Global, regional, and national burdens of common micronutrient deficiencies from 1990 to 2019: A secondary trend analysis based on the Global Burden of Disease 2019 study

Mendelian randomization analyses explore the effects of micronutrients on different kidney diseases

Background

The impact of micronutrients, including vitamins and minerals, on different kidney diseases has been reported in some observational studies; however, their causal relationship remains uncertain. We aimed to ascertain the causal genetic relationships between micronutrients and different kidney diseases using the Mendelian randomization (MR) method.

Methods

Instrumental variables (IVs) for genetically predicting calcium (Ca), iron (Ir), Zinc (Zn), selenium (Se), copper (Cu), vitamin D (Vit D), and vitamin C (Vit C) levels in humans were obtained, and a bidirectional two-sample MR was used to examine potential associations between the levels of these seven micronutrients and the risk of seven different kidney diseases including hypertensive renal disease, diabetic nephropathy, IgA nephropathy, membranous nephropathy, cystic nephropathy, chronic kidney disease (CKD), and chronic tubulo-interstitial nephritis. Five different MR analyses were conducted, with the main method being the inverse variance-weighted (IVW) method. Moreover, sensitivity analyses were performed to assess heterogeneity and potential pleiotropy.

Results

The IVW method revealed that Ca levels were associated with a decreased risk of hypertensive renal disease (OR = 0.61, 95% CI: 0.40-0.93, p-value = 0.022), and Se levels were associated with a decreased risk of hypertensive renal disease (OR = 0.72, 95% CI: 0.53-0.99, p-value = 0.040), diabetic nephropathy (OR = 0.83, 95% CI: 0.73-0.93, p-value = 0.002), and CKD (OR = 0.87, 95% CI: 0.77-0.99, p-value = 0.028). Conversely, Vit D levels were associated with an increased risk of polycystic kidney disease (OR = 1.76, 95% CI: 1.15-2.69, p-value = 0.0095). In addition, no potential causal relationship was found between vitamin C levels, iron levels, zinc levels, and copper levels and different kidney diseases. Meanwhile, inverse Mendelian randomization showed no potential causal relationship between different chronic kidney diseases and micronutrients. The Cochrane's Q test, MR-Egger regression, and MR-PRESSO did not suggest heterogeneity and pleiotropy, providing evidence of the validity of the MR estimates.

Conclusion

Our results indicate a cause-and-effect connection between micronutrients and certain kidney diseases, but additional study is required to provide more conclusive evidence. This research has the potential to assist clinicians in managing the consumption of specific micronutrients among individuals with chronic kidney diseases, as well as in promoting disease prevention among both healthy populations and those who are susceptible to chronic underlying conditions.

Nutrient-Dense African Indigenous Vegetables and Grains in the FAO Food Composition Table for Western Africa (WAFCT) Identified Using Nutrient-Rich Food (NRF) Scores

Nutrient profiling (NP) models that assess nutrient density of foods can help remedy micronutrient deficiencies. We used NP methods to identify the most nutrient-rich foods in the 2019 FAO/INFOODS Western Africa Food Composition Table (WAFCT). The WAFCT had complete data for 909 foods. Three versions of the well-established Nutrient-Rich Food (NRF) model were used: (1) the original NRF9.3 based on 9 micronutrients (protein, fiber, calcium, iron, potassium, magnesium, vitamin A, vitamin C, and vitamin D); (2) a new NRF6.3 based on 6 priority micronutrients (iron, zinc, calcium, folate, vitamin A, vitamin B12); and (3) NRF 15.3, based on 15 nutrients to encourage (NRF6.3 nutrients + vitamin D, vitamin E, vitamin C, vitamin B1, vitamin B2, vitamin B3, vitamin B6, copper, and magnesium). Data analyses used one-way ANOVAs and independent t-tests, with significance at α = 0.05. Animal-source foods were rated higher by NRF6.3 priority micronutrient and NRF15.3 NP models than by the NRF9.3 model. African indigenous vegetables had higher protein content and higher nutrient density compared to non-indigenous vegetables, and African indigenous grains had higher nutrient density compared to non-indigenous grains. Though animal-source foods received some of the highest scores, NP models adapted to the West African context showed that African indigenous vegetables and grains were also nutrient rich. Indigenous foods could be important sources of priority micronutrients for the region.

Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020

Background

Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents.

Methods

Data from 10- to 18-year-old female participants (n = 1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes.

Findings

Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16-18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p < 0.01), as was thinness (12.25 [3.47, 43.33], p < 0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p < 0.01).

Interpretation

More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam.

Funding

UK BBSRCBB/T008989/1.

Development of a Population-Level Dichotomous Indicator of Minimum Dietary Diversity as a Proxy for Micronutrient Adequacy in Adolescents Aged 10-19 Y in the United States

BACKGROUND

Diversity is a key component of diet quality and health, but no indicator exists for adolescents under the age of 15 y.

OBJECTIVES

To establish a dichotomous indicator for population-level assessment of adolescent dietary diversity as a proxy for micronutrient adequacy.

METHODS

We used the probability approach to construct mean probability of adequacy (MPA) of 11 micronutrients from 2 d of 24-h dietary recall data from NHANES, 2007-2018. For each micronutrient, probability of adequacy (PA) was calculated using the best linear unbiased predictor of usual intake. Adolescent dietary diversity score (ADDS) was derived with a maximum score of 10 food groups. Generalized linear mixed models were used to examine associations between ADDS and MPA. Receiver operating characteristic analysis was used to establish a cutoff for minimum dietary diversity for adolescents (MDD-A) using an energy-adjusted logistic model with ADDS predicting MPA > 0.6.

RESULTS

PA was >80% for all nutrients except vitamin C (42.1%), folate (65.7%), and calcium (23.8%). Population MPA was 79.4%, and nearly 92% of adolescents had an MPA > 0.6. ADDS was positively associated with MPA, and energy was a significant confounder. The area under the curve was >0.8 on both days with sensitivity and specificity ranging from 0.71 to 0.80. The MDD-A cutoff was calculated as 5.12 and 5.10 food groups on days 1 and 2, respectively.

CONCLUSIONS

In U.S. adolescents, the best cutoff for a dichotomous indicator of dietary diversity as a proxy for micronutrient adequacy is 6 food groups in a given day. Future research could validate MDD-A and its associated cutoff for use across country contexts.

The Policy of Compulsory Large-Scale Food Fortification in Sub-Saharan Africa

Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women's education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources.

Potential Nutrient Contribution of Community-Based Insects in Children's Food in Northern Ghana

Background

Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children's nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted, appears to be a great alternative.

