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Sirakawin C, Lin D, Zhou Z, Wang X, Kelleher R, Huang S, Long W, Pires‐daSilva A, Liu Y, Wang J, Vinnikov IA. SKN-1/NRF2 upregulation by vitamin A is conserved from nematodes to mammals and is critical for lifespan extension in Caenorhabditis elegans. Aging Cell 2024; 23:e14064. [PMID: 38100161 PMCID: PMC10928581 DOI: 10.1111/acel.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 03/13/2024] Open
Abstract
Vitamin A (VA) is a micronutrient essential for the physiology of many organisms, but its role in longevity and age-related diseases remains unclear. In this work, we used Caenorhabditis elegans to study the impact of various bioactive compounds on lifespan. We demonstrate that VA extends lifespan and reduces lipofuscin and fat accumulation while increasing resistance to heat and oxidative stress. This resistance can be attributed to high levels of detoxifying enzymes called glutathione S-transferases, induced by the transcription factor skinhead-1 (SKN-1). Notably, VA upregulated the transcript levels of skn-1 or its mammalian ortholog NRF2 in both C. elegans, human cells, and liver tissues of mice. Moreover, the loss-of-function genetic models demonstrated a critical involvement of the SKN-1 pathway in longevity extension by VA. Our study thus provides novel insights into the molecular mechanism of anti-aging and anti-oxidative effects of VA, suggesting that this micronutrient could be used for the prevention and/or treatment of age-related disorders.
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Affiliation(s)
- Chaweewan Sirakawin
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Dongfa Lin
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
- Key Laboratory for Molecular Enzymology and Engineering, School of Life SciencesJilin UniversityChangchunChina
| | - Ziyue Zhou
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaoxin Wang
- Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | | | - Shangyuan Huang
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Weimiao Long
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | | | - Yu Liu
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Jingjing Wang
- Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ilya A. Vinnikov
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
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Wang X, Xu Y, Tan B, Duan R, Shan S, Zeng L, Zou K, Zhao L, Xiong J, Zhang L, Rong S, Cheng G. Development of the Chinese preschooler dietary index: a tool to assess overall diet quality. BMC Public Health 2022; 22:2428. [PMID: 36572858 PMCID: PMC9791773 DOI: 10.1186/s12889-022-14672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diet quality in early childhood has a long-term impact on health outcomes. However, there are scarce dietary indexes for Chinese preschool children, and the existing indexes had limited validity and reliability. This study thus aimed to develop a dietary index for preschool children based on the Chinese Dietary Guideline and Chinese Dietary Reference Intakes and to assess their overall diet quality using the China Health and Nutrition Survey (CHNS). METHODS The Chinese Preschooler Dietary Index (CPDI) included 11 components, covering 9 food group components and two nutrient components. The total scores of CPDI ranged from 0 to 90, with a higher score indicating greater diet quality. This study assessed the diet quality of 1742 preschoolers aged two to five years old from CHNS using the CPDI. Dietary intake data were obtained using three-day 24-h diet recalls, and sociodemographic information was also collected. Cochran-Mantel-Haensel (CMH) test was used to explore the association between demographic and CPDI total scores. The principal component analysis, correlation analysis and Cronbach's alpha were used to evaluate the relative reliability and validity of the CPDI. Finally, a stepwise multiple regression analysis was performed to explore potential influencing factors of CPDI. RESULTS Among the 1742 CHNS preschool children, more than 70% resided in rural areas and 41.2% of the sample were raised in a low-income family. The mean CPDI score of the preschoolers was 38.8 ± 12.9. Higher diet scores were correlated with higher energy and nutrient intake. Children with higher age (β = 0.93, SE = 0.26, P = 0.0003), raised in a home with higher household income (β = 3.11, SE = 0.27, P < 0.0001) or living in urban areas (β = -4.44, SE = 0.66, P < 0.0001) were associated with higher CPDI scores. CONCLUSIONS The CPDI is useful in evaluating the diet quality of preschool children. Based on the CPDI, the diet quality of Chinese preschoolers needs to be improved, especially in rural areas.
