Dietary strategies for improving iron status: balancing safety and efficacy

Improvement of in vivo iron bioavailability using mung bean peptide-ferrous chelate

There is an increasing amount of research into the development of a third generation of iron supplementation using peptide-iron chelates. Peptides isolated from mung bean were chelated with ferrous iron (MBP-Fe) and tested as a supplement in mice suffering from iron-deficiency anemia (IDA). Mice were randomly divided into seven groups: a group fed the normal diet, the IDA model group, and IDA groups treated with inorganic iron (FeSO4), organic iron (ferrous bisglycinate, Gly-Fe), low-dose MBP-Fe(L-MBP-Fe), high-dose MBP-Fe(H-MBP-Fe), and MBP mixed with FeSO4 (MBP/Fe). The different iron supplements were fed for 28 days via intragastric administration. The results showed that MBP-Fe and MBP/Fe had ameliorative effects, restoring hemoglobin (HGB), red blood cell (RBC), hematocrit (HCT), and serum iron (SI) levels as well as total iron binding capacity (TIBC) and body weight gain of the IDA mice to normal levels. Compared to the inorganic (FeSO4) and organic (Gly-Fe) iron treatments, the spleen coefficient and damage to liver and spleen tissues were significantly lower in the H-MBP-Fe and MBP/Fe mixture groups, with reparative effects on jejunal tissue. Gene expression analysis of the iron transporters Dmt 1 (Divalent metal transporter 1), Fpn 1 (Ferroportin 1), and Dcytb (Duodenal cytochrome b) indicated that MBP promoted iron uptake. These findings suggest that mung bean peptide-ferrous chelate has potential as a peptide-based dietary supplement for treating iron deficiency.

Digestion and absorption characteristics of iron-chelating silver carp scale collagen peptide and insights into their chelation mechanism

Iron deficiency is widespread throughout the world, supplementing sufficient iron or improving the bioavailability of iron is the fundamental strategy to solve the problem of iron scarcity. Herein, we explored a new form of iron supplement, iron chelates of silver carp scales (SCSCP-Fe) were prepared from collagen peptide of silver carp scales (SCSCP) and FeCl2·4H2O, the effects of external environment and simulated gastrointestinal digestive environment on the stability of SCSCP-Fe and the structural changes of peptide iron chelates during digestion were investigated. The results of in vitro iron absorption promotion showed that the iron bioavailability of SCSCP-Fe was higher than that of FeSO4. Two potential high iron chelating peptides DTSGGYDEY (DY) and LQGSNEIEIR (LR) were screened and synthesized from the SCSCP sequence by molecular dynamics and LC-MS/MS techniques. The FTIR results displayed that the binding sites of DY and LR for Fe2+ were the carboxyl group, the amino group, and the nitrogen atom on the amide group on the peptide. ITC results indicated that the chelation reactions of DY and LR with Fe2+ were mainly dominated by electrostatic interactions, forming chelates in stoichiometric ratios of 1:2 and 1:1, respectively. Both DY and LR had a certain ability to promote iron absorption. The transport of DY-Fe chelate may be a combination of the three pathways: PepT1 vector pathway, cell bypass, and endocytosis, while LR-Fe chelate was dominated by bivalent metal ion transporters. This study is expected to provide theoretical reference and technical support for the high-value utilization of silver carp scales and the development of novel iron supplements.

High Iron Consumption Modifies the Hepatic Transcriptome Related to Cholesterol Metabolism

Iron supplementation is a common method for alleviating symptoms of iron deficiency, but excessive iron intake may lead to systemic copper deficiencies and hypercholesterolemia. In our study, we explored the intricate relationship between dietary iron and copper levels and their impact on cholesterol metabolism. Using a rat model, we conducted dietary interventions with varying iron and copper concentrations and analyzed hepatic transcriptomes. High iron intake coupled with low copper intake induced hypercholesterolemia and altered the expression of genes associated with cholesterol and lipid metabolism, thereby, exacerbating cardiovascular disease risks. Conversely, copper supplementation mitigated these hepatic gene expression alterations, suggesting that dietary copper plays a role in cholesterol regulation. Transcriptomic analysis revealed significant upregulation of genes involved in cholesterol synthesis and antioxidative pathways in response to high iron intake, while genes involved in cholesterol elimination were downregulated. Furthermore, high iron consumption was associated with cellular apoptosis and the activation of cholesterol synthesis. Our findings underscore the importance of balanced iron and copper intake in cholesterol homeostasis and highlight the potential of copper supplementation for mitigating iron-induced hypercholesterolemia.

Iron Absorption: Molecular and Pathophysiological Aspects

Iron is an essential nutrient for growth among all branches of life, but while iron is among the most common elements, bioavailable iron is a relatively scarce nutrient. Since iron is fundamental for several biological processes, iron deficiency can be deleterious. On the other hand, excess iron may lead to cell and tissue damage. Consequently, iron balance is strictly regulated. As iron excretion is not physiologically controlled, systemic iron homeostasis is maintained at the level of absorption, which is mainly influenced by the amount of iron stores and the level of erythropoietic activity, the major iron consumer. Here, we outline recent advances that increased our understanding of the molecular aspects of iron absorption. Moreover, we examine the impact of these recent insights on dietary strategies for maintaining iron balance.

Effects of Iron-Fortified Foods on the Nutritional Status of Children Residing in Regions Vulnerable to Parasitic Diseases: A Systematic Review

Parasitic infections (PIs) remain a public health concern among school-age children living in areas of greater socioeconomic vulnerability, especially in Brazil, Russia, India, China, and South Africa. PIs can promote nutritional deficiencies, increasing the risk of anemia and impaired physical and cognitive development. Thus, fortified foods have been considered as a promising strategy for improving the nutritional status of children and preventing PI complications. This systematic review aimed to present the effects of iron-fortified foods for deworming and improving blood parameters in schoolchildren residing in areas that are vulnerable to PIs. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of randomized clinical trials addressing the use of fortified foods and micronutrients in children living in areas endemic for PIs. The PubMed, LILACS, Scopus, and Cochrane databases were searched to identify articles published between 2000 and 2020. A total of 153 records were retrieved from the databases, 10 of which were considered eligible for this study. On the basis of our analysis, most of the selected studies showed that the inclusion of fortified foods in the diet improved blood and infectious parameters. Therefore, fortified foods can be used as an important tool for controlling the adverse outcomes of PIs among children living in areas of greater vulnerability. However, more studies on this topic are needed to provide more evidence and consolidate strategies using iron-fortified food.

Perspectives on Iron Deficiency as a Cause of Human Disease in Global Public Health

Iron (Fe) is a necessary trace element in numerous pathways of human metabolism. Therefore, Fe deficiency is capable of causing multiple health problems. Apart from the well-known microcytic anemia, lack of Fe can cause severe psychomotor disorders in children, pregnant women, and adults in general. Iron deficiency is a global health issue, mainly caused by dietary deficiency but aggravated by inflammatory conditions. The challenges related to this deficiency need to be addressed on national and international levels. This review aims to summarize briefly the disease burden caused by Fe deficiency in the context of global public health and aspires to offer some hands-on guidelines.

Blueberry-added black tea: Effects of infusion temperature, drying method, fruit concentration on the iron-polyphenol complex formation, polyphenols profile, antioxidant activity, and sensory properties

Herein, a food-to-food fortification with blueberries and black tea was performed for people suffering from iron deficiency, creating a new functional product with high consumer acceptance. Black tea was mixed with varying concentrations of sun-dried or freeze-dried blueberries and infused at different temperatures. Spectrophotometric analysis revealed that the addition of blueberries to black tea inhibited the formation of the iron-polyphenol complex by up to 97 % (p <.001). Using β-carotene bleaching and 2,2-diphenyl-1-picrylhydrazyl assays, 50 % freeze-dried blueberry and 50 % black tea (FDFBT₅₀) was determined to be the sample with the highest antioxidant activity (p <.001).The polyphenol profiles were investigated by high-performance liquid chromatography. Principal component analysis (PCA) was performed to categorize the tea samples. The findings demonstrated that the FDFBT₅₀ sample was the best candidate among the samples, considering both the consumer acceptance and the bioactive parameters that showed statistically significant differences.

Acknowledging the gap: a systematic review of micronutrient supplementation in infants under six months of age

Background: Micronutrient deficiencies remain common worldwide, but the consequences to growth and development in early infancy (under six months of age) are not fully understood. We present a systematic review of micronutrient interventions in term infants under six months of age, with a specific focus on iron supplementation. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) from January 1980 through December 2019. Interventions included iron or multiple micronutrients (MMNs). Results: Of 11,109 records identified, 33 publications from 24 trials were included (19 iron and five MMN supplementation trials). All but one trial (evaluating only morbidity and mortality) evaluated the effect of supplementation on biochemical outcomes, ten reported on growth, 15 on morbidity and/or mortality and six on neuro-behavioural development. Low- and middle- income countries made up 88% (22/25) of the total trial locations. Meta-analysis was not possible due to extensive heterogeneity in both exposure and outcome measures.  However, these trials indicated that infants less than six months of age benefit biochemically from early supplementation with iron, but the effect of additional nutrients or MMNs, along with the impacts on growth, morbidity and/or mortality, and neuro-behavioural outcomes remain unclear. Conclusions: Infants less than six months of age appear to benefit biochemically from micronutrient supplementation. However, well-powered randomised controlled trials are required to determine whether routine supplementation with iron or MMNs containing iron should commence before six months of life in exclusively breast-fed infants in low-resource settings.

