Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children

Bioavailability of Australian pre-schooler iron intakes at specific eating occasions is low

PURPOSE

Poor bioavailability may contribute to iron deficiency among children in high-resource countries, but iron bioavailability of Australian pre-schooler diets is unknown. This study aimed to estimate the bioavailability of Australian pre-schooler iron intakes across the day and by eating occasions to identify optimal timing for intervention, by using five previously developed algorithms, and to estimate the proportion of children with intakes of absorbable iron below the requirements.

METHODS

Dietary data of children aged 2 to < 6 y (n = 812) from the 2011-12 National Nutrition and Physical Activity Survey were collected via two 24-h recalls. Usual food and nutrient intakes were estimated via Multiple Source Method. Phytate, polyphenol, and heme iron values were sourced from international databases or the literature. Five previously published algorithms were applied to observed dietary data to estimate iron bioavailability and calculate the prevalence of children with intakes of absorbable iron below requirements.

RESULTS

Pre-schooler daily iron bioavailability was low (2.7-10.5%) and corresponded to intakes of 0.18-0.75 mg/d of absorbable iron. The proportion of children with inadequate intakes of absorbable iron ranged between 32 and 98%. For all eating occasions, dinner offered iron of the greatest bioavailability (4.2-16.4%), while iron consumed at breakfast was of the lowest bioavailability (1.2-5.6%).

CONCLUSION

Future strategies are required to improve intakes of bioavailable iron for pre-schoolers to prevent the risk of deficiency. These strategies could include the encouragement of concomitant consumption of enhancers of iron absorption with iron-rich sources, particularly at breakfast.

Associations of fish and meat intake with iron and anaemia in Malawian children

Animal flesh foods are rich in bioavailable iron but infrequently consumed by young children. We aimed to determine whether flesh food intake was associated with iron and anaemia status among 585 Malawian infants enroled in a 6-month egg-feeding trial. The percentage of days of small fish, large fish and meat consumption were assessed through weekly 7-day animal-source food screeners. Grams of intake were assessed through 24-h recalls conducted at 6-9, 9-12 and 12-15 months of age. Plasma ferritin, soluble transferrin receptor (sTfR) and haemoglobin concentrations were measured at 6-9 and 12-15 months of age. Iron biomarkers were adjusted for inflammation during analysis. At enrolment, each flesh food category was consumed by <5% of children in the past 24 h. Over the next 6 months, small fish, large fish and meat were consumed on 25%, 8% and 6% of days, respectively, with mean usual intakes of <5 g/day. More frequent small fish consumption was associated with lower sTfR (geometric mean ratio [95% CI]: 0.98 mg/L [0.96, 1.00] per 10 percentage point difference) but not ferritin (1.03 µg/L [0.98, 1.07]) or haemoglobin (1.01 g/dL [1.00, 1.01]). Large fish consumption was associated with higher anaemia (prevalence ratio [95% CI]: 1.09 [1.01, 1.19]) and lower iron deficiency (0.96 [0.93, 1.00]) prevalence. Gram intakes of flesh food categories were not associated with any iron or anaemia indicators. Small fish were a primary contributor to flesh food intake in this cohort of Malawian children, although usual portions were small. Fish was associated with modest improvements to iron status, but meat was too infrequent to be associated with anaemia and iron deficiency.

Anaemia of chronic disease among pulmonary tuberculosis patients is associated with inflammatory marker at the start of intensive phase

Background

Tuberculosis (TB) disrupts iron balance through systemic inflammation. Pulmonary tuberculosis (PTB) is linked to diverse anaemia types, necessitating intricate haematological and biochemical assessments for diagnosis. This study aims to describe the prevalence of anaemia of chronic disease (ACD), iron deficiency anaemia (IDA) among PTB patients and factors associated with these types of anaemia.

Methods

A cross-sectional analysis was conducted from community-based cohort study involving sputum-positive PTB patients from 2018 to 2020 in urban Puducherry. Participants were enrolled from 10 primary health centres within 2 weeks of initiating anti-tubercular treatment (ATT). Blood samples were collected for assessing haematological and biochemical parameters. The sTfR/log ferritin ratio was used to distinguish between ACD and IDA. Data were captured using Epicollect5 and analysed using STATA V14.

Result

Of the 176 PTB patients included, 63.07% (111/176) had anaemia, with ACD being the predominant type (84.6%, 94/111). The C-reactive protein (CRP) levels were higher among the anaemic group [40.77 (16.66-58.51) mg/dl vs 24.65 (14.23-47.26) mg/dl] and higher among the ACD as compared to IDA [46.9 (22.3-61.2) vs 20.8 (13.0-39.1) mg/dl]. Undernourished [adjusted prevalence ratio (APR) =3.43; confidence interval (CI): 1.21-9.69] and patients having low risk of dependence on tobacco [APR = 1.52; CI: 1.10-2.11] had higher risk of ACD. Female patients had higher risk of IDA [APR = 4.95, P < 0.01].

Conclusion

The largest proportion of the PTB participants with anaemia had ACD. Acute-phase reactant and inflammatory marker are increased among newly diagnosed new sputum smear-positive (NSP) PTB participants at the start of ATT. Addressing inflammation is needed for combating anaemia in PTB patients.

Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls

Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10-17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by -9·6 % (95 % CI (-18·9, -0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.

Thyroid dysfunction alters gene expression of proteins related to iron homeostasis and metabolomics in male rats

Thyroid hormones (THs) are crucial in bodily functions, while iron is essential for processes like oxygen transport. Specialized proteins maintain iron balance, including ferritin, transferrin, ferroportin, and hepcidin. Research suggests that THs can influence iron homeostasis by affecting mRNA and protein expression, such as ferritin and transferrin. Our study focused on male rats to assess mRNA expression of iron homeostasis-related proteins and metabolomics in thyroid dysfunction. We found altered gene expression across various tissues (liver, duodenum, spleen, and kidney) and identified disrupted metabolite patterns in thyroid dysfunction. These findings highlight tissue-specific effects of thyroid dysfunction on essential iron homeostasis proteins and provide insights into associated metabolic changes. Our research contributes to understanding the intricate interplay between thyroid hormones and iron balance. By unveiling tissue-specific gene expression alterations and metabolic disruptions caused by thyroid dysfunction, our work lays a foundation for future investigations to explore underlying mechanisms and develop targeted strategies for managing iron-related complications in thyroid disorders.