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Affiliation(s)
- Xiaoyu Wang
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Yujie Xu
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Bingbing Tan
- grid.13291.380000 0001 0807 1581Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ruonan Duan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China ,grid.470966.aShanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China ,grid.412793.a0000 0004 1799 5032Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shufang Shan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Linan Zeng
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kun Zou
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- grid.13291.380000 0001 0807 1581Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jingyuan Xiong
- grid.13291.380000 0001 0807 1581Healthy Food Evaluation Research Center, West China School of Public Health and West China Fourth Hospital,, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuang Rong
- grid.412787.f0000 0000 9868 173XDepartment of Nutrition Hygiene and Toxicology, Academic of Nutrition and Health, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Guo Cheng
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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Wang N, Cao Y, Chen X, Sun M, Ma L, Dai X, Zhao Y. Evaluation of the growth and nutritional status of preschool children: a pilot study in the cold area of China. J Pediatr Endocrinol Metab 2022; 35:1020-1027. [PMID: 35771737 DOI: 10.1515/jpem-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The growth and development of children is influenced not only by heredity factors but also by environmental factors, including nutrition and temperature. The aim of this study was to evaluate the growth and nutritional status of preschool children in Daxing'anling, the coldest region of China. METHODS A descriptive, cross-sectional survey was performed among preschool children aged 3-6 years by stratified cluster sampling in Daxing'anling. The children's parents completed the questionnaires. Height, body weight and head circumference were measured, and Z scores for weight for height, weight for age, height for age and head circumference for age were evaluated. Anthropometric data were compared with World Health Organization standards and China's growth references. The levels of vitamin A, E and 25-(OH)-D3 in serum were detected by high-performance liquid chromatography. RESULTS A total of 305 children were recruited. The average height of the preschool children was lower than China's growth reference but higher than the WHO standard. More than half of the preschool children ranged from -1 SD to +1 SD. Both the values of weight for height and of weight for age were positive and higher than the WHO standards (p<0.01), with a significant difference between boys and girls (p<0.01). The incidences of stunting, wasting, and underweight were 4.59%, 2.95%, and 2.30%, respectively, although the prevalence of overweight and obesity was high (18.03% and 6.89%, respectively). The rates of vitamin A and D deficiency were 7.54% and 88.85%, respectively. Vitamin A was also positively associated with 25-(OH)-D3. CONCLUSIONS The burden of malnutrition in preschool children exists in cold regions, and a cold climate may be an important factor. Therefore, we should pay attention to the nutrition and physical growth of local preschool children; in particular, vitamin D deficiency should be given high priority, and necessary nutritional interventions should be made.
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Affiliation(s)
- Nan Wang
- Department of Anesthesiology, The Heilongjiang Province Key Lab of Research on Anesthesiology and Critical Care Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Yue Cao
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Xin Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Mengyun Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Lingyu Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Xuezheng Dai
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Yan Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
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Association of vitamin A with anemia and serum hepcidin levels in children aged 6 to 59 mo. Nutrition 2021; 91-92:111463. [PMID: 34628277 DOI: 10.1016/j.nut.2021.111463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study evaluates the association of serum retinol, hepcidin levels, and anemia in children. METHODS This cross-sectional study included 312 children, ages 6 to 59 mo, from Rio de Janeiro, Brazil. The association between hepcidin and retinol levels, hematologic parameters, and body mass index (BMI) was analyzed using a generalized linear model with and without adjustment for C-reactive protein (CRP) level. Logistic regression analysis was used to test anemia as an outcome and serum retinol level as a predictive variable using the odds ratio (OR) function. RESULTS Anemia was present in 14.6% of the children, 5.8% presented iron deficiency anemia, and 9.6% had vitamin A deficiency. The increase in serum retinol levels reduced the chances of anemia (OR = 0.13; confidence interval = 0.29-0.59). When CRP level was not adjusted for in the multiple regression analyses, retinol, ferritin levels, and BMI/age were predictors of serum hepcidin levels (β = -3.36, 0.14, 1.02, respectively; P = 0.032). Accordingly, serum retinol levels were inversely associated with CRP levels (β = -0.025 and P < 0.001). CONCLUSIONS The association between serum retinol and hepcidin levels in children ages 6 to 59 mo seems to be dependent on inflammation. Taken together, the results reinforce the need for the development of further studies to better understand the relationship between vitamin A and anemia of inflammation.
