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Abrams Lab International Projects |
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Beverage Study
Peru
Our group went to Lima, Peru in 2001 to study the
bioavailability effects of iron and zinc from a multiple
micronutrient fortified beverage. Multiple micronutrient
deficiencies are common among children in resource-poor
areas. A fortified beverage containing multiple micronutrients
may effectively combat such deficiencies if key nutrients
are adequately bioavailable.
Our key collaborator at the Instituto de Investigacion Nutricional is Dr. Nelly Zavaleta.
For more information visit the website below.
http://www.iin.sld.pe/iin_researchers2.php?inv=3&par=2
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Botswana
Similar to the Peruvian study of micronutrient-fortified
beverages, the Botswana study was conducted to study
the efficacy of the multiple micronutrient fortified
beverage to enhance the nutritional status of children
in Botswana. Study results showed that such a beverage
supplementation program may be beneficial to children
in areas at risk for micronutrient deficiencies. (Paper
in press).
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Iron Bioavailbility Study
Mexico
The team traveled to Mexico in 2002 to collaborate
with Dr.
Salvador Villalpando Hernández and the Centro
de Invesitgation en Nutriciion y Salud in Cuernavaca,
Mexico to study the bioavailability of iron in different
types of supplements.
Because iron can be delivered via a number of different
methods, discovering which of these methods provides
the greatest amount of iron that is usable by the body
(bioavailable) is very important.
Iron deficiency, which can cause a myriad of health
problems, could be more effectively and efficiently
combated with the use of the most efficient supplementation
techniques.
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Rickets Study
Nigeria
Nutritional rickets, a pressing pediatric nutrition
issue in a large portion of the developing world, has
traditionally been ascribed to Vitamin D deficiency.
Recent studies in Nigeria, however, suggested that the
disease might have its roots in inadequate calcium intake.
We traveled to Nigeria in 2003 to collaborate with a
team of physicians there to study the affects of calcium
supplementation on calcium absorption. We are attempting
to determine whether high levels of fractional calcium
absorption seen previously in children with rickets
are maintained after therapy is begun, leading to a
net increase in total calcium absorption.
A team with Dr. Abrams' lab returned to Jos, Nigeria in
January 2005 to kick off a new and expanded study on calcium-deficiency
rickets in children. We plan to supplement 18 children with
active rickets with calcium supplements for 6 weeks. We
also hope to evaluate the effect of adding phytase enzymes
to the typical Nigerian foods in an effort to decrease the
inhibitors of calcium in the foods and therefore improve
overall calcium absorption among children.
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Educational Activities
Neonatal Intensive Care Unit (NICU) Education
Lima, Peru and Panama City, Panama
Our group of doctors, nurses, dietitians, and medical
students has traveled to both Lima and Panama City on
several occasions to present up-to-date information
on the clinical and practical management of premature
infants. Through our lecture series and hands-on bedside
rounds, we have extended and expanded our relationship
with the staff at El Hospital de La Maternidad in Lima
and the Hospital del Niño in Panama City.
Lectures have included such topics as Ventilatory
Management, Pain Management, Infections, Fortifying
Breastmilk for Premature Babies, Vitamins and Minerals,
as well as many other issues of clinical concern.
The program has met with success for numerous reasons.
pending quality time in the unit and working hands-on
with the staff allows them to practice new ideas and
techniques. Through our previous trips to both Lima
and Panama City, our team has a better understanding
of each unit’s strengths and weaknesses, freeing
us to focus on areas of particular concern to each group.
Because of our returns for follow-up visits, the medical
staffs in Lima and in Panama City have gained a level
of familiarity with our team that has led to greater
receptiveness to new practices. Finally, the support
of Baylor College of Medicine and Texas Children’s
Hospital create the opportunity for international education
and research trips.
Bolivia
Our team traveled to Santa Cruz and Cochabamba in Bolivia in August 2005.
In participation with the Pediatric Society of Santa Cruz, we visited with doctors, nurses, nutritionists,
and medical students at several hospitals. In addition, we presented educational lectures to all invited
guests at the 2nd International Course on Advances in Neonatology. Featured speakers included:
- Dr. Steven Abrams Management of Bronchopulmonary Dysplasia
- Dr. Teresa Ochoa Common Infections and Guidelines for Prevention in the Neonatal Intensive Care Unit
- Keli Hawthorne, MS, RD, LD Management of Enteral Nutrition: Fortifying Breast Milk, the Use of Formulas, and Promotion of
Breastfeeding; and also Management and Complications of Total Parenteral Nutrition for Premature Infants
- Shari Hemphill, RN Pain Management in the Newborn
- Erika Hernandez, RN Developmental Care for the Newborn
Guatemala
Our team from BCM and TCH visited Roosevelt Hospital and IGSS Hospital (the social security hospital) in Guatemala City,
Guatemala in 2005. The trip was also supported by the Neonatal and Perinatal Medical Association of Guatemala.
