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Ciulei MA, Gallagher K, Ba DM, Beck C, Pobee RA, Gernand AD, Walker RE. Iron status and anemia in a representative sample of US pregnant women is not associated with pre-pregnancy BMI: Results from the NHANES (1999-2010) study. PLoS One 2024; 19:e0300912. [PMID: 39255312 PMCID: PMC11386453 DOI: 10.1371/journal.pone.0300912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/23/2024] [Indexed: 09/12/2024] Open
Abstract
Iron deficiency in pregnancy is related to many poor health outcomes, including anemia and low birth weight. A small number of previous studies have identified maternal body mass index (BMI) as a potential risk factor for poor iron status. Our objective was to examine the association between pre-pregnancy BMI, iron status, and anemia in a nationally representative sample of US adult women. We used data from the National Health and Nutrition Examination Survey (NHANES; 1999-2010) for pregnant women ages 18-49 years (n = 1156). BMI (kg/m2) was calculated using pre-pregnancy weight (self-reported) and height (measured at examination). Iron deficiency (ID) was defined as total body iron (calculated from serum ferritin and transferrin receptor using Cook's equation) < 0 mg/kg and anemia as hemoglobin < 11 g/dL. Associations were examined using weighted linear and Poisson regression models, adjusted for confounders (age, race/ethnicity, education, and trimester). Approximately 14% of pregnant women had ID and 8% had anemia in this sample. Ferritin and total body iron trended slightly lower (p = 0.12, p = 0.14) in women with pre-pregnancy BMI in the normal and overweight categories compared to the underweight and obese categories; hemoglobin concentrations were similar across BMI groups (p = 0.76). There were no differences in the prevalence of ID or anemia in women with pre-pregnancy overweight and obesity (ID: overweight, adjusted prevalence ratio (PR) = 1.27, 95%CI: 0.89-1.82; obesity, PR = 0.75, 95%CI: 0.39-1.45; anemia: overweight, PR = 1.08, 95%CI: 0.53-2.19; obesity, PR = 0.99, 95%CI: 0.49-2.01) compared to women with a normal BMI. Findings from these US nationally representative data indicate that total body iron, serum hemoglobin, ID, and anemia in pregnancy do not differ by pre-pregnancy BMI. Since ID and anemia during pregnancy remain significant public health concerns, NHANES should consider measuring current iron status in upcoming cycles.
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Affiliation(s)
- Mihaela A Ciulei
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Kelly Gallagher
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Celeste Beck
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Ruth A Pobee
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Rachel E Walker
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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Young MF. New Frontier for Assessing Iron Status in Young Children? J Nutr 2024; 154:2609-2610. [PMID: 38992470 DOI: 10.1016/j.tjnut.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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3
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Tan X, Tan PY, Som SV, Nguyen SD, Tran DT, Tran NT, Tran VK, Moore JB, Gong YY. Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 50:101164. [PMID: 39219625 PMCID: PMC11363818 DOI: 10.1016/j.lanwpc.2024.101164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024]
Abstract
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.
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Affiliation(s)
- Xiaomian Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Pui Yee Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Somphos Vicheth Som
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
- Section of International Health, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Son Duy Nguyen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Nutrition Surveillance and Policy Department, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Do Thanh Tran
- Nutrition Surveillance and Policy Department, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Nga Thuy Tran
- Department of Micronutrient, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Van Khanh Tran
- Department of Micronutrient, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | | | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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4
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Palmer AC, Bedsaul-Fryer JR, Stephensen CB. Interactions of Nutrition and Infection: The Role of Micronutrient Deficiencies in the Immune Response to Pathogens and Implications for Child Health. Annu Rev Nutr 2024; 44:99-124. [PMID: 38724105 DOI: 10.1146/annurev-nutr-062122-014910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
Approximately five million children die each year from preventable causes, including respiratory infections, diarrhea, and malaria. Roughly half of those deaths are attributable to undernutrition, including micronutrient deficiencies (MNDs). The influence of infection on micronutrient status is well established: The inflammatory response to pathogens triggers anorexia, while pathogens and the immune response can both alter nutrient absorption and cause nutrient losses. We review the roles of vitamin A, vitamin D, iron, zinc, and selenium in the immune system, which act in the regulation of molecular- or cellular-level host defenses, directly affecting pathogens or protecting against oxidative stress or inflammation. We further summarize high-quality evidence regarding the synergistic or antagonistic interactions between MNDs, pathogens, and morbidity or mortality relevant to child health in low- and middle-income countries. We conclude with a discussion of gaps in the literature and future directions for multidisciplinary research on the interactions of MNDs, infection, and inflammation.