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Shimanda PP, Amukugo HJ, Norström F. Socioeconomic factors associated with anemia among children aged 6-59 months in Namibia. J Public Health Afr 2020; 11:1131. [PMID: 33209233 PMCID: PMC7649727 DOI: 10.4081/jphia.2020.1131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
Abstract
Anemia remains a public health concern, and its prevalence varies between countries as well as between age, sex and levels of poverty. This study aims at examining the association between socio-demographic factors and anemia among children aged 6–59 months in Namibia. Data was extracted from the 2013 Namibian Demographic Health Survey. The association between anemia and other factors was examined with logistic regression. Results are reported in odds ratio (OR), with 95% confidence intervals (CI). In total, 1,383 children aged 6–59 months had complete data and included in the analyses. Our study shows that there is a statistically significantly increased risk of anemia among children from poorer households compared with the richest quintile. Also, there was a statistically significance supporting anemia being more common among boys than girls. There was also a statistically significant negative effect related to age. Our study shows that young children, boys and children in poorer households have an increased risk of anemia. Considering the adverse impact of anemia on child development, policies must prioritize factors exacerbating anemia risk.
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Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia
| | - Hans Justus Amukugo
- School of Nursing Science, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Onyeneho NG, Ozumba BC, Subramanian SV. Determinants of Childhood Anemia in India. Sci Rep 2019; 9:16540. [PMID: 31719548 PMCID: PMC6851096 DOI: 10.1038/s41598-019-52793-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022] Open
Abstract
We analyzed a sample of 112714 children from the 2015-2016 Indian National Fertility and Health Survey with available data on hemoglobin. Multinomial logistic regression models were used to establish associations between parent anemia, household characteristics and nutritional intake of children. Linear regression analysis was also conducted to see the link between the household characteristic and childhood nutritional intake on one hand and hemoglobin levels on the other hand. A number of socio-demographic factors, namely maternal age, type of residence and maternal education, as well as wealth index, among others correlate with incidence of childhood anemia. For instance, whereas 52.9% of children in the richest households were anemic, 63.2% of children in the poorest household were anemic (p < 0.001). Mean Vitamin A intake in the last six months was 0.63 (0.626-0.634) which was 0.18% of the recommended intake. Mean iron intake, from sources other than breast milk, in the last 24 hours was 0.29 (0.286-0.294) and 2.42% of the recommended daily intake. Fifty-nine percent (58.5%) of the children surveyed were anemic (Hb level: 9.75 g/dL [9.59-9.91]). Children with anemia were more prone to being iron deficient (odds ratio [OR]: 0.981 (0.961-1.001), Vitamin A deficient (OR: 0.813 (0.794-0.833)), and have lower maternal hemoglobin level (OR: 1.992 (1.957-2.027)). Combining nutritional supplementation and food-fortification programmes with reduction in maternal anemia and family poverty may yield optimal improvement of childhood anemia in India.
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Affiliation(s)
- Nkechi G Onyeneho
- Takemi Program in International Health, Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, USA. .,Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Benjamin C Ozumba
- Department of Obstetrics and Gynaecology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, USA
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Pedraza DF, Araujo EMND, Santos GLDD, Chaves LRM, Lima ZN. Factores asociados a las concentraciones de hemoglobina en preescolares. CIENCIA & SAUDE COLETIVA 2018; 23:3637-3647. [DOI: 10.1590/1413-812320182311.24042016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Resumen El presente estudio buscó identificar en niños preescolares la asociación de las concentraciones de hemoglobina con características socio-ambientales, maternas, biológico-nutricionales y las condiciones de salud; así como con las concentraciones séricas de zinc y retinol. Estudio transversal con muestra de 335 individuos, representativa de los niños de jardines infantiles del municipio de Campina Grande, Paraíba. En los 294 niños estudiados, el modelo ajustado mostró menores concentraciones de hemoglobina en casos de tipo de casa diferente de ladrillo; ausencia de red de escoto; colecta no pública de la basura; no tratamiento del agua para beber; dificultades maternas para leer, escribir o hacer cuentas; edad entre 9-24 meses; peso/edad < - 2 escore Z y problemas de salud en los últimos 15 días, bien como en casos de bajas concentraciones séricas de zinc y retinol. La multicausalidad de concentraciones inferiores de hemoglobina comprendió condiciones socio-ambientales y características materno-infantiles que refuerzan la importancia de medidas que prioricen los niños de menor edad, de madres con menor nivel educacional y con prejuicios en su peso, estado de salud y condición nutricional de otros micronutrientes importantes en el crecimiento.
