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Stoffel NU, Cepeda-López AC, Zeder C, Herter-Aeberli I, Zimmermann MB. Measurement of iron absorption and iron gains from birth to 6 months in breastfed and formula-fed infants using iron isotope dilution. SCIENCE ADVANCES 2024; 10:eado4262. [PMID: 38985881 PMCID: PMC11235178 DOI: 10.1126/sciadv.ado4262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024]
Abstract
Little is known about iron kinetics in early infancy. We administered stable iron isotopes to pregnant women and used maternal-fetal iron transfer to enrich newborn body iron. Dilution of enriched body iron by dietary iron with natural isotopic composition was used to assess iron kinetics from birth to 6 months. In breastfed (BF, n = 8), formula-fed (FF, n = 7), or mixed feeding (MF, n = 8) infants, median (interquartile range) iron intake was 0.27, 11.19 (10.46-15.55), and 4.13 (2.33-6.95) mg/day; iron absorbed was 0.128 (0.095-0.180), 0.457 (0.374-0.617), and 0.391 (0.283-0.473) mg/day (BF versus FF, P < 0.01); and total iron gains were 0.027 (-0.002-0.055), 0.349 (0.260-0.498), and 0.276 (0.175-0.368) mg/day (BF versus FF, P < 0.001; BF versus MF, P < 0.05). Isotope dilution can quantify long-term iron absorption and describe the trajectory of iron depletion during early infancy.
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Affiliation(s)
- Nicole U. Stoffel
- Laboratory of Human Nutrition, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Ana Carla Cepeda-López
- Tecnologico de Monterrey, Institute for Obesity Research, Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Mexico
| | - Christophe Zeder
- Laboratory of Human Nutrition, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Michael B. Zimmermann
- Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Ceballos-Rasgado M, Lowe NM, Moran VH, Clegg A, Mallard S, Harris C, Montez J, Xipsiti M. Toward revising dietary zinc recommendations for children aged 0 to 3 years: a systematic review and meta-analysis of zinc absorption, excretion, and requirements for growth. Nutr Rev 2022:6881443. [PMID: 36478064 DOI: 10.1093/nutrit/nuac098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT The Food and Agriculture Organization of the United Nations and the World Health Organization are updating their dietary zinc recommendations for children aged 0 to 3 years. OBJECTIVE The aim of this review was to retrieve and synthesize evidence regarding zinc needs for growth as well as zinc losses, absorption, and bioavailability from the diet. DATA SOURCES MEDLINE, Embase, and Cochrane Library databases were searched electronically from inception to August 2020. Studies assessing the above factors in healthy children aged 0 to 9 years were included, with no limits on study design or language. DATA EXTRACTION Ninety-four studies reporting on zinc content in tissue (n = 27); zinc absorption (n = 47); factors affecting zinc bioavailability (n = 30); and endogenous zinc losses via urine, feces, or integument (n = 40) met the inclusion criteria. Four reviewers extracted data and two reviewers checked for accuracy. DATA ANALYSES Studies were synthesized narratively, and meta-analyses of zinc losses and gains as well the subgroups of age, type of feeding, country's income, and molar ratio of phytate to zinc were conducted. Meta-analysis revealed an overall mean (95%CI) urinary and endogenous fecal zinc excretion of 17.48 µg/kg/d (11.80-23.15; I2 = 94%) and 0.07 mg/kg/d (0.06-0.08; I2 = 82%), respectively, with a mean fractional zinc absorption of 26.75% (23.69-29.81; I2 = 99%). Subgrouping by age revealed differences in mean values associated with the transition from milk-based diets to solid food during the first 3 years of life. CONCLUSION This review synthesizes data that may be used to formulate zinc requirements in young children. Results should be interpreted with caution because of considerable heterogeneity in the evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020215236.
