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Abdallah HR, Abdelrazek AA, Youness ER, Orban HA, Mahmoud MA, El Sayed AH, Zaki M. Assessment of vitamin status; A, E and D in Egyptian neonates with IUGR: a cross sectional study. BMC Pediatr 2024; 24:144. [PMID: 38413919 PMCID: PMC10900583 DOI: 10.1186/s12887-024-04624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Neonates with intrauterine growth retardation (IUGR) may present with fatal complications and permanent serious consequences. Vitamin status may influence fetal development. In this study we assessed vitamin A, E and D concentrations in umbilical cord blood in newborns with IUGR. METHODS Maternal data were obtained. Neonatal assessment included; age of gestation calculated from last menstrual period, Ultrasound (U/S), new Ballard, Apgar scores and anthropometric measurements including; Head circumference, length and weight. WHO growth percentile curves were used. Vitamin A, E and D in cord blood samples were measured by high performance liquid chromatography (HPLC) and ELISA consecutively. RESULTS A total of 86 full term newborns were enrolled in this study, 42 (48.8%) with IUGR with gestational age (33.59 ± 1.20) week by U/S and 44 (51.2%) appropriate for gestational age neonates with gestational age (38.70 ± 1.50). Ballard and Apgar scores (p < 0.05) and Z scores for weight, length and head circumference (p < 0.001) at birth were significantly lower in neonates with Intrauterine growth retardation (IUGR) than appropriate for gestational age (AGA) neonates. The levels of Vitamin A, E and D were significantly lower in the IUGR group than the AGA (p < 0.05) for all. Significant positive correlations of weight with vitamin A, and E cord blood levels were found (p < 0.05), while length was significantly positively correlated only with vitamin A (p < 0.05). Head circumference showed significant positive correlations with the three vitamins (p < 0.05) for all. CONCLUSION Neonates with IUGR had significantly lower levels of Vitamin A, E and D than AGA neonates. Significant positive correlations of weight with vitamin A, and E cord blood levels was detected, while neonatal length was associated only with vitamin A level. The present study highlights the significance of nutritional policies for inhibiting deficiency of these vitamins during pregnancy and childhood.
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Affiliation(s)
- Hanaa Reyad Abdallah
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt.
| | | | - Eman Refaat Youness
- Medical Biochemistry Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt
| | - Hisham A Orban
- Medical Biochemistry Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt
| | - Marwa A Mahmoud
- Medical Biochemistry Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt
| | - Ahmed Helal El Sayed
- Department of Pediatrics, Faculty of Medicine for boys, Al- Azhar University, Cairo, Egypt
| | - Moushira Zaki
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt
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Zhang H, Ren X, Yang Z, Lai J. Vitamin A Concentration in Human Milk: A Meta-Analysis. Nutrients 2022; 14:nu14224844. [PMID: 36432530 PMCID: PMC9699574 DOI: 10.3390/nu14224844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Humans require vitamin A (VA). However, pooled VA data in human milk is uncommon internationally and offers little support for dietary reference intake (DRIs) revision of infants under 6 months. As a result, we conducted a literature review and a meta-analysis to study VA concentration in breast milk throughout lactation across seven databases by August 2021. Observational or intervention studies involving nursing mothers between the ages of 18 and 45, with no recognized health concerns and who had full-term infants under 48 months were included. Studies in which retinol concentration was expressed as a mass concentration on a volume basis and determined using high-, ultra-, or ultra-fast performance liquid chromatography (HPLC, UPLC, or UFLC) were chosen. Finally, 76 papers involving 9171 samples published between 1985 and 2021 qualified for quantitative synthesis. Results from the random-effects model showed that the VA concentration of healthy term human milk decreased significantly as lactation progressed. VA (µg/L) with 95% CI at the colostrum, transitional, early mature and late mature stages being 920.7 (744.5, 1095.8), 523.7 (313.7, 733.6), 402.4 (342.5, 462.3) and 254.7 (223.7, 285.7), respectively (X2 = 71.36, p < 0.01). Subgroup analysis revealed no significant differences identified in VA concentration (µg/L) between Chinese and non-Chinese samples at each stage, being 1039.1 vs. 895.8 (p = 0.64), 505.7 vs. 542.2(p = 0.88), 408.4 vs. 401.2 (p = 0.92), 240.0 vs. 259.3 (p = 0.41). The findings have significant implications for the revision of DRIs for infants under six months.