Phytate degradation in composite wheat/cassava/sorghum bread: Effects of phytase-secreting yeasts and addition of yeast extracts

Iron deficiency anemia is highly prevalent in developing countries due to the consumption of cereal-based foods rich in phytate that chelates minerals such as iron and zinc making them unavailable for absorption by humans. The aim of the present study was to degrade phytic acid in composite flour (wheat/cassava/sorghum) bread by the addition of phytase-producing yeasts in the baking process to achieve a phytate-to-iron molar ratio <1 and a phytate-to-zinc molar ratio <15, ratios needed to achieve an enhanced absorption by humans. The high-phytase (HP)-producing yeasts were two Saccharomyces cerevisiae (YD80 and BY80) that have been genetically modified by a directed mutagenesis strategy, and Pichia kudriavzevii TY13 isolated from a Tanzanian lactic fermented maize gruel (togwa) and selected as naturally HP yeast. To further improve the phytase production by the yeasts, four different brands of phytase-promoting yeast extracts were added in the baking process. In addition, two yeast varieties were preincubated for 1 h at 30°C to initiate phytase biosynthesis. The phytate content was measured by high-performance ion chromatography (HPIC) and the mineral content by ion chromatography (HPIC). The results showed that all three HP yeasts improved the phytate degradation compared with the composite bread with no added HP yeast. The composite bread with preincubated S. cerevisiae BY80 or P. kudriavzevii TY13 plus Bacto yeast extract resulted in the lowest phytate content (0.08 μmol/g), which means a 99% reduction compared with the phytate content in the composite flour. With added yeast extracts from three of the four yeast extract brands in the baking process, all composite breads had a phytate reduction after 2-h fermentation corresponding to a phytate: iron molar ratio between 1.0 and 0.3 and a phytate: zinc molar ratio <3 suggesting a much-enhanced bioavailability of these minerals.

Iron Nutrition of Pre-Schoolers in High-Income Countries: A Review

Pre-schoolers are vulnerable to iron deficiency, which, in high-resource countries, is mainly caused by suboptimal or poorly absorbable iron intakes. This review examines the prevalence of inadequate iron intakes and status, and the non-dietary factors associated with these, among children aged between 2 and 5 years within high-income countries. It then considers the quality of the pre-schooler diet in terms of dietary factors, dietary patterns, and iron intakes. Additionally, it discusses the assessment of iron bioavailability and examines the various methods used to estimate the amount of absorbable iron in pre-schooler diets. Knowledge of the adequacy of iron intakes and bioavailability of iron intakes, and dietary patterns associated with iron intakes can facilitate the design and implementation of effectively targeted community-based intervention studies to improve iron intakes and iron bioavailability to minimise the risk of iron deficiency.

Edible Halophytes with Functional Properties: In Vitro Protein Digestibility and Bioaccessibility and Intestinal Absorption of Minerals and Trace Elements from Australian Indigenous Halophytes

Halophytes are considered emerging functional foods as they are high in protein, minerals, and trace elements, although studies investigating halophyte digestibility, bioaccessibility, and intestinal absorption are limited. Therefore, this study investigated the in vitro protein digestibility, bioaccessibility and intestinal absorption of minerals and trace elements in saltbush and samphire, two important Australian indigenous halophytes. The total amino acid contents of samphire and saltbush were 42.5 and 87.3 mg/g DW, and even though saltbush had a higher total protein content overall, the in vitro digestibility of samphire protein was higher than the saltbush protein. The in vitro bioaccessibility of Mg, Fe, and Zn was higher in freeze-dried halophyte powder compared to the halophyte test food, suggesting that the food matrix has a significant impact on mineral and trace element bioaccessibility. However, the samphire test food digesta had the highest intestinal Fe absorption rate, whereas the saltbush digesta exhibited the lowest (37.7 vs. 8.9 ng/mL ferritin). The present study provides crucial data about the digestive "fate" of halophyte protein, minerals, and trace elements and increases the understanding of these underutilized indigenous edible plants as future functional foods.

Lower Non-Heme Iron Absorption in Healthy Females from Single Meals with Texturized Fava Bean Protein Compared to Beef and Cod Protein Meals: Two Single-Blinded Randomized Trials

Meat analogs based on plant protein extracts are rising in popularity as meat consumption declines. A dietary shift away from meat, which has a high iron bioavailability, may have a negative effect on the amount of iron absorbed from the diet. Iron absorption from legumes cultivated in regions not suitable for soy production, such as fava bean, has not yet been explored. The aim of this study was to evaluate non-heme iron absorption from a meal with texturized fava bean protein compared to beef and cod protein meals. The study included two single-blinded iron isotope trials in healthy Swedish women of the ages 18–45 years, each of whom served as their own control. The participants were served matched test meals containing beef and fava bean protein (Study 1) or cod and fava bean protein (Study 2) with radiolabeled non-heme iron 55Fe and 59Fe. The absorption of non-heme iron from test meals was measured by whole-body counting and erythrocyte incorporation. The absorption of non-heme iron, measured as erythrocyte incorporation ratio, from beef protein meal was 4.2 times higher compared to texturized fava bean meal, and absorption from cod protein meal was 2.7 times higher compared to the fava bean meal. The adjusted non-heme iron absorption, normalized to a 40% reference dose uptake, was 9.2% for cod protein meal, 21.7% for beef protein meal, and 4.2% for texturized fava bean meal. A fava bean protein meal has markedly lower iron bioavailability in healthy females compared with a meal of beef or cod protein. Therefore, a dietary shift from meat and fish protein to fava bean protein may increase the risk of iron deficiency.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data

OBJECTIVE

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

DESIGN

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

SETTING

Countrywide, covering rural and urban areas in Ghana.

PARTICIPANTS

Non-pregnant adolescent girls aged 15-19 years.

RESULTS

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

CONCLUSIONS

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Frequent Consumption of Micronutrient-Rich Foods Is Associated With Reduced Risk of Anemia Among Adolescent Girls and Boys in Indonesia: A Cross-Sectional Study

BACKGROUND

Anemia is a global public health concern. Its devastating consequences include impaired cognitive and motor development, reduced work productivity, and adverse birth outcomes, all of which apply to adolescents, as well as adults and children.

OBJECTIVE

This study aimed to examine the determinants of anemia in Indonesian adolescent girls and boys from Klaten and Lombok Barat districts.

METHODS

A total of 2150 adolescents who participated in a cross-sectional household survey were included in the analysis. The dietary intake of adolescents was assessed using a 7-day food frequency questionnaire. The relationship between anemia status, dietary intake, and other hypothesized determinants was assessed for adolescent girls and boys on a separate basis, using complex samples Cox regression analysis. Variables were selected for inclusion in multivariate models if they were significantly associated with the dependent variable in univariate models (P < .05).

