A question mark on iron deficiency in 185 million people of Pakistan: its outcomes and prevention

The Level of Selected Metals in Made Tea and Tea Infusion from the Roadside Tea Plants and Health Risk Assessment

The effects of human activities are becoming clearer every year, with multiple reports of struggling and eroded ecosystems resulting in new threats of plant and animal extinctions throughout the world. It has been speculated that roadside tea-growing soils impact on metal dynamics from soil to tea plants and subsequently to tea infusion which may be threatened by increasingly unpredictable and dangerous surroundings. Furthermore, heavy metals released from vehicles on the national highway (NH) could be a source of metal contamination in roadside tea soils and tea plants. This study was articulated to realize the effect of NH on a buildup of selected metals (Cu, Cd, Fe, Mn, Ni, and Zn) in made tea along with repeated tea infusion. In general, metal concentration was found significantly higher in made tea prepared from the young shoots collected from the vicinity of NH. The results also showed that distance from the NH and infusion process significantly influenced to content of the analysed metal in tea infusions. The mean average daily intake (ADI) and hazard quotient (HQ) values of analysed tea samples were found in the orderMn˃Fe˃Zn˃Cu˃Ni˃Cd and Mn˃Cu˃Zn˃Fe˃Ni˃Cd, respectively. The HQ values of all analysed metals were found << 1, indicating that ingestion of tea infusion with analysed heavy metals should not cause a danger to human health. However, this study further demonstrates the consumption of tea infusion prepared from made tea around the vicinity of NH may contribute to a significantly higher quantity of metal intake in the human body. From the hierarchical cluster analysis, it has been observed that there are three homogenous groups of analysed heavy metals.

Evolving trends and burden of iron deficiency among children, 1990-2019: a systematic analysis for the global burden of disease study 2019

Objectives

We aimed to provide a timely, comprehensive, and reliable assessment of the burden of iron deficiency (ID) in children between 1990 and 2019 at the global, regional, and national levels to inform policymakers in developing locally appropriate health policies.

Methods

Data related to ID among children younger than 15 years old were analyzed by sex, age, year, socio-demographic index (SDI), and location according to the Global Burden of Disease Study 2019 (GBD 2019). Age-standardized rates were used to compare the burden between different regions and countries. Furthermore, the Joinpoint regression model was used to assess temporal trends from 1990 to 2019.

Results

In 2019, the number of prevalent cases and disability-adjusted life years (DALYs) for ID in children were 391,491,699 and 13,620,231, respectively. The global age-standardized prevalence and DALY rates for childhood ID in 2019 were 20,146.35 (95% confidence interval: 19,407.85 to 20,888.54) and 698.90 (466.54 to 1015.31) per 100,000, respectively. Over the past 30 years, the global prevalence of ID among children has been highest in low-SDI regions, particularly in Western Sub-Saharan Africa, South Asia, and Eastern Sub-Saharan Africa. Since 1990, the prevalence and DALY of ID in children have been declining in most geographic regions. Nationally, Ecuador, China, and Chile have shown the most significant decreases in prevalence. The greatest decline in age-standardized DALY rate was observed in Ecuador, while Burkina Faso experienced the highest increase. Bhutan had the highest prevalence and DALY rates in 2019. On the age level, the prevalence was relatively higher among the <5 years age group. At the gender dimension, the prevalence of ID in children overall was more pronounced in girls than in boys, as was the case for DALY.

Conclusion

Although the burden of ID in children has been declining, this disease remains a major public health problem, especially in countries with low SDI. Children younger than 5 years of age are an important group for whom targeted measures are needed to reduce the burden of ID.

Screening of Iron Deficiency Anemia in Children Using Mentzer Index in Pakistan: A Cross Sectional Study

The objective of the study was to determine the diagnostic accuracy of Mentzer Index in children with hypochromic microcytic anemia by taking serum ferritin levels as a gold standard. This cross-sectional study was conducted in the Department of Pediatric Medicine, Liaquat National Hospital Karachi, from 1st January to 30th June 2022. Children age 1 to 5 years and both genders were included in this study. Children who have had a history of blood transfusion in the past 3 months or Thalassemia or blood disorders, chronic liver disease or kidney diseases, and children with malignancy and congenital abnormalities were excluded. Eligible children were enrolled after taking written informed consent. Complete blood count (CBC) and serum ferritin were sent to the laboratory. Sensitivity, specificity, diagnostic accuracy, and likelihood ratio were calculated taking serum ferritin levels as a gold standard. A total of 347 subjects were enrolled. The median age was 26 (IQR-18) months and 42.9% were males. The most common symptom was fatigue 40.9%. The sensitivity of the Mentzer index was 80.7% while the specificity was 77.7%. Similarly, the positive predictive value (PPV) was 56.8% while the negative predictive value (NPV) was 91.6%. Finally, the accuracy of the Mentzer index in determining iron deficiency anemia was 78.4%. Diagnostic accuracy was 78.4% and the likelihood ratio was 3.6. Mentzer index is a valuable tool in the early detection of IDA in children. It has got high sensitivity, specificity diagnostic accuracy, and likelihood ratio.