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Affiliation(s)
- Huanmei Zhang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Xiangnan Ren
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Zhenyu Yang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
| | - Jianqiang Lai
- China-DRIs Expert Committee on Human Milk Composition, Chinese Nutrition Society, Beijing 100050, China
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence:
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Yang C, Zhao A, Ren Z, Zhang J, Wang P, Zhang Y. Vitamin A Nutritional Status of Urban Lactating Chinese Women and Its Associated Factors. Nutrients 2022; 14:nu14153184. [PMID: 35956361 PMCID: PMC9370282 DOI: 10.3390/nu14153184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
We aimed to investigate dietary vitamin A (DVA) intake, serum vitamin A (SVA) concentrations, and breast milk vitamin A (BMVA) concentrations of urban lactating Chinese women and explore the associated factors. We recruited 326 lactating women from ten cities in China and collected their dietary information, blood samples, and breast milk samples. SVA and BMVA were assessed with high-performance liquid chromatography. Mann–Whitney U tests, Kruskal–Wallis H tests, Chi-square tests, Spearman correlation tests, and multiple regression analyses were conducted. The median (25th, 75th) of DVA, SVA and BMVA were 372.36 (209.12, 619.78) μg RAE/day, 1.99 (1.71, 2.35) μmol/L, and 1.67 (1.13, 2.15) μmol/L, respectively. Only 3.1% of lactating women met the recommended nutrient intake of Vitamin A (VA), and 20.6% had a BMVA level below 1.05 μmol/L. Compared to underweight or normal weight women, overweight or obese lactating women had lower DVA and BMVA but higher SVA (p = 0.022; p = 0.030; p = 0.003). Multiparous women had a higher risk of inadequate BMVA (p = 0.023) than primiparous women. SVA and BMVA were positively associated with DVA, especially for lactating women not using VA supplements (β = 0.174, 95%CI = 0.025, 0.324, p = 0.022; β = 0.501, 95%CI = 0.208, 0.795, p = 0.001). There was no association between SVA and BMVA (β = 0.165, 95%CI = −0.037, 0.366, p = 0.109). In conclusion, VA nutritional status among Chinese urban lactating women needs more attention, especially for those who are obese, overweight, or higher parity. Increased DVA may contribute to increased BMVA.
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Affiliation(s)
- Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (Z.R.); (J.Z.)
- Children’s Health Care Center, Beijing Children’s Hospital of Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China;
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (Z.R.); (J.Z.)
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (Z.R.); (J.Z.)
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China;
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100191, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (Z.R.); (J.Z.)
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100191, China
- Correspondence:
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Prevalence of vitamin A deficiency in women of childbearing age in Brazil: a systematic review and meta-analysis. Br J Nutr 2022; 129:1765-1775. [PMID: 35670044 DOI: 10.1017/s0007114522001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vitamin A is an essential micronutrient, especially during pregnancy. We aimed to assess the prevalence of vitamin A deficiency in Brazilian women of childbearing age. We conducted a systematic review with meta-analysis of studies that assessed vitamin A deficiency in women of childbearing age following the registered protocol (CRD42020171856). Independent peer researchers selected the studies retrieved from MEDLINE, Embase, Scopus and other sources. Data from the eligible studies were extracted in pairs and assessed for methodological quality. The prevalence of vitamin A deficiency (< 0·70 µmol/l or <0·20 µg/dl) and 95 % CI was combined by meta-analysis, and heterogeneity was estimated by I2. Out of 3610 screened records, thirty-two studies were included, which assessed 12 577 women from 1965 to 2017, mostly in maternity hospitals. Main limitations of the studies were in sample frame (30/32) and sampling method (29/32). Deficiency occurred in 13 % (95 % CI 9·4, 17·2 %; I² = 97 %) of all women and was higher in pregnant women (16·1 %; 95 % CI 5·6, 30·6 %; I² = 98 %) than non-pregnant women (12·3 %; 95 % CI 8·4, 16·8 %; I² = 96 %). The prevalence increased according to the decade, from 9·5 % (95 % CI 1·9–21·6 %; I² = 98 %) up to 1990, 10·8 % (95 % CI 7·9, 14·2 %; I² = 86 %) in the 2000s and 17·8 % (95 % CI 8·7, 29·0 %; I² = 98 %) in the 2010s. Over 10 % of Brazilian women in childbearing age were deficient in vitamin A. Higher prevalence was observed in pregnant women, and deficiency seemed to be increasing over the decades. Low representativeness of the studies, mainly based on convenience sampling that included pregnant, postpartum, lactating and non-pregnant women, as well as high heterogeneity, limits the findings.