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Onyeneho NG, Corsi DJ, Kurpad A, Subramanian SV. Intergenerational influences on childhood anaemia. MATERNAL AND CHILD NUTRITION 2018; 15:e12673. [PMID: 30207425 DOI: 10.1111/mcn.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/07/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
Prior research on assessing intergenerational influences on child anaemia has largely approached it from purely maternal perspective. Although there is much merit to focus on that, it is an extremely limited/reductionist view of understanding intergenerational influences. We expanded the intergenerational influences to include the fathers and overall of intergenerational household transfers. We analysed a sample of 19,619 mother-father-offspring trios from the 2015-2016 Indian National Fertility and Health Survey with available data on haemoglobin (Hb). Multinomial logistic regression models were used to establish associations between parent anaemia, household characteristics, and categories of offspring anaemia. Maternal and paternal Hb was measured as in children using a finger prick blood sample. The primary outcome was child's Hb level (in g/dl) and grades of anaemia defined as mild (10-10.9 g/dl), moderate (7-9.9 g/dl), and severe (<7 g/dl). Mean Hb was 10.1 g/dl for children, 14.2 g/dl among fathers, and 11.4 g/dl among mothers. Hb correlation was 0.1 between fathers and offspring and 0.2 between mothers and offspring (P < 0.001 for all correlations). Maternal-paternal Hb correlations were consistent across quintiles of wealth index. Maternal anaemia was associated with odds ratio of 1.3 (95% CI [1.1, 1.4]) and 1.6 (95% CI [1.4, 1.7]) for childhood mild and moderate/severe anaemia, respectively. Paternal mild anaemia was associated with an odds ratio of 1.1 (95% CI [0.9, 1.4]) and 1.4 (95% CI [1.2, 1.7]) for child moderate/severe anaemia. The clustering of poor circumstances suggests that public health strategies target social deprivation at the household level. A comprehensive perspective will provide holistic interventions to control childhood anaemia.
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Affiliation(s)
- Nkechi G Onyeneho
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Takemi Program in International Health, Boston, Massachusetts.,Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Daniel J Corsi
- OMNI Research Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Anura Kurpad
- Department of Physiology, St. John's Medical College, Bangalore, India
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Huang Z, Liu Y, Qi G, Brand D, Zheng SG. Role of Vitamin A in the Immune System. J Clin Med 2018; 7:E258. [PMID: 30200565 PMCID: PMC6162863 DOI: 10.3390/jcm7090258] [Citation(s) in RCA: 263] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
Vitamin A (VitA) is a micronutrient that is crucial for maintaining vision, promoting growth and development, and protecting epithelium and mucus integrity in the body. VitA is known as an anti-inflammation vitamin because of its critical role in enhancing immune function. VitA is involved in the development of the immune system and plays regulatory roles in cellular immune responses and humoral immune processes. VitA has demonstrated a therapeutic effect in the treatment of various infectious diseases. To better understand the relationship between nutrition and the immune system, the authors review recent literature about VitA in immunity research and briefly introduce the clinical application of VitA in the treatment of several infectious diseases.
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Affiliation(s)
- Zhiyi Huang
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - Yu Liu
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - Guangying Qi
- Department of Pathology and Physiopathology, Guilin Medical University, Guilin 541004, Guangxi, China.
- Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin 541004, Guangxi, China.
| | - David Brand
- Research Service, VA Medical Center, Memphis, TN 38104, USA.
| | - Song Guo Zheng
- Department of Medicine, Division of Rheumatology, Milton S. Hershey Medical Center at Penn State University, Hershey, PA 17033, USA.
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Liu X, Liu J, Xiong X, Yang T, Hou N, Liang X, Chen J, Cheng Q, Li T. Correlation between Nutrition and Symptoms: Nutritional Survey of Children with Autism Spectrum Disorder in Chongqing, China. Nutrients 2016; 8:nu8050294. [PMID: 27187463 PMCID: PMC4882707 DOI: 10.3390/nu8050294] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Restricted diets and inadequate nutrient intake of children with autism spectrum disorder (ASD) have been reported. This study examined the nutritional statuses of children with ASD and the relationships between their behaviors and nutritional intake. A total of 154 children with ASD (age = 5.21 ± 1.83 years) and 73 typically-developing (TD) children (age = 4.83 ± 0.84 years) from Chongqing, China, were enrolled. The severity of ASD was evaluated using the Childhood Autism Rating Scale (CARS). The serum ferritin, folate, vitamin B12, 25(OH) vitamin D, and vitamin A concentrations in the children with ASD were determined. All participants underwent anthropometric examinations, dietary assessments, and questionnaire assessments about their feeding behaviors, and gastrointestinal symptoms. The ZHA, ZWA, and ZBMIA were found to be significantly lower in the children with ASD compared with those without ASD. In addition, the percentages of children exhibiting severe picky eating and severe resistance to new foods, as well as those with a reported general impression of severe eating problems and constipation, were higher among the children with ASD. These children consumed significantly fewer macronutrients compared with the children without ASD. In addition, the children with ASD had the highest rate of vitamin A deficiency, followed by iron deficiency. After adjusting for sex, the vitamin A concentration was found to be negatively correlated with the CARS score (rs = -0.222, p = 0.021). No correlation between the ferritin, folate, vitamin D, or vitamin B12 concentration and the CARS score was found. These results suggest that reduced macronutrient intakes, severe feeding behavior issues, constipation, and vitamin A deficiency are quite common among children with ASD. Further, a low serum vitamin A level may be a risk factor for symptoms of ASD. However, the underlying mechanism should be further studied.
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Affiliation(s)
- Xiao Liu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Juan Liu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Xueqin Xiong
- Pediatric Department of Clinical Medicine of Dazhou Vocational and Technical College, Dazhou 635001, China.
| | - Ting Yang
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Nali Hou
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Xiaohua Liang
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Jie Chen
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Qian Cheng
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Tingyu Li
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
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11
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Effect of single-dose albendazole and vitamin A supplementation on the iron status of pre-school children in Sichuan, China. Br J Nutr 2016; 115:1415-23. [PMID: 26902307 DOI: 10.1017/s0007114516000350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to explore the effect of single-dose albendazole and vitamin A intervention on the anaemic status and Fe metabolism of pre-school children. This study was a randomised, placebo-controlled and double-blinded intervention trial. All eligible anaemic pre-school children were randomly divided into three groups: group 1 received no intervention, which served as the control group, group 2 received 400 mg single-dose albendazole administration and group 3 received a 60000 μg vitamin A capsule combined with 400 mg single-dose albendazole at the beginning of the study. The follow-up period was for 6 months. Anthropometry and biochemical index about Fe metabolism were measured before and after intervention. A total of 209 pre-school anaemic children were randomly divided into three intervention groups (sixty-four, sixty-two and sixty for groups 1, 2 and 3, respectively). The mean age of the children in the study was 4·4 (sd 0·7) years and 50·5 % of the children were female (94/186). After a follow-up period of 6 months, the levels of serum retinol, ferritin, transferrin receptor-ferritin index and body total Fe content of children in group 3 were significantly higher compared with children in groups 1 and 2 (P<0·05). Moreover, the proportion of vitamin A deficiency, marginal vitamin A deficiency and Fe deficiency among children in group 3 were markedly lower compared with children in groups 1 and 2 (P<0·05). Albendazole plus vitamin A administration showed more efficacy on the improvement of serum retinol and Fe metabolic status.