RESULTS

The prevalence of anemia among adolescent girls and boys was 19% and 5%, respectively. In multivariate analyses, frequent consumption of animal-based iron-rich foods was significantly associated with a lower risk of anemia (prevalence ratio [PR]: 0.59; 95% CI: 0.36-0.97) among adolescent girls, whereas a higher intake of vitamin A-rich fruits and vegetables was associated with a reduced risk of anemia (PR: 0.41; 95% CI: 0.20-0.85) among adolescent boys, after adjustment for all potential confounders.

CONCLUSIONS

Increased consumption of iron- and vitamin A-rich foods through the implementation of gender-responsive Social Behaviour Change Communication (SBCC) interventions is warranted. This should be coupled with improved coverage and quality of iron and folic acid supplementation programs in adolescents.

Genetic control of iron bioavailability is independent from iron concentration in a diverse winter wheat mapping population

BACKGROUND

Anemia is thought to affect up to 1.6 billion people worldwide. One of the major contributors to low iron (Fe) absorption is a higher proportion of cereals compared to meats and pulse crops in people's diets. This has now become a problem in both the developed and developing world, as a result of both modern food choice and food availability. Bread wheat accounts for 20 % of the calories consumed by humans and is an important source of protein, vitamins and minerals meaning it could be a major vehicle for bringing more bioavailable Fe into the diet.

RESULTS

To investigate whether breeding for higher concentrations of Fe in wheat grains could help increase Fe absorption, a multiparent advanced generation intercross (MAGIC) population, encompassing more than 80 % of UK wheat polymorphism, was grown over two seasons in the UK. The population was phenotyped for both Fe concentration and Fe bioavailability using an established Caco-2 cell bioassay. It was found that increasing Fe concentrations in the grains was not correlated with higher Fe bioavailability and that the underlying genetic regions controlling grain Fe concentrations do not co-localise with increased Fe absorption. Furthermore, we show that phytate concentrations do not correlate with Fe bioavailability in our wheat population and thus phytate-binding is insufficient to explain the lack of correlation between Fe bioavailability and Fe concentrations in the wheat grain. Finally, we observed no (Fe bioavailability) or low (Fe concentration) correlation between years for these traits, confirming that both are under strong environmental influence.

CONCLUSIONS

This suggests that breeders will have to select not only for Fe concentrations directly in grains, but also increased bioavailability. However the use of numerous controls and replicated trials limits the practicality of adoption of screening by Caco-2 cells by many breeders.

Iron Fortification Practices and Implications for Iron Addition to Salt

This introductory article provides an in-depth technical background for iron fortification, and thus introduces a series of articles in this supplement designed to present the current evidence on the fortification of salt with both iodine and iron, that is, double-fortified salt (DFS). This article reviews our current knowledge of the causes and consequences of iron deficiency and anemia and then, with the aim of assisting the comparison between DFS and other common iron-fortified staple foods, discusses the factors influencing the efficacy of iron-fortified foods. This includes the dietary and physiological factors influencing iron absorption; the choice of an iron compound and the fortification technology that will ensure the necessary iron absorption with no sensory changes; encapsulation of iron fortification compounds to prevent unacceptable sensory changes; the addition of iron absorption enhancers; the estimation of the iron fortification level for each vehicle based on iron requirements and consumption patterns; and the iron status biomarkers that are needed to demonstrate improved iron status in populations regularly consuming the iron-fortified food. The supplement is designed to provide a summary of evidence to date that can help advise policy makers considering DFS as an intervention to address the difficult public health issue of iron deficiency anemia, while at the same time using DFS to target iodine deficiency.

Dietary patterns of Australian pre-schoolers and associations with haem and non-haem iron intakes

PURPOSE

To describe Australian pre-schooler dietary patterns and examine their associations with dietary iron intakes.

METHODS

Dietary data of children (n = 812, 2 to < 6 years old) from the 2011-12 National Nutrition and Physical Activity Survey were collected via two non-consecutive 24-h recalls and analysed using AUSNUT 2011-13. Usual food and nutrient intakes were estimated via Multiple Source Method. Principal component analysis was used to extract dietary patterns from 32 food groups. Associations between dietary patterns and energy-adjusted iron intakes were assessed using linear regression, accounting for the complex survey design.

RESULTS

Mean (SD) usual total dietary and haem iron intakes were 6.3 (1.9) and 0.5 (0.3) mg/day, respectively. Three dietary patterns were identified, explaining 14% of the variance. Pattern 1 (positive loadings for cheese, breads, fats and oils, and water) was positively associated with total dietary iron intakes (β = 0.08, 95% CI 0.01, 0.15). Pattern 3 (positive loadings for red meat, fortified fruit and vegetable products, and sauces and spreads) was negatively associated with total dietary iron (β = - 0.08, 95% CI - 0.14, - 0.01) and non-haem iron (β = - 0.09, 95% CI - 0.15, - 0.02) intakes. No dietary patterns were associated with haem iron intakes.

CONCLUSIONS

Three main patterns characterise Australian pre-schooler diets. The pattern with which dietary iron is positively associated is predominately characterised by non-haem iron sources and non-iron-fortified foods. Future research is required to estimate the iron bioavailability of Australian pre-schooler diets.

Opportunities for plant-derived enhancers for iron, zinc, and calcium bioavailability: A review

Understanding of the mechanism of interactions between dietary elements, their salts, and complexing/binding ligands is vital to manage both deficiency and toxicity associated with essential element bioavailability. Numerous mineral ligands are found in both animal and plant foods and are known to exert bioactivity via element chelation resulting in modulation of antioxidant capacity or micobiome metabolism among other physiological outcomes. However, little is explored in the context of dietary mineral ligands and element bioavailability enhancement, particularly with respect to ligands from plant-derived food sources. This review highlights a novel perspective to consider various plant macro/micronutrients as prospective bioavailability enhancing ligands of three essential elements (Fe, Zn, and Ca). We also delineate the molecular mechanisms of the ligand-binding interactions underlying mineral bioaccessibility at the luminal level. We conclude that despite current understandings of some of the structure-activity relationships associated with strong mineral-ligand binding, the physiological links between ligands as element carriers and uptake at targeted sites throughout the gastrointestinal (GI) tract still require more research. The binding behavior of potential ligands in the human diet should be further elucidated and validated using pharmacokinetic approaches and GI models.