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Carotenoids and Vitamin A in Breastmilk of Hong Kong Lactating Mothers and Their Relationships with Maternal Diet. Nutrients 2022; 14:nu14102031. [PMID: 35631170 PMCID: PMC9148123 DOI: 10.3390/nu14102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Carotenoids and vitamin A are nutrients crucial to infants’ development. To date, there is limited data on their availability in breastmilk and the associated dietary factors, especially in Hong Kong, where people follow a westernized Chinese diet. This study determined the selected breastmilk’s carotenoid and vitamin A (retinol) contents by ultraperformance liquid chromatography with photodiode detection (UPLC-PDA) and the dietary intakes by three-day food records in 87 Hong Kong lactating mothers, who were grouped into tertiles based on their daily carotenoid intake. Low vitamin A intake (530.2 ± 34.2 µg RAE/day) and breastmilk retinol level (1013.4 ± 36.8 nmol/L) were reported in our participants, suggesting a poor vitamin A status of the lactating participants having relatively higher socioeconomic status in Hong Kong. Mothers in the highest tertile (T3) had higher breastmilk carotenoid levels than those in the lowest (T1) (p < 0.05). There were significant associations between maternal carotenoid intakes and breastmilk lutein levels in the linear regression models (p < 0.05) regardless of dietary supplement intake. Furthermore, maternal dark green vegetable intakes were associated with breastmilk retinol, lutein, and β-carotene levels. These findings can serve as dietary references for lactating mothers to enhance breastmilk carotenoid and vitamin A contents for the benefits of child growth and development.
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Ferraz IS, Vieira DMC, Ciampo LAD, Ued FDV, Almeida ACF, Jordão AA, Aragon DC, Martinez EZ, Martinelli CE, Nogueira-de-Almeida CA. Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome. J Pediatr (Rio J) 2022; 98:76-83. [PMID: 34000230 PMCID: PMC9432046 DOI: 10.1016/j.jped.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. METHODS Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 µmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. RESULTS VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). CONCLUSION a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.
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Affiliation(s)
- Ivan Savioli Ferraz
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Débora Mônica Costa Vieira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Luiz Antonio Del Ciampo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil.
| | - Fábio da Veiga Ued
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil
| | - Ane Cristina Fayão Almeida
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Alceu Afonso Jordão
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil
| | - Davi Casale Aragon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Edson Zangiacomi Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social, Ribeirão Preto, SP, Brazil
| | - Carlos Eduardo Martinelli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
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Gannon BM, Jones C, Mehta S. Vitamin A Requirements in Pregnancy and Lactation. Curr Dev Nutr 2020; 4:nzaa142. [PMID: 32999954 PMCID: PMC7513584 DOI: 10.1093/cdn/nzaa142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/06/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.
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Affiliation(s)
- Bryan M Gannon
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Camille Jones
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
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Samuel TM, Zhou Q, Giuffrida F, Munblit D, Verhasselt V, Thakkar SK. Nutritional and Non-nutritional Composition of Human Milk Is Modulated by Maternal, Infant, and Methodological Factors. Front Nutr 2020; 7:576133. [PMID: 33117843 PMCID: PMC7557356 DOI: 10.3389/fnut.2020.576133] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
Human milk (HM) is dynamic and shows a high inter- and intra-individual variability. To characterize HM with precision, it is necessary to understand the factors that modulate its composition. The objective of this narrative review is to summarize the maternal, infant and methodological factors that affect HM composition. We searched SCOPUS and PubMed databases for articles related to factors that are known to or could potentially influence HM composition and volume across lactation periods. Our comprehensive review encompasses various maternal-, infant-related, and methodological factors that modulate aspects of HM composition including macro- and micronutrients, vitamins and minerals, as well as volume. The most profound changes were observed in HM lipids and lipophiles. Evidence exists for many of the infant-related factors known to affect the nutritive and non-nutritive components of HM (e.g., birth weight, gestational age, infant age/stage of lactation). In contrast, less is known with respect to maternal factors; where there is either limited research or conflicting evidence (e.g., maternal lifestyle, obstetric history, medical conditions), except for the mother's diet, for which there is a relatively well-established understanding. Equally, although many of the methodological factors (e.g., HM sampling, handling and analytics) are known to impact HM composition, few studies have investigated this as a primary outcome, making it an important area of future research in HM. Here we propose a systematic capture of numerous maternal- and infant-related characteristics to facilitate associative comparisons of HM data within and across studies. Additionally, it would be prudent to standardize the methodological aspects known to affect HM composition in analytics, not only for HM lipids and lipophiles, but also for those nutrients whose variability is yet less well-understood. Defining the factors determining HM composition with accuracy will open perspectives for maternal intervention to optimize milk composition for specific needs of infants.