Objectives

This study aimed to 1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, 2) document the reasons for adding or not adding insects to household meals, and 3) determine the nutrient contribution of community-based insects in children's food.

Methods

Both qualitative and quantitative research methods were concurrently applied in this exploratory study (N = 392 individuals; 6 focus group discussions) in northern Ghana.

Results

Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children's diets were unable to meet the acceptable recommended nutrient intake (RNI; within a given age and gender group, the RNI is the amount of a nutrient ingested daily that would meet the needs of almost all healthy individuals in that group) level of all nutrients under consideration, especially for zinc, vitamin B-12, folate, and fat. Inclusion of community-based edible insects increased the RNI levels for all 11 micronutrients considered and met children's zinc, vitamin B-12, folate, and fat requirements.

Conclusions

Community-based insects demonstrate a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households' adoption of community-based insects as part of household meals and to make insects accessible to households.

Determinants of Hemoglobin Among Pregnant Women at Agro-Pastoralist Communities in South Omo Zone, Ethiopia: Community Based Cross-Sectional Study, Nutrition Experience from Movable Community

Background

Low hemoglobin level is the most common public health problem during pregnancy in developing countries including Ethiopia, which is affecting both mother and fetus. However, the determinants of anemia among pregnant women are not well studied.

Objective

To assess the determinates of hemoglobin among pregnant women in rural agro-pastoralist communities in the South Omo zone, Ethiopia.

Method

Community-based cross-sectional study was done in rural agro-pastoralist communities. A multistage stratified sampling technique was used to select 526 pregnant women. Data were collected by using structured questionnaires. Hemoglobin level was measured by using HemoCue ® Hb301. Data were analyzed by using a statistical package for the social science version 26. Descriptive (Mean, standard deviation, frequency, range), bivariate and multivariate analysis was carried out to check the association between lower hemoglobin levels and independent variables. The output is presented in tables and figures.

Result

The mean (±SD) of hemoglobin concentration was 11.8 ± 1.7. The overall prevalence of anemia was 39.9% [95% CI: 35.5, 44.4], 19.4% (95% CI: 16.0, 23.2) was mild, 19.6% (95% CI: 16.27, 2.5) was moderate and 0.9% (95% CI: 0.25, 2.25) was severe anemia. Not taking IFA (AOR = 5.7(3.3, 9.8)), severe under nutrition (AOR = 8.9(2.1, 37.3)), no fish food (AOR = 2.4(1.3, 4.5)), drinking coffee (AOR = 1.6(1.0, 2.6)), moderate food insecurity (AOR = 2.5(1.4, 4.6)), and no malaria infection (AOR = 0.6(0.4, 0.9)) were statistically significant with anemia.

Conclusion

The anaemia is a public health problem in this study area. Therefore, nutrition education and counselling to enhance iron supplementation, dietary diversity and a flesh diets are very essential to enhance haemoglobin levels.

Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda

BACKGROUND

Undernutrition has deleterious consequences to both the mother and the unborn child, significantly contributing to maternal and neonatal morbidity and mortality. We assessed dietary diversity, the prevalence, and predictors of undernutrition among pregnant adolescents and young women (PAYW) attending antenatal clinic (ANC) at two large teaching hospitals in northern Uganda.

METHODS

Between 12th June 2023 to 27th October 2023, we conducted a facility-based, cross-sectional study at Gulu Regional Referral Hospital (GRRH) and St Mary's Hospital Lacor (SMHL), both in Gulu district, Uganda. We recruited PAYW aged 15-24 years attending ANCs. Sociodemographic and clinical characteristics of the study participants were collected using a pre-tested, semi-structured questionnaire. Undernutrition was defined as a mid-upper arm circumference (MUAC) of < 23 cm. Modified Poisson regression analysis was performed to determine factors independently associated with undernutrition. Data analyses was performed using STATA version 17.0. A p<0.05 was considered statistically significant.

RESULTS

A total of 324 participants, with a mean age of 21.2±2.2 years were enrolled. About 62.0% (n = 201) of the participants dewormed during pregnancy. The prevalence of undernutrition was 12.7% [n = 41]. Prevalence was higher among participants who maintained pre-pregnancy diet (adjusted prevalence ratio [aPR] = 2.27, 95% Confidence Interval [CI]: 1.26-4.05, p = 0.006), those who did not receive nutritional education (aPR = 2.25, 95% CI: 1.21-4.20, p = 0.011) and consumption of non-green leafy vegetables (aPR = 4.62 95% CI: 1.64-13.01, p = 0.004). The prevalence of undernutrition was lower among participants who consumed milk and milk products (aPR = 0.44 95% CI: 0.24-0.81, p = 0.009) and among those who consumed fish and seafood compared to those who did not (aPR = 0.45 95% CI: 0.20-1.00, p = 0.050).

CONCLUSIONS

About 1 in 8 of PAYW attending GRRH or SMHL had undernutrition, particularly those who lacked education about feeding habits during pregnancy and limited access to milk and milk products, fish and seafoods. We recommend health workers to offer timely education of pregnant adolescent and young women mothers about good feeding habits during pregnancy, appropriate monitoring of weight gain and physiological changes during pregnancy.

Children with disabilities lack access to nutrition, health and WASH services: A secondary data analysis

Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.

Development and Validation of a Micronutrients Knowledge, Attitudes, and Practices Questionnaire for Adolescents Using Psychometric Analysis

Introduction The development of a questionnaire that measures knowledge, attitude, and practices towards micronutrients will help to develop nutrition intervention programs. The present study aimed to develop and assess the validity and reliability of a questionnaire on knowledge, attitude, and practices (KAP) on micronutrients in adolescents in India. Methods A total of 150 adolescent girls participated in the study. The literature was reviewed to formulate an initial draft of a questionnaire (122 items). Face and content validity were measured by participants and subject experts, respectively, and the content validity index was calculated. Construct validity was assessed using the principal component method of exploratory factor analysis. Internal consistency and test-retest reliability were determined by Cronbach's α value and interclass correlation coefficient correlations, respectively. Results The content validity index for all items except eight items from the practice subscale was satisfactory. Face validity results showed that participants understood all items. Exploratory factor analysis suggested a four-factor construct (perceived susceptibility and severity, perceived benefits, readiness to change, and perceived barrier) in the attitude subscale. Internal consistency for knowledge, attitude, and practice items were 0.980, 0.840, and 0.930, respectively. For knowledge and attitude items, interclass correlation coefficient correlation estimates ranged between 0.705 to 0.987 and 0.775 to 0.997, respectively, whereas for practice items, it ranged from 0.701 to 0.945. In the final questionnaire, 134 items consisting of 33 knowledge, 21 attitudes, and 80 practices (55 dietary practices and 25 other practices related to micronutrients) were included. Conclusion The results provided evidence of the validity and reliability of the questionnaire on micronutrients and that can be used to assess the knowledge, attitude, and practices on micronutrients in adolescents. Further studies in different diverse settings are recommended.