Acknowledging the gap: a systematic review of micronutrient supplementation in infants under six months of age

Background: Micronutrient deficiencies remain common worldwide, but the consequences to growth and development in early infancy (under six months of age) are not fully understood. We present a systematic review of micronutrient interventions in term infants under six months of age, with a specific focus on iron supplementation. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) from January 1980 through December 2019. Interventions included iron or multiple micronutrients (MMNs). Results: Of 11,109 records identified, 32 publications from 23 trials were included (18 iron and five MMN supplementation trials). All 23 trials evaluated the effect of supplementation on biochemical outcomes, ten reported on growth, 14 on morbidity and/or mortality and six on neuro-behavioural development. Low- and middle- income countries made up 88% (21/24) of the total trial locations. Meta-analysis was not possible due to extensive heterogeneity in both exposure and outcome measures.  However, these trials indicated that infants less than six months of age benefit biochemically from early supplementation with iron, but the effect of additional nutrients or MMNs, along with the impacts on growth, morbidity and/or mortality, and neuro-behavioural outcomes remain unclear. Conclusions: Infants less than six months of age appear to benefit biochemically from micronutrient supplementation. However, well-powered randomised controlled trials are required to determine whether routine supplementation with iron or MMNs containing iron should commence before six months of life in exclusively breast-fed infants in low-resource settings.

The correlation between family role and anemia prevention in pregnancy

Introduction: It is important to reduce the high incidence of anemia in pregnancy globally. Pregnant women need the support of their families to face any difficulties in order to prevent anemia. Design and Methods: This study aims to determine the correlation between family role and anemia prevention in pregnancy. This cross-sectional study was conducted in August 2021 among 60 pregnant women who went for check-ups at two primary healthcare centers in Surabaya, Indonesia, and received iron supplements. Additionally, it was discovered that family role andanemia prevention in pregnancy were evaluated using questionnaires. Result: The Spearman test was used as a test for significance and the results showed that there was a correlation between family role and anemia prevention in pregnancy (r = 0.318; P = 0.013). Also, it was found that informational, emotional, and affirmational support, as well as having a role model were significantly correlated with anemia prevention at (r = 0.311; p = 0.015), (r = 0.265; p = 0.041), (r = 0.400; p = 0.002), and (r = 0.353; p = 0.006), respectively. Conclusions: There was a relationship between family role and anemia prevention in pregnancy, as well as adequate nutrition, adherence to iron supplements, and prevention of worms. Therefore, there is the need for health promotion to the families of pregnant women in order to increase the understanding of anemia prevention in pregnancy.

Iron sulfate and molasses treated anthocyanin-rich black cane silage improves growth performance, rumen fermentation, antioxidant status, and meat tenderness in goats

OBJECTIVE

This study investigated the effects of feeding anthocyanin-rich black cane treated with ferrous sulfate and molasses on animal performance, rumen fermentation, microbial composition, blood biochemical indices, and carcass characteristics in meat goats.

METHODS

Thirty-two Thai-native×Anglo-Nubian crossbred male goats (14.47±2.3 kg) were divided equally into two groups (n = 16) to investigate the effect of feeding diet containing 50% untreated anthocyanin-rich black cane silage (BS) vs diet containing anthocyaninrich black cane silage treated with 0.03% ferrous sulfate and 4% molasses (TBS) on average daily gain (ADG) and dry matter intake (DMI). At the end of 90 d feeding trial, the goats were slaughtered to determine blood biochemical indices, rumen fermentation, microbial composition, and carcass characteristics differences between the two dietary groups.

RESULTS

Goats fed the TBS diet had greater ADG and ADG to DMI ratio (p<0.05). TBS diet did not affect rumen fluid pH; however, goats in the TBS group had lower rumen ammonia N levels (p<0.05) and higher total volatile fatty acid concentrations (p<0.05). Goats in the TBS group had a higher (p<0.05) concentration of Ruminococcus albus but a lower (p<0.05) concentration of methanogenic bacteria. The TBS diet also resulted in lower (p<0.05) thiobarbituric acid-reactive substances concentration but higher (p<0.05) total antioxidant capacity, superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase concentrations in blood plasma, while having no effect on plasma protein, glucose, lipid, immunoglobin G, alanine transaminase, and aspartate aminotransferase. Meat from goats fed the TBS diet contained more intramuscular fat (p<0.05) and was more tender (p<0.05).

CONCLUSION

In comparison to goats fed a diet containing 50% untreated anthocyanin-rich black cane silage, feeding a diet containing 50% anthocyanin-rich black cane silage treated with 0.03% ferrous sulfate and 4% molasses improved rumen fermentation and reduced oxidative stress, resulting in higher growth and more tender meat.

A novel nano-iron supplement versus standard treatment for iron deficiency anaemia in children 6-35 months (IHAT-GUT trial): a double-blind, randomised, placebo-controlled non-inferiority phase II trial in The Gambia

BACKGROUND

Iron deficiency anaemia (IDA) is the leading cause of years lost to disability in most sub-Saharan African countries and is especially common in young children. The IHAT-GUT trial assessed the efficacy and safety of a novel nano iron supplement, which is a dietary ferritin analogue termed iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in children under 3 years of age.

METHODS

In this single-country, randomised, double-blind, parallel, placebo-controlled, non-inferiority Phase II study in The Gambia, children 6-35 months with IDA (7≤Hb < 11 g/dL and ferritin<30 μg/L) were randomly assigned (1:1:1) to receive either IHAT, ferrous sulphate (FeSO₄) or placebo daily for 3 months (85 days). The daily iron dose was 12.5 mg Fe equivalent for FeSO₄ and the estimated dose with comparable iron-bioavailability for IHAT (20 mg Fe). The primary efficacy endpoint was the composite of haemoglobin response at day 85 and correction of iron deficiency. The non-inferiority margin was 0.1 absolute difference in response probability. The primary safety endpoint was moderate-severe diarrhoea analysed as incidence density and prevalence over the 3 months intervention. Secondary endpoints reported herein include hospitalisation, acute respiratory infection, malaria, treatment failures, iron handling markers, inflammatory markers, longitudinal prevalence of diarrhoea and incidence density of bloody diarrhoea. Main analyses were per-protocol (PP) and intention-to-treat (ITT) analyses. This trial is registered with clinicaltrials.gov (NCT02941081).

FINDINGS

Between Nov 2017 and Nov 2018, 642 children were randomised into the study (214 per group) and included in the ITT analysis, the PP population included 582 children. A total of 50/177 (28.2%) children in the IHAT group achieved the primary efficacy endpoint, as compared with 42/190 (22.1%) in the FeSO₄ group (OR 1.39, 80% CI 1.01-1.91, PP population) and with 2/186 (1.1%) in the placebo group. Diarrhoea prevalence was similar between groups, with 40/189 (21.2%) children in the IHAT group developing at least one episode of moderate-severe diarrhoea over the 85 days intervention, compared with 47/198 (23.7%) in the FeSO₄ group (OR 1.18, 80% CI 0.86-1.62) and 40/195 (20.5%) in the placebo group (OR 0.96, 80% CI 0.7-1.33, PP population). Incidence density of moderate-severe diarrhoea was 2.66 in the IHAT group and 3.42 in the FeSO₄ group (RR 0.76, 80% CI 0.59-0.99, CC-ITT population).There were 143/211 (67.8%) children with adverse events (AEs) in the IHAT group, 146/212 (68.9%) in the FeSO₄ group and 143/214 (66.8%) in the placebo group. There were overall 213 diarrhoea-related AEs; 35 (28.5%) cases reported in the IHAT group compared with 51 (41.5%) cases in the FeSO₄ group and 37 (30.1%) cases in the placebo group.

INTERPRETATION

In this first Phase II study conducted in young children with IDA, IHAT showed sufficient non-inferiority compared to standard-of-care FeSO₄, in terms of ID correction and haemoglobin response, to warrant a definitive Phase III trial. In addition, IHAT had lower incidence of moderate-severe diarrhoea than FeSO₄, with no increased adverse events in comparison with placebo.

FUNDING

The Bill & Melinda Gates Foundation (OPP1140952).

Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals

The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.

Effectiveness of Dietary Intervention with Iron and Vitamin C Administered Separately in Improving Iron Status in Young Women

In order to maintain an adequate iron status in young women, effective dietary interventions should provide sufficient amounts of iron in everyday meals and improve the bioavailability of non-heme iron by providing vitamin C. While some intervention studies administering products rich in vitamin C in conjunction with iron sources showed improved iron status, it is unknown whether a separate administration of products rich in iron and vitamin C may be a successful strategy as well. The aim of this study was to assess the effectiveness of dietary intervention with iron and vitamin C administered separately in improving iron status in young women to prevent iron deficiency anemia. The study was conducted in a group of 29 women aged 18-30, and an 8-week dietary intervention was performed. Study participants with an adequate iron status received 50 g of iron-fortified oat flakes (as a source of non-heme iron) with breakfast and 200 mL of orange juice (as a source of vitamin C) in the second part of the day. Iron status was analyzed based on red blood cells, hemoglobin, hematocrit, serum ferritin, and serum iron, and it was assessed at baseline, after 4 weeks, and after 8 weeks of the intervention. The intakes of iron, vitamin C, and folate were controlled throughout the study period, and menstrual blood loss was estimated. After 8 weeks of intervention, statistically significant differences compared with baseline were observed only for hematocrit, as its level after 8 weeks of intervention was higher than the baseline (p = 0.0491). Comparing subsamples within the dietary intervention considered effective and ineffective for red blood cell levels, it was indicated that lower baseline vitamin C intake may result in a more effective dietary intervention (p = 0.0231). Comparing subsamples within the dietary intervention considered effective and ineffective for hemoglobin, hematocrit, iron, and serum ferritin levels, it was indicated that higher baseline levels of hemoglobin (p = 0.0143), hematocrit (p = 0.0497), iron (p = 0.0101), and serum ferritin (p = 0.0343) respectively may result in a more effective dietary intervention. It was concluded that dietary intervention with iron and vitamin C administered separately may be effective in improving iron status in young women to prevent iron deficiency anemia. It may be concluded that in the studied group, a better baseline iron status and lower baseline vitamin C intake may result in a more effective dietary intervention with iron and vitamin C administered separately to improve iron status in young women.