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12
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A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr 2016; 55:2179-97. [PMID: 26883916 DOI: 10.1007/s00394-016-1155-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/06/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The connection between iron and excessive adiposity has received much research interest. Although children and adolescents have unique developmental phases and nutritional demands, to date, reviews of iron in the overweight (OW) and obese (OB) have combined studies of children and adults or have focussed on adults. PURPOSE The aim of this review was to critically evaluate studies of the relationship between iron and OW and obesity in children and adolescents, with emphasis on iron status, oral iron response, dietary intake and systemic inflammatory markers. METHODS A PubMed search was conducted to identify relevant articles published up to December 2015. Combinations of the following keywords were used: iron, OW, OB, children, adolescents, diet, hepcidin, inflammation, fortification, supplementation, weight loss, trace elements, obesity, iron deficiency (ID), minerals. RESULTS AND CONCLUSION A higher prevalence of ID, or risk of ID, among OW and OB children and adolescents has been consistently observed. Chronic inflammation caused by excessive adiposity offers a plausible explanation for this finding, rather than dietary factors. However, future studies must employ screening for the presence of both acute and chronic infections and inflammatory conditions and report other factors such as pubertal status. Intervention studies, although few, indicate that OW and OB children and adolescents have reduced response to oral iron. Further trials are needed to explore the connection between body fat mass, inflammatory proteins and iron absorption, together with the effect of weight loss on iron status in iron-deficient OW and OB children and adolescents.
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Wong AYS, Chan EW, Chui CSL, Sutcliffe AG, Wong ICK. The phenomenon of micronutrient deficiency among children in China: a systematic review of the literature. Public Health Nutr 2014; 17:2605-18. [PMID: 25248458 PMCID: PMC10282226 DOI: 10.1017/s1368980013002978] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 09/30/2013] [Accepted: 10/04/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to review the literature on micronutrient deficiency and other factors influencing a deficiency status among children living in China. DESIGN A systematic review was performed to analyse the literature. SETTING Studies were identified through a search of PubMed and secondary references. SUBJECTS Children living in China aged less than 18 years. RESULTS Sixty-one articles were included. The prevalence of vitamin A deficiency decreased to approximately 10 % in 1995-2009. It increased with age but no significant difference was found between genders. The prevalence of thiamin and vitamin B12 deficiency was 10·5 % in Yunnan and 4·5 % in Chongqing provinces, respectively. Higher vitamin D deficiency rates were seen in spring and winter. The incidence of bleeding due to vitamin K deficiency was 3·3 % in 1998-2001 and more prevalent in rural areas. Both iodine deficiency and excess iodine intake were observed. Goitre rates were reported in Tibet, Jiangxi, Gansu and Hong Kong (3·5-46 %). Anaemia rates ranged from 20 % to 40 % in 2007-2011. High Se deficiency rates were found in Tibet, Shaanxi and Jiangsu. High Zn deficiency rates were also found (50-70 %) in 1995-2006. Few studies reported Ca deficiency rates (19·6-34·3 %). The degrees of deficiency for vitamin A, vitamin B12, Fe and Zn were more substantial in rural areas compared with urban areas. CONCLUSIONS The prevalence of micronutrient deficiency rates varied. Socio-economic status, environmental factors and the Chinese diet may influence micronutrient deficiency. Public health policies should consider implementing programmes of supplementation, food fortification and nutrition education to address these deficiencies among Chinese children.
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Affiliation(s)
- Angel YS Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Hong Kong Special Administrative Region, People's Republic of China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Hong Kong Special Administrative Region, People's Republic of China
| | - Celine SL Chui
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Hong Kong Special Administrative Region, People's Republic of China
| | - Alastair G Sutcliffe
- General and Adolescent Paediatric Unit, UCL Institute of Child Health, University College London, London, UK
| | - Ian CK Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Hong Kong Special Administrative Region, People's Republic of China
- UCL School of Pharmacy, University College London, London, UK
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14
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Pedraza DF, Sales MC. Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba. REV NUTR 2014. [DOI: 10.1590/1415-52732014000300004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.