The global burden, trends, and inequalities of individuals with developmental and intellectual disabilities attributable to iodine deficiency from 1990 to 2019 and its prediction up to 2030

Objective

The objective of this study was to assess the global burden of disease for developmental and intellectual disabilities caused by iodine deficiency from 1990 to 2019.

Methods

Using data from the global burden of disease (GBD) 2019, we conducted a cross-country inequity analysis to examine the worldwide burden of developmental and intellectual disabilities caused by the issue of iodine deficiency from 1990 to 2019. Absolute and relative inequality were assessed by the slope index of inequality and the concentration index, respectively. After summarising the latest evidence, we also projected the age-standardized prevalence and years lived with disability (YLD) rates up to 2030 using the BAPC and INLA packages in R statistical software.

Results

In 2019, the global age-standardized prevalence and YLD rates for developmental and intellectual disabilities due to iodine deficiency were 22.54 per 100,000 population (95% UI 14.47 to 29.23) and 4.12 per 100,000 population (95% UI 2.25 to 6.4), respectively. From 1990 to 2019, the age-standardized prevalence and YLD rates of developmental and intellectual disabilities due to iodine deficiency decreased significantly. Geographic distribution showed that areas with lower socio-demographic indices (SDI) were the most affected. The correlation between higher SDI and lower prevalence highlights the role of economic and social factors in the prevalence of the disease. Cross-national inequity analysis shows that disparities persist despite improvements in health inequalities. In addition, projections suggest that the disease burden may decline until 2030.

Conclusion

This research underscores the necessity for targeted interventions, such as enhancing iodine supplementation and nutritional education, especially in areas with lower SDI. We aim to provide a foundation for policymakers further to research effective preventative and potential alternative treatment strategies.

Vitamin A deficiency in the MENA region: a 30-year analysis (1990-2019)

Background

Vitamin A deficiency (VAD) is a common micronutrient deficiency that imposes a substantial burden worldwide. This study examined the burden of VAD from 1990 to 2019 in the Middle East and North Africa (MENA) region by age, sex and sociodemographic index (SDI).

Methods

The data were obtained from the Global Burden of Disease (GBD) 2019 database. We reported the prevalence, incidence, and years lived with disability (YLDs) that were attributable to VAD for the MENA region, along with its constituent countries.

Results

In 2019, the MENA region had 30.6 million prevalent cases of VAD, with an age-standardized prevalence rate of 5249.9 per 100,000 population. In addition, VAD was responsible for 62.2 thousand YLDs, with an age-standardized YLD rate of 10.2 per 100,000. The age-standardized prevalence [50.3% (-55.9 to -44.7)] and YLD [-49.3% (-55.3 to -43.1)] rates of VAD have significantly decreased since 1990. In 2019, the MENA region's VAD-attributable YLD rate was below the global average for males and females across all age groups. Additionally, SDI was negatively associated the age-standardized YLD rate of VAD.

Conclusion

This study underscores the necessity of frequently updating health data and developing guidelines and regulations to prevent, detect early, and effectively treat VAD in the MENA countries.

Global, regional and national burdens of nutritional deficiencies, from 1990 to 2019

The epidemiological and burden characteristics of nutritional deficiencies (ND) have been evolving, and it is crucial to identify geographical disparities and emerging trends. This study aimed to analyse the global, regional and national trends in the burden of ND over the past 30 years. Data were obtained from the Global Burden of Disease (GBD) 2019 database for the period 1990-2019. The study examined the incidence rates and disability-adjusted life years (DALY) of ND at various levels. Globally, the incidence rate of ND decreased from 2226·2 per 100 000 in 2019 to 2096·3 per 100 000 in the same year, indicating a decline of 5·8 %. The average annual percentage change (AAPC) was -0·21 (-0·31, -0·11). Similarly, DALY, prevalence and mortality rates of ND exhibited significant declines (AAPC = -3·21 (-3·45, -2·96), AAPC = -0·53 (-0·55, -0·51) and AAPC = -4·97 (-5·75, -4·19), respectively). The incidence rate of ND varied based on age group, sex, cause and geographical area. Moreover, a negative association was observed between incidence and the sociodemographic index. At the regional level, the South Asia and sub-Saharan Africa regions had the highest incidence rates of ND. In conclusion, the global incidence rate of ND showed a mixed pattern, while the DALY rate consistently declined. Additionally, prevalence and mortality rates of ND decreased between 1990 and 2019.

Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis

CONTEXT

Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive.

OBJECTIVE

The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs).

DATA SOURCES

Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded.

DATA EXTRACTION

Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation.

DATA ANALYSIS

The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55).

CONCLUSION

A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023409483.

Preventive Intake of a Multiple Micronutrient Supplement during Mild, Acute SARS-CoV-2 Infection to Reduce the Post-Acute COVID-19 Condition: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Patients hospitalized with COVID-19 have low levels of vitamins and trace elements. This could lead to a post-acute COVID-19 condition (PCC) that can worsen a patient's quality of life. We aimed to study the baseline micronutrient status of patients and assess whether a multiple micronutrient supplement (MMS) taken for 2 weeks at the first sign of COVID-19 symptoms would be able to reduce the incidence of PCC. This double-blind, placebo-controlled, randomized clinical trial was conducted in adult outpatients with acute COVID-19, recruited between 2021 and 2023 in Spain. Of the 285 patients assessed for eligibility, 267 were randomized and 246 were included in the intent-to-treat population. The mean age was 46.8 years, and 68% were female. Overall, 54.6% had micronutrient deficiencies in the acute phase of COVID-19 at baseline, and 26.2% had PCC after 180 days of follow-up (D180). The most frequently recorded PCC symptoms were neurological (14.1%), with 24% patients scoring worse in the cognitive tests compared to their baseline status. The rate of PCC at D180 was similar between the placebo (25.0%) and intervention (27.7%) groups, without significant differences (p = 0.785). Age over 50 years was the most relevant risk factor for developing PCC, followed by female sex. The most important protective factor against PCC was SARS-CoV-2 vaccination. In this population of predominantly middle-aged, white women with acute COVID-19 not requiring hospital admission, MMS intake for 14 days at symptom onset did not prevent PCC nor improve their micronutrient status at D180.