Prevalence and factors associated with anaemia in children aged 6–24 months living a high malaria transmission setting in Burundi

Background

In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6–24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi.

Methods

Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6–24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child’s primary caregiver to capture information on child’s demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections.

Results

The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79–6.99, p<0.001), the child’s home location (Mukenke II: aOR = 2.22, 95% CI 1.89–2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46–3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94–3.31, p<0.001) and the child’s age group (Children aged 6–11 months: aOR = 2.27, 95% CI 1.32–3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child’s primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47–0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38–0.61, p<0.001).

Conclusion

Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.

Dietary inclusion of anthocyanin-rich black cane silage treated with ferrous sulfate heptahydrate reduces oxidative stress and promotes tender meat production in goats

Pre-treating anthocyanin-rich black cane with ferrous sulfate heptahydrate (FSH) produces high-quality silage with anthocyanin and nutritional losses. However, it's unclear how to apply this to studies on how FSH-treated silage affects animal performance and meat quality. Therefore, this study aimed to investigate the effects of a standard total mixed ration (TMR) containing anthocyanin-rich black cane silages either with or without dilutions of FSH on animal performance, blood biochemical indices, rumen fermentation, microbial community, and carcass characteristics in meat goats. Forty healthy crossbred Thai-native Anglo-Nubian male goats (14.42 ± 1.4 kg) were used to compare the feasibility of using anthocyanin-rich black cane silage (ABS) as a functional feed resource as opposed to anthocyanin-rich black cane treated with 0.030% commercial FSH silage (ABSF). All goats received a 90-day routine feeding of two isocaloric and isonitrogenous experimental diets: the control group received TMR containing 50% anthocyanin-rich black cane silage (ABS; n = 20), and one group received TMR containing 50% FSH-treating anthocyanin-rich black cane (ABSF; n = 20). As performance indicators, average daily weight gain (ADG) and dry matter intake (DMI) were measured. Samples of meat, blood, and rumen were taken at the end of the experiment. There were no differences in final body weight, ADG, DMI, or ADG/DMI between the two groups. The ABSF group did not differ from the ABS group in terms of rumen pH, but the ABSF had a tendency to lower rumen ammonia N levels, and to higher total volatile fatty acid (VFA) concentrations. Individual VFA concentrations differed, with the ABSF group having more Ruminococcus albus and the ABS group having more methanogenic bacteria. Blood biochemical indices differed, with the ABSF group having lower TBARS concentrations and the ABS group having lower TAC, SOD, CAT, GSH-Px, and GSH-Rx concentrations. In comparison to goat meat from the ABS group, goat meat from the ABSF group contained more intramuscular fat and was more tender. The current results indicate that the feeding of a TMR containing 50% anthocyanin-rich black cane, along with FSH pre-treatment prior to ensiling, reduces oxidative stress and promotes the production of tender meat without affecting animal performance.

Computational Modeling of Macrophage Iron Sequestration during Host Defense against Aspergillus

Iron is essential to the virulence of Aspergillus species, and restricting iron availability is a critical mechanism of antimicrobial host defense. Macrophages recruited to the site of infection are at the crux of this process, employing multiple intersecting mechanisms to orchestrate iron sequestration from pathogens. To gain an integrated understanding of how this is achieved in aspergillosis, we generated a transcriptomic time series of the response of human monocyte-derived macrophages to Aspergillus and used this and the available literature to construct a mechanistic computational model of iron handling of macrophages during this infection. We found an overwhelming macrophage response beginning 2 to 4 h after exposure to the fungus, which included upregulated transcription of iron import proteins transferrin receptor-1, divalent metal transporter-1, and ZIP family transporters, and downregulated transcription of the iron exporter ferroportin. The computational model, based on a discrete dynamical systems framework, consisted of 21 3-state nodes, and was validated with additional experimental data that were not used in model generation. The model accurately captures the steady state and the trajectories of most of the quantitatively measured nodes. In the experimental data, we surprisingly found that transferrin receptor-1 upregulation preceded the induction of inflammatory cytokines, a feature that deviated from model predictions. Model simulations suggested that direct induction of transferrin receptor-1 (TfR1) after fungal recognition, independent of the iron regulatory protein-labile iron pool (IRP-LIP) system, explains this finding. We anticipate that this model will contribute to a quantitative understanding of iron regulation as a fundamental host defense mechanism during aspergillosis.

IMPORTANCE Invasive pulmonary aspergillosis is a major cause of death among immunosuppressed individuals despite the best available therapy. Depriving the pathogen of iron is an essential component of host defense in this infection, but the mechanisms by which the host achieves this are complex. To understand how recruited macrophages mediate iron deprivation during the infection, we developed and validated a mechanistic computational model that integrates the available information in the field. The insights provided by this approach can help in designing iron modulation therapies as anti-fungal treatments.

Effectiveness of Dietary Interventions to Treat Iron-Deficiency Anemia in Women: A Systematic Review of Randomized Controlled Trials

Iron-deficiency anemia is the most frequent nutritional deficiency, with women of reproductive age being particularly at risk of its development. The aim of the systematic review was to assess the effectiveness of dietary interventions to treat iron-deficiency anemia in women based on the randomized controlled trials. The systematic review was conducted according to the PRISMA guidelines and registered in the PROSPERO database (CRD42021261235). The searching procedure was based on PubMed and Web of Science databases, while it covered records published until June 2021. It included all randomized controlled trials assessing effectiveness of various dietary interventions on treatment of iron-deficiency anemia in women of childbearing age. The total number of 7825 records were screened, while 14 of them were finally included in the systematic review. The studies were screened, included, and reported, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials by two independent researchers. The included studies compared the effectiveness of various dietary interventions with supplementation, placebo, control, or any other dietary intervention, while the assessed dietary interventions were based either on increasing iron supply and/or on increasing its absorption (by increasing vitamin C or vitamin D or decreasing phytate intake). The duration of applied intervention was diversified from 3 months or less, through 4 or 5 months, to half of a year or more. Among the assessed biochemical measures, the following were analyzed in majority of studies: hemoglobin, ferritin, transferrin receptor, hematocrit, and transferrin. The majority of included studies supported the influence of dietary interventions on the treatment of iron-deficiency anemia, as the applied dietary intervention was not effective in only three studies. The majority of included studies were assessed as characterized by medium risk of bias, while the overall risk was high for only four studies, which resulted from the randomization process, deviations from the intended interventions, and selection of the reported result. The majority of included studies were conducted for increasing iron supply and/or increasing vitamin C supply; however, only for the interventions including increasing iron supply and simultaneously increasing its absorption by vitamin C supply were all results confirmed effective. Vitamin D also seems to be an effective dietary treatment, but further studies are necessary to confirm the observations. Considering this fact, dietary interventions recommended for anemic female patients should include increased intake of iron and vitamin C.

Fortification of salt with iron and iodine versus fortification of salt with iodine alone for improving iron and iodine status

BACKGROUND

Iron deficiency is an important micronutrient deficiency contributing to the global burden of disease, and particularly affects children, premenopausal women, and people in low-resource settings. Anaemia is a possible consequence of iron deficiency, although clinical and functional manifestations of anemia can occur without iron deficiency (e.g. from other nutritional deficiencies, inflammation, and parasitic infections). Direct nutritional interventions, such as large-scale food fortification, can improve micronutrient status, especially in vulnerable populations. Given the highly successful delivery of iodine through salt iodisation, fortifying salt with iodine and iron has been proposed as a method for preventing iron deficiency anaemia. Further investigation of the effect of double-fortified salt (i.e. with iron and iodine) on iron deficiency and related outcomes is warranted.  OBJECTIVES: To assess the effect of double-fortified salt (DFS) compared to iodised salt (IS) on measures of iron and iodine status in all age groups.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, five other databases, and two trial registries up to April 2021. We also searched relevant websites, reference lists, and contacted the authors of included studies.

SELECTION CRITERIA

All prospective randomised controlled trials (RCTs), including cluster-randomised controlled trials (cRCTs), and controlled before-after (CBA) studies, comparing DFS with IS on measures of iron and iodine status were eligible, irrespective of language or publication status. Study reports published as abstracts were also eligible.