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Affiliation(s)
- Amanda C Palmer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
| | - Jacquelyn R Bedsaul-Fryer
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
| | - Charles B Stephensen
- Department of Nutrition, University of California, Davis, California, USA
- Western Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Davis, California, USA
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5
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Mendoza E, Duque X, Reyes-Maldonado E, Hernández-Franco JI, Martínez-Andrade G, Vilchis-Gil J, Martinez H, Morán S. Serum hepcidin recalibrated values in Mexican schoolchildren by demographic characteristics, nutritional and infection/inflammation status. Ann Hematol 2024:10.1007/s00277-024-05889-4. [PMID: 39039174 DOI: 10.1007/s00277-024-05889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
Hepcidin production is regulated by iron concentration, erythropoietic activity, and inflammation. There is no reference method for determining its levels, but results obtained through various methods strongly correlate and can be compared using recalibration equations. OBJECTIVE To describe recalibrated serum hepcidin values at different percentiles in schoolchildren, considering age, sex, inflammatory processes, H. pylori infection, and iron status. METHODS Secondary analysis of data incorporating information on inflammation, H. pylori infection, and iron status of 349 schoolchildren. Hepcidin analysis was performed using a competitive ELISA, and recalibrated hepcidin values were calculated using the inverse of the linear regression model equation obtained by van der Vorm et al. Results: Recalibrated hepcidin values were lower than non-calibrated values. In schoolchildren without infection/inflammation and without iron deficiency, recalibrated values at the 50th percentile (25th-75th) were 4.89 ng/mL (2.68-8.42). For schoolchildren without infection/inflammation but with iron deficiency, recalibrated values were 2.34 ng/mL (1.10-6.58), the lowest hepcidin values observed. The highest values were found in the group with infection/inflammation, regardless of iron deficiency status. CONCLUSIONS Recalibrated hepcidin values were lower than non-calibrated values. The highest values were observed in schoolchildren with infectious or inflammatory processes, and the lowest values were observed in schoolchildren with iron deficiency but only in the absence of infectious or inflammatory processes. Using recalibrated hepcidin values allows comparison between data obtained using different analytical methods.
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Affiliation(s)
- Eugenia Mendoza
- Infectious Diseases Research Unit, Mexican Social Security Institute, Av. Cuauhtemoc No. 330, Col. Doctores, Del. Cuauhtemoc, Mexico City, CP 06720, Mexico
| | - Ximena Duque
- Infectious Diseases Research Unit, Mexican Social Security Institute, Av. Cuauhtemoc No. 330, Col. Doctores, Del. Cuauhtemoc, Mexico City, CP 06720, Mexico.
| | - Elba Reyes-Maldonado
- Department of Hematopathology, National Polytechnic Institute, National School of Biological Sciences, Mexico City, 01135, Mexico
| | | | - Gloria Martínez-Andrade
- Academic Area of Nutrition, Institute of Health Sciences, Autonomous University of the State of Hidalgo, Pachuca Hidalgo, 42039, Mexico
| | - Jenny Vilchis-Gil
- Hospital Infantil de México "Federico Gomez", Mexico City, 06720, Mexico
| | - Homero Martinez
- Hospital Infantil de México "Federico Gomez", Mexico City, 06720, Mexico
- Global Technical Services-NTEAM, Nutrition International, Ottawa, ON, K2P 2K3, Canada
| | - Segundo Morán
- Gastroenterology Research Laboratory, Mexican Social Security Institute, Mexico City, 06720, Mexico
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6
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McLean NH, Haszard JJ, Daniels L, Taylor RW, Wheeler BJ, Conlon CA, Beck KL, von Hurst PR, Te Morenga LA, McArthur J, Paul R, Katiforis I, Brown KJ, Gash MC, Rowan MM, Casale M, Cox AM, Jones EA, Jupiterwala RM, Bruckner B, Fleming L, Heath ALM. Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study. Nutrients 2024; 16:1494. [PMID: 38794732 PMCID: PMC11124519 DOI: 10.3390/nu16101494] [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: 04/27/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.
