals at risk for progressing to active tuberculosis (TB) disease may limit new transmission and improve clinical outcomes. Evidence indicates altered iron homeostasis may identify those at greater risk of disease progression in HIV co-infection. We aimed to investigate iron homeostasis biomarkers as risk factors for p...

Background: Anemia is common in tuberculosis, and multiple etiologies necessitate targeted interventions. The proportion of iron-responsive anemia due to iron deficiency compared with iron-unresponsive anemia due to impaired iron absorption/redistribution from tuberculosis-associated immune activation or inflammation is unknown. This impedes selec...

Background Cryptosporidium epidemiology is poorly understood, but infection is suspected of contributing to childhood malnutrition and diarrhea-related mortality worldwide. Methods/Findings A prospective cohort of 108 women and their infants in rural/semi-rural Tanzania were followed from delivery through six months. Cryptosporidium infection wa...

Background Healthcare access and resources differ considerably between urban and rural settings making cross-setting generalizations difficult. In resource-restricted rural/semi-rural environments, identification of feasible screening tools is a priority. The objective of this study was to evaluate gestational anthropometry in relation to birth and...

Among exclusively breastfed infants, human milk (HM) provides complete nutrition in the first mo of life and remains an important energy source as long as breastfeeding continues. Consisting of digestible carbohydrates, proteins, and amino acids, as well as fats and fatty acids, macronutrients in human milk have been well studied; however, many asp...

Human milk (HM) contains macronutrients, micronutrients, and a multitude of other bioactive factors, which can have a long-term impact on infant growth and development. We systematically searched MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry th...

Characterization of the nutrients in human milk is important to understand the dietary and developmental requirements of infants. The objective of this review was to summarize the state-of-the-science on the nutrient composition of human milk in the United States and Canada published from 2017 to 2022. Four databases were searched for randomized co...

Celiac disease is an autoimmune disorder in which the immune system of genetically susceptible individuals elicits a reaction to gluten causing small intestine damage. If left undiagnosed and untreated, the resulting nutritional malabsorption can lead to anemia, bone disease, growth faltering or other consequences. The condition is lifelong and lac...

Human milk (HM) provides a plethora of nutritional and non-nutritional compounds that support infant development. For many compounds, concentrations vary substantially among mothers and across lactation, and their impact on infant growth is poorly understood. We systematically searched Medline, EMBASE, the Cochrane Library, Scopus, and Web of Scien...

Background: Children in low-resource areas experience nutritional and infection challenges delaying growth and cognitive development. Objective: Our goal was to assess for associations of circulating biomarkers related to nutrition and inflammation, with growth and developmental outcomes among children in a birth cohort in a resource-poor area i...

In 2015, the Council on Research published their vision for scientific decision making which provided nutrition and dietetics practitioners and practitioners-in-training key information on the Academy’s newly developed scientific integrity principles (SIP). Given that it has been 7 years since the original publication, it was felt the original 6 pr...

Background: In population-based growth surveys in sub-Saharan Africa, boys have higher rates of growth failure than girls. Objective: Our goal was to assess for the presence, timing and potential etiology of sex-based differences in length-for-age z-score (LAZ), weight-for-age z-score (WAZ) and head-circumference-for-age z-score (HCZ) in a birth...

Background Stunting among children in low-resource settings is associated with enteric pathogen carriage and micronutrient deficiencies. Our goal was to test whether administration of scheduled antimicrobials and daily nicotinamide improved linear growth in a region with a high prevalence of stunting and enteric pathogen carriage. Methods and find...

Recurrent enteric infections and micronutrient deficiencies, including deficiencies in the tryptophan-kynurenine-niacin pathway, have been associated with environmental enteric dysfunction, potentially contributing to poor child growth and development. We are conducting a randomized, placebo-controlled, 2 × 2 factorial interventional trial in a rur...

Malnutrition during the critical period of pregnancy has significant health outcomes for both the mother and her offspring. Medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) may help mitigate negative health effects, although studies that support the role of the RDN have not been comprehensively evaluated. The objective w...