Evaluation of iron content in bakery flour samples of Tehran, Iran

Given that iron-deficiency anemia is a major nutritional problem in Iran and bread is one of the main foods in Iranian household basket, a flour fortification program with iron was established in 2001. Thereafter, to quality control of the mentioned program, the iron concentration was measured in flour samples. Accordingly, this study was conducted to investigate the iron content in wheat flour samples in Tehran, Iran. One hundred and twenty-one samples of wheat flour (i.e., Confectionery, Taftoon, Setareh, Barbary, Sangak wheat flour) were randomly collected from bakeries in Tehran by simple random sampling method. The content of iron was determined by flame atomic absorption spectrometry. The mean levels of iron in Confectionery, Taftoon, Setareh, Barbary, Sangak flour were 18.56 ± 5.64 ppm, 28.32 ± 1.74 ppm, 17.21 ± 5.02 ppm, 32.81 ± 3.98 ppm, 14.02 ± 4.99 ppm, respectively. The mean iron concentration of all sample groups was not complied with the minimum recommended level set by the Iranian Ministry of Health and Medical education (40 ppm). The mean iron content of all tested flour was significantly (P ≤ 0.05) lower than the minimum recommended level. The highest iron level was obtained in Barbary (32.81 ppm) and Taftoon (28.32 ppm) flour. While the lowest mean iron level was obtained in Sangak flour (14.02 ppm), followed by Setareh (17.21 ppm), and Confectionery (18.56 ppm) flour. In conclusion, it was identified that the iron fortification program in Tehran, Iran was not well performed as the minimum required level of iron in wheat flours (40 ppm) was not fulfilled. Therefore, the supervision and encouragement of the authorities to provide iron-fortified flours is highly recommended.

Nutritional Attributes and Phenolic Composition of Flower and Bud of Sophora japonica L. and Robinia pseudoacacia L

Sophora japonica L. (SJL) and Robinia pseudoacacia L. (RPL) are widely cultivated in China. However, the utilization of their main by-products are limited due to a lack of comprehensive nutritional attributes. Herein, the proximate composition, mineral elements, fatty acids, amino acids, monosaccharides, and phenolics were analyzed to investigate the nutritional attributes of SJL and RPL. Dietary fiber was the main ingredient in SJL and RPL, followed by protein and lipids. The content of Fe in SJL and RPL was highest, especially in flowers of SJL, reaching about 1179.51 mg/kg. The total unsaturated fatty acids accounted for 89.67% of the bud of SJL. Meanwhile, the essential amino acids contents of the flower and bud of SJL and RPL accounted for 35.95-40.59% of total amino acids. The flower of SJL (373.75 mg/g) exhibited the most abundant monosaccharides. Meanwhile, the total phenolics and flavonoid contents in the buds of SJL and RPL were significantly higher than that of the flower, implying the buds possessed better biological activity. Moreover, the bud of SJL possessed the most abundant phenolics. The results provided a reference for the development of functional food derived from SJL and RPL.

Prevalence and Associated Factors of Iron Deficiency and Iron Deficiency Anemia Among Under-5 Children: A Systematic Review and Meta-Analysis

Background. Iron deficiency anemia is a common health problem that affects children under the age of five. Children’s cognitive performance is impaired by iron deficiency, which impacts their psychomotor development. Therefore, the aim of this study was to determine the global prevalence and associated factors of iron deficiency and iron deficiency anemia among under-5 children. Methods. Relevant publications published till March 30, 2021 were identified in databases such as Medline/PubMed, Science Direct, Popline, EMBASE, African Journals Online, Scopus, and Google Scholar. The STATA version 11 software was utilized for the analysis. To determine the level of heterogeneity, I² test statistics were used. To detect publication bias, funnel plots analysis and the Egger weighted regression test were used. Results. The global pooled prevalence of iron deficiency anemia and iron deficiency was 16.42% (95% CI: 10.82, 22.01) and 17.95% (95% CI: 13.49, 22.41), respectively. Age less than 2 years (OR = 1.26; 95% CI: 1.14, 1.38) and living in a large family size (OR = 1.38; 95% CI: 1.18, 1.58) were associated with iron deficiency anemia. Children born from anemic mother, low birth weight, and do not drink iron fortified milk (OR = 1.20; 95% CI: 1.05, 1.36), (OR = 1.15; 95% CI: 1.01, 1.36) and (OR = 1.28; 95% CI: 1.10, 1.46), respectively were associated factors of iron deficiency in under-5 children. Conclusion. The prevalence of iron deficiency anemia and iron deficiency was significant across the globe, particularly in Asia and Africa. Therefore, regular screening and treatment of iron deficiency and iron deficiency anemia are required especially in high-risk children to reduce their complication.