The MED_EAT-IT approach: A modelling study to develop feasible, sustainable and nutritionally targeted dietary patterns based on the Planetary health diet

In 2019, the EAT-Lancet Commission introduced the Planetary Health Diet (PHD), a guide for creating 2500 kcal/day country-specific sustainable diets that promote health while reducing the environmental impact associated with food systems. The PHD was previously adapted to the Italian food context, resulting in the EAT-IT dietary pattern. However, this adaptation revealed several challenges in terms of nutritional adequacy, feasibility, and environmental impact. This study reports on strategies to improve the previous pattern and align it more closely with the Mediterranean Diet, resulting in the MED_EAT-IT pattern. The study also explores feasible strategies for adapting this pattern to different energy targets, enhancing its scalability and promoting personalized approaches. For the optimization of this pattern, a specific calculation tool was developed to introduce variation to the pattern, considering realistic and feasible serving sizes and frequency of consumption. This tool integrates a defined food ontology, food composition data, and two environmental impact metrics (Carbon and Water Footprint). To optimize nutritional adequacy, several adaptations of the amount within the different food groups were made, for instance by increasing cereals and animal source by 25.5% kcal/day and 36.2% kcal/day respectively compared to EAT-IT. The resulting 2500 kcal/die pattern meets all nutritional requirements except for vitamin D and does not hamper the possibility to limit environmental impact (Carbon Footprint increased only by 12.2% but Water Footprint decreased by 6.3%). Lower energy targets were achieved by modulating amounts of the different food groups to ensure nutritional adequacy. The strategies and tools proposed here could aid in optimizing dietary plans, evaluating their potential for environmental impact reduction, and identifying issues that could hinder their adoption. Furthermore, the analyses carried out pave the way for the potential future development of new or improved foods that may contribute to the optimization of nutritional and environmental impact of diets.

The close association of micronutrients with COVID-19

Objectives

The present study was conducted to explore the performance of micronutrients in the prediction and prevention of coronavirus disease 2019 (COVID-19).

Methods

This is an observational case-control study. 149 normal controls (NCs) and 214 COVID-19 patients were included in this study. Fat-soluble and water-soluble vitamins were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis, and inorganic elements were detected by inductively coupled plasma-mass spectrometry (ICP-MS) analysis. A logistic regression model based on six micronutrients were constructed using DxAI platform.

Results

Many micronutrients were dysregulated in COVID-19 compared to normal control (NC). 25-Hydroxyvitamin D3 [25(OH)D3], magnesium (Mg), copper (Cu), calcium (Ca) and vitamin B6 (pyridoxic acid, PA) were significantly independent risk factors for COVID-19. The logistic regression model consisted of 25(OH)D3, Mg, Cu, Ca, vitamin B5 (VB5) and PA was developed, and displayed a strong discriminative capability to differentiate COVID-19 patients from NC individuals [area under the receiver operating characteristic curve (AUROC) = 0.901]. In addition, the model had great predictive ability in discriminating mild/normal COVID-19 patients from NC individuals (AUROC = 0.883).

Conclusions

Our study showed that micronutrients were associated with COVID-19, and our logistic regression model based on six micronutrients has potential in clinical management of COVID-19, and will be useful for prediction of COVID-19 and screening of high-risk population.

Dietary Quality and Associated Factors among Women of Reproductive Age in Six Sub-Saharan African Countries

The burden of micronutrient malnutrition is high among women of reproductive age (WRA) in sub-Saharan Africa. We examined the dietary quality and associated factors for WRA in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal, and Tanzania. Data were collected from women aged 15-49 years using representative Diet Quality Questionnaire surveys. The Minimum Dietary Diversity for Women (MDD-W), All-5 (key food group) consumption, noncommunicable disease risk (NCD-Risk), and Global Dietary Recommendation (GDR) indicators were assessed. Participants included N = 16,584 women [Cameroon: N = 2073; Côte d'Ivoire: N = 242; Kenya: N = 864; Adamawa State (Nigeria): N = 1283; Benue State (Nigeria): N = 1047; Nasarawa State (Nigeria): N = 1151; Senegal: N = 7232; Tanzania: N = 2692]. The MDD-W ranged from 43.0% in Tanzania to 81.4% in Côte d'Ivoire and was higher in urban, compared to rural, areas in Cameroon, Kenya, Nasarawa, Senegal, and Tanzania (p < 0.001). Increased education and wealth were positively associated with MDD-W in Kenya, Benue, Senegal, and Tanzania. Fewer than half of all women attained All-5 consumption. NCD-Risk scores ranged from 1.13 (95% CI: 1.08, 1.17) in Tanzania to 2.28 (95% CI: 2.16, 2.40) in Nasarawa, and women's GDR scores ranged from 10.47 (95% CI: 10.40, 10.54) in Cameroon to 11.45 (95% CI: 11.25, 11.64) in Côte d'Ivoire. Our findings highlight key aspects of women's diets in sub-Saharan African settings to enable greater awareness and more targeted responses to the specific areas needing the most improvement.

Cross-country health inequalities of four common nutritional deficiencies among children, 1990 to 2019: data from the Global Burden of Disease Study 2019

BACKGROUND

Nutritional deficiencies remain serious medical and public health issues worldwide, especially in children. This study aims to analyze cross-country inequality in four common nutritional deficiencies (protein-energy malnutrition, dietary iron deficiency, vitamin A deficiency and iodine deficiency) among children from 1990 to 2019 based on Global Burden of Disease (GBD) 2019 data.

METHODS

Prevalence and disability-adjusted life years (DALYs) data as measures of four nutritional deficiency burdens in people aged 0 to 14 years were extracted from the GBD Results Tool. We analyzed temporal trends in prevalence by calculating the average annual percent change (AAPC) and quantified cross-country inequalities in disease burden using the slope index.

RESULTS

Globally, the age-standardized prevalence rates of dietary iron deficiency, vitamin A deficiency and iodine deficiency decreased, with AAPCs of -0.14 (-0.15 to -0.12), -2.77 (-2.96 to -2.58), and -2.17 (-2.3 to -2.03) from 1999 to 2019, respectively. Significant reductions in socio-demographic index (SDI)-related inequality occurred in protein-energy malnutrition and vitamin A deficiency, while the health inequality for dietary iron deficiency and iodine deficiency remained basically unchanged. The age-standardized prevalence and DALY rates of the four nutritional deficiencies decreased as the SDI and healthcare access and quality index increased.

CONCLUSIONS

The global burden of nutritional deficiency has decreased since 1990, but cross-country health inequalities still exist. More efficient public health measures are needed to reduce disease burdens, particularly in low-SDI countries/territories.