Contribution of Amaranthus cruentus and Solanum macrocarpon Leaves Flour to Nutrient Intake and Effect on Nutritional Status of Rural School Children in Volta Region, Ghana

BACKGROUND

Plant-based foods are staple diets and main micronutrient sources of most rural Ghanaian households. The objective of this study was to determine the effect of Amaranthus cruentus and Solanum macrocarpon leafy vegetable flour on micronutrient intake and nutritional status of rural Ghanaian school children.

METHOD

This study was a randomized controlled trial that consisted of baseline data collection and a three-month nutrition intervention feeding program. Two groups of 53 children, age 4-9 years, involved in the Ghana School Feeding Program took part in the study. An experimental group consumed Amaranthus cruentus and Solanum macrocarpon leaves flour (ACSMLVF) stews and soup. The control group consumed stews and soup without ACSMLVF. Haemoglobin and serum vitamin A concentrations were determined. Dietary and anthropometric data were collected and analysed. Participants were screened for malaria parasitaemia and hookworm.

RESULTS

Anaemia was present in 41.5% and 37.3%, respectively, of the intervention and control groups at baseline. It was present in 28.3% and 53.3%, respectively, at the end of the study. This was significantly different (p=0.024). There was a low vitamin A concentration in 66.0% and 64.7% at baseline and 20.8% and 23.4% at the end of the study in the intervention and control groups, respectively. The mean iron, zinc, and provitamin A (beta-carotene) intakes of the intervention group were 14.2 ± 7.1 mg, 5.7 ± 2.1 mg, and 214.5 ± 22.6 μg, respectively, at baseline. Those of the control were 13.7 ± 6.1 mg, 5.4 ± 2.1 mg, and 210.6 ± 20.1 μg, respectively. At the end of the study, the mean intake of iron, zinc, and beta-carotene for the intervention group was 24.1 ± 10.9 mg, 13.8 ± 8.2 mg, and 694.2 ± 33.1 μg, respectively. The intake of these micronutrients for the control at the end of the study was 14.8 ± 6.2 mg, 5.9 ± 2.3 mg, and 418.4 ± 34.7 μg, respectively.

CONCLUSION

Consumption of ACSMLVF stews and soup increased iron, zinc, and beta-carotene intakes. Anaemia prevalence was lower in the intervention group at the end of the study.

From Environment to Genome and Back: A Lesson from HFE Mutations

The environment and the human genome are closely entangled and many genetic variations that occur in human populations are the result of adaptive selection to ancestral environmental (mainly dietary) conditions. However, the selected mutations may become maladaptive when environmental conditions change, thus becoming candidates for diseases. Hereditary hemochromatosis (HH) is a potentially lethal disease leading to iron accumulation mostly due to mutations in the HFE gene. Indeed, homozygosity for the C282Y HFE mutation is associated with the primary iron overload phenotype. However, both penetrance of the C282Y variant and the clinical manifestation of the disease are extremely variable, suggesting that other genetic, epigenetic and environmental factors play a role in the development of HH, as well as, and in its progression to end-stage liver diseases. Alcohol consumption and dietary habits may impact on the phenotypic expression of HFE-related hemochromatosis. Indeed, dietary components and bioactive molecules can affect iron status both directly by modulating its absorption during digestion and indirectly by the epigenetic modification of genes involved in its uptake, storage and recycling. Thus, the premise of this review is to discuss how environmental pressures led to the selection of HFE mutations and whether nutritional and lifestyle interventions may exert beneficial effects on HH outcomes and comorbidities.

Geospatial analysis of childhood morbidity in Ghana

INTRODUCTION

Childhood morbidities are common in Ghana. The present study sought to geospatially analyze morbidities among children (0-23 months of age) using five different survey datasets (1993-2014) from the Ghana Demographic and Health Survey.

METHODS

Logistic regression was used to examine childhood morbidity within a place of residence. Then three spatial statistical tools were applied to analyze morbidities among children (0-23 months of age). These tools were: spatial autocorrelation (Global Moran's I)-used to examine clustering or dispersion patterns; cluster and outlier analysis (Anselin's local Moran's I)-to ascertain geographic composition of childhood morbidity clusters and outliers; and hot spot analysis (Getis-Ord G)-to identify clusters of high values (hot spots) and low values (cold spots).

RESULTS

Children in rural areas were much burdened with the occurrence of childhood morbidity. The study revealed positive spatial autocorrelation for childhood morbidity in Ghana. Childhood morbidity (diarrhoea, ARI, anaemia, and fever) clusters were identified within districts in the country. Children in rural areas were more likely to be morbid with diarrhoea, anaemia, and fever compared to those in urban areas. Hot spot districts for diarrhoea, anaemia and fever were mainly situated in semi-arid areas and those with ARI were located both at the semi-arid areas and coastal portions of Ghana.

CONCLUSION

Rural children are much exposed to have higher burden of a childhood morbidity compared to their urban counterparts. Most semi-arid districts in Ghana are burdened with diarrhoea, ARI, anaemia, and fever. To minimize the occurrence of childhood morbidity in Ghana, designing of more context-based interventions to target hot spots districts of these morbidities are required in order to use scarce resources judiciously.

Analysis of Heme and Non-Heme Iron Intake and Iron Dietary Sources in Adolescent Menstruating Females in a National Polish Sample

Iron intake and heme/non-heme iron proportions are crucial for iron deficiency anemia prevention. Women of childbearing age are indicated by World Health Organization as the primary target group, but maintaining iron balance is particularly challenging for adolescents. The aim of the presented study was to analyze heme and non-heme iron intake and dietary sources in adolescent menstruating females in a national Polish sample. The study was conducted in a representative sample of adolescents (aged 15-20) who were recruited from all regions of Poland based on secondary school sampling (random quota sampling), with 1385 female adolescents being included in the sample. The iron intake was assessed using the previously validated IRONIC-FFQ (IRON Intake Calculation-Food Frequency Questionnaire). The intakes of iron, heme iron, non-heme iron, and iron from food product groups were assessed and compared with those of male adolescents (n = 1025) who were recruited from the same schools, as well as between sub-groups stratified by age, body mass index, anemia history, following vegetarian diet, applying iron supplementation and school type. Compared with male individuals, females were characterized by a lower intake of all forms of iron. It was stated that non-heme iron intake was highest in younger ones, overweight ones, vegetarian ones, and comprehensive school students. Female adolescents with anemia history were characterized by similar iron intake as others. For the target group, there is inadequate nutritional education and a necessity to broaden the knowledge about specific sources of iron.

