We organized prevailing research and theories on telomere biology and micronutrients to better hypothesize our expected findings in an observational statistical analysis of study data from the WASH Benefits trial from Bangladesh!
The WASH+N Benefits trial was a large, cluster-randomized trial that improved infrastructure for clean water, sanitation, hygiene, and nutrition!
The WASH Benefits trial in Bangladesh was one of the largest water, sanitation, hygiene, and nutrition trials.
The intervention measured the health outcomes of childhood growth and diarrhea.
DOHaD is a theory which suggests that early life is sensitive to changes from environmental stimuli and that fetal and newborn populations are more sensitive to environmental factors that affect their susceptibility to disease later in life (Barker, 2007)(Barker, 2013)
Bangladeshi Newborn (WHO, 2019)
Telomeres are non-coding DNA sequences at the ends of chromosomes that protect essential coding regions from degradation. Following each cell division, oxidative stress or inflammation, telomeres gradually shorten, leading to cell senescence and disease (Fitzpatrick et al., 2007). Shorter telomeres are associated with diseases like diabetes, cardiovascular-disorders and early mortality (Steenstrup et al., 2017; De Meyer et al., 2018; Wang et al., 2018).
Telomere attrition, the rate of shortening, is highest within the first three years of life (Factor-Litvak, 2016; Gorenjak, 2020; Frenk et al.,1998). If a child has prematurely shorter telomeres, they have less room for telomere attrition as they get older. This may mean that children with prematurely short telomeres may reach critically short telomeres earlier in life, which can affect their health and disease susceptibility (Factor-Litvak, 2016).
Telomere biology is a predictive biomarker that can be used to interpret the biological stress endured throughout life. Understanding the factors that may help curb childhood telomere attrition ensures good health outcomes later on in life.
What factors may influence telomeres?
Micronutrients are essential molecules we consume from our diet that support human metabolism and prevent disease (Shergill-Bonner, 2017).
According to the World Health Organization, over 2 billion people worldwide don’t get enough essential micronutrients like vitamin A and iron; most of them live in low- and middle-income countries (WHO, 2007).
As a result, people—especially children—face a higher risk of health issues like stunted growth, developmental delays, and diseases such as diarrhea, measles, malaria, and pneumonia (WHO, 2007).
Micronutrient deficiencies are associated with chromosomal instability (Fenech et al., 2023)
Micronutrient deficiencies impair DNA replication and repair by disrupting cofactors and substrates essential for these processes (Fenech et al., 2023). They contribute to chromosomal instability through replication stress, faulty DNA repair, and mitotic errors - resulting in aberrant karyotypes (Fenech et al., 2023).
Several studies have found that antioxidant micronutrients, like vitamin A, are associated with longer telomeres (Nomura et al., 2017; Xu et al., 2009; Sen et al., 2014). One large U.S. study reported that people who took vitamin A supplements had longer telomeres in their white blood cells (Nomura et al., 2017). Another study on adult women found that higher levels of antioxidant micronutrients in the blood were associated with longer telomeres (Xu et al., 2009). These findings suggest that antioxidant micronutrients might help protect telomeres by reducing oxidative stress.
Micronutrients involved in DNA repair, like vitamins B9 and B12, are associated with longer telomeres. A study in Colombian children found that higher B12 levels were tied to longer telomeres (Flannagan et al., 2018), though a study in Nepal didn’t find the same effect in infants under one year old (Ulak et al., 2018).
On the other hand, higher iron levels are associated with shorter telomeres. A U.S. study found that adults with high blood ferritin (a marker of iron) had shorter telomeres (Liu et al., 2019), and a study in Rwanda showed that pregnant women with lower iron biomarkers had longer telomeres (Nsereko et al., 2020). Since iron can promote oxidative stress when levels are too high, it may contribute to telomere shortening (Fenech et al., 2023). Altogether, these findings suggest that while some micronutrients may help protect telomeres, others, like iron, might have the opposite effect.