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Affiliation(s)
| | | | | | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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Schulze KJ, Gernand AD, Khan AZ, Wu LSF, Mehra S, Shaikh S, Ali H, Shamim AA, Sungpuag P, Udomkesmalee E, Labrique AB, West KP, Christian P. Newborn micronutrient status biomarkers in a cluster-randomized trial of antenatal multiple micronutrient compared with iron folic acid supplementation in rural Bangladesh. Am J Clin Nutr 2020; 112:1328-1337. [PMID: 32844185 PMCID: PMC7657323 DOI: 10.1093/ajcn/nqaa223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown. OBJECTIVE We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA supplementation and maternal gestational micronutrient status in rural Bangladeshi newborns. DESIGN In a double-blinded, cluster-randomized trial of antenatal IFA or MM (with the same IFA content), we analyzed cord blood plasma from 333 singleton births, and corresponding maternal plasma at 32.5 ± 2.6 wk of gestation, for ferritin (iron stores), folate, cobalamin (vitamin B-12), retinol (vitamin A), 25-hydroxyvitamin D [25(OH)D, vitamin D status], α-tocopherol (vitamin E), zinc, thyroglobulin, and free thyroxine (iodine status). Intervention effects and associations were determined using linear regression, exploring maternal status as a mediator of intervention effects on cord biomarkers. RESULTS The MM intervention increased cord ferritin (mean: +12.4%; 95% CI: 1.3, 24.6%), 25(OH)D (mean: +14.7%; 95% CI: 4.8, 25.6%), and zinc (mean: +5.8%; 95% CI: 1.0, 10.8%). Cord folate (mean: +26.8%; 95% CI: 19.6, 34.5%), cobalamin (mean: +31.3%; 95% CI: 24.6, 38.3%), 25(OH)D (mean: +26.7%; 95% CI: 23.2, 30.3%), α-tocopherol (mean: +8.7%; 95% CI: 3.6, 13.7%), zinc (mean: +2.3%; 95% CI: 0.5, 4.2%), thyroglobulin (mean: +20.1%; 95% CI: 9.0, 32.2%) and thyroxine (mean: +1.5%; 95% CI: 0.0, 3.0%) increased per 1-SD increment in maternal status (all P < 0.05); ferritin and retinol changed by +2.0%; 95% CI: -8.9, 14.3%; P = 0.72; and +3.5%; 95% CI: -0.4, 7.3%; P = 0.07, respectively. Ferritin, folate, cobalamin, zinc, and thyroglobulin averaged 1.57-6.75 times higher and retinol, α-tocopherol, and 25(OH)D 0.30-0.84 times lower in cord than maternal plasma, suggesting preferential maternal-fetal transfer of iron, folate, cobalamin, and zinc; limited transfer of fat-soluble vitamins; and high fetal iodine demand. CONCLUSIONS Antenatal MM supplementation increased newborn ferritin, 25(OH)D, and zinc, while maternal and newborn folate, vitamins B-12, D, and E, zinc, and iodine biomarkers were positively related. Despite limited effects of MM, better maternal micronutrient status was associated with improved micronutrient status of Bangladeshi newborns. This trial was registered at clinicaltrials.gov as NCT00860470.