DATA COLLECTION AND ANALYSIS

Three review authors applied the study selection criteria, extracted data, and assessed risk of bias. Two review authors rated the certainty of the evidence using GRADE. When necessary, we contacted study authors for additional information. We assessed RCTs, cRCTs and CBA studies using the Cochrane RoB 1 tool and Cochrane Effective Practice and Organisation of Care (EPOC) tool across the following domains: random sequence generation; allocation concealment; blinding of participants and personnel; blinding of outcome assessment; incomplete outcome data; selective reporting; and other potential sources of bias due to similar baseline characteristics, similar baseline outcome assessments, and declarations of conflicts of interest and funding sources. We also assessed cRCTs for recruitment bias, baseline imbalance, loss of clusters, incorrect analysis, and comparability with individually randomised studies. We assigned studies an overall risk of bias judgement (low risk, high risk, or unclear).  MAIN RESULTS: We included 18 studies (7 RCTs, 7 cRCTs, 4 CBA studies), involving over 8800 individuals from five countries. One study did not contribute to analyses. All studies used IS as the comparator and measured and reported outcomes at study endpoint.  With regards to risk of bias, five RCTs had unclear risk of bias, with some concerns in random sequence generation and allocation concealment, while we assessed two RCTs to have a high risk of bias overall, whereby high risk was noted in at least one or more domain(s). Of the seven cRCTs, we assessed six at high risk of bias overall, with one or more domain(s) judged as high risk and one cRCT had an unclear risk of bias with concerns around allocation and blinding. The four CBA studies had high or unclear risk of bias for most domains. The RCT evidence suggested that, compared to IS, DFS may slightly improve haemoglobin concentration (mean difference (MD) 0.43 g/dL, 95% confidence interval (CI) 0.23 to 0.63; 13 studies, 4564 participants; low-certainty evidence), but DFS may reduce urinary iodine concentration compared to IS (MD -96.86 μg/L, 95% CI -164.99 to -28.73; 7 studies, 1594 participants; low-certainty evidence), although both salts increased mean urinary iodine concentration above the cut-off deficiency. For CBA studies, we found DFS made no difference in haemoglobin concentration (MD 0.26 g/dL, 95% CI -0.10 to 0.63; 4 studies, 1397 participants) or urinary iodine concentration (MD -17.27 µg/L, 95% CI -49.27 to 14.73; 3 studies, 1127 participants). No studies measured blood pressure. For secondary outcomes reported in RCTs, DFS may result in little to no difference in ferritin concentration (MD -3.94 µg/L, 95% CI -20.65 to 12.77; 5 studies, 1419 participants; low-certainty evidence) or transferrin receptor concentration (MD -4.68 mg/L, 95% CI -11.67 to 2.31; 5 studies, 1256 participants; low-certainty evidence) compared to IS. However, DFS may reduce zinc protoporphyrin concentration (MD -27.26 µmol/mol, 95% CI -47.49 to -7.03; 3 studies, 921 participants; low-certainty evidence) and result in a slight increase in body iron stores (MD 1.77 mg/kg, 95% CI 0.79 to 2.74; 4 studies, 847 participants; low-certainty evidence). In terms of prevalence of anaemia, DFS may reduce the risk of anaemia by 21% (risk ratio (RR) 0.79, 95% CI 0.66 to 0.94; P = 0.007; 8 studies, 2593 participants; moderate-certainty evidence). Likewise, DFS may reduce the risk of iron deficiency anaemia by 65% (RR 0.35, 95% CI 0.24 to 0.52; 5 studies, 1209 participants; low-certainty evidence).  Four studies measured salt intake at endline, although only one study reported this for both groups. Two studies reported prevalence of goitre, while one CBA study measured and reported serum iron concentration. One study reported adverse effects. No studies measured hepcidin concentration.

AUTHORS' CONCLUSIONS

Our findings suggest DFS may have a small positive impact on haemoglobin concentration and the prevalence of anaemia compared to IS, particularly when considering efficacy studies. Future research should prioritise studies that incorporate robust study designs and outcome measures (e.g. anaemia, iron status measures) to better understand the effect of DFS provision to a free-living population (non-research population), where there could be an added cost to purchase double-fortified salt. Adequately measuring salt intake, both at baseline and endline, and adjusting for inflammation will be important to understanding the true effect on measures of iron status.

Effects of dietary fiber on intestinal iron absorption, and physiological status: a systematic review of in vivo and clinical studies

The benefits of dietary fiber on intestinal health have been well established. However, there is no consensus on the dietary fiber effects on mineral absorption. The objective of this systematic review is to discuss the evidence on the dietary fiber effects on iron absorption and iron status-related biomarkers. A comprehensive search of 3 databases: PubMed, Scopus and Web of Science was carried out. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and a total of 32 studies were included with 9 of them clinical studies and 23 in vivo. The studies included assessment of dietary fiber in the form of fructo-oligosaccharides, galacto-oligosaccharides, inulin, pectin, guar gum, oligofructose, xylo-oligosaccharides, and mannan-oligosaccharide. Hemoglobin (n = 21) and fractional iron absorption (n = 6) were the most frequently reported outcomes. The results showed no significant correlations between consumption of dietary fiber to iron absorption/status-related biomarkers. However, the current evidence may not be substantial to invalidate the recommendation of dietary fiber as an agent to improve dietary iron bioavailability, and absorption. In conclusion, there is a need to conduct further clinical trials with long dietary fiber intervention focusing on population at high risk for iron deficiency.

Preparation and related properties of melanin iron supplement

In this study, BM-Fe (black sesame melanin-iron complex) was prepared and characterized. The results showed that the carboxyl hydroxyl group of BSM (black sesame melanin) participated in the chelation of iron ions. EDS (energy dispersive spectroscopy) and XPS (X-ray photoelectron spectroscopy) results confirmed the presence of iron ions in BM-Fe. The results of DLS (dynamic light scattering) showed that the average particle sizes of BSM and BM-Fe were 844.9 nm and 294.3 nm, respectively, indicating that the structure of BM-Fe with a smaller particle size was formed after the binding of iron ions with the active group on BSM. Finally, the in vitro iron dissolution, iron ion identification, in vitro iron ion reduction, antioxidant activity, cytotoxicity and moisture resistance properties of BM-Fe and FST (ferrous sulfate tablets, a commonly used iron supplement) were comprehensively compared. The results showed that BSM combined with iron instead of physically mixing, and BM-Fe was easily reduced in the gastrointestinal environment. BM-Fe had good bioavailability and retained the excellent characteristics (such as oxidation resistance and biocompatibility) of BSM, and had the potential to be applied in the treatment of iron-deficiency-related diseases. In summary, BM-Fe prepared in this study not only retained the excellent characteristics of BSM but also had a good effect on iron supplementation, high bioavailability and low side effects. Comprehensive analysis showed that the performance of BM-Fe prepared in this study was similar to or even better than that of the control (FST). Thus, BM-Fe is expected to become a new comprehensive multi-functional iron supplement and has a broad developmental prospect.

Prognostic impact of anemia on the mortality of United Arab Emirates nationals with cardiovascular disease

Background: Cardiovascular disease is the leading cause of death worldwide. Multiple risk factors, including low hemoglobin levels, have been associated with poor outcomes in patients with cardiovascular disease. However, the long-term impact of anemia on death has not been investigated in high-risk patients in the United Arab Emirates. Therefore, this study evaluated whether anemia is a significant predictor of mortality in United Arab Emirates nationals with cardiovascular disease over 10 years.

Methods: A retrospective cohort study was conducted in an adult population of United Arab Emirates nationals with a history of cardiovascular disease, recruited from a tertiary healthcare facility. Electronic medical records between April 2008 and December 2008 were reviewed, and follow-up was conducted until December 2019. The survival functions for all-cause mortality in the presence and absence of anemia were compared using univariate Kaplan–Meier analysis with a log-rank test. The association between anemia and all-cause mortality was evaluated using a multivariable Cox regression model.

Results: A total of 224 patients were included in the follow-up for 10.5 years. At baseline, 46% of the patients had anemia, with a mean Hgb level of 105.5 ± 28.0 g/L. Patients with anemia were older (68 vs. 63 years, p = 0.001) and had a higher rate of chronic kidney disease (37.5% vs. 17.5%, p = 0.001) than those without anemia. A total of 77 (34.4%) deaths were recorded by the end of the follow-up period. Risk of all-cause mortality was significantly higher in patients with anemia than in those without (hazard ratio = 2.03, 95% confidence interval = 1.22–3.40, p = 0.006). Age and chronic kidney disease were also statistically significant predictors of death (p < 0.001 and p = 0.001, respectively).

Conclusion: Anemia is an independent predictor of all-cause mortality in United Arab Emirates nationals with underlying cardiovascular disease. Early intervention and treatment for anemia may improve clinical outcomes in this population.

Formulations with microencapsulated Fe–peptides improve in vitro bioaccessibility and bioavailability

The bioaccessibility and the bioavailability of iron complexed to peptides (active) in microparticles forms contained in dry beverages formulations were evaluated. The peptide-iron complexes microparticles were obtained by spray drying and added in three dry formulations (tangerine, strawberry, and chocolate flavors). The peptides isolated by iron ion affinity (IMAC-Fe III) had their biological activity predicted by BIOPEP® database and were evaluated by molecular coupling. The bioaccessibility was evaluated by solubility and dialysability and the bioavalability was assessed by Caco-2 cellular model. The proportion 10:1 of peptide-iron complexes presented higher rates of bioaccessibility (49%) and bioavailability (56%). The microparticle with peptide-iron complex showed greater solubility after digestion (39.1%), bioaccessibility (19.8%), and bioavailability (34.8%) than the ferrous sulfate salt (control) for the three assays (10.2%; 12.9%; 9.7%, respectively). Tangerine and strawberry formulations contributed to the iron absorption according to the results of bioaccessibility (36.2%, 30.0% respectively) and bioavailability (80.5%, 84.1%, respectively). The results showed that iron peptide complexation and microencapsulation process improve the bioaccessibility and bioavailability when incorporated into formulations.