Assessing the dietary intake of calcium, magnesium, iron, zinc and copper in institutionalised children and adolescents from Guatemala. Contribution of nutritional supplements

In childhood and adolescence an adequate mineral intake is essential for normal growth and immune function, and to prevent chronic diseases in adulthood. The aim of this study was to analyse the dietary intake of Ca, Mg, Fe, Zn and Cu in children and adolescents from an orphanage-school in Guatemala and to assess the mineral contribution of nutritional supplements used by this population. Mineral content was analysed in nutritional supplements, bioaccesible fractions obtained after an in vitro gastrointestinal method, and diets sampled by a 7-day duplicate diet study. The average mineral content in the duplicate diets, including supplements, was (mg/d): Ca 452, Mg 230, Fe 25, Zn 8 and Cu 0.22. Especially Ca and Cu values were below recommended daily intakes. The content of these minerals in the nutritional supplements (mg/serving) was 49-112 for Ca, 1.2-3.8 for Fe, 24-47 for Mg, 0.7-4.16 for Zn and 0.08-0.23 for Cu. A great proportion of dietary minerals was provided by supplements, the contribution of which was: Ca 53.1%, Mg 58.4%, Fe 27.6%. Zn 82.2% and Cu 98.5%. Mineral bioaccessibility in supplements was particularly low for Ca and, to a lesser extent, for Fe and Zn. In spite of the high supplement consumption (up to 4 servings/d) important mineral deficiencies were detected in the diet of institutionalised children. Findings suggest that formulation and nutritional values of supplements used in Latin America should be carefully reviewed, in order to be a useful tool in the prevention and treatment of hidden hunger.

Heme and Non-heme Iron on Growth Performances, Blood Parameters, Tissue Mineral Concentration, and Intestinal Morphology of Weanling Pigs

This experiment was conducted to evaluate the effects of heme and non-heme iron sources on growth performances, blood parameters, tissue mineral concentration, and intestinal morphology in weanling pigs. At 25 days of age, 32 newly weaned piglets (Duroc × Landrace × Yorkshire; 8.66 ± 0.59 kg) were allocated to one of the following dietary treatments: control group (basal diet with no extra iron addition), FeSO₄ group (basal diet + 100 mg Fe/kg as FeSO₄), Fe-Gly group (basal diet + 100 mg Fe/kg as Fe-Gly), and Heme group (basal diet + 100 mg Fe/kg as Heme). Each treatment had eight replicates and one pig per replicate. The experiment lasted for 28 days. The results showed that compared with basal diet, supplement with 100 mg/kg iron can increase ADG of the piglets, especially in the late experiment period (15~28 days). Heme significantly increased the a* value of longissimus dorsi muscle of piglets when compared with other iron sources (P < 0.05). The iron supplementations had no significant effect on hematological parameters, while Fe-Gly and heme increased pigs' serum iron content on day 28 when compared with FeSO₄ and basal diet (P < 0.05). The liver iron deposition in pigs fed Fe-Gly and heme was also higher than those fed FeSO₄ or basal diet (P < 0.05). Besides, diet supplement with iron significantly increased villus height (P < 0.05) in duodenum and it had tendency to increase villus height and crypt depth ratio in duodenum (P = 0.095). In conclusion, iron supplementation in diets can improve piglet's body iron state and intestinal development, but Fe-Gly and heme exhibited better bioavailability than traditional additive of FeSO₄.

Coordination of Fe(II) to Eugenol to Engineer Self-Assembled Emulsions by Rice Proteins for Iron Fortification

Fortification of ferrous irons (Fe^II ) is challenging due to fast oxidation. In this paper, we report that the coordination of Fe^II to eugenol can effectively inhibit the oxidation of Fe^II . The coordination was studied by UV-Vis spectra, nuclear magnetic resonance, Raman spectra, and so on, showing that it took less than 1 hr for Fe^II to be fully oxidized in water, whereas more than 10 days in eugenol. In addition, by gently mixing Fe^II coordinated eugenol and modified rice protein (MRP) solutions at ambient temperature, core-shell structures <200 nm were spontaneously formed, which can be utilized as protective and delivery systems for the organic ferrous irons. Based on the simulated digestion of MRPs, the Fe^II loaded emulsions may be delivered into intestinal tract beyond 2-hr oral administration. The results highlight the effectiveness of fortification of ferrous irons via polyphenol coordination combined with self-emulsification, advancing the future oral fortification of ferrous irons towards a feasible approach. PRACTICAL APPLICATION: The coordination of metal ions with food polyphenols can provide the functional food with excellent redox stability. The Fe^II loaded eugenol emulsified by MRPs can be used as a straightforward protocol for the development of functional ingredients for iron fortification in food industry.

Prevalence of Anemia and Its Associated Risk Factors Among 6-Months-Old Infants in Beijing

Objective: The worldwide prevalence of anemia is ~24.8%. Iron deficiency anemia is common in children and women and associated with sensory, motor, cognitive, language, and socioemotional deficits. Therefore, detection and early intervention strategies for anemia in infants are urgently needed. To prevent the occurrence of iron deficiency anemia, we aimed to identify risk factors associated with anemia in infants. Methods: This investigation involved a cross-sectional study of 6-months-old infants discharged between April 2014 and September 2017 from Peking University First Hospital. We assessed birth information, maternal age, and maternal educational level as well as data on feeding style, complementary foods and primary caregivers. The infants were assessed with the Denver Developmental Screening Test (DDST). Results: A total of 1,127 6-months-old infants were enrolled at the hospital. We found that the prevalence of anemia among infants in Beijing was ~11.8%. Premature infants had a higher rate of anemia than full-term infants (χ² = 40.103, P < 0.001). Infants born in autumn or winter were at an elevated risk of developing anemia (χ² = 22.949, P < 0.001). Birth weight had no effect on the rate of anemia in infants (χ² = 0.023, P = 0.568). Infants who were exclusively breastfeeding had higher anemia rates than those who were fed formula (χ² = 38.466, P < 0.001). Infants whose caregivers added no complementary foods had higher anemia rates (24.7%) than those whose caregivers added more than two kinds of complementary food (8.2%). The type of caregiver had no effect on the anemia rate in infants (χ² = 0.031, P = 1.000). Conclusions: The following factors resulted in a higher prevalence of anemia in our study a gestational age at birth of <37 weeks, exclusive breastfeeding, a lack of supplementation with complementary foods and a spring birth date. No significant differences in DDST pass rates were evident between infants with and without anemia.

Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana

Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.

Maternal haemoglobin concentrations before and during pregnancy as determinants of the concentrations of children at 3-5 years of age: A large follow-up study

OBJECTIVE

To examine the association between haemoglobin (Hb) concentrations in mothers before and during pregnancy and those in children at 3-5 years of age.

METHODS

The study included 78,923 women who conceived during 1993-1996 and delivered a singleton live infant. Maternal Hb concentrations were measured at pre-pregnancy health check-up and first prenatal visit, and during the second and third trimester. Hb concentrations of children born to these women were measured at 3-5 years of age. Associations between Hb levels in mothers and children were examined. Unconditional logistic regression was used to explore the association between maternal Hb levels and risk for anaemia in children.

RESULTS

Maternal Hb levels before and during pregnancy were positively associated with children's Hb levels. Using maternal Hb ≥ 130 g/L as the referent, the risk for anaemia in children at 3-5 years of age was higher when maternal second trimester Hb concentrations were 70-99 g/L (odds ratio [OR] = 1.76, 95% confidence interval [CI] = 1.56-1.99), 100-109 g/L (OR = 1.45, 95% CI = 1.29-1.64), and 110-119 g/L (OR = 1.18, 95% CI = 1.04-1.33). Children were 1.52 and 1.23-times more likely to suffer from anaemia when maternal third trimester Hb concentrations were 70-99 and 100-109 g/L, respectively. A pre-pregnancy Hb concentration of 80-109 g/L and first prenatal visit Hb concentrations of 80-109 and 100-119 g/L were also associated with increased risks for childhood anaemia.

CONCLUSION

Low maternal Hb concentrations before or during pregnancy increase the risk for anaemia in children at 3-5 years of age.

Dietary Iron Bioavailability: Agreement between Estimation Methods and Association with Serum Ferritin Concentrations in Women of Childbearing Age

Predictive iron bioavailability (FeBio) methods aimed at evaluating the association between diet and body iron have been proposed, but few studies explored their validity and practical usefulness in epidemiological studies. In this cross-sectional study involving 127 women (18–42 years) with presumably steady-state body iron balance, correlations were checked among various FeBio estimates (probabilistic approach and meal-based and diet-based algorithms) and serum ferritin (SF) concentrations. Iron deficiency was defined as SF < 15 µg/L. Pearson correlation, Friedman test, and linear regression were employed. Iron intake and prevalence of iron deficiency were 10.9 mg/day and 12.6%. Algorithm estimates were strongly correlated (0.69≤ r ≥0.85; p < 0.001), although diet-based models (8.5–8.9%) diverged from meal-based models (11.6–12.8%; p < 0.001). Still, all algorithms underestimated the probabilistic approach (17.2%). No significant association was found between SF and FeBio from Monsen (1978), Reddy (2000), and Armah (2013) algorithms. Nevertheless, there was a 30–37% difference in SF concentrations between women stratified at extreme tertiles of FeBio from Hallberg and Hulthén (2000) and Collings’ (2013) models. The results demonstrate discordance of FeBio from probabilistic approach and algorithm methods while suggesting two models with best performances to rank individuals according to their bioavailable iron intakes.

Anemia in tuberculosis cases and household controls from Tanzania: Contribution of disease, coinfections, and the role of hepcidin

Background

Tuberculosis (TB) induces a systemic inflammatory state affecting iron homeostasis. Patients with TB often have additional comorbidities such as anemia which can result in poorer treat outcomes. We studied the contribution of anemia and the role of the iron regulatory hormone hepcidin among TB patients and household contacts.

Methods

We analyzed serum samples from 102 TB cases and 98 controls without TB, matched by age/sex, for hepcidin, iron, and inflammation parameters. Five controls developed TB within 12 months. We used linear regression to assess associations.

Results

Anemia of chronic disease (ACD) was more frequent among cases than controls (59.8% vs. 26.1%), but iron-deficiency anemia more frequent in controls (10% vs. 1%). The median hepcidin level was higher in cases than controls (63.7 vs. 14.2 ng/mL), but coinfections with HIV, helminths, and respiratory pathogens did not show cumulative effects. Hepcidin was associated with more severe TB symptom scoring (coefficient 0.8, 95% confidence interval [CI] 0.5–1.2) and higher mycobacterial load (0.7, 95% CI 0.4–1.0). Hepcidin was higher in TB cases and controls who developed TB compared to controls without TB (p<0.001), even when restricting to HIV-negative study participants.

Conclusions

ACD was the predominate etiology in TB patients suggesting limited benefit from iron supplementation. Increased hepcidin levels long before active disease, indicating altered iron metabolism, may be a marker for developing disease among TB-exposed individuals. Clinical management of anemia and nutrition interventions in TB patients need to be considered to improve the clinical course and outcomes.

Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three-year results of a prospective observational study

BACKGROUND

Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment.

STUDY DESIGN AND METHODS

A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis.

RESULTS

Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions.

CONCLUSIONS

Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.

Relative Bioavailability of Iron in Bangladeshi Traditional Meals Prepared with Iron-Fortified Lentil Dal

Due to low Fe bioavailability and low consumption per meal, lentil must be fortified to contribute significant bioavailable Fe in the Bangladeshi diet. Moreover, since red lentil is dehulled prior to consumption, an opportunity exists at this point to fortify lentil with Fe. Thus, in the present study, lentil was Fe-fortified (using a fortificant Fe concentration of 2800 µg g⁻¹) and used in 30 traditional Bangladeshi meals with broad differences in concentrations of iron, phytic acid (PA), and relative Fe bioavailability (RFeB%). Fortification with NaFeEDTA increased the iron concentration in lentil from 60 to 439 µg g⁻¹ and resulted in a 79% increase in the amount of available Fe as estimated by Caco-2 cell ferritin formation. Phytic acid levels were reduced from 6.2 to 4.6 mg g⁻¹ when fortified lentil was added, thereby reducing the PA:Fe molar ratio from 8.8 to 0.9. This effect was presumably due to dephytinization of fortified lentil during the fortification process. A significant (p ≤ 0.01) Pearson correlation was observed between Fe concentration and RFeB% and between RFeB% and PA:Fe molar ratio in meals with fortified lentil, but not for the meal with unfortified lentil. In conclusion, fortified lentil can contribute significant bioavailable Fe to populations at risk of Fe deficiency.

Iron for Africa-Report of an Expert Workshop

Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue.