An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project

OBJECTIVE

To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study.

DESIGN

A cross-sectional pilot study.

SETTING

The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar.

PARTICIPANTS

32 women (14-49 years) and 36 children and adolescents (2-17 years).

RESULTS

70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041).

CONCLUSIONS

These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.

Consumption of ultra-processed products is associated with vitamin D deficiency in Brazilian adults and elderly

Although studies show that the intake of ultra-processed products (UPP) has a negative impact on health, diet quality and dietary vitamin D, its influence on serum concentrations of this vitamin remains unknown; therefore, it is essential to verify the association between the UPP consumption and vitamin D deficiency. This is a cross-sectional, household, population-based study, carried out with 229 individuals aged 20 years or older, residents of the city of Teresina, Piauí, Brazil. Socio-demographic, lifestyle, food consumption and anthropometric data were collected. Food consumption was obtained using a 24-h food recall, and foods were grouped according to the NOVA classification. Plasma concentrations of calcidiol-25 (OH) D3 were determined by HPLC. Crude and adjusted binary logistic regression was applied to estimate the association between UPP consumption and vitamin D deficiency. Most individuals aged 20-39 years were vitamin D deficient (52·1 %). UPP contributed 19·9 % to the energetic intake of the participant's diet. This contribution was higher for individuals with vitamin D deficiency (22·5 %, P = 0·04). In addition, a high intake of UPP was associated with twice the risk of vitamin D deficiency in comparison with low consumption of UPP (OR: 2·05; CI 1·06, 4·50; P: 0·04). Our results suggest that the consumption of UPP may have a negative impact on serum concentrations of vitamin D; more studies are needed.

Proteosomes based on milk phospholipids and proteins to enhance the stability and bioaccessibility of β-carotene

Proteosomes (P) based on milk fat globule membrane's phospholipids (MPs), whey protein isolate (WPI) and sodium caseinate (CasNa) were developed by ultrasonication to encapsulate β-carotene. Entirely milk-ingredients based proteosomes (WPI-MPs-P and CasNa-MPs-P) revealed homogenous distribution with size diameters < 250 nm. WPI-MPs-P depicted positive ζ-potential values (+15.7 ± 0.5 mV), while CasNa-MPs-P demonstrated negative (-32.5 ± 3.4 mV) values of surface charge, respectively and hydrophilic nature of proteosomes was observed by measuring contact-angle (θ). AFM and SEM exhibited spherical to oval and slightly irregular morphology of nanocarriers. For various concentrations of β-carotene, the highest encapsulation efficiency of β-carotene was 90 ± 0.2% and 92 ± 0.8% in WPI-MPs-P and CasNa-MPs-P respectively. FTIR analyses confirmed the hydrophobic and electrostatic interactions-based encapsulation of β-carotene. Beneficial antioxidant-potential of β-carotene was retained after its encapsulation in the proteosomes. Proteosomes increased the digestive-stability (>50%) and bioaccessibility (>85%) of β-carotene. Thus, milk-ingredients based proteosomes offer a novel-strategy to develop functional dairy products to overcome widespread vitamin-A-deficiency.

Infantile scurvy as a consequence of agricultural intensification in the 1st millennium BCE Etruria Campana

The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730-580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.

Multiple micronutrient deficiencies in early life cause multi-kingdom alterations in the gut microbiome and intrinsic antibiotic resistance genes in mice

Globally, ~340 million children suffer from multiple micronutrient deficiencies, accompanied by high pathogenic burden and death due to multidrug-resistant bacteria. The microbiome is a reservoir of antimicrobial resistance (AMR), but the implications of undernutrition on the resistome is unclear. Here we used a postnatal mouse model that is deficient in multiple micronutrients (that is, zinc, folate, iron, vitamin A and vitamin B12 deficient) and shotgun metagenomic sequencing of faecal samples to characterize gut microbiome structure and functional potential, and the resistome. Enterobacteriaceae were enriched in micronutrient-deficient mice compared with mice fed an isocaloric experimental control diet. The mycobiome and virome were also altered with multiple micronutrient deficiencies including increased fungal pathogens such as Candida dubliniensis and bacteriophages. Despite being antibiotic naïve, micronutrient deficiency was associated with increased enrichment of genes and gene networks encoded by pathogenic bacteria that are directly or indirectly associated with intrinsic antibiotic resistance. Bacterial oxidative stress was associated with intrinsic antibiotic resistance in these mice. This analysis reveals multi-kingdom alterations in the gut microbiome as a result of co-occurring multiple micronutrient deficiencies and the implications for antibiotic resistance.

Unveiling the Spectrum of Ophthalmic Manifestations in Nutritional Deficiencies: A Comprehensive Review

This comprehensive review explores the intricate relationship between nutrition and ocular health, focusing on the crucial roles of essential nutrients like Vitamin A, Vitamin B1 (thiamine), Vitamin B12, Vitamin C, Vitamin D, Vitamin E, Zinc, and Folate (Vitamin B9) in maintaining eye well-being. Nutrient deficiencies have significant consequences, leading to various eye-related issues, from night blindness to age-related conditions such as cataracts and macular degeneration. It is imperative to address these deficiencies, emphasizing the importance of a well-rounded diet with the necessary nutrients. When necessary, supplementation and regular eye examinations are vital components for effectively monitoring ocular health. Public health campaigns and educational initiatives also play a key role in raising awareness about the profound impact of nutrition on eye health. Future research should explore personalized nutrition plans, nutrigenomics, longitudinal studies, and targeted nutritional interventions. Such investigations will not only enhance our understanding of this crucial connection but also have the potential to reduce the global burden of eye diseases.

Trace elements dyshomeostasis in liver and brain of weanling mice under altered dietary selenium conditions

BACKGROUND

A balanced diet containing selenium (Se) and other trace elements is essential for normal development and growth. Se has been recognized as an essential trace element; however, its interaction with other elements has not been fully investigated. In the present study, sodium (Na), magnesium (Mg), potassium (K), calcium (Ca), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), Se and rubidium (Rb), were analysed in liver and brain regions under altered dietary Se intake in weanling mice to identify major discriminatory elements.

METHODS

The study investigated the effects of different levels of Se intake on the elemental composition in liver and brain tissues of weaned mice. After 24 weeks of feeding with Se adequate, deficient, and excess diets, elemental analysis was performed on the harvested tissues using Inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis that included analysis of covariance (ANCOVA), correlation coefficient analysis, principal component analysis, and partial least squares discriminant analysis were performed.