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Affiliation(s)
| | - Nicola M Lowe
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
| | - Victoria H Moran
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Simonette Mallard
- New Zealand College of Public Health Medicine, Wellington, New Zealand
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Jason Montez
- Nutrition and Food Safety Department, World Health Organization, Geneva, Switzerland
| | - Maria Xipsiti
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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Rana ZH, Bourassa MW, Gomes F, Khadilkar A, Mandlik R, Owino V, Pettifor JM, Roth DE, Shlisky J, Thankachan P, Weaver CM. Calcium status assessment at the population level: Candidate approaches and challenges. Ann N Y Acad Sci 2022; 1517:93-106. [PMID: 36044378 DOI: 10.1111/nyas.14886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Inadequate dietary calcium intake is a global public health problem that disproportionately affects low- and middle-income countries. However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high-risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium-rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population-level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population-based surveys.
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Affiliation(s)
- Ziaul H Rana
- The New York Academy of Sciences, New York, New York, USA
| | | | - Filomena Gomes
- The New York Academy of Sciences, New York, New York, USA.,NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Victor Owino
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - John M Pettifor
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Daniel E Roth
- The Hospital for Sick Children/University of Toronto, Toronto, Ontario, Canada
| | - Julie Shlisky
- The New York Academy of Sciences, New York, New York, USA
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Impact of Zinc on Oxidative Signaling Pathways in the Development of Pulmonary Vasoconstriction Induced by Hypobaric Hypoxia. Int J Mol Sci 2022; 23:ijms23136974. [PMID: 35805984 PMCID: PMC9266543 DOI: 10.3390/ijms23136974] [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: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Hypobaric hypoxia is a condition that occurs at high altitudes (>2500 m) where the partial pressure of gases, particularly oxygen (PO2), decreases. This condition triggers several physiological and molecular responses. One of the principal responses is pulmonary vascular contraction, which seeks to optimize gas exchange under this condition, known as hypoxic pulmonary vasoconstriction (HPV); however, when this physiological response is exacerbated, it contributes to the development of high-altitude pulmonary hypertension (HAPH). Increased levels of zinc (Zn2+) and oxidative stress (known as the “ROS hypothesis”) have been demonstrated in the vasoconstriction process. Therefore, the aim of this review is to determine the relationship between molecular pathways associated with altered Zn2+ levels and oxidative stress in HPV in hypobaric hypoxic conditions. The results indicate an increased level of Zn2+, which is related to increasing mitochondrial ROS (mtROS), alterations in nitric oxide (NO), metallothionein (MT), zinc-regulated, iron-regulated transporter-like protein (ZIP), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-induced protein kinase C epsilon (PKCε) activation in the development of HPV. In conclusion, there is an association between elevated Zn2+ levels and oxidative stress in HPV under different models of hypoxia, which contribute to understanding the molecular mechanism involved in HPV to prevent the development of HAPH.
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Abstract
PURPOSE Osteoporosis in pregnancy is an uncommon disease and there is little information regarding its pathogenesis and its effects on the skeleton. This review aims to describe changes in mineral metabolism during pregnancy and lactation as well as their clinical impact. METHODS We performed a narrative review of the literature using the PubMed and Google Scholar databases for articles published from 1955 to 2021. RESULTS Mineral metabolism in the mother must adapt to the demand created by the fetus and the placenta, which together absorb calcium and other minerals from the mother to mineralize the developing fetal skeleton; analyses of iliac bone biopsies at the beginning and end of pregnancy have shown that pregnancy significantly modifies maternal bone status. The greatest demand for calcium for the maternal skeleton occurs during lactation; women who breastfeed have an even greater loss of calcium to produce milk. However, it is controversial whether breastfeeding can increase the risk of osteoporotic fractures, and the possible mechanism is considerably complicated. Osteoporosis in pregnancy is an uncommon disease characterized by the occurrence of fragility fractures, most commonly in the vertebral column, in the third trimester of pregnancy, or early postpartum. The pathogenesis of PLO remains unclear owing to its rarity; DXA provides a sensitive and specific method for diagnosing osteoporosis by measuring BMD, one of the parameters that allow a better understanding of fracture risk. One limitation is the controversy in using radiation in pregnant women and the risk to the embryo/fetus; a safe alternative can be MRI. CONCLUSION Pregnancy and lactation alter the maternal bone status; without a balance in metabolism, this may cause an increased risk of fracture due to changes in BMD. There is little information on BMD during pregnancy; more clinical studies are required to elucidate if this represents a risk factor for osteoporosis.