Age of Complementary Foods Introduction and Risk of Anemia in Children Aged 4-6 years: A Prospective Birth Cohort in China

Age of complementary foods introduction is associated with childhood anemia, but the ideal age for the introduction of complementary foods to infants is a continuing topic of debate. We examined the longitudinal association between complementary foods introduction age and risk of anemia in 18,446 children from the Jiaxing Birth Cohort, who had detailed complementary feeding records at 3 and 6 months of age and had hemoglobin concentrations measured at 4–6 years. Early introduction of complementary foods at 3–6 months of age was significantly associated with a higher risk of anemia (odds ratio = 1.14; 95% confidence interval: 1.01–1.28) and a lower hemoglobin concentration of −0.84 g/L (95% confidence interval: −1.33 to −0.35) in children aged 4–6 years, compared with those fed complementary foods starting at 6 months of age. When it comes to the specific type of complementary foods, early introduction of all plant-based foods was associated with increased anemia risks and lower hemoglobin concentrations, while early introduction of most animal-based foods was not. These findings may be informative regarding the appropriate time to introduce complementary foods in infants.

The Combined Application of the Caco-2 Cell Bioassay Coupled with In Vivo (Gallus gallus) Feeding Trial Represents an Effective Approach to Predicting Fe Bioavailability in Humans

Research methods that predict Fe bioavailability for humans can be extremely useful in evaluating food fortification strategies, developing Fe-biofortified enhanced staple food crops and assessing the Fe bioavailability of meal plans that include such crops. In this review, research from four recent poultry (Gallus gallus) feeding trials coupled with in vitro analyses of Fe-biofortified crops will be compared to the parallel human efficacy studies which used the same varieties and harvests of the Fe-biofortified crops. Similar to the human studies, these trials were aimed to assess the potential effects of regular consumption of these enhanced staple crops on maintenance or improvement of iron status. The results demonstrate a strong agreement between the in vitro/in vivo screening approach and the parallel human studies. These observations therefore indicate that the in vitro/Caco-2 cell and Gallus gallus models can be integral tools to develop varieties of staple food crops and predict their effect on iron status in humans. The cost-effectiveness of this approach also means that it can be used to monitor the nutritional stability of the Fe-biofortified crop once a variety has released and integrated into the food system. These screening tools therefore represent a significant advancement to the field for crop development and can be applied to ensure the sustainability of the biofortification approach.

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5-17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

Fermentation of food and feed: A technology for efficient utilization of macro and trace elements in monogastrics

Mineral deficiencies, especially of iron, zinc, and calcium, respectively, negatively affect human health and may lead to conditions such as iron deficiency anemia, rickets, osteoporosis, and diseases of the immune system. Cereal grains and legumes are of global importance in nutrition of monogastrics (humans and the respective domestic animals) and provide high amounts of several minerals, e.g., iron, zinc, and calcium. Nevertheless, their bioavailability is low. Plants contain phytates, the salts of phytic acid, chemically known as inositol-hexakisphosphate, which interact with several minerals and proteins. However, phytate may be hydrolysed by phytase. This enzyme is naturally present in plants and also widely distributed in microorganisms. Several food processing methods have been reported to enhance phytate hydrolysis, due to the activation of endogenous phytase activity or via the enzyme produced by microbes. In recent years, fermentation for food and feed improvement and preservation, respectively, has gained increasing interest as a promising method to degrade phytate and enhance mineral utilization in monogastrics. Indeed, several in vitro as well as in vivo studies confirm a positive effect on the utilization of minerals, such as P, Ca, Fe and Zn, using sourdough fermentation for baking or fermentation of legumes, mainly soybeans. This review summarizes the current knowledge regarding the potential of fermentation to enhance macro and trace element bioavailability in monogastric species.

Associations between Common Variants in Iron-Related Genes with Haematological Traits in Populations of African Ancestry

BACKGROUND

Large genome-wide association (GWA) studies of European ancestry individuals have identified multiple genetic variants influencing iron status. Studies on the generalizability of these associations to African ancestry populations have been limited. These studies are important given interethnic differences in iron status and the disproportionate burden of iron deficiency among African ancestry populations.

METHODS

We tested the associations of 20 previously identified iron status-associated single nucleotide polymorphisms (SNPs) in 628 Kenyans, 609 Tanzanians, 608 South Africans and 228 African Americans. In each study, we examined the associations present between 20 SNPs with ferritin and haemoglobin, adjusting for age, sex and CRP levels.

RESULTS

In the meta analysis including all 4 African ancestry cohorts, we replicated previously reported associations with lowered haemoglobin concentrations for rs2413450 (β = -0.19, P = 0.02) and rs4820268 (β = -0.16, P = 0.04) in TMPRSS6. An association with increased ferritin concentrations was also confirmed for rs1867504 in TF (β = 1.04, P = <0.0001) in the meta analysis including the African cohorts only.

CONCLUSIONS

In all meta analyses, we only replicated 4 of the 20 single nucleotide polymorphisms reported to be associated with iron status in large GWA studies of European ancestry individuals. While there is now evidence for the associations of a number of genetic variants with iron status in both European and African ancestry populations, the considerable lack of concordance highlights the importance of continued ancestry-specific studies to elucidate the genetic underpinnings of iron status in ethnically diverse populations.

Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area

BACKGROUND

Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs.

OBJECTIVE

To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren.

METHODS

The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively.

RESULTS

Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%.

CONCLUSION

Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.

Studies of Cream Seeded Carioca Beans (Phaseolus vulgaris L.) from a Rwandan Efficacy Trial: In Vitro and In Vivo Screening Tools Reflect Human Studies and Predict Beneficial Results from Iron Biofortified Beans