PROSPERO registration number: CRD42021267060

Amaranth Leaves and Skimmed Milk Powders Improve the Nutritional, Functional, Physico-Chemical and Sensory Properties of Orange Fleshed Sweet Potato Flour

Vitamin A deficiency (VAD) and under nutrition are major public health concerns in developing countries. Diets with high vitamin A and animal protein can help reduce the problem of VAD and under nutrition respectively. In this study, composite flours were developed from orange fleshed sweet potato (OFSP), amaranth leaves and skimmed milk powders; 78:2:20, 72.5:2.5:25, 65:5:30 and 55:10:35. The physico-chemical characteristics of the composite flours were determined using standard methods while sensory acceptability of porridges was rated on a nine-point hedonic scale using a trained panel. Results indicated a significant (p < 0.05) increase in protein (12.1 to 19.9%), iron (4.8 to 97.4 mg/100 g) and calcium (45.5 to 670.2 mg/100 g) contents of the OFSP-based composite flours. The vitamin A content of composite flours contributed from 32% to 442% of the recommended dietary allowance of children aged 6–59 months. The composite flours showed a significant (p < 0.05) decrease in solubility, swelling power and scores of porridge attributes with increase in substitution levels of skimmed milk and amaranth leaf powder. The study findings indicate that the OFSP-based composite flours have the potential to make a significant contribution to the improvement in the nutrition status of children aged 6–59 months in developing countries.

Sources of Dietary Sodium in Food and Beverages Consumed by Spanish Schoolchildren between 7 and 11 Years Old by the Degree of Processing and the Nutritional Profile

Excessive salt intake has negative effects on health and persists as a dietary problem in Spanish children. However, the analysis of dietary sodium sources has not been extensively studied. A group of 321 children between 7 and 11 years old from five Spanish regional communities was studied. A three-day dietary record was used to determine the contribution of food and beverages to dietary sodium intake. The food consumed was classified based on the level of processing (NOVA classification) and the nutritional profile. Boys consumed more dietary sodium and sodium from ultra-processed food (UPF) than girls (p < 0.05). The main sources of dietary sodium from discretionary food were meat and meat products (25.1%), some ready-to-eat and pre-cooked dishes (7.4%) and sugars and sweets (6.3%). More than 4/5 of the total dietary sodium consumed came from processed foods (PF) and UPF. Ready-to-eat and pre-cooked dishes (14.4%), meat and meat products (10.6%), and cereals (10.2%) were the most relevant UPF. These results demonstrate that a key point for Spanish children is a reduction in the sodium content in PF and UPF, whether these foods are for basic or discretionary consumption. Furthermore, a decrease in the frequency and the quantity of discretionary food consumption should be encouraged.

Micronutrients (B, Co, Cu, Fe, Mn, Mo, and Zn) content in made tea (Camellia sinensis L.) and tea infusion with health prospect: A critical review

Tea (Camellia sinensis L.) is a perennial acidophilic crop, and known to be a nonalcoholic stimulating beverage that is most widely consumed after water. The aim of this review paper is to provide a detailed documentation of selected micronutrient contents, viz. boron (B), cobalt (Co), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), and zinc (Zn) in made tea and tea infusion. Available data from the literature were used to calculate human health aspect associated with the consumption of tea infusion. A wide range of micronutrients reported in both made tea and tea infusion could be the major sources of micronutrients for human. The content of B, Co, Cu, Fe, Mn, Mo, and Zn in made tea are ranged from 3.04 to 58.44 μg g^-1, below detectable limit (BDL) to 122.4 μg g^-1, BDL to 602 μg g^-1, 0.275 to 13,040 μg g^-1, 0.004 to 15,866 μg g^-1, 0.04 to 570.80 μg g^-1 and 0.01 to 1120 μg g^-1, respectively. Only 3.2 μg L^-1 to 7.25 mg L^-1, 0.01 μg L^-1 to 7 mg L^-1, 3.80 μg L^-1 to 6.13 mg L^-1, 135.59 μg L^-1 -11.05 mg L^-1, 0.05 μg L^-1 to 1980.34 mg L^-1, 0.012 to 3.78 μg L^-1, and 1.12 μg L^-1 to 2.32 μg L^-1 of B, Co, Cu, Fe, Mn, Mo, and Zn, respectively, are found in tea infusion which are lower than the prescribed limit of micronutrients in drinking water by World Health Organization. Furthermore, micronutrient contents in tea infusion depend on infusion procedure as well as on the instrument used for analysis. The proportion of micronutrients found in different tea types are 1.0-88.9% for B, 10-60% for Co, 2.0-97.8% for Cu, 67.8-89.9% for Fe, 71.0-87.4% for Mn, 13.3-34% for Mo, and 34.9-83% for Zn. From the results, it can also be concluded that consumption of three cups of tea infusion per day does not have any adverse effect on human health with respect to the referred micronutrients rather got beneficial effects to human.