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Shertukde SP, Cahoon DS, Prado B, Cara KC, Chung M. Calcium Intake and Metabolism in Infants and Young Children: A Systematic Review of Balance Studies for Supporting the Development of Calcium Requirements. Adv Nutr 2022; 13:1529-1553. [PMID: 35038320 PMCID: PMC9526821 DOI: 10.1093/advances/nmac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023] Open
Abstract
Determining calcium requirements for infants and children is vital due to high calcium needs for growth. Balance studies enable comprehensive measurement of calcium metabolism and can support nutrient requirement development. This systematic review summarizes evidence from mass balance and isotopic studies in children aged 0-4 y to address key questions on calcium loss and absorption/retention identified by an expert group developing calcium requirements. Literature searches were implemented in multiple electronic databases to June 2020. Balance studies assessing calcium intake, loss, absorption, or retention in healthy children were eligible. A newly developed risk-of-bias assessment tool was used for balance studies, and a modified Grades of Recommendation, Assessment, Development, and Evaluation approach determined strength of evidence. Altogether, 23 studies (15 mass balance; 8 isotope) with 485 total participants were included. Only 3 studies were of children >6 mo. Mass balance studies suggested infant feed components may influence calcium balance. The random-effects model meta-regression on 42 mass balance study arms showed an average net calcium retention of 40.4% among infants aged 0-6 mo (β = 0.404 [95% CI: 0.302, 0.506]). Isotope studies suggested calcium intake of 240 to 400 mg/d may promote optimal calcium absorption with minimal loss, and intake from human milk may lead to greater absorption and retention efficacy than formula or solid foods. Most studies had low risk of bias. Strength of evidence was low due to variability in infant feedings, limited endogenous and dermal calcium loss measures, and few studies isolating calcium effects. To improve certainty of the body of evidence, more balance studies isolating effects of calcium intake in this age group are needed. Future work on calcium needs should incorporate both balance measures and biological endpoints of importance (e.g. bone mineral density or content) to determine adequate calcium intake for growth in infants and children.
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Affiliation(s)
- Shruti P Shertukde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Danielle S Cahoon
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Belen Prado
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kelly Copeland Cara
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Mei Chung
- Address correspondence to MC (e-mail: )
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Fournier E, Roussel C, Dominicis A, Ley D, Peyron MA, Collado V, Mercier-Bonin M, Lacroix C, Alric M, Van de Wiele T, Chassard C, Etienne-Mesmin L, Blanquet-Diot S. In vitro models of gut digestion across childhood: current developments, challenges and future trends. Biotechnol Adv 2021; 54:107796. [PMID: 34252564 DOI: 10.1016/j.biotechadv.2021.107796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023]
Abstract
The human digestion is a multi-step and multi-compartment process essential for human health, at the heart of many issues raised by academics, the medical world and industrials from the food, nutrition and pharma fields. In the first years of life, major dietary changes occur and are concomitant with an evolution of the whole child digestive tract anatomy and physiology, including colonization of gut microbiota. All these phenomena are influenced by child exposure to environmental compounds, such as drugs (especially antibiotics) and food pollutants, but also childhood infections. Due to obvious ethical, regulatory and technical limitations, in vivo approaches in animal and human are more and more restricted to favor complementary in vitro approaches. This review summarizes current knowledge on the evolution of child gut physiology from birth to 3 years old regarding physicochemical, mechanical and microbial parameters. Then, all the available in vitro models of the child digestive tract are described, ranging from the simplest static mono-compartmental systems to the most sophisticated dynamic and multi-compartmental models, and mimicking from the oral phase to the colon compartment. Lastly, we detail the main applications of child gut models in nutritional, pharmaceutical and microbiological studies and discuss the limitations and challenges facing this field of research.