RESULTS

The ANCOVA showed statistically significant changes and correlations among the analysed elements under altered dietary Se status. The multivariate analysis showed differential changes in elements in liver and brain regions. The results suggest that long-term dietary Se alternations lead to dyshomeostasis in trace elements that are required in higher concentrations compared to Se. It was observed that changes in the Fe, Co, and Rb levels were similar in all the tissues studied, whereas the changes in Mg, Cr, and Mn levels were different among the tissues under altered dietary Se status. Additionally, the changes in Rb levels correlated with the dietary Se intake but had no relation with the tissue Se levels.

CONCLUSIONS

The findings suggest interactions between Mg, Cr, Mn, Fe, Co, and Se under altered Se status may impact cellular functions during postnatal development. However, the possible biological significance of alterations in Rb levels under different dietary Se paradigms needs to be further explored.

Global disease burden and its attributable risk factors of peripheral arterial disease

Peripheral arterial disease (PAD) is a prevalent subtype of atherosclerotic cardiovascular diseases. It is crucial to assess the PAD-related burden and its attributable risk factors. We use the Global Burden of Disease study 2019 database to calculate the incidence, prevalence, mortality, disability-adjusted life years (DALY), attributable risk factors and estimated annual percentage change. The disease burden of PAD grows significantly with age accompanied by prominent heterogeneity between male and female. Despite the increase in the absolute numbers of disease burden from 1990 to 2019, the global PAD-related age-standardized death rate (ASDR) and age-standardized disability-adjusted life years rate (ASDALYR) have a mild downward trend from 1990 to 2019, which negatively correlated with sociodemographic index (SDI). Smoking and high systolic blood pressure (SBP) were the primary attributable risk factors for males (ASDR: 33.4%; ASDALYR: 43.4%) and females (ASDR: 25.3%; ASDALYR: 27.6%), respectively. High fasting plasma glucose (FPG) had become the second risk factor for ASDR (males: 28.5%; females: 25.2%) and ASDALYR (males: 29.3%; females: 26.3%) with an upward tendency. Low-middle SDI regions were predicted to have the most remarkable upward trend of PAD-related burden caused by high FPG. Smoking caused more disease burden in males before 85-90 years old and females before 65-70 years old, while high FPG and high SBP caused more burden after that. The patterns of PAD-related burden and its attributable risk factors are heterogeneous across ages, genders, and SDI regions. To reduce disease burden, tailored strategies should be implemented.

Iodine status and its association with prevalence of thyroid diseases in adults from Jiangxi Province, China

BACKGROUND

Iodine is an essential element for the biosynthesis of thyroid-stimulating hormone (TSH). Both excessive and deficient iodine are major risk factors for thyroid diseases, including thyroid dysfunction, thyroid nodules, and thyroid autoimmunity (TAI). This study aimed to elucidate the relationship between iodine status and the prevalence of thyroid diseases through a national cross-sectional epidemiological survey in Jiangxi province (China).

METHODS

This population-based, cross-sectional study enrolled 2636 Chinese local inhabitants who aged over 18 years old from April to August in 2015. Physical examination was performed and biochemical indices, urinary iodine concentration (UIC), and TSH level were measured. The Chi-square test, nonparametric test, and 4 multivariate logistic regression models adjusted for risk factors were applied to analysis. Spearman correlation coefficients were calculated to investigate the relationship between iodine intake level and the prevalence of thyroid diseases.

RESULTS

The median UIC was 176.4 μg/L, and a significant difference was found in median UIC between men (182.45 μg/L) and women (169.25 μg/L) (P = 0.03). Among these study subjects, 14.4%, 44.5%, 26.1%, and 15.0% had deficient, adequate, more than adequate, and excessive iodine concentrations, respectively. The prevalence rates of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, thyroid nodules, and TAI were 0.91%, 0.57%, 0.34% and 7.89%, 9.45%, and 12.7%, respectively. Significant differences were found in iodine status, waist circumstance, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), TSH, thyroid nodules, and TAI between men and women (P < 0.05). Compared with those with adequate UIC, subjects with excessive UIC had higher prevalence rates of thyroid dysfunction (odds ratio (OR) = 1.74, 95% confidence interval (CI): 1.40-2.54) and thyroid nodules (OR = 3.33, 95%CI 1.32-8.42). In addition, subjects with deficient and excessive UIC were at the higher risk of TAI compared with those with adequate UIC (OR = 1.68, 95%CI: 1.19-2.60; OR = 1.52, 95%CI: 1.04-2.96, respectively). UIC was positively correlated with the prevalence rates of thyroid nodules (r = -0.44, P < 0.01) and TAI (r = -0.055, P < 0.01). On the contrary, UIC was negatively correlated with the risk of thyroid dysfunction (r = -0.24, P > 0.05).

CONCLUSION

Adult inhabitants from Jiangxi province in the TIDE study were in the adequate iodine status. Excessive iodine status was noted as a risk factor for thyroid dysfunction and thyroid nodules. In addition, both iodine deficiency and excessive iodine were risk factors for TAI.

Activation of robust bonds by carbonyl complexes of Mn, Fe and Co

Metal carbonyl complexes possess among the most storied histories of any compound class in organometallic chemistry. Nonetheless, these old dogs continue to be taught new tricks. In this Feature, we review the historic discoveries and recent advances in cleaving robust bonds (e.g., C-H, C-O, C-F) using carbonyl complexes of three metals: Mn, Fe, and Co. The use of Mn, Fe, and Co carbonyl catalysts in controlling selectivity during hydrofunctionalization reactions is also discussed. The chemistry of these earth-abundant metals in the field of robust bond functionalization is particularly relevant in the context of sustainability. We expect that an up-to-date perspective on these seemingly simple organometallic species will emphasize the wellspring of reactivity that continues to be available for discovery.

Iron Deficiency in Heart Failure: A Korea-Oriented Review

Iron deficiency (ID) occurs at high frequency across the spectrum of heart failure (HF), with HF severity and race being potentially important predictors for its development. ID, irrespective of anaemia status, leads to poor outcomes in patients with HF, including exacerbated reduction in exercise capacity, poor quality of life (QoL) and increased risk of HF hospitalisation. As ID has a large public health and economic burden in Asia, and patients hospitalised with acute HF in the Asia Pacific vs. other regions commonly present with more severe clinical symptoms, there is a clear need to identify and treat ID promptly in Asian patients with HF. The biomarkers serum ferritin and transferrin saturation are used for ID diagnosis, and periodic screening is recommended in all patients with HF. The intravenous iron treatments, ferric carboxymaltose (FCM) and ferric derisomaltose, have demonstrated efficacy and tolerability in patients with acute or chronic HF and ID, with FCM shown to be cost-effective (and in some cases cost-saving). Meta-analyses support the likely benefits of intravenous FCM for improving QoL and reducing HF hospitalisation, without reducing mortality risk in patients with HF and ID. Accordingly, European Society of Cardiology guidelines recommend considering intravenous FCM for patients with symptomatic HF with left ventricular ejection fraction ≤50% who were recently hospitalised for HF and have ID. Although analyses of Asian patients with HF and ID are limited, the effects of intravenous iron would be expected to be similar to that in White populations; further clarifying studies may be of interest.