Background Immune activation and inflammation are common symptoms throughout HIV infection and lead to elevated circulating concentrations of cachectic cytokines. Aims To evaluate cachexia-like symptoms among HIV-positive and HIV-negative pregnant women, and investigate whether cachexic mechanisms may contribute to impaired HIV-exposed fetal and i...

Background: Given the high rates of vitamin D deficiency among pregnant women and possible effects on offspring health, a systematic review on this topic was conducted to help inform future practice guidelines. Objective: To evaluate associations between maternal vitamin D supplementation, maternal 25-hydroxyvitamin D (25(OH)D) concentrations, a...

Background: While obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined. Objective: A systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bari...

Cultural competency is a required standard for American medical students, but it can be challenging to effectively engage students with this topic. Because nutrition and culture are inherently intertwined in patient care, classroom role-play with nutrition-focused case scenarios enables students to practice strategies for navigating cultural barrie...

Introduction In many developing areas in the world, a high burden of enteric pathogens in early childhood are associated with growth deficits. The tryptophan-kynurenine-niacin pathway has been linked to enteric inflammatory responses to intestinal infections. However, it is not known in these settings whether scheduled antimicrobial intervention to...

Initiating breastfeeding within the first hour of life confers an important benefit in terms of child mortality and severe morbidity. Intestinal permeability to ingested macromolecules and immunoglobulins is limited to the first days of human life. These exchanges cease in the very early post-partum period but may increase beyond the neonatal perio...

While major success has been achieved in tuberculosis prevention and control in recent years, the disease continues to affect many millions worldwide. Overall, this chapter summarizes the fundamental principles and concepts related to tuberculosis, and outlines key barriers that must be overcome to further reduce the global burden. The chapter open...

Objectives: HIV infection is associated with chronic systemic inflammation, with or without antiretroviral therapy. Consequences for fetal growth are not understood, particularly in settings where multiple maternal infections and malnutrition are common. The study was designed to examine maternal systemic circulating and umbilical cord blood cytok...

Early and chronic inflammation is a hallmark of HIV infection, and inflammation is known to increase hepcidin expression. Consequently, hepcidin may be a key determinant of the iron homeostasis and anemia associated with poorer HIV prognoses. The objective of this study was to understand how hepcidin is related to anemia, iron homeostasis, and infl...

Background Infection causes immune activation and inflammatory cytokines may be mediators of intrauterine growth restriction (IUGR). While infection and IUGR are common in developing regions, the intrauterine cytokine environment and its impact on birth size is undefined. Understanding the fetal environment mediated by multiple cytokines may inform...

Hepcidin inhibits ferroportin-mediated iron efflux, leading to intracellular macrophage iron retention, possibly favoring Mycobacterium tuberculosis iron acquisition and tuberculosis (TB) pathogenesis. Plasma hepcidin was measured at human immunodeficiency virus (HIV) diagnosis in a retrospective HIV-prevalent, antiretroviral-naïve African cohort t...

Chronic HIV immune activation alters systemic levels of cytokines regulating appetite and body composition and we hypothesized this is contributing to a mild degree of cachexia that typically remains undetected during pregnancy in food insecure regions. We developed a novel cachexia scoring system adapted to this context that included nutritional s...

Complex biological, behavioral, socioeconomic and psychological factors influence appetite and subsequent dietary intake; as such, focusing only on a single factor can lead to inappropriate dietary recommendations. This is especially true when poverty‐associated malnutrition and infectious diseases coexist; although both negatively impact dietary i...

Breast milk (BM) offers an important immunological bridge from mothers to infants; but BM immunology is incompletely understood. We aimed to determine how BM cytokines and immunoglobulins (Ig) were associated with infant Cryptosporidium infection in a prospective cohort of 108 mother (39% HIV+)/infant pairs. BM and maternal serum was analyzed at mo...