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Iron solubility is increased in iron peptide complexes.

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In silico interaction between peptides > 5 KDa and ferric iron (Fe²⁺).

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Microparticle with Fe-peptides increase iron bioavailability after digestion.

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Microparticle formulations improve iron bioaccessibility and bioavailability.

Iron Bioavailability from Infant Cereals Containing Whole Grains and Pulses: A Stable Isotope Study in Malawian Children

BACKGROUND

Compared with infant cereals based on refined grains, an infant cereal containing whole grains (WGs) and pulses with adequate amounts of ascorbic acid to protect against absorption inhibitors could be a healthier source of well-absorbed iron. However, iron absorption from such cereals is uncertain.

OBJECTIVE

We measured iron bioavailability from ferrous fumarate (Fefum) added to commercial infant cereals containing 1) refined wheat flour (reference meal), 2) WG wheat and lentil flour (WG-wheat-lentil), 3) WG wheat and chickpea flour (WG-wheat-chickpeas), and 4) WG oat flour (WG-oat) and from ferrous bisglycinate (FeBG) added to the same oat-based cereal (WG-oat-FeBG).

METHODS

In a prospective, single-blinded randomized crossover study, 6- to 14-mo-old Malawian children (n = 30) consumed 25-g servings of all 5 test meals containing 2.25 mg stable isotope-labeled iron and 13.5 mg ascorbic acid. Fractional iron absorption (FIA) was assessed by erythrocyte incorporation of isotopes after 14 d. Comparisons were made using linear mixed models.

RESULTS

Seventy percent of the children were anemic and 67% were iron deficient. Geometric mean FIA percentages (-SD, +SD) from the cereals were as follows: 1) refined wheat, 12.1 (4.8, 30.6); 2) WG-wheat-lentil, 15.8 (6.6, 37.6); 3) WG-wheat-chickpeas, 12.8 (5.5, 29.8); and 4) WG-oat, 9.2 (3.9, 21.5) and 7.4 (2.9, 18.9) from WG-oat-FeBG. Meal predicted FIA (P ≤ 0.001), whereas in pairwise comparisons, only WG-oat-FeBG was significantly different compared with the refined wheat meal (P = 0.02). In addition, FIAs from WG-wheat-lentil and WG-wheat-chickpeas were significantly higher than from WG-oat (P = 0.002 and P = 0.04, respectively) and WG-oat-FeBG (P < 0.001 and P = 0.004, respectively).

CONCLUSION

In Malawian children, when given with ascorbic acid at a molar ratio of 2:1, iron bioavailability from Fefum-fortified infant cereals containing WG wheat and pulses is ≈13-15%, whereas that from FeBG- and Fefum-fortified infant cereals based on WG oats is ≈7-9%.

Effect of ascorbic acid and citric acid on bioavailability of iron from Tegillarca granosa via an in vitro digestion/Caco-2 cell culture system

Iron deficiency anaemia (IDA) has been receiving worldwide attention. Developing safe and effective iron supplements is of great significance for IDA treatment. Tegillarca granosa (T. granosa), a traditional aquaculture bivalve species in China, is considered to be an excellent source of micronutrients, but the distribution and bioavailability of these minerals have yet to be investigated. The present research was conducted to determine the contents and in vitro enzymatic digestibility of minerals in T. granosa, using beef and wheat flour as reference foods. Meanwhile, two iron-binding proteins, hemoglobin and ferritin, were extracted from T. granosa, and their structures, iron accessibility and bioavailability were investigated. Moreover, the effects of ascorbic acid (AA) and citric acid (CA), two commonly applied dietary factors, on these parameters were evaluated. Our results indicated that the mineral levels varied significantly among different food matrices, with T. granosa showing the highest contents of the tested elements. Comparison of iron absorption of meat versus wheat flour and hemoglobin versus ferritin confirmed that heme iron exhibited higher bioavailability than non-heme iron. The addition of the two organic acids notably enhanced the cellular iron uptake of T. granosa-derived proteins. This could be because AA/CA weakened hydrogen bonds within proteins and caused disordered secondary structures, thereby improving their enzymatic digestibility and releasing more soluble iron to be available for absorption. The results of this study provided a basis for the development of T. granosa-derived protein-based iron supplements, promoting the diverse utilization of marine aquatic resources.

Iron Deficiency Anemia in Inflammatory Bowel Diseases-A Narrative Review

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. IBD has been associated with numerous symptoms and complications, with the most common being iron deficiency anemia (IDA). Iron deficiency in IBD is caused by inadequate intake, malabsorption (including duodenal involvement and surgical removal), and chronic blood loss by mucosal ulcerations. Therefore, an appropriate diet should be enforced. Iron deficiency and iron supplementation have been associated with alterations to gut microbiota. IBD-associated anemia, in particular iron deficiency anemia, is associated with a significant decrease in quality of life and with clinical symptoms such as chronic fatigue, headaches and dizziness, reduced exercise tolerance, pale skin, nails, conjunctiva, and fainting. However, despite these numerous adverse symptoms, IDA remains undertreated. The European Crohn's and Colitis Organisation (ECCO) guidelines state that patients should be monitored for anemia. Adequate treatment, whether oral or intravenous, should be implemented while taking into consideration C-reactive protein values (CRP), hemoglobin levels, and therapeutic response. It should be stressed that every case of anemia in IBD patients should be treated. Intravenous iron formulations, which are more superior compared to the oral form, should be used. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.

The role of legume peptides released during different digestion stages in modulating the bioaccessibility of exogenous iron and zinc: An in-vitro study

The effects of legume protein fractions on Fe and Zn bioaccessibility remain equivocal to date, largely due to the protein’s structure and the presence of anti-nutritional compounds. We administered Fe and Zn salts with legume concentrates consisting mainly of albumin or globulin from lupin, pea and faba to in vitro gastrointestinal digestion. Under the fasted intestinal state, faba globulins were found to enhance Fe²⁺ and Zn solubility compared to control salts without legume proteins. Meanwhile, other fractions had no effect or significantly lowered Fe and Zn solubility. Under the fed intestinal state, the presence globulins enhanced Fe solubility versus the control, where protein solubilization due to high bile concentration likely played a role in circumventing precipitation. The lupin albumin fraction significantly enhanced Fe²⁺ and Zn solubility, whilst other fractions generally reduced Zn solubility under fed state. Our results highlight the complex role of legume proteins towards Fe and Zn solubility.

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Bioaccessibility of Fe/Zn mineral salts were examined with and without legume protein fractions.

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Bile concentrations and/or digestion time affected Fe³⁺/Fe²⁺ and Zn solubility in presence of legume protein fractions.

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Globulins consistently enhanced Fe²⁺, but not Fe³⁺ solubility during the high-bile (fed state) intestinal digestion phase.

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Both enhancements and reductions in Zn solubility were reflected by different legume fractions.

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A non-linear relationship was observed between soluble protein and Fe/Zn bioaccessibility during simulated digestion.

Nutraceuticals: unlocking newer paradigms in the mitigation of inflammatory lung diseases

Persistent respiratory tract inflammation contributes to the pathogenesis of various chronic respiratory diseases, such as asthma, chronic obstructive pulmonary disease, and pulmonary fibrosis. These inflammatory respiratory diseases have been a major public health concern as they are the leading causes of worldwide mortality and morbidity, resulting in heavy burden on socioeconomic growth throughout these years. Although various therapeutic agents are currently available, the clinical applications of these agents are found to be futile due to their adverse effects, and most patients remained poorly controlled with a low quality of life. These drawbacks have necessitated the development of novel, alternative therapeutic agents that can effectively improve therapeutic outcomes. Recently, nutraceuticals such as probiotics, vitamins, and phytochemicals have gained increasing attention due to their nutritional properties and therapeutic potential in modulating the pathological mechanisms underlying inflammatory respiratory diseases, which could ultimately result in improved disease control and overall health outcomes. As such, nutraceuticals have been held in high regard as the possible alternatives to address the limitations of conventional therapeutics, where intensive research are being performed to identify novel nutraceuticals that can positively impact various inflammatory respiratory diseases. This review provides an insight into the utilization of nutraceuticals with respect to their molecular mechanisms targeting multiple signaling pathways involved in the pathogenesis of inflammatory respiratory diseases.

Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews

BACKGROUND

Anaemia is a prevalent health problem worldwide. Some types are preventable or controllable with iron supplementation (pills or drops), fortification (sprinkles or powders containing iron added to food) or improvements to dietary diversity and quality (e.g. education or counselling).

OBJECTIVES

To summarise the evidence from systematic reviews regarding the benefits or harms of nutrition-specific interventions for preventing and controlling anaemia in anaemic or non-anaemic, apparently healthy populations throughout the life cycle.

METHODS

In August 2020, we searched MEDLINE, Embase and 10 other databases for systematic reviews of randomised controlled trials (RCTs) in anaemic or non-anaemic, apparently healthy populations. We followed standard Cochrane methodology, extracting GRADE ratings where provided. The primary outcomes were haemoglobin (Hb) concentration, anaemia, and iron deficiency anaemia (IDA); secondary outcomes were iron deficiency (ID), severe anaemia and adverse effects (e.g. diarrhoea, vomiting).