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Michelazzo FB, Oliveira JM, Stefanello J, Luzia LA, Rondó PHC. The influence of vitamin A supplementation on iron status. Nutrients 2013; 5:4399-413. [PMID: 24212089 PMCID: PMC3847738 DOI: 10.3390/nu5114399] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/10/2013] [Accepted: 10/30/2013] [Indexed: 01/01/2023] Open
Abstract
Vitamin A (VA) and iron deficiencies are important nutritional problems, affecting particularly preschool children, as well as pregnant and lactating women. A PubMed (National Library of Medicine, National Institutes of Health, Bethesda, MD, USA) literature review was carried out to search for clinical trials published from 1992 to 2013 that assessed the influence of vitamin A supplementation on iron status. Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone. Some studies did not include a placebo group and only a few of them assessed vitamin A status of the individuals at baseline. Moreover, the studies did not consider any inflammatory marker and a reasonable number of iron parameters. Another important limitation was the lack of assessment of hemoglobin variants, especially in regions with a high prevalence of anemia. Assessment of hemoglobin variants, inflammatory markers and anemia of chronic inflammation would be important to the studies investigated. Studies involving different populations are necessary to elucidate the interaction between the two micronutrients, especially regarding iron absorption and modulation of erythropoiesis.
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Affiliation(s)
- Fernanda B. Michelazzo
- Department of Food Science and Experimental Nutrition, School of Pharmacy, University of São Paulo, São Paulo 05508-900, Brazil; E-Mail:
| | | | - Juliana Stefanello
- Department of Maternal-Infant Nursing and Public Health, College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; E-Mail:
| | - Liania A. Luzia
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; E-Mail:
| | - Patricia H. C. Rondó
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +55-11-3061-7867; Fax: +55-11-3061-7130
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16
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Pedraza DF, Rocha ACD, Sales MC. Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais. CIENCIA & SAUDE COLETIVA 2013; 18:3333-47. [DOI: 10.1590/s1413-81232013001100023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022] Open
Abstract
O objetivo do artigo é avaliar a associação das deficiências de ferro, vitamina A e zinco com o déficit de crescimento linear. Revisão sistemática nas bases de dados eletrônicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e março de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associação estatística entre o estado nutricional de ferro e o déficit de estatura; o outro apontou associação estatística entre as concentrações de ferritina sérica e o ganho de estatura. Dez estudos transversais investigaram a associação estatística entre as deficiências de micronutrientes e o déficit de estatura, resultando três deles na associação para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associação entre o déficit de estatura e as deficiências de ferro, vitamina A e zinco dificulta-se por fatores de caráter biológico e relacionados à magnitude das deficiências, o que sugere a importância da padronização metodológica dos estudos.
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Pedraza DF, Rocha ACD, Sousa CPDC. Crescimento e deficiências de micronutrientes: perfil das crianças assistidas no núcleo de creches do governo da Paraíba, Brasil. CIENCIA & SAUDE COLETIVA 2013; 18:3379-90. [DOI: 10.1590/s1413-81232013001100027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo é avaliar o perfil de crescimento das crianças assistidas no Núcleo de Creches do Governo da Paraíba e a contribuição relativa das deficiências de vitamina A, ferro e zinco. Estudo transversal em 240 crianças pré-escolares. Foram consideradas as categorias de diagnóstico nutricional: déficit ponderal, déficit de estatura e sobrepeso. As concentrações séricas de retinol, zinco e de hemoglobina foram determinadas para avaliar a deficiência de vitamina A (< 0,70 µmol/L), deficiência de zinco (< 65 Μmol/L) e anemia (< 110 g/L), respectivamente. A prevalência de déficit de estatura foi de 5,8%, a de sobrepeso de 3,8%, e a de déficit de peso de 0,4%. A média de Escore-Z para o índice P/E foi menor e estatisticamente significante quando a mãe da criança foi diagnosticada com baixa estatura ou com baixo peso e nas crianças de 12-36 meses de idade. Para o índice E/I, a média de Escore-Z foi menor e estatisticamente significante quando a criança nasceu com baixo peso e quando a mãe da criança apresentou baixa estatura. Crianças de 12-36 meses e sem o beneficio do Programa Bolsa Família tiveram média de hemoglobina menor. Verificou-se ausência de associação significante entre as deficiências de vitamina A, ferro e zinco e os índices antropométricos estudados.