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Affiliation(s)
| | - Alison D Gernand
- Present address for ADG: Department of Nutritional Sciences, The Pennsylvania State University, 224 Chandlee Lab, University Park, PA 16802, USA
| | - Afreen Zaman Khan
- Present address for AZK: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Abu Ahmed Shamim
- Present address for AAS: BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sheftel J, Bresnahan KA, Fadjarwati T, Tanumihardjo SA. Modified relative dose response values differ between lactating women in the United States and Indonesia. Exp Biol Med (Maywood) 2020; 245:797-804. [PMID: 32326757 PMCID: PMC7273887 DOI: 10.1177/1535370220921550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
IMPACT STATEMENT Vitamin A (VA) deficiency is a major health issue globally, and lactating women are particularly vulnerable due to increased needs for milk production. Accurate detection of VA deficiency is important; however, most population surveys measure VA status using serum retinol, which is affected by inflammation and lacks sensitivity. The modified relative dose response (MRDR) test qualitatively distinguishes between VA deficiency and sufficiency and could improve population surveys if completed in a randomly selected subsample of individuals in surveys. The original relative dose response test required two blood samples, while MRDR requires only one, a significant improvement in accessibility of the technique by decreasing burden on subjects and investigators. This work demonstrates significant deficiency in Indonesian women compared with US women. In combination with previous research using lactating sows, these human data support milk as a surrogate for blood in the MRDR, which may be less invasive, but requires further validation.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Kara A Bresnahan
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Tetra Fadjarwati
- National Institute for Health Research and Development (Badan Litbang Kesehatan), Jakarta 10560, Indonesia
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
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Bezerra DS, Ribeiro KDS, Lima MSR, Pires Medeiros JF, da Silva AGCL, Dimenstein R, Osório MM. Retinol status and associated factors in mother-newborn pairs. J Hum Nutr Diet 2019; 33:222-231. [PMID: 31602713 DOI: 10.1111/jhn.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamin A deficiency is still considered to be a nutritional problem during pregnancy, lactation and early childhood. The present study aimed to assess the vitamin A status of women and their newborns in the Brazilian Northeast and to determine the association between retinol in the maternal serum, umbilical cord blood and colostrum. METHODS Vitamin A status in 65 pairs of women and newborns was assessed from samples of the mother's serum, umbilical cord serum and colostrum using high-performance liquid chromatography. The inadequacy of the vitamin A status of mothers and infants was identified if the retinol values were <0.7 µmol L- 1 in maternal serum or umbilical cord blood or <1.05 µmol L-1 in colostrum. RESULTS The prevalence of inadequate maternal vitamin A status was 21.5% (95% CI: 11.5%-31.5%) and 13.8% [95% confidence interval (CI) = 5.4%-22.2%] based on maternal serum and colostrum, respectively. Among newborns, 41.5% (95% CI = 29.3%-53.5%) presented a low status of vitamin A based on cord serum. Multiple linear regression analysis identified that maternal serum retinol is a predictor of umbilical cord retinol (P = 0.005). Retinol in maternal serum was lower in mothers who were less educated (P = 0.04) and colostrum retinol was higher in older (P = 0.04) and multiparous (P = 0.002) mothers. CONCLUSIONS Vitamin A deficiency is a common problem among mothers attended in public hospitals in Northeast Brazil and maternal retinol concentrations are associated with retinol status in newborns. Maternal age, parity and educational level were related to the maternal vitamin A status.
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Affiliation(s)
- D S Bezerra
- Department of Nutrition, School of Health Sciences of Trairi - Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - K D S Ribeiro
- Department of Nutrition - Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - M S R Lima
- Department of Biochemistry, Bioscience Centre - Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - J F Pires Medeiros
- Department of Biochemistry, Bioscience Centre - Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - A G C L da Silva
- Department of Nutrition - Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - R Dimenstein
- Department of Biochemistry, Bioscience Centre - Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - M M Osório
- Program in Nutrition - Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Machado MR, Kamp F, Nunes JC, El-Bacha T, Torres AG. Breast Milk Content of Vitamin A and E from Early- to Mid-Lactation Is Affected by Inadequate Dietary Intake in Brazilian Adult Women. Nutrients 2019; 11:E2025. [PMID: 31470574 PMCID: PMC6770016 DOI: 10.3390/nu11092025] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/18/2022] Open
Abstract
Our aims were to investigate vitamin A and E status during lactation and the determinants of breast milk content for the appropriate nutrition of the infant in a study with nursing Brazilian women. We hypothesized that both inadequate intake and the lipoprotein distribution of vitamin A and E during lactation could have an impact on their breast milk levels from early- to mid-lactation. Nineteen adult lactating women participated in this longitudinal observational study, in which dietary records, blood and mature breast milk samples were collected for the analysis of vitamin A and E, and carotenoids in early- (2nd to 4th week) and mid-lactation (12th to 14th week). Nutrient intake was balanced by the Multiple Source Method (MSM), and the intake of vitamin A and E was inadequate in 74 and 100% of the women, respectively. However, these results were not reflected in low serum concentrations of retinol and only 37% of the volunteers were vitamin E deficient according to the blood biomarker. As lactation progressed, vitamin A and E status worsened, and this was clearly observed by the decrease in their content in breast milk. The reduced content of vitamin A and E in the breast milk was not related to their distribution in lipoproteins. Taken together, the contents of vitamin A and E in breast milk seemed to be more sensitive markers of maternal nutrition status than respective blood concentrations, and dietary assessment by the MSM in early lactation was sensitive to indicate later risks of deficiency and should support maternal dietary guidance to improve the infant's nutrition.