MAIN RESULTS

We included 75 systematic reviews, 33 of which provided GRADE assessments; these varied between high and very low. Infants (6 to 23 months; 13 reviews) Iron supplementation increased Hb levels and reduced the risk of anaemia and IDA in two reviews. Iron fortification of milk or cereals, multiple-micronutrient powder (MMNP), home fortification of complementary foods, and supplementary feeding increased Hb levels and reduced the risk of anaemia in six reviews. In one review, lipid-based nutrient supplementation (LNS) reduced the risk of anaemia. In another, caterpillar cereal increased Hb levels and IDA prevalence. Food-based strategies (red meat and fortified cow's milk, beef) showed no evidence of a difference (1 review). Preschool and school-aged children (2 to 10 years; 8 reviews) Daily or intermittent iron supplementation increased Hb levels and reduced the risk of anaemia and ID in two reviews. One review found no evidence of difference in Hb levels, but an increased risk of anaemia and ID for the intermittent regime. All suggested that zinc plus iron supplementation versus zinc alone, multiple-micronutrient (MMN)-fortified beverage versus control, and point-of-use fortification of food with iron-containing micronutrient powder (MNP) versus placebo or no intervention may increase Hb levels and reduce the risk of anaemia and ID. Fortified dairy products and cereal food showed no evidence of a difference on the incidence of anaemia (1 review). Adolescent children (11 to 18 years; 4 reviews) Compared with no supplementation or placebo, five types of iron supplementation may increase Hb levels and reduce the risk of anaemia (3 reviews). One review on prevention found no evidence of a difference in anaemia incidence on iron supplementation with or without folic acid, but Hb levels increased. Another suggested that nutritional supplementation and counselling reduced IDA. One review comparing MMN fortification with no fortification observed no evidence of a difference in Hb levels. Non-pregnant women of reproductive age (19 to 49 years; 5 reviews) Two reviews suggested that iron therapy (oral, intravenous (IV), intramuscular (IM)) increased Hb levels; one showed that iron folic acid supplementation reduced anaemia incidence; and another that daily iron supplementation with or without folic acid or vitamin C increased Hb levels and reduced the risk of anaemia and ID. No review reported interventions related to fortification or dietary diversity and quality. Pregnant women of reproductive age (15 to 49 years; 23 reviews) One review apiece suggested that: daily iron supplementation with or without folic acid increased Hb levels in the third trimester or at delivery and in the postpartum period, and reduced the risk of anaemia, IDA and ID in the third trimester or at delivery; intermittent iron supplementation had no effect on Hb levels and IDA, but increased the risk of anaemia at or near term and ID, and reduced the risk of side effects; vitamin A supplementation alone versus placebo, no intervention or other micronutrient might increase maternal Hb levels and reduce the risk of maternal anaemia; MMN with iron and folic acid versus placebo reduced the risk of anaemia; supplementation with oral bovine lactoferrin versus oral ferrous iron preparations increased Hb levels and reduced gastrointestinal side effects; MNP for point-of-use fortification of food versus iron and folic acid supplementation might decrease Hb levels at 32 weeks' gestation and increase the risk of anaemia; and LNS versus iron or folic acid and MMN increased the risk of anaemia. Mixed population (all ages; 22 reviews) Iron supplementation versus placebo or control increased Hb levels in healthy children, adults, and elderly people (4 reviews). Hb levels appeared to increase and risk of anaemia and ID decrease in two reviews investigating MMN fortification versus placebo or no treatment, iron fortified flour versus control, double fortified salt versus iodine only fortified salt, and rice fortification with iron alone or in combination with other micronutrients versus unfortified rice or no intervention. Each review suggested that fortified versus non-fortified condiments or noodles, fortified (sodium iron ethylenediaminetetraacetate; NaFeEDTA) versus non-fortified soy sauce, and double-fortified salt versus control salt may increase Hb concentration and reduce the risk of anaemia. One review indicated that Hb levels increased for children who were anaemic or had IDA and received iron supplementation, and decreased for those who received dietary interventions. Another assessed the effects of foods prepared in iron pots, and found higher Hb levels in children with low-risk malaria status in two trials, but no difference when comparing food prepared in non-cast iron pots in a high-risk malaria endemicity mixed population. There was no evidence of a difference for adverse effects. Anaemia and malaria prevalence were rarely reported. No review focused on women aged 50 to 65 years plus or men (19 to 65 years plus).

AUTHORS' CONCLUSIONS

Compared to no treatment, daily iron supplementation may increase Hb levels and reduce the risk of anaemia and IDA in infants, preschool and school-aged children and pregnant and non-pregnant women. Iron fortification of foods in infants and use of iron pots with children may have prophylactic benefits for malaria endemicity low-risk populations. In any age group, only a limited number of reviews assessed interventions to improve dietary diversity and quality. Future trials should assess the effects of these types of interventions, and consider the requirements of different populations.

Prevalence and approaches to manage iron deficiency anemia (IDA)

Iron is a vital micronutrient required for growth and development at all stages of human life. Its deficiency is the primary cause of anemia that poses a significant global health problem and challenge for developing countries. Various risks are involved during iron deficiency anemia (IDA), such as premature delivery, low birth weight, etc. Further, it affects children's cognitive functioning, delays motor development, hampers physical performance and quality of life. It also speeds up the morbidity and mortality rate among women. The major reasons accountable are elevated iron demand in diet, socio-economic status, and disease condition. Various strategies have been adopted to reduce the IDA occurrence, such as iron supplementation, iron fortificants salts, agronomic practices, dietary diversification, biofortification, disease control measures, and nutritional education. Usually, the staple food groups for fortification are considered, but the selection of food fortificants and their combination must be safe for the consumers and not alter the finished product's stability and acceptability. Genetically modified breeding practices also increase the micronutrient levels of cereal crops. Therefore, multiple strategies could be relied on to combat IDA.

Brazilian Genetic Diversity for Desirable and Undesirable Elements in the Wheat Grain

Micronutrient deficiency affects billions of people, especially in countries where the diet is low in diversity with inadequate consumption of fruits, vegetables, and animal-source foods, and higher consumption of staple food, i.e., cereals, that have low concentrations of micronutrients. Genetic biofortification is a strategy to mitigate this problem and ensure nutritional security. Wheat is a target of genetic biofortification since it contributes significantly to the caloric requirement. The biofortification process involves a screening related to the presence of genetic variability for grain mineral content. Also, the accumulation of toxic elements must be considered to ensure food safety, because if ingested above the allowed concentrations, it represents health risks. In this sense, this study aimed to quantify the micronutrients iron, zinc, copper, selenium, and manganese and toxic elements arsenic and cadmium in a Brazilian wheat panel grown in Southern Brazil. The presence of genetic variability for the accumulation of micronutrients in the grain was detected; however, we observed that only the copper and manganese accumulation meet the human daily requirements. Iron, zinc, and selenium were detected in insufficient concentration to meet the daily demand. Arsenic and cadmium accumulation were not detected in wheat grain. The wheat genotypes grown in Brazil displayed a similar profile to that found in other countries which may be due to common high-yield breeding goals and the narrowing of the genetic variability, observed worldwide. Thus, the wheat genetic biofortification success in Brazil depends on the introduction of foreign genotypes, landraces, and wild relatives.

Soluble Transferrin Receptor during infancy and reference intervals for the Roche Cobas platform

INTRODUCTION

Infant iron status assessments may be difficult to interpret due to infections. The soluble transferrin receptor (sTfR) has been suggested as a biomarker mainly unaffected by the acute phase response. Reference intervals reflecting dynamics of infant growth first year in life are not well established.

METHODS

The sTfR and CRP concentrations were measured in samples from 451 term infants with the Roche Cobas platform in umbilical cord, at 48-96 hours, 4 and 12 months. Reference values were constructed as the 2.5th and 97.5th percentiles. The relationship between CRP concentrations >1 mg/L and sTfR was tested by Kendall correlation.

RESULTS

Reference intervals for girls and boys were 2.4-9.5 mg/L at birth, 2.9-8.4 mg/L at 48-96 hours, 2.6-5.7 mg/L at 4 months and 3.0-6.3 mg/L at 12 months. No differences between sexes were observed except for at 4 months. sTfR did not covariate with CRP concentrations >1 mg/L except in 48-96 hours samples.

CONCLUSION

This study reports reference intervals for sTfR from birth to 12 months of age in a large group of infants in a low-risk area for iron deficiency. sTfR might add value to infant iron status diagnostics since no covariation with CRP was found at birth, at 4 months or at 12 months.

Analysis of Environmental Determinants of Heme and Nonheme Iron Intake in a National Sample of Polish Adolescents

Intake of sufficient amounts of iron by adolescents is a matter of great concern. Therefore, it is crucial to determine the factors that may influence iron intake in this specific population. The present study aimed to analyze the environmental determinants of the intake of heme and nonheme iron in a national homogenous sample of Polish adolescents. Adolescents (aged 15-20 years) were randomly chosen from all the regions of Poland by performing a sampling of secondary schools (random quota sampling). The total iron intake, as well as the intake of heme iron, nonheme iron, animal iron, plant iron, and iron from various food products, was assessed among 1385 female respondents and 1025 male respondents using the validated IRON Intake Calculation-Food Frequency Questionnaire (IRONIC-FFQ). The intake was compared between the subgroups stratified by meat intake in the region, gross domestic product (GDP) in the region, and size of the city (rural vs. urban environment). It was observed that meat intake in the region did not influence the intake of total iron, as well as the intake of heme iron, nonheme iron, animal iron, plant iron, and iron from various food products (p > 0.05). However, GDP and the size of the city were determined as the most influencing factors, as they were associated with iron intake in both female and male adolescents, with the most prominent differences between the subgroups found in the case of females. Female adolescents from high-GDP regions had significantly higher intake of heme iron (p = 0.0047) and animal iron (p = 0.0029), and lower intake of nonheme iron compared to those from low-GDP regions (p = 0.0342). The total iron intake was higher among female adolescents who were from medium cities than those from big cities (p = 0.0350), but significantly higher animal iron intake (p = 0.0404) and plant iron intake (p = 0.0385) were observed among females from villages and small towns compared to females from other groups. Based on the results, it may be concluded that size of the city and the economic status of the region are the most important environmental determinants of iron intake in adolescents and, hence, they should be taken into account while developing educational programs, especially for the female adolescent population.