Topics presented included Advances in Neonatal Respiratory Therapy, Nutrition for the Neonate, Pain Management
in the Newborn, and HIV Infection in the Perinatal Period. We extend our great appreciation to Dr. Cabrera-Meza
for organizing this trip.
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Developing a Spanish-language
Nutrition Curriculum
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Malnutrition is a concern for people throughout
the world, especially in Latin America . And despite
many children having access to nutritious foods through
school programs, they may choose unhealthy alternatives
simply because they do not understand the importance
of a balanced diet. Medical students and residents
at Baylor College of Medicine have the opportunity
to participate in various health care experiences throughout
Central and South America and the ability to improve
nutritional interventions for the communities in these
regions. However, nutrition curriculum materials and
resources in Spanish are not widely available.
Under the direction of Dr. Steve Abrams, Baylor medical students
have signed up for a one-month nutrition elective to
develop such a program for medical teams to use in
their travels. The project includes both small group
lecture material for local health care workers and
a community discussion with parents covering topics
such as breastfeeding, weaning foods, iron deficiency,
macronutrient deficiencies, and re-hydration of children
with diarrhea. The program also includes material for
school-aged children such as a coloring book, interactive
lectures, and games to make learning about the Food
Guide Pyramid enjoyable and memorable.
During the upcoming
calendar year, students will have the opportunity to
share the new curriculum with communities in Guatemala,
Honduras, and Peru.
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Student Activities
Bolivia
In the words of BCM 4th year medical student Michelle Lopez:
Medical and college students prepared nutrition lesson plans for students of all ages,
parents, and teachers. For younger children, the curriculum included starting the
lesson with a story about a hungry caterpillar. We used the story to teach the
children about bad food choices leading to a stomachache and good food
choices allowing the caterpillar to become a beautiful butterfly. This led
to a brief discussion about the components of the food pyramid. Finally, we
talked about the importance of combining exercise with healthy eating for a
healthy body. We then asked the children to volunteer to show their favorite
exercises. We gave volunteers Carlito’s ABC coloring book and crayons. This
coloring book was created by two medical students and discusses healthy food
choices from A-Z in Spanish while giving fun food facts about each choice. Eventually,
we distributed copies of these to the entire class. We also gave copies to
the teachers to go through the activities with the class and reinforce the
lesson. The lesson plan for older children was more flexible and based on the
age of the group we encountered. For the older children, we used a felt
pyramid and laminated foods to thoroughly go through the food pyramid and
quizzed the children at the end of the lesson. We also discussed the
importance of exercise.
We found that school directors and teachers were
extremely receptive to our visits. The school children
seemed to enjoy the lectures as they paid attention,
participated in the discussions and asked thoughtful
questions. Overall, we saw the need for our lectures.
In many of the schools, there were candy vendors sitting
at the entrance. By the end of the lectures, the students
were able to talk about choosing options like bananas
and yucca over candy when buying snacks at school.
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Guatemala
In addition to the NICU training aspect of our Guatemala trip in 2005, 2
Baylor medical students also came to provide nutritional educations to a group
of mothers at a medical clinic in Zacapa, Guatemala called “Seeds of Hope.”
Evelyn Chang and Rachel Scheisser led a presentation in Spanish on the food
guide pyramid; although in Guatemala the national food educational tool is
a pot instead of a pyramid. They educated mothers on how to provide healthy
and nutritious foods for their families. Afterwards, we were able to venture
out into the community to visit with some of the families who had attended
and there was a very positive response back from everyone who had attended.
In addition, they were able to verbalize some of the nutrition information
that Evelyn and Rachel had taught to them that day. And the children loved
the Spanish nutrition coloring books and crayons that we passed out.
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Upcoming Events & Studies
The Gambia – Iron deficiency and malaria
We plan to collaborate with the medical team in
The Gambia to study the effects of iron supplementation
on the contraction and severity of malaria in children.
Peru: Absorption of Zinc in HIV+ Children
There are indications that supplementation of
micronutrients such as zinc may be particularly important
in HIV-positive patients because of the constant struggle
of these individuals to maintain immunocompetency.
Key questions that need to be answered include the
effects of HIV and the effects of highly active antiretroviral
therapy on the absorption of zinc. In this study, absorption
of zinc will be measured using the technique of stable
isotopic labeling of trace minerals. This study could
provide concrete evidence that the virus or the medications
that treat HIV induce a pathologic change in zinc absorption
and that an inexpensive nutritional intervention, such
as zinc supplementation, can provide a positive benefit
in the care of HIV patients. This information would
be useful not only in developing countries, but everywhere,
including the United States, where this virus continues
to affect the population in epidemic proportions. |
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