Iron biomarker patterns identify tuberculosis (TB) risk, but evidence of the evolution of iron biomarkers from treatment initiation to disease resolution is limited. Plasma/serum ferritin, hepcidin and soluble transferrin receptor (sTfR) were measured in 45 Gambians diagnosed with TB (active disease) at treatment initiation, 2 and 6 months and comp...

Globally, Cryptosporidium spp. is the most common diarrhea‐causing protozoan infection among children at health facilities. Infection may be asymptomatic or may manifest as severe, chronic diarrhea especially in malnourished or HIV‐positive individuals. Long‐term physical and cognitive impairment has been associated with infection. The objective of...

Women in rural and semi‐urban areas of Africa face additional healthcare access barriers affecting birth outcomes and HIV‐exposed infants have a poorer prognosis compared to unexposed infants. Our objective was to characterize associations between maternal nutritional status during pregnancy and birth outcomes of HIV+ and HIV− women enrolled in a s...

Background Identifying people at higher risk of developing tuberculosis with human immunodeficiency virus (HIV) infection may improve clinical management of co-infections. Iron influences tuberculosis (TB) pathogenesis, but understanding the exact mechanisms of how and timing of when iron is involved remains challenging since biological samples are...

Rationale for study hypothesis.

Baseline characteristics of participants.

To the Editor: Esbjörnsson and colleagues (July 19 issue)(1) conclude that infection with human immunodeficiency virus type 2 (HIV-2) attenuates the course of HIV-1 infection. Their report raises three issues. First, in Guinea-Bissau, up to 30% of persons infected with both HIV-1 and HIV-2 have coinfection with human T-cell lymphotropic virus type...

SETTING: Data on pediatric tuberculosis (TB) from TB-endemic, resource-constrained regions are limited, impacting awareness of disease burden and influencing diagnostic actions. OBJECTIVE: To obtain recorded incidence of childhood (age <5 years) TB in Mwanza Municipality, Tanzania, to estimate true incidence and to explore setting-specific reasons...

Iron-related genes and iron status may independently contribute to variable HIV outcomes. The nature of the biologically plausible gene-nutrient interaction remains unknown. The objectives were to investigate whether iron-related genotypes and clinically abnormal iron status independently predict mortality in HIV and whether a gene-nutrient interac...

To comprehensively assess iron status and determine whether elevated iron status, like anemia, predicts mortality. We followed 1362 Gambian adults (53% female) in an HIV-seroprevalent clinic-based cohort over 11.5 years to ascertain all-cause mortality. Baseline iron status (iron, soluble transferrin receptor [sTfR], transferrin, ferritin, transfer...

There are many lines of evidence illustrating that iron plays a pivotal role in modulating the battle for survival between mammalian hosts and their pathogens. Each displays considerable genetic investment in a wide range of mechanisms for acquiring and maintaining iron. These competitive mechanisms are highly complex, existing within an interactin...

It is the position of the American Dietetic Association (ADA) and Dietitians of Canada (DC) that efforts to optimize nutritional status, including medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential components throughout the continuum of care available to people with human immunodeficiency viru...

Young children in rural Gambia face constant exposure to gastrointestinal and respiratory infections and, during the rainy season (July–November), suffer recurrent bouts of Plasmodium falciparum malaria. Within living memory, these conditions led to more than half of the children dying before their fifth birthday, providing a graphic demonstration...

Caucasians carry TNFA-308*2 in the 8.1 ancestral haplotype (AH) (HLA-A1,B8,DR3). In Gambians, TNFA-308*2 occurs without HLA-B8 or -DR3, suggesting an independent effect of TNFA-308 on disease. Hence we sought a segment of the 8.1 AH in Gambians. BAT1 (intron 10)*2 was selected as a specific marker of the haplotype and was found with TNFA-308*2 in G...

To describe the relationship between dietary antioxidant intake and oxidative stress in clinically stable HIV-positive and HIV-negative adults. A cross-sectional study. Average total daily dietary intakes of vitamin C, beta-carotene, alpha-tocopherol, selenium, and zinc from foods and nutritional supplements were estimated in noninstitutionalized i...