Oral iron supplementation in patients with chronic kidney disease: Can it be harmful to the gut microbiota?

Patients with chronic kidney disease (CKD) have several pathophysiological alterations, including anemia, one of the first changes in CKD patients. More recently, researchers have observed that the intestinal microbiota alterations are also another complication in these patients. The most common treatment for anemia is oral (mainly ferrous sulfate) or intravenous iron supplementation. Despite being a necessary treatment, recent studies have reported that supplementation with oral iron may increase its availability in the intestine, leading to disturbance in the gut microbiota and also to oxidative stress in the enterocytes, which may change the permeability and the microbiota profile. Although it is a therapy routinely used in patients with CKD, supplementation with oral iron on the gut microbiota has been rarely studied in these patients. Thus, this review will discuss the relationship between iron and the gut microbiota and the possible effects of oral iron supplementation on gut microbiota in patients with CKD.

Indicators and Recommendations for Assessing Sustainable Healthy Diets

Research coupling human nutrition and sustainability concerns is a rapidly developing field, which is essential to guide governments' policies. This critical and comprehensive review analyzes indicators and approaches to "sustainable healthy diets" published in the literature since this discipline's emergence a few years ago, identifying robust gauges and highlighting the flaws of the most commonly used models. The reviewed studies largely focus on one or two domains such as greenhouse gas emissions or water use, while overlooking potential impact shifts to other sectors or resources. The present study covers a comprehensive set of indicators from the health, environmental and socio-economic viewpoints. This assessment concludes that in order to identify the best food option in sustainability assessments and nutrition analysis of diets, some aspects such as the classification and disaggregation of food groups, the impacts of the rates of local food consumption and seasonality, preservation methods, agrobiodiversity and organic food and different production systems, together with consequences for low-income countries, require further analysis and consideration.

The IHAT-GUT Iron Supplementation Trial in Rural Gambia: Barriers, Facilitators, and Benefits

Introduction: In most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical trial (termed IHAT-GUT), conducted at the Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM) (abbreviated as MRCG hereof). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in the Gambia. Methods: Individual interviews (n = 17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis. Results: Potential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff, and the local partnership. Conclusions: While facilitators and barriers were identified to conducting this clinical trial in a rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand.

Nano urea effects on Pleurotus ostreatus nutritional value depending on the dose and timing of application

The work investigated the effect of Lithovit-Urea50 on the composition of Pleurotus ostreatus (Jacq. Ex Fr.) P. Kumm. (1871) cultivated on spent oyster substrate mixed with wheat straw (1:1, w/w mixture). The product was applied in different doses (C1: 3 g kg-1 and C2: 5 g kg-1) at three distinct timings (t1: at spawning, t2: after first harvest, t3: at spawning and after first harvest). Protein and fiber contents increased respectively by 0.64 and 0.2% in C1t1 and by 0.46 and 0.8% in C2t2 compared to control (C0t0). Total carbohydrates increased by 0.48-3.76%. Sucrose and glucose contents decreased in the majority of treatments, while fructose increased in C2t1 (by 0.045%). Essential amino acids were the highest in C1t1, wherein respective improvement of 0.31, 0.10, 0.05, 0.21, 0.18, and 0.09% compared to C0t0. Similarly, C1t1 was superior in non-essential amino acids. Potassium, sodium, calcium, iron, and copper contents decreased in all treatments, with minor exceptions, zinc decreased in C1t1 and C2t1, while nickel and lead increased in all treatments. Conclusively, despite important ameliorations in the mushroom nutritional value, mostly in C1t1, the product should be further tested in lower doses (< 3 g kg-1) to counteract its effect on heavy metal bioaccumulation.

The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines

BACKGROUND

Postpartum anemia can negatively affect maternal health and interfere with early parenting. Thus, it is important to have clear, evidence-informed recommendations on its diagnosis and treatment.

OBJECTIVE

To compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences.

METHODS

Systematic searches were conducted in the databases PubMed, CINAHL, LILACS, TRIP database, and Scopus, and in the websites of health institutions and scientific societies. Search terms were related to anemia and the postpartum period. Two hundred and eighty papers were identified; the full texts of 30 sets of guidelines were reviewed, with seven being included in the final analysis. Recommendations were extracted through an evaluation of the evidence on the definition, screening, and diagnosis of anemia. The quality of the guidelines was assessed using the AGREE II instrument.

RESULTS

Two sets of guidelines have been elaborated by international organizations, and the rest were produced by professional associations within high-resource countries. The discrepancies found in the guidelines are important and affect the definition of anemia, the criteria for screening asymptomatic women, or the criteria guiding treatment. The quality of the guidelines commonly scored between 4 and 6 on a scale of 0 to 7. Recommendations with poor-quality evidence predominated over recommendations with high-quality evidence.

CONCLUSIONS

This review highlights the need to reach a consensus on the definition of postpartum anemia, to agree on what constitutes a problem for maternal health, and to provide recommendations that reach greater consensus on its diagnosis and treatment.

Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children: A randomized controlled trial

Background

Diarrhea and respiratory tract infections are leading causes of childhood morbidity and mortality. This individually randomized, double-blind placebo-controlled trial was designed to evaluate the effects of different zinc supplementation regimens on the incidence and duration of diarrhea and acute lower (ALRI) and upper (AURI) respiratory tract infections among rural Laotian children. The study included 3407 children, 6-23 months at enrollment.

Methods

Children were randomized to one of four study groups: therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days with each episode; TZ), daily preventive zinc tablets (7 mg/d; PZ), daily multiple micronutrient powder (10 mg/d zinc, 6 mg/d iron and 13 other micronutrients; MNP), or daily placebo powder for 9 months. Incidence and duration of diarrhea (≥3 liquid stools/24 hours), ALRI (persistent cough with wheezing, stridor or chest in-drawing) and AURI (purulent nasal discharge with cough) were assessed by parental report during weekly home visits and analyzed using negative binomial models.

Results

Baseline mean age was 14.2 ± 5.1 months, and 71% had low plasma zinc (<65 μg/dL). Overall diarrhea incidence (0.61 ± 0.01 episodes/100 days at risk) and duration (2.12 ± 0.03 days/episode) did not differ by study group. Age modified the impact of the interventions on diarrhea incidence (P = 0.06) and duration (P = 0.01). In children >18 months, TZ reduced diarrhea incidence by 24% vs MNP (P = 0.035), and 36% vs Control (P = 0.004), but there was no difference with PZ. This patterned remained when analyses were restricted to diarrhea episode occurring after the first treatment with TZ. Also, in children >18 months, TZ reduced diarrhea duration by 15% vs PZ (P = 0.03), and 16% vs Control (P = 0.03), but there was no difference with MNP. There were no overall effects of study group on incidence of ALRI (overall mean 0.005 ± 0.001 episodes/100 days, P = 0.14) or AURI (overall mean 0.09 ± 0.01 episodes/100 days, P = 0.72).

Conclusions

There was no overall impact of TZ, PZ or MNP on diarrhea, ALRI and AURI. However, in children >18 months, TZ significantly reduced both the duration of diarrhea episodes and the incidence of future diarrhea episodes compared with placebo.

Trial registration

ClinicalTrials.gov: NCT02428647.

An overview on mechanism, cause, prevention and multi-nation policy level interventions of dietary iron deficiency

Iron deficiency anemia (IDA) is probably the most ignored situation in the world of malnutrition-largely due to its slow progression. Multiple reasons can be attributed as the cause of IDA, which is not limited to any specific region or population; therefore, making it a matter of global concern. Despite the human body's ability to absorb and conserve iron stores, the gradual loss due to various physiological conditions leads to net deficiency of iron. Countless commercial iron supplements are available, but at given physiological conditions, almost all of these "Bio-not-available" iron forms quite often become ineffective. World Health Organization and other government bodies have jointly developed health advisories and tried to developed nutrition supplements several times in the last two decades. IDA, when combined with other disease conditions, becomes a life-threatening situation. At the same time, an overdose of iron could also be very harmful to the body. Therefore, it is important to deal with this situation with caution. This article covers iron metabolism, available options for iron supplementation, regulatory aspects and strategies to prevent IDA.

How Barunga Aboriginal community implemented and sustained an anaemia program - A case study evaluation

ISSUE ADDRESSED

Anaemia persists as a public health issue in many Aboriginal communities despite having standard practice guidelines. This case study reveals how Barunga Aboriginal Community in the Northern Territory (NT), Australia, implemented an Anaemia Program (1998-2016) which contributed to low anaemia prevalence in children aged under 5 years.