The prevalence of vitamin A deficiency and its public health significance in children in low- and middle-income countries: A systematic review and modelling analysis

Background

Vitamin A deficiency (VAD) is widely recognised as a major public health concern in low- and middle-income countries (LMICs). Despite various interventions implemented in many countries, a lack of reliable data is hindering progress. We aimed to consolidate available data and quantify estimates of the prevalence of VAD among children ≤18 years in LMICs.

Methods

We searched PubMed, Medline and Embase for studies reported the prevalence of VAD or marginal (m)VAD among children. A multilevel mixed-effects meta-regression approach was applied to establish the regression models for VAD and mVAD prevalence. The total numbers of children affected by VAD and mVAD in LMICs in 2019 were separately calculated from the estimated age- and socio-demographic index (SDI)-specific prevalence with their corresponding United Nations Population Division populations projections. We estimated areas of significant public health concern in 165 LMICs using the lower confidence interval (CI) of VAD prevalence.

Results

A total of 116 articles from 40 LMICs were retained. In 2019, VAD and mVAD affected 333.95 million (95% CI = 253.00-433.74) and 556.13 million (95% CI = 388.83-767.94) children and adolescents in 165 LMICs, respectively, corresponding to a prevalence of 14.73% (95% CI = 11.16-19.14) and 24.54% (95% CI = 17.15-33.88). The prevalence of both VAD and mVAD was the highest in children aged 0-5 years at 19.53% (95% CI = 15.03-24.91) and 28.22% (95% CI = 20.00-38.24), respectively, with both steadily decreasing to 10.09% (95% CI = 7.44-13.50) and 20.76% (95% CI = 14.16-29.50) in adolescents aged 13-18 years. The prevalence of VAD was significantly higher in the low SDI region at 29.67% (95% CI = 22.67-37.53) compared to 5.17% (95% CI = 3.14-8.43) estimated in the high-middle SDI region. 68 of the 165 LMICs (41.21%) were classified as areas of moderate to severe VAD public health significance.

Conclusions

VAD continues to pose a significant public health concern in many low-income settings. Development in LMICs is a crucial factor for VAD, with a disproportionately higher burden in low SDI regions.

Registration

This study protocol was registered with PROSPERO, CRD42020220654.

Association of Pork (All Pork, Fresh Pork and Processed Pork) Consumption with Nutrient Intakes and Adequacy in US Children (Age 2-18 Years) and Adults (Age 19+ Years): NHANES 2011-2018 Analysis

Pork is a rich source of high-quality protein and select nutrients. The objective of this work was to assess the intakes of all pork (AP), fresh pork (FP) and processed pork (PP) and their association with nutrient intake and meeting nutrient recommendations using 24 h dietary recall data. Usual intake was determined using the NCI method and the percentage of the population with intakes below the Estimated Average Requirement, or above the Adequate Intake for pork consumers and non-consumers, was estimated. About 52, 15 and 45% of children and 59, 20 and 49% of adults were consumers of AP, FP and PP, respectively, with mean intakes in consumers of 47, 60 and 38 g/day for children and 61, 77 and 48 g/day for adults, respectively. Among consumers of AP, FP and PP, the intakes of copper, potassium, selenium, sodium, zinc, thiamine, niacin, vitamin B₆ and choline were higher (p < 0.05) and a higher (p < 0.05) proportion met nutrient recommendations for copper, potassium, zinc, thiamin and choline compared to non-consumers. There were additional differences (p < 0.05) in intakes and adequacies for other nutrients between consumers and non-consumers depending upon the age group and pork type. In conclusion, pork intake was associated with higher intakes and adequacies in children and adults for certain key nutrients.

The Effect of the Meat Factor in Animal-Source Foods on Micronutrient Absorption: A Scoping Review

The EAT-Lancet Commission's planetary health guidelines suggest a reduction in the consumption of animal-source foods (ASFs) for better health and more sustainable food systems. ASFs are highly nutrient dense, therefore suited to address the widespread issue of micronutrient deficiencies, particularly in low-resource settings where diets are predominantly plant based. ASFs are also believed to contain the meat factor, a substance enhancing the absorption of micronutrients from plant-based foods. We conducted a scoping review with the objective of systematically mapping the available evidence on the meat factor. The MEDLINE/PubMed and Web of Science databases were searched for literature published up to September 2021. Articles eligible for inclusion were all studies assessing the effect of adding ASFs and/or ASF fractions on micronutrient absorption from a plant-based meal or the overall diet in animal models and human subjects. Screening and data extraction were performed, and results were charted into 12 categories. We identified 77 articles eligible for inclusion, 52 of which were conducted in human subjects, 24 in animal models, and 1 in both. The addition of muscle tissue and muscle tissue fractions to single plant-based meals steadily increased absorption of iron and zinc across studies. The efficacy of the meat factor in increasing iron and zinc absorption in the overall diet is less clear. No clear differences emerged between red meat, poultry, and fish in promoting the meat factor effect. No clear evidence indicates that milk and egg products contain the meat factor. Our review highlights the importance of muscle tissue for the potential of the meat factor to enhance absorption of micronutrients of concern. Although the literature supports including sustainable and economically accessible forms of these ASFs into the diet, we found limited studies in resource-poor countries and of diets with low meat intake.

Changes in the global, regional, and national burdens of NAFLD from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

Background

Understanding the burdens and trends of non-alcoholic fatty liver disease (NAFLD) is necessary for developing effective intervention strategies. In this study, Global Burden of Disease (GBD) 2019 study data were extracted and analyzed to elucidate trends of NAFLD.

Methods

The prevalence, incidence, disability-adjusted life year (DALY), and death rates of NAFLD in geographic populations worldwide from 1990 to 2019 were extracted from the GBD 2019 study data. The global temporal trend of NAFLD from 1990 to 2019 was evaluated using estimated annual percentage changes (EAPCs) and age-standardized rates.