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Affiliation(s)
- Elora Fournier
- Université Clermont Auvergne, INRAE, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, CRNH Auvergne, 63000 Clermont-Ferrand, France; Toxalim, Research Centre in Food Toxicology, INRAE, ENVT, INP-Purpan, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Charlène Roussel
- Laval University, INAF Institute of Nutrition and Functional Foods, G1V 0A6 Quebec, Canada
| | - Alessandra Dominicis
- European Reference Laboratory for E. coli, Istituto Superiore di Sanità, Rome, Italy
| | - Delphine Ley
- Université Lille 2, Faculté de Médecine, Inserm U995 Nutritional Modulation of Infection and Inflammation, 59045 Lille, France
| | - Marie-Agnès Peyron
- Université Clermont Auvergne, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - Valérie Collado
- Université Clermont Auvergne, EA 4847, CROC, Centre de Recherche en Odontologie Clinique, 63000 Clermont-Ferrand, France
| | - Muriel Mercier-Bonin
- Toxalim, Research Centre in Food Toxicology, INRAE, ENVT, INP-Purpan, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zürich, Switzerland
| | - Monique Alric
- Université Clermont Auvergne, INRAE, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - Tom Van de Wiele
- Ghent University, Center for Microbial Ecology and Technology (CMET), Coupure Links 653, 9000 Ghent, Belgium
| | - Christophe Chassard
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMRF, 15000 Aurillac, France
| | - Lucie Etienne-Mesmin
- Université Clermont Auvergne, INRAE, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphanie Blanquet-Diot
- Université Clermont Auvergne, INRAE, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, CRNH Auvergne, 63000 Clermont-Ferrand, France.
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A Substantial Proportion of 6- to 12-Month-Old Infants Have Calculated Daily Absorbed Iron below Recommendations, Especially Those Who Are Breastfed. J Pediatr 2021; 231:36-42.e2. [PMID: 33144115 DOI: 10.1016/j.jpeds.2020.10.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To calculate the amount of bioavailable iron consumed among 6- to 12- month-old infants considering differences in iron bioavailability among dietary iron sources and to compare this with current recommended intakes. STUDY DESIGN We used the Feeding Infants and Toddlers Study database of dietary intakes from 2016 and the estimated bioavailability of dietary iron sources to evaluate the proportion of infants whose calculated total daily absorbed iron fell below physiologic requirements, that is, the recommended amount needed to fully support growth and erythropoiesis. RESULTS The calculated daily iron absorption was below the recommended amount in 54.3% of infants evaluated ranging from 19.5% of 448 exclusively formula-fed infants, to 95.8% of 296 exclusively breastfed infants and 72.2% of 102 mixed fed infants. The calculated mean iron absorption of 6- to 9- month-old breastfed infants was 0.27 mg/day, far less than the estimated physiologic requirement of 0.69 mg/day. The most highly bioavailable iron, heme iron, was <12% of the contributor to total iron absorbed in breastfed infants. CONCLUSIONS These data indicate a need for further education and public health policies to support increased iron intake in 6- to 12- month-old infants, emphasizing those receiving any breast milk. Exclusively formula-fed infants are at lower risk, but rates of low absorbed iron indicate that all infants may need monitoring for clinical evidence of low iron status. Consideration should be given to increasing the proportion of heme iron obtained from animal products in the diet where feasible.