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Affiliation(s)
- Michele R Machado
- Laboratory of Food Science and Nutritional Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-909, Brazil
- School of Nutrition, Faculdade Arthur Sa Earp Neto (FMP/FASE), Petropolis, Rio de Janeiro 25680-120, Brazil
| | - Fernanda Kamp
- Laboratory of Food Science and Nutritional Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-909, Brazil.
- Biochemistry Core, Federal Institute of Education, Science and Technology of Rio de Janeiro, Rio de Janeiro 20270-021, Brazil.
| | - Juliana C Nunes
- Laboratory of Food Science and Nutritional Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-909, Brazil
- School of Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-250, Brazil
| | - Tatiana El-Bacha
- Laboratory of Food Science and Nutritional Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-909, Brazil
- Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EL, UK
| | - Alexandre G Torres
- Laboratory of Food Science and Nutritional Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-909, Brazil.
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da Silva AGCL, de Sousa Rebouças A, Mendonça BMA, Silva DCNE, Dimenstein R, Ribeiro KDDS. Relationship between the dietary intake, serum, and breast milk concentrations of vitamin A and vitamin E in a cohort of women over the course of lactation. MATERNAL & CHILD NUTRITION 2019; 15:e12772. [PMID: 30578660 PMCID: PMC7198973 DOI: 10.1111/mcn.12772] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/12/2018] [Accepted: 12/13/2018] [Indexed: 12/16/2022]
Abstract
This study evaluated the nutritional status of lactating women with regard to vitamins A and E and the relationship between dietary intake and concentrations in serum and milk. A longitudinal study was conducted with 43 women at a hospital in northeastern Brazil. Blood and milk samples and food intake recalls were obtained at three moments during the breastfeeding period. Retinol and alpha-tocopherol were analysed by high-performance liquid chromatography. Dietary inadequacy was analysed according to the estimated average requirement, with intrapersonal variation adjusted by the multiple source method. Food intake was classified by quartiles of consumption. Serum retinol was 1.65 μmol/L, with 5% of low concentrations (<0.7 μmol/L) at the first collection. Serum alpha-tocopherol decreased from 30.18 to 25.49 μmol/L at the third collection (P = 0.008), with an increase in the percentage frequency of deficiency (<12 μmol/L). Both vitamins maintained stable concentrations in milk at the different collection times, and the overall dietary inadequacy of vitamins A and E was 58% and 100%, respectively. There was a correlation only between vitamin A intake and serum retinol (r = 0.403, P = 0.007), and higher retinol concentrations were found in women classified in the highest consumption quartile (P = 0.031). Over the course of lactation, there was a high degree of inadequacy in vitamin intake and a reduction in serum alpha-tocopherol, whereas its concentrations in milk remained unchanged. Dietary intake of vitamin A has been shown to influence serum retinol, which underscores the importance of adequate nutrition and monitoring of vitamin deficiency during lactation.
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Affiliation(s)
| | - Amanda de Sousa Rebouças
- Department of BiochemistryFederal University of Rio Grande do NorteNatalRio Grande do NorteBrazil
| | | | | | - Roberto Dimenstein
- Department of BiochemistryFederal University of Rio Grande do NorteNatalRio Grande do NorteBrazil
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