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Affiliation(s)
- Neve H. McLean
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | | | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Rachael W. Taylor
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, University of Otago, Dunedin 9016, New Zealand;
| | - Cathryn A. Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Kathryn L. Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Pamela R. von Hurst
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Lisa A. Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington 6140, New Zealand;
| | - Jenny McArthur
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Rebecca Paul
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Ioanna Katiforis
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Kimberley J. Brown
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Madeline C. Gash
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Madeleine M. Rowan
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Maria Casale
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Alice M. Cox
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (L.D.); (R.W.T.); (J.M.); (A.M.C.)
| | - Emily A. Jones
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Rosario M. Jupiterwala
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (C.A.C.); (K.L.B.); (P.R.v.H.); (R.P.); (K.J.B.); (M.C.); (E.A.J.); (R.M.J.)
| | - Bailey Bruckner
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Liz Fleming
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
| | - Anne-Louise M. Heath
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (N.H.M.); (I.K.); (M.C.G.); (M.M.R.); (B.B.); (L.F.)
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Renaud D, Höller A, Michel M. Potential Drug-Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds with Acetylsalicylic Acid and Warfarin-A Review of the Literature. Nutrients 2024; 16:950. [PMID: 38612984 PMCID: PMC11013948 DOI: 10.3390/nu16070950] [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: 03/05/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
In cardiology, acetylsalicylic acid (ASA) and warfarin are among the most commonly used prophylactic therapies against thromboembolic events. Drug-drug interactions are generally well-known. Less known are the drug-nutrient interactions (DNIs), impeding drug absorption and altering micronutritional status. ASA and warfarin might influence the micronutritional status of patients through different mechanisms such as binding or modification of binding properties of ligands, absorption, transport, cellular use or concentration, or excretion. Our article reviews the drug-nutrient interactions that alter micronutritional status. Some of these mechanisms could be investigated with the aim to potentiate the drug effects. DNIs are seen occasionally in ASA and warfarin and could be managed through simple strategies such as risk stratification of DNIs on an individual patient basis; micronutritional status assessment as part of the medical history; extensive use of the drug-interaction probability scale to reference little-known interactions, and application of a personal, predictive, and preventive medical model using omics.
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Affiliation(s)
- David Renaud
- DIU MAPS, Fundamental and Biomedical Sciences, Paris-Cité University, 75006 Paris, France
- DIU MAPS, Health Sciences Faculty, Universidad Europea Miguel de Cervantes, 47012 Valladolid, Spain
- Fundacja Recover, 05-124 Skrzeszew, Poland
| | - Alexander Höller
- Department of Nutrition and Dietetics, University Hospital Innsbruck, 6020 Innsbruck, Austria
| | - Miriam Michel
- Department of Child and Adolescent Health, Division of Pediatrics III—Cardiology, Pulmonology, Allergology and Cystic Fibrosis, Medical University of Innsbruck, 6020 Innsbruck, Austria
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8
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Berti TL, de Castro IR, Pedrosa LF, Normando P, Farias DR, Lacerda EM, Oliveira N, Alves-Santos NH, Kac G. Serum Zinc Concentrations by Inflammation Status, Time of Day, and Fasting Status for Estimating Zinc Deficiency in 6-59-Mo-Old Children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019). J Nutr 2024; 154:994-1003. [PMID: 38218540 DOI: 10.1016/j.tjnut.