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Leong C, Gibson RS, Diana A, Haszard JJ, Rahmannia S, Ansari MB, Inayah LS, Purnamasari AD, Houghton LA. Differences in Micronutrient Intakes of Exclusive and Partially Breastfed Indonesian Infants from Resource-Poor Households are Not Accompanied by Differences in Micronutrient Status, Morbidity, or Growth. J Nutr 2021; 151:705-715. [PMID: 33438018 PMCID: PMC7948196 DOI: 10.1093/jn/nxaa381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND When maternal micronutrient intakes and statuses are compromised, reductions in micronutrient concentrations in neonatal stores and human milk may result in suboptimal micronutrient intakes, statuses, and functional outcomes of breastfed infants during the critical first 6-month period. OBJECTIVES We compared the adequacy of micronutrient intakes and statuses at 2 and/or 5 months and morbidity and growth faltering at 2, 5, and 12 months in a cohort of exclusively breastfed (EBF) and partially breastfed (PBF) infants from low-resource Indonesian households. METHODS At 2 and 5 months, the breastfeeding status and human milk intake of 212 infants were determined using the deuterium oxide dose-to-mother technique, and intakes were calculated from milk micronutrient concentrations and 3-d weighed food intakes. At 5 months, five infant micronutrient biomarkers, hemoglobin, C-reactive protein, and α-1-acid-glycoprotein were measured. Infant morbidity, weight, and length were measured at 2, 5, and 12 months. Means, medians, or proportions were reported for each group and differences between groups were statistically determined. RESULTS Median intakes of iron, thiamin, niacin, and vitamin B-12 were higher in PBF than EBF infants at 5 months (all P values < 0.05), but intakes in all infants were below adequate intakes. At 5 months, anemia was <20% in both groups, although fewer PBF versus EBF infants had vitamin B-12 deficiency (11.5% vs. 28.6%, respectively; P = 0.011). The mean ± SD length-for-age z-scores for EBF versus PBF infants at 2 months were 0.7 ± 0.9 versus -0.5 ± 1.1, respectively (P = 0.158), declining to -1.4 ± 0.9 versus -1.1 ± 1.2, respectively, at 12 months (P = 0.059). Reported morbidity rates were generally low, with no evidence of a difference between infant groups (all P values > 0.126). CONCLUSIONS Irrespective of exclusive or partial breastfeeding status, micronutrient intakes of infants were low, statuses were compromised, and growth faltering during the critical 6 months period of early infancy was present. The findings highlight the importance of improving maternal nutritional statuses and evaluating their impacts on infant outcomes.
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Affiliation(s)
- Claudia Leong
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Sofa Rahmannia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Medicine, Universitas Pasundan, Bandung, Indonesia
| | | | - Lina Sofiatul Inayah
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Afini Dwi Purnamasari
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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11
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Patterson KY, Veillon C. Stable Isotopes of Minerals as Metabolic Tracers in Human Nutrition Research. Exp Biol Med (Maywood) 2016; 226:271-82. [PMID: 11368418 DOI: 10.1177/153537020122600403] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Enriched stable isotopes used as tracers have proven to be valuable in studies of the absorption and metabolism of minerals. Unlike radioisotopes, they can be used in high-risk population groups such as infants, children, and pregnant or lactating women. Estimates of mineral absorption can be made from the oral administration of a single tracer or from two tracers, one given orally and the other intravenously (IV). It is possible to determine the metabolism of the mineral with modeling based on the amount of the tracer or tracers in different biological samples. One of the key decisions in studies of this type is determining which enriched isotope and what amount to use. An example is given of calculations to estimate and compare the amounts of tracers needed for an absorption study. Methods for calculating the amounts of tracer in oral and IV doses are presented, and limits of detection and quantitation are discussed in terms of percent of enrichment and related to isotope ratio measurement precision. A general review of the use of mass spectrometric instruments for quantifying various stable isotopes is given.