Iron (Fe) deficiency is a highly prevalent micronutrient insufficiency predominantly caused by a lack of bioavailable Fe from the diet. The consumption of beans as a major food crop in some populations suffering from Fe deficiency is relatively high. Therefore, our objective was to determine whether a biofortified variety of cream seeded carioca bean (Phaseolus vulgaris L.) could provide more bioavailable-Fe than a standard variety using in-vivo (broiler chicken, Gallus gallus) and in-vitro (Caco-2 cell) models. Studies were conducted under conditions designed to mimic the actual human feeding protocol. Two carioca-beans, a standard (G4825; 58 μg Fe/g) and a biofortified (SMC; 106 μg Fe/g), were utilized. Diets were formulated to meet the nutrient requirements of Gallus gallus except for Fe (33.7 and 48.7 μg Fe/g, standard and biofortified diets, respectively). In-vitro observations indicated that more bioavailable-Fe was present in the biofortified beans and diet (P<0.05). In-vivo, improvements in Fe-status were observed in the biofortified bean treatment, as indicated by the increased total-body-Hemoglobin-Fe, and hepatic Fe-concentration (P<0.05). Also, DMT-1 mRNA-expression was increased in the standard bean treatment (P<0.05), indicating an upregulation of absorption to compensate for less bioavailable-Fe. These results demonstrate that the biofortified beans provided more bioavailable Fe; however, the in vitro results revealed that ferritin formation values were relatively low. Such observations are indicative of the presence of high levels of polyphenols and phytate that inhibit Fe absorption. Indeed, we identified higher levels of phytate and quercetin 3-glucoside in the Fe biofortified bean variety. Our results indicate that the biofortified bean line was able to moderately improve Fe-status, and that concurrent increase in the concentration of phytate and polyphenols in beans may limit the benefit of increased Fe-concentration. Therefore, specific targeting of such compounds during the breeding process may yield improved dietary Fe-bioavailability. Our findings are in agreement with the human efficacy trial that demonstrated that the biofortified carioca beans improved the Fe-status of Rwandan women. We suggest the utilization of these in vitro and in vivo screening tools to guide studies aimed to develop and evaluate biofortified staple food crops. This approach has the potential to more effectively utilize research funds and provides a means to monitor the nutritional quality of the Fe-biofortified crops once released to farmers.

Natural selection on HFE in Asian populations contributes to enhanced non-heme iron absorption

BACKGROUND

HFE, a major regulator of iron (Fe) homeostasis, has been suggested to be under positive selection in both European and Asian populations. While the genetic variant under selection in Europeans (a non-synonymous mutation, C282Y) has been relatively well-studied, the adaptive variant in Asians and its functional consequences are still unknown. Identifying the adaptive HFE variants in Asians will not only elucidate the evolutionary history and the genetic basis of population difference in Fe status, but also assist the future practice of genome-informed dietary recommendation.

RESULTS

Using data from the International HapMap Project, we confirmed the signatures of positive selection on HFE in Asian populations and identified a candidate adaptive haplotype that is common in Asians (52.35-54.71%) but rare in Europeans (5.98%) and Africans (4.35%). The T allele at tag SNP rs9366637 (C/T) captured 95.8% of this Asian-common haplotype. A significantly reduced HFE expression was observed in individuals carrying T/T at rs9366637 compared to C/C and C/T, indicating a possible role of gene regulation in adaptation. We recruited 57 women of Asian descent and measured Fe absorption using stable isotopes in those homozygous at rs9366637. We observed a 22% higher absorption in women homozygous for the Asian-common haplotype (T/T) compared to the control genotype (C/C). Additionally, compared with a group of age-matched Caucasian women, Asian women exhibited significantly elevated Fe absorption.

CONCLUSIONS

Our results indicate parallel adaptation of HFE gene in Europeans and Asians with different genetic variants. Moreover, natural selection on HFE may have contributed to elevated Fe absorption in Asians. This study regarding population differences in Fe homeostasis has significant medical impact as high Fe level has been linked to an increased disease risk of metabolic syndromes.

Review: The potential of the common bean (Phaseolus vulgaris) as a vehicle for iron biofortification

Common beans are a staple food and the major source of iron for populations in Eastern Africa and Latin America. Bean iron concentration is high and can be further increased by biofortification. A major constraint to bean iron biofortification is low iron absorption, attributed to inhibitory compounds such as phytic acid (PA) and polyphenol(s) (PP). We have evaluated the usefulness of the common bean as a vehicle for iron biofortification. High iron concentrations and wide genetic variability have enabled plant breeders to develop high iron bean varieties (up to 10 mg/100 g). PA concentrations in beans are high and tend to increase with iron biofortification. Short-term human isotope studies indicate that iron absorption from beans is low, PA is the major inhibitor, and bean PP play a minor role. Multiple composite meal studies indicate that decreasing the PA level in the biofortified varieties substantially increases iron absorption. Fractional iron absorption from composite meals was 4%–7% in iron deficient women; thus the consumption of 100 g biofortified beans/day would provide about 30%–50% of their daily iron requirement. Beans are a good vehicle for iron biofortification, and regular high consumption would be expected to help combat iron deficiency (ID).

Micronutrients Deficiency, a Hidden Hunger in Nepal: Prevalence, Causes, Consequences, and Solutions

Micronutrient deficiency is a global challenge to health as in Nepal. In Nepal, the targeted beneficiaries are less aware about importance of micronutrients (MNs), which has resulted in low intake of foods rich in MNs. Micronutrient deficiencies (MNDs) have huge impact on health of vulnerable population like women and children and have jeopardized the national economy and prosperity of developing countries including Nepal. However, less attention has been paid towards MNDs, which can be prevented. Therefore, this study aims to draw attention of the concerned authorities and researchers to combat against MNDs in Nepal. This study showed that different types of MNDs with higher prevalence exist in Nepal. The major causes of MNDs were poor diet, diseases and infestations, and poor health caring practices. The results of MNDs were unwanted child and maternal mortality, impairments of lives, and reduction in productivity and intellectual capacity. School health and nutrition education and supplementation and fortification of essential MNs proved to be effective while dietary diversification and economic growth and poverty eradication seemed promising. Control and prevention of MNDs can help to achieve Millennium Development Goals as well, so studies in this sector should be emphasized.

Prevalence and severity of anaemia stratified by age and gender in rural India

Anaemia is a major public health problem in India. Although nearly three quarters of the Indian population live in rural areas, the epidemiology of anaemia in rural settings is not well known. We performed a retrospective observational study using routine clinical data from patients attending the out-patient clinics of a rural hospital in India from June 2011 to August 2014. The study included 73,795 determinations of haemoglobin. 49.5% of patients were female. The median haemoglobin concentration was 11.3 g/dL (interquartile range (IQR), 9.8–12.4) in females and 12.5 g/dL (IQR, 10.6–14.2) in males. Anaemia was present in the majority of children <10 years, women after puberty, and older adults. Children <5 years had the highest prevalence of anaemia, especially children aged 1-2 years. The high proportion of microcytic anaemia and the fact that gender differences were only seen after the menarche period in women suggest that iron deficiency was the main cause of anaemia. However, the prevalence of normocytic anaemia increased with age. The results of this study can be used by public health programmes to design target interventions aimed at reducing the huge burden of anaemia in India. Further studies are needed to clarify the aetiology of anaemia among older adults.