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Miglioli TC, Fonseca VM, Gomes Junior SC, Lira PICD, Batista Filho M. Deficiência de Vitamina A em mães e filhos no Estado de Pernambuco. CIENCIA & SAUDE COLETIVA 2013. [DOI: 10.1590/s1413-81232013000500028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Analisou-se a prevalência e os fatores associados à deficiência de vitamina A (DVA) em mães (664) e seus filhos (790) menores de cinco anos em Pernambuco/2006. Estudo transversal populacional, com amostra representativa do meio urbano e rural. A DVA foi definida como níveis de retinol sérico < 20µg/dL para os dois grupos (mães e filhos). Análises bi e multivariadas foram realizadas utilizando o modelo log-log complementar como função de ligação adotando-se modelo de ordenação hierárquica explicativa da DVA para as crianças e modelo logístico para as mães. A prevalência de DVA foi 6,9% nas mães e 16,1% em seus filhos, com ocorrências semelhantes para cada grupo na comparação urbano x rural. Na área urbana, o regime de ocupação da moradia teve relação significante com a DVA nas mães. Para crianças urbanas, após o ajuste final do modelo, figuraram como variáveis preditivas a idade da mãe; nº de consultas pré-natais e peso ao nascer. No meio rural a DVA materna se associou à DVA dos filhos RP = 3,99 (IC:1,73-9,19), ao peso ao nascer e diarreia nos últimos 15 dias. A DVA mantém-se como um problema de saúde pública em Pernambuco, com marcantes diferenças de prevalência e fatores associados em mães e filhos.
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Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, Prashanth NS, Sudarshan H, Biggs BA, Shet AS. Determinants of anemia among young children in rural India. Pediatrics 2010; 126:e140-9. [PMID: 20547647 DOI: 10.1542/peds.2009-3108] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE More than 75% of Indian toddlers are anemic. Data on factors associated with anemia in India are limited. The objective of this study was to determine biological, nutritional, and socioeconomic risk factors for anemia in this vulnerable age group. METHODS We conducted a cross-sectional study of children aged 12 to 23 months in 2 rural districts of Karnataka, India. Children were excluded if they were unwell or had received a blood transfusion. Hemoglobin, ferritin, folate, vitamin B(12), retinol-binding protein, and C-reactive protein (CRP) levels were determined. Children were also tested for hemoglobinopathy, malaria infection, and hookworm infestation. Anthropometric measurements, nutritional intake, family wealth, and food security were recorded. In addition, maternal hemoglobin level was measured. RESULTS Anemia (hemoglobin level < 11.0 g/dL) was detected in 75.3% of the 401 children sampled. Anemia was associated with iron deficiency (low ferritin level), maternal anemia, and food insecurity. Children's ferritin levels were directly associated with their iron intake and CRP levels and with maternal hemoglobin level and inversely associated with continued breastfeeding and the child's energy intake. A multivariate model for the child's hemoglobin level revealed associations with log(ferritin level) (coefficient: 1.20; P < .001), folate level (0.05; P < .01), maternal hemoglobin level (0.16; P < .001), family wealth index (0.02; P < .05), child's age (0.05 per month; P < .005), hemoglobinopathy (-1.51; P < .001), CRP level (-0.18; P < .001), and male gender (-0.38; P < .05). Wealth index and food insecurity could be interchanged in this model. CONCLUSIONS Hemoglobin level was primarily associated with iron status in these Indian toddlers; however, maternal hemoglobin level, family wealth, and food insecurity were also important factors. Strategies for minimizing childhood anemia must include optimized iron intake but should simultaneously address maternal anemia, poverty, and food insecurity.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia
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