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions

Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem. Based on the availability of more recent data, this review is primarily focused on countries that are in advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports indicate that food fortification in the region is sporadic and ineffective, and the use of dietary supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information present challenges for implementing new policies and approaches to address the problem. Government-sponsored initiatives are necessary to assess current dietary intakes/patterns, support nutrition education, and to reduce food insecurity, especially among vulnerable population groups. Public-private partnerships should be considered in targeting micronutrient fortification programs and supplementation recommendations as approaches to help alleviate the burden of micronutrient deficiencies and inadequacies in the Middle East.

Risk assessment of mineral and heavy metal content of selected tea products from the Ghanaian market

Food consumption is the most likely route of human exposure to metals. Tea (Camellia sinensis L.) is among the most widely consumed non-alcoholic beverages. Concentrations of heavy metals and minerals in tea from 15 different brands in Kumasi, Ghana were measured to assess the health risk associated with their consumption. The mineral and metal contents (Fe, Cu, Zn, Pb, As, Cd) were analyzed using atomic absorption spectrophotometer (Z-8100 polarized Zeeman). The results revealed that the mean concentrations were in the order: Ca > Fe > As > Cd > Zn > Pb. The average contents of Ca, Fe, Zn, Pb, Cd, and As in the samples were 94.08, 6.15, 0.20, 0.16, 0.36, and 1.66 mg/kg, respectively. All the minerals and heavy metals were below the maximum permissible limits stipulated by the World Health Organization (WHO) and US Pharmacopeia (USP). Metal-to-metal correlation indicated strong correlations between As/Zn, Cd/Zn, Cd/As, and Pb/As pairs. Factor analysis demonstrated a clear separation between minerals, grouped on one side, and heavy metals, clustered on another side. Both the target hazard quotient (THQ) and hazard index (HI) levels in green tea were far below 1, suggesting that consumption of green tea should pose no potential risk to human health. However, carcinogenic risk levels for arsenic were high; R > 10(-6). The results showed that residents in Kumasi consume tea could be at risk from exposure to these heavy metals and minerals.

Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012

BACKGROUND

Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.

METHODS

Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011-2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS.

FINDINGS

A total of 7138 children aged between 6-59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18-1.55 p <0.05), stunting (AOR 1.42 CI 1.23-1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93-6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47-2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10-1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65-0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76-0.98 p<0.05) were associated with reduced odds of IDA.

CONCLUSION

The prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.

Concept of double salt fortification; a tool to curtail micronutrient deficiencies and improve human health status

Fortification of food with micronutrients such as vitamins and minerals is one of the main strategies used to combat micronutrient deficiencies. Fortification in common salt is a fruitful strategy because of the daily consumption of 5-12 g salt per person globally. Therefore double fortification of salt with iodine and iron could be a reasonable approach to prevent both iodine and iron deficiencies. It is reckoned that about two billion people are iodine-deficient worldwide. Iodine deficiency during pregnancy may affect the health status of both mother and fetus and increase infant mortality. Deficiencies of both these micronutrients during childhood affect somatic growth and cognitive and neurological function. Thyroid metabolism is negatively affected by iron deficiency and reduced effectiveness of iodine prophylaxis in areas of endemic goiter. High prevalence of iron deficiency among children may be reduced by the application of effective iodized salt programs. However, ensuring the stability and bioavailability of both iron and iodine as double-fortified salt is difficult. Iodine present in iodide or iodate form in dual-fortified salt is oxidized to free iodine in the presence of ferrous ions and oxygen and consequently loses its characteristics. Moreover, ferrous iron is more bioavailable but is readily oxidized to the less bioavailable ferric form. However, both forms of iron may lead to discoloration of the final product, which can be reduced by providing a physical barrier around the iron. Salt encapsulation is one of the best tools to provide a physical barrier for undesirable reactions and interactions during storage. In this review the concept of dual salt fortification, the impact of fortification on curing various life-threatening maladies, latest assessments of mineral deficiencies and the choice of fortificants are discussed.