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Serum zinc concentration (SZC) is considered the best biomarker of zinc status in population-level evaluations. However, zinc deficiency (ZD) estimations can be biased if they do not consider blood collection timing, inflammation, and fasting status. OBJECTIVES The objectives of this study were to determine SZC without and with adjustment for inflammation, according to blood collection timing and fasting status, estimate ZD prevalence, and evaluate the associated factors with ZD in a representative sample of Brazilian children aged <5 y. METHODS Population-based study with 7597 children aged 6-59 mo surveyed by the Brazilian National Survey on Child Nutrition. SZC was adjusted for inflammation using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia regression correction approach, with high-sensitive C-reactive protein, assessed according to blood collection timing (morning/afternoon) and fasting status (<8 and ≥8 h). SZC <65 μg/dL (morning collection) or SZC <57 μg/dL (afternoon collection) were classified as ZD. The analysis between associated factors and ZD used the adjusted prevalence ratio (PR). RESULTS After adjusting for inflammation, SZC was higher in all percentiles and varied according to collection timing and fasting status. Children who had blood collected in the morning without fasting or in the afternoon had lower SZC than those assessed in the morning with fasting. The differences in adjusted SZC according to the timing of collection and fasting status were greater in the higher percentiles of the distribution, with the greatest absolute difference observed when comparing the 95th percentile of morning fasting compared with nonfasting (20.3 μg/dL). The prevalence of ZD estimated without and with adjusting SZC for inflammation was 17.8% and 13.8%, respectively. The occurrence of diarrhea, fever, or respiratory symptoms in the 15 d before blood collection was associated with a higher prevalence of ZD (PR: 1.42; 95% confidence interval: 1.04, 1.94). CONCLUSIONS Adjusting SZC for inflammation and considering fasting status is important to avoid overestimating the prevalence of ZD.
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Affiliation(s)
- Talita L Berti
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Inês Rr de Castro
- Department of Social Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucia Fc Pedrosa
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Paula Normando
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana R Farias
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Ma Lacerda
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália Oliveira
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Gilberto Kac
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
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9
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Yang CL, Leung CW, Lee JT, Park SK, Jansen EC, Seo YA. Manganese and Sleep Outcomes in United States Adults: Results from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). J Nutr 2024; 154:213-223. [PMID: 37984743 PMCID: PMC10925890 DOI: 10.1016/j.tjnut.2023.11.012] [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: 07/14/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Manganese (Mn) is an essential micronutrient, but inadequate or excess Mn intake can have a detrimental impact on human health. Despite the essentiality, little is known about the relationship between Mn and sleep. OBJECTIVE This study aimed to examine the relationship between blood Mn concentrations and sleep outcomes in US adults. METHODS This cross-sectional study used data on blood Mn and sleep from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) (n = 8356, age ≥18 y). Multivariable logistic regression was used to examine associations between quintiles of blood Mn concentrations and subjective sleep outcomes (short sleep duration, late sleep midpoint, trouble sleeping, and obstructive sleep apnea [OSA] symptoms), adjusting for age, gender, body mass index, race/ethnicity, income, smoking, inflammation-adjusted serum ferritin concentration (iron status), caffeine, and alcohol intake. Gender-stratified models were used due to interactions with gender. RESULTS The mean (SE) blood Mn concentration was 9.7 (0.1) μg/L in US adults. In males, a nonlinear association was noted in the relationship between blood Mn levels and short sleep duration on weekdays and weekends. The third Mn quintile (Q3) group had lower odds of short sleep duration (<7 h) on weekdays (odds ratio [OR]=0.6, 95% confidence interval [CI]: 0.4, 0.9) than the lowest Mn quintile (Q1, reference) after adjusting for covariates in males. The second Mn quintile (Q2) group had lower odds of late sleep midpoint on weekdays than Q1 (OR=0.6, 95% CI: 0.4, 0.8). In females, Q2 group had lower odds of OSA symptoms than Q1 (OR: 0.6, 95% CI: 0.4, 0.9). No relationship was noted between Mn and trouble sleeping. CONCLUSIONS Gender differences exist in the association between Mn and sleep in adults. Q1 group had the poorest sleep outcomes, including higher odds of short sleep duration (in males), late sleep midpoint (in males), and OSA symptoms (in females).
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Affiliation(s)
- Chia-Lun Yang
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jennifer T Lee
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Sung Kyun Park
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Young Ah Seo
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.