Results

Globally, between 1999 and 2019, the age-standardized prevalence rate of NAFLD increased, with EAPCs of 0.77 [95% CI (0.69, 0.85)], whereas the DALY and Death rates decreased, with EAPCs of -0.82 [95% CI (-0.92, -0.71)], and -0.67 [95% CI (-0.76, -0.58)], respectively. Geographically, the age-standardized prevalence rate showed the most serious upward trend in high-income North America with an EAPC of 0.98 [95% CI (0.95, 1.02)], and the age-standardized incidence rate showed an upward trend in Central Asia with an EAPC of 3.17 [95% CI (2.2, 2.49)]. The most significant upward trend of DALY and death rates appeared in Eastern Europe, with EAPCs of 4.06 [95% CI (3.31, 4.82)], and 3.36 [95% CI (2.77, 3.96)], respectively. At the country level, the age-standardized rates showed an upward trend in Armenia, Belarus, and Republic of Korea. Regarding age groups, the percentage change of prevalence was the highest in the 40 to 44 group [0.29 (0.26, 0.34)] from 1990 to 2019; the percentage change of incidence was the highest in the 85 to 89 group [0.46 (0.12, 0.71)] from 1990 to 2019; the percentage change of DALY was the highest in the 80 to 84 group [0.25 (0.11, 0.39)] from 1990 to 2019; and the percentage change of death rate was the highest in the 15 to 19 group [0.36 (0.17, 0.60)] from 1990 to 2019. The percentage change of prevalence of liver cancer due to NASH was the highest in the group of 85 to 89, whereas those of incidence, DALY, and death were the highest in the group above 95 from 1990 to 2019. Regarding the sociodemographic index (SDI), the highest age-standardized prevalence, incidence, and Death rates of NAFLD occurred in middle-SDI countries, and the highest DALY rates of NAFLD occurred in low-SDI countries.

Conclusion

Global NAFLD burdens have increased since 1990. Our findings provide a reference for policymakers to reduce the burden of NAFLD, especially in middle and low-SDI countries.

Temporal Trends in Incidence of Nutritional Deficiency among Older Adults in China: A Secondary Analysis of the Global Burden of Disease Study 1990-2019

Nutritional deficiency is prevalent among the elderly, and it is associated with many adverse health consequences. China is rapidly moving toward an aging society with a large population; however, evidence on the epidemiological trends in nutritional deficiency among the Chinese elderly is limited. Data on the incidence of nutritional deficiency among Chinese adults aged 65 years or above from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. We used the joinpoint regression method to estimate the average annual percentage change (AAPC) and to describe trend patterns. Age, period, and cohort effects were determined using age-period-cohort models. From 1990 to 2019, the incidence of vitamin A deficiency and iodine deficiency among Chinese older adults decreased from 1784.12 and 8.20 to 304.27 and 7.26 per 100,000, with AAPCs of -0.41 (-0.44, -0.38)% and -5.86 (-6.29, -5.43)%, respectively. A continually increasing trend was seen for incidence rates of protein-energy malnutrition, from 1342.02 to 2275.87 per 100,000 person-years, with an AAPC of 1.70 (1.40, 2.01)%. These trends were more pronounced among men than women. A strong age effect and birth cohort effect were present. Specifically, the population that was older or born later had a lower incidence of deficiencies in vitamin A and iodine but a higher incidence of protein-energy malnutrition. The results show a substantial reduction in vitamin A and iodine deficiencies among the Chinese elderly, and health policies and public awareness are needed to address the burden of protein-energy malnutrition in this population.

SARS-CoV-2 vaccines: What we know, what we can do to improve them and what we could learn from other well-known viruses

In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the globe, even in countries where vaccination programs have been strongly implemented. In these regions in 2021, a reduction in the number of hospitalizations and deaths compared to 2020 was observed. This decrease is certainly associated with the introduction of vaccination measures. The process of the development of effective vaccines represents an important challenge. Overall, the breakthrough infections occurring in vaccinated subjects are in most cases less severe than those observed in unvaccinated individuals. This review examines the factors affecting the immunogenicity of vaccines against SARS-CoV-2 and the possible role of nutrients in modulating the response of distinct immune cells to the vaccination.

"Planeterranea": An attempt to broaden the beneficial effects of the Mediterranean diet worldwide

Non-communicable diseases (NCDs) lead to a dramatic burden on morbidity and mortality worldwide. Diet is a modifiable risk factor for NCDs, with Mediterranean Diet (MD) being one of the most effective dietary strategies to reduce diabetes, cardiovascular diseases, and cancer. Nevertheless, MD transferability to non-Mediterranean is challenging and requires a shared path between the scientific community and stakeholders. Therefore, the UNESCO Chair on Health Education and Sustainable Development is fostering a research project-"Planeterranea"-aiming to identify a healthy dietary pattern based on food products available in the different areas of the world with the nutritional properties of MD. This review aimed to collect information about eating habits and native crops in 5 macro-areas (North America, Latin America, Africa, Asia, and Australia). The information was used to develop specific "nutritional pyramids" based on the foods available in the macro-areas presenting the same nutritional properties and health benefits of MD.

Suboptimal Plasma Vitamin C Is Associated with Lower Bone Mineral Density in Young and Early Middle-Aged Men: A Retrospective Cross-Sectional Study

Background: This study was conducted to evaluate associations between bone mineral density (BMD) and four selected circulating nutrients, particularly vitamin C, among adults aged 20−49 years. Methods: In this retrospective cross-sectional study, the lumbar spine BMD of 866 men and 589 women were measured by dual-energy X-ray absorptiometry and divided into tertiles, respectively. Logistic regressions were used to identify the predictors of low BMD by comparing subjects with the highest BMD to those with the lowest. Results: Multivariate logistic regressions identified suboptimal plasma vitamin C (adjusted odds ratio (AOR) 1.64, 95% confidence interval (CI) 1.16, 2.31), suboptimal serum vitamin B12 (AOR 2.05, 95% CI 1.02, 4.12), and low BMI (BMI < 23) (AOR 1.68, 95% CI 1.12, 2.53) as independent predictors for low BMD in men. In women, low BMI was the only independent predictor for low BMD. Plasma vitamin C, categorized as suboptimal (≤8.8 mg/L) and sufficient (>8.8 mg/L), was positively significantly correlated with the lumbar spine BMD in men, but there was no association in women. Conclusions: Plasma vitamin C, categorized as suboptimal and sufficient, was positively associated with the lumbar spine BMD in young and early middle-aged men. A well-designed cohort study is needed to confirm the findings.

Dietary diversity as a sustainable approach towards micronutrient deficiencies in India

The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.