METHODS

This retrospective qualitative case study used purposive sampling to describe the Anaemia Program and factors influencing its implementation. Themes were developed from convergence of three data sources: interviews, program observation and document review. Data were inductively analysed by an Aboriginal and non-Aboriginal researcher and themes were validated by Barunga community health practitioners and compared to practice guidelines and implementation literature.

RESULTS

Health practitioners reported that the Anaemia Program contributed to a marked reduction in childhood anaemia prevalence over time. This was supported by available prevalence data. The locally adapted Anaemia Program was unique in the NT with a novel approach to community supplementation for anaemia prevention in addition to anaemia treatment. Supportive implementation influences included: Aboriginal leadership and the use of culturally supportive processes which reinforced the development of trust and strong relationships facilitating community acceptance of the Program. Routine, opportunistic and flexible health care practice, a holistic approach and a stable, skilled and experienced team sustained program implementation.

CONCLUSIONS

The holistic and successful Barunga Anaemia Program is supported by evidence and guidelines for treating and preventing childhood anaemia. The contextualisation of these guidelines aligned with the literature on effective Aboriginal primary health care implementation. SO WHAT?: This Anaemia Program provides a model for implementation of evidence-informed guidelines in an Aboriginal primary health care setting.

The Impact of Low-Level Iron Supplements on the Faecal Microbiota of Irritable Bowel Syndrome and Healthy Donors Using In Vitro Batch Cultures

Ferrous iron supplementation has been reported to adversely alter the gut microbiota in infants. To date, the impact of iron on the adult microbiota is limited, particularly at low supplementary concentrations. The aim of this research was to explore the impact of low-level iron supplementation on the gut microbiota of healthy and Irritable Bowel Syndrome (IBS) volunteers. Anaerobic, pH-controlled in vitro batch cultures were inoculated with faeces from healthy or IBS donors along with iron (ferrous sulphate, nanoparticulate iron and pea ferritin (50 μmol⁻¹ iron)). The microbiota were explored by fluorescence in situ hybridisation coupled with flow cytometry. Furthermore, metabolite production was assessed by gas chromatography. IBS volunteers had different starting microbial profiles to healthy controls. The sources of iron did not negatively impact the microbial population, with results of pea ferritin supplementation being similar to nanoparticulate iron, whilst ferrous sulphate led to enhanced Bacteroides spp. The metabolite data suggested no shift to potentially negative proteolysis. The results indicate that low doses of iron from the three sources were not detrimental to the gut microbiota. This is the first time that pea ferritin fermentation has been tested and indicates that low dose supplementation of iron is unlikely to be detrimental to the gut microbiota.

Personalized Nutrition Through The Gut Microbiota: Current Insights And Future Perspectives

This narrative review discusses how to preserve or increase health through personalized nutritional products and services using microbiome data. In contrast to other reviews, which discuss this subject in the light of metabolic disorders and/or with a nutrition-affects-the-microbiota view, this review takes the perspective that the gut microbiota (GM) affects nutrition. Gut microbes affect host nutritional status through their role in energy harvest and nutrient availability. Consequently, GM modulation could contribute to fulfil nutritional requirements and in this way conquer malnutrition and disease. This review provides an overview of microbiota modulation methods that could be used to improve nutritional status as well as the personalization of these approaches. While some of these methods are immediately applicable, others require more development to assess their feasibility and safety.

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.

Iron Absorption from Iron-Biofortified Sweetpotato Is Higher Than Regular Sweetpotato in Malawian Women while Iron Absorption from Regular and Iron-Biofortified Potatoes Is High in Peruvian Women

BACKGROUND

Sweetpotato and potato are fast-maturing staple crops and widely consumed in low- and middle-income countries. Conventional breeding to biofortify these crops with iron could improve iron intakes. To our knowledge, iron absorption from sweetpotato and potato has not been assessed.

OBJECTIVE

The aim was to assess iron absorption from regular and iron-biofortified orange-fleshed sweetpotato in Malawi and yellow-fleshed potato and iron-biofortified purple-fleshed potato in Peru.

METHODS

We conducted 2 randomized, multiple-meal studies in generally healthy, iron-depleted women of reproductive age. Malawian women (n = 24) received 400 g regular or biofortified sweetpotato test meals and Peruvian women (n = 35) received 500 g regular or biofortified potato test meals. Women consumed the meals at breakfast for 2 wk and were then crossed over to the other variety. We labeled the test meals with 57Fe or 58Fe and measured cumulative erythrocyte incorporation of the labels 14 d after completion of each test-meal sequence to calculate iron absorption. Iron absorption was compared by paired-sample t tests.

RESULTS

The regular and biofortified orange-fleshed sweetpotato test meals contained 0.55 and 0.97 mg Fe/100 g. Geometric mean (95% CI) fractional iron absorption (FIA) was 5.82% (3.79%, 8.95%) and 6.02% (4.51%, 8.05%), respectively (P = 0.81), resulting in 1.9-fold higher total iron absorption (TIA) from biofortified sweetpotato (P < 0.001). The regular and biofortified potato test meals contained 0.33 and 0.69 mg Fe/100 g. FIA was 28.4% (23.5%, 34.2%) from the regular yellow-fleshed and 13.3% (10.6%, 16.6%) from the biofortified purple-fleshed potato meals, respectively (P < 0.001), resulting in no significant difference in TIA (P = 0.88).

CONCLUSIONS

FIA from regular yellow-fleshed potato was remarkably high, at 28%. Iron absorbed from both potato test meals covered 33% of the daily absorbed iron requirement for women of reproductive age, while the biofortified orange-fleshed sweetpotato test meal covered 18% of this requirement. High polyphenol concentrations were likely the major inhibitors of iron absorption. These trials were registered at www.clinicaltrials.gov as NCT03840031 (Malawi) and NCT04216030 (Peru).

Toxicological risk factors in the burden of malnutrition: The case of nutrition (and risk) transition in sub-Saharan Africa

Toxicant exposures may worsen the micronutrient status, especially during the womb-to-childhood development, impairing organism programming and increasing the risk for health disorders in adulthood. Growing evidence calls for an integrated risk analysis of the interplay of environment, behavior and lifestyle, where a) imbalanced diet and micronutrient deficiencies may increase the vulnerability to toxicants and alter body defence systems and b) intake of antinutrients and contaminants may increase nutritional requirements. Such scenarios are especially evident in communities undergoing a fast nutrition transition, such as in many countries of sub-Saharan Africa. Specific challenges of toxicological risk analysis in sub-Saharan Africa still need a thorough assessment, including: rapid changes of lifestyle and consumers' preferences; dumping of foods and consumer' products; risk management under weak or non-existent awareness, legislation enforcement and infrastructures. The significant and growing literature from Africa-led scientific research should be used to build quality-controlled data repositories supporting regulatory top-down actions. Meanwhile, bottom-up actions (eg consumer's empowerment) could exploit social and economic drivers toward a qualified African presence in the global and local markets. A science-based combination of top-down and bottom-up actions on preventable toxicological risk factors will contribute fighting the new forms of malnutrition and prevent multi-factorial diseases. Exposures to toxicants should be included in the integrated approach proposed by WHO to address the urgent health challenge of simultaneously reduce the risk or burden of both malnutrition (ie deficiency of one or more essential nutrients) and overweight, obesity, and diet-related NCDs.

Hemoglobin point-of-care testing in rural Gambia: Comparing accuracy of HemoCue and Aptus with an automated hematology analyzer

Background

Anemia is one of the most impactful nutrient deficiencies in the world and disproportionately affects children in low-resource settings. Point-of-care devices (PoCDs) measuring blood hemoglobin (Hb) are widely used in such settings to screen for anemia due to their low cost, speed, and convenience. Here we present the first iteration of Aptus, a new PoCD which measures Hb and hematocrit (HCT).

Aim

To evaluate the accuracy of Aptus and HemoCue® Hb 301 against an automated hematology analyzer (Medonic®) in Gambian children aged 6–35 months and the Aptus’ usage in the field.

Methods

Aptus, HemoCue® and Medonic® were compared using venous blood (n = 180), and Aptus and HemoCue® additionally using capillary blood (n = 506). Agreement was estimated using Bland-Altman analysis and Lin’s concordance. Usage was assessed by error occurrence and user experience.

Results

Mean Hb values in venous blood did not significantly differ between Aptus and HemoCue® (10.44±1.05 vs 10.56±0.93g/dl, p>0.05), but both measured higher Hb concentrations than Medonic® (9.75±0.99g/dl, p<0.0001). Lin’s coefficient between Aptus and Medonic® was r_c = 0.548, between HemoCue® and Medonic® r_c = 0.636. Mean bias between the PoCDs venous measurements was -0.11g/dl with limits of agreement (LoA) -1.63 and 1.40g/dl. The bias was larger for the comparisons between the Medonic® and both Aptus (0.69g/dl, LoA 0.92 and 2.31g/dl) and HemoCue® (0.81g/dl, LoA 0.17 and 1.78g/dl). ROC curves showed an AUC of 0.933 in HemoCue® and 0.799 in Aptus. Capillary Hb was higher with Aptus than HemoCue® (10.33±1.11g/dl vs 10.01±1.07g/dl, p<0.0001). Mean bias was 0.32g/dl with LoA of -1.91 and 2.54g/dl. Aptus‘ usage proved intuitive, yet time-to-results and cuvettes could be improved.

Conclusion

Both PoCDs showed a relatively limited bias but large LoA. Aptus and HemoCue® showed similar accuracy, while both overestimated Hb levels. Aptus showed promise, with its operation unimpaired by field conditions as well as being able to show HCT values.