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10
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Belay A, Joy EJM, Lark RM, Ander EL, Young SD, Bailey EH, Broadley MR, Gashu D. Micronutrients and socio-demographic factors were major predictors of anaemia among the Ethiopian population. Br J Nutr 2023; 130:2123-2135. [PMID: 37424305 PMCID: PMC10657751 DOI: 10.1017/s0007114523001472] [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: 11/05/2022] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023]
Abstract
Anaemia is characterised by low hemoglobin (Hb) concentration. Despite being a public health concern in Ethiopia, the role of micronutrients and non-nutritional factors as a determinant of Hb concentrations has been inadequately explored. This study focused on the assessment of serum micronutrient and Hb concentrations and a range of non-nutritional factors, to evaluate their associations with the risk of anaemia among the Ethiopian population (n 2046). It also explored the mediation effect of Zn on the relation between se and Hb. Bivariate and multivariate regression analyses were performed to identify the relationship between serum micronutrients concentration, inflammation biomarkers, nutritional status, presence of parasitic infection and socio-demographic factors with Hb concentration (n 2046). Sobel-Goodman test was applied to investigate the mediation of Zn on relations between serum se and Hb. In total, 18·6 % of participants were anaemic, 5·8 % had iron deficiency (ID), 2·6 % had ID anaemia and 0·6 % had tissue ID. Younger age, household head illiteracy and low serum concentrations of ferritin, Co, Cu and folate were associated with anaemia. Serum se had an indirect effect that was mediated by Zn, with a significant effect of se on Zn (P < 0·001) and Zn on Hb (P < 0·001). The findings of this study suggest the need for designing a multi-sectorial intervention to address anaemia based on demographic group.
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Affiliation(s)
- Adamu Belay
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Gulele Sub City, Addis Ababa, Ethiopia
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R. Murray Lark
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, UK
| | - E. Louise Ander
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, UK
| | - Scott D. Young
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, UK
| | - Elizabeth H. Bailey
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, UK
| | - Martin R. Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, UK
- Rothamsted Research, West Common, Harpenden, Hertfordshire, UK
| | - Dawd Gashu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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11
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Luo H, Beal T, Blake T, Zeiler M, Geng J, Werner ER, Addo OY, Suchdev PS, Young MF. Streamlining Micronutrient Biomarker Statistical Analysis in Populations: An Introduction to the SAMBA R Package. J Nutr 2023; 153:2753-2761. [PMID: 37354979 PMCID: PMC10517230 DOI: 10.1016/j.tjnut.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023] Open
Abstract
Micronutrient deficiency is a common global health problem, and accurately assessing micronutrient biomarkers is crucial for planning and managing effective intervention programs. However, analyzing micronutrient data and applying appropriate cutoffs to define deficiencies can be challenging, particularly when considering the confounding effects of inflammation on certain micronutrient biomarkers. To address this challenge, we developed the Statistical Apparatus of Micronutrient Biomarker Analysis (SAMBA) R package, a new tool that increases ease and accessibility of population-based micronutrient biomarker analysis. The SAMBA package can analyze various micronutrient biomarkers to assess status of iron, vitamin A, zinc, and B vitamins; adjust for inflammation; account for complex survey design when appropriate; and produce reports of summary statistics and prevalence estimates of micronutrient deficiencies using recommended age-specific and sex-specific cutoffs. In this study, we aimed to provide a step-by-step procedure for how to use the SAMBA R package, including how to customize it for broader use, and made both the package and user manual publicly available on GitHub. SAMBA was validated by comparing results by analyzing 24 data sets on nonpregnant women of reproductive age from 23 countries and 30 data sets on preschool-aged children from 26 countries with those obtained by an independent analyst. SAMBA generated identical means, percentiles, and prevalence of micronutrient deficiencies to those calculated by the independent analyst. In conclusion, SAMBA simplifies and standardizes the process for deriving survey-weighted and inflammation-adjusted (when appropriate) estimates of the prevalence of micronutrient deficiencies, reducing the time from data cleaning to result generation. SAMBA is a valuable tool that facilitates the accurate and rapid analysis of population-based micronutrient biomarker data, which can inform public health research, programs, and policy across contexts.
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Affiliation(s)
- Hanqi Luo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington DC, United States
| | - Tineka Blake
- University of Nottingham, Nottingham, United Kingdom
| | - Madeleine Zeiler
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Jiaxi Geng
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - E Rochelle Werner
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - O Yaw Addo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States; Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States; Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States; Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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