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Affiliation(s)
- K Y Patterson
- USDA, Beltsville Human Nutrition Research Center, Maryland 20705, USA
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Affiliation(s)
- Michael Hambidge
- Department of Pediatrics, at the University of Colorado Health Sciences Center in Denver, Colorado, USA
| | - Nancy F. Krebs
- Department of Pediatrics, at the University of Colorado Health Sciences Center in Denver, Colorado, USA
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Thacher TD, Smith L, Fischer PR, Isichei CO, Cha SS, Pettifor JM. Optimal Dose of Calcium for Treatment of Nutritional Rickets: A Randomized Controlled Trial. J Bone Miner Res 2016; 31:2024-2031. [PMID: 27311415 DOI: 10.1002/jbmr.2886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 02/05/2023]
Abstract
Calcium supplementation is indicated for the treatment of nutritional rickets. Our aim was to determine the optimal dose of calcium for treatment of children with rickets. Sixty-five Nigerian children with radiographically confirmed rickets were randomized to daily supplemental calcium intake of 500 mg (n = 21), 1000 mg (n = 23), or 2000 mg (n = 21). Venous blood, radiographs, and forearm areal bone density (aBMD) were obtained at baseline and at 8, 16, and 24 weeks after enrollment. The primary outcome was radiographic healing, using a 10-point radiographic severity score. The radiographic severity scores improved in all three groups, but the rate of radiographic healing (points per month) was significantly more rapid in the 1000-mg (-0.29; 95% confidence interval [CI] -0.13 to -0.45) and 2000-mg (-0.36; 95% CI -0.19 to -0.53) supplementation groups relative to the 500-mg group. The 2000-mg group did not heal more rapidly than the 1000-mg group. Of those who completed treatment for 24 weeks, 12 (67%), 20 (87%), and 14 (67%) in the 2000-mg, 1000-mg, and 500-mg groups, respectively, had achieved a radiographic score of 1.5 or less (p = 0.21). Serum alkaline phosphatase decreased and calcium increased similarly in all groups. Forearm diaphyseal aBMD improved significantly more rapidly in the 2000-mg group than in the 500-mg and 1000-mg groups (p < 0.001). Daily calcium intakes of 1000 mg or 2000 mg produced more rapid radiographic healing of rickets than 500 mg, but 2000 mg did not have greater benefit than 1000 mg. Some children require longer than 24 weeks for complete healing of nutritional rickets. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen S Cha
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ, USA
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jovaní M, Barberá R, Farré R. Review: Effect of Some Components of Milk- and Soy-Based Infant Formulas on Mineral Bioavailability. FOOD SCI TECHNOL INT 2016. [DOI: 10.1106/r4eb-xxla-9mlp-bqyk] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Infants’ high nutritional needs are fulfilled by mother’s milk or infant formulas to provide all the necessary nutrients, among them minerals. Minerals uptake depends not only on mineral content but also on their bioavailability which, in turn, is affected by the different components of the infant formulas. An understanding of these effects would help to improve mineral bioavailability. This work reviews the influence of endogenous (proteins and phytates) and added (ascorbic and citric acid) components in infant formulas on the bioavailability of nutritionally important mineral elements (calcium, zinc, iron and copper) and their interactions. Special attention is given to the influence of protein, which is positive for calcium and negative for iron absorption. The marked negative effect of phytates on iron and zinc absorption can be counteracted by a dephytinization process. Of the added compounds, ascorbic acid has a positive effect on iron absorption that depends on the molar ratio between ascorbic acid and iron. In fact, adding ascorbic acid can counteract the negative effect of phytic acid on iron absorption but does not alter the effect of phytic acid on zinc absorption. The null effect of an increase in citric acid content can be ascribed to the fact that the citrate contents of infant formulas are already high. One of the most important element interactions is the negative effect of calcium on zinc and iron intestinal absorption and also the interaction between zinc and iron. These interactions deserve our attention because these minerals are essential to infants’ growth and development.
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Affiliation(s)
| | - R. Barberá
- Department of Nutrition and Food Chemistry, Faculty of Pharmacy, University of Valencia, Avda. Vicente Andrés Estellés s/n, 46100 Burjassot, Valencia, Spain
| | - R. Farré
- Department of Nutrition and Food Chemistry, Faculty of Pharmacy, University of Valencia, Avda. Vicente Andrés Estellés s/n, 46100 Burjassot, Valencia, Spain
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Abstract
BACKGROUND Large discrepancies exist among the dietary zinc recommendations set by expert groups. OBJECTIVE To describe the basis for the differences in the dietary zinc recommendations set by the World Health Organization, the US Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency. METHODS We compared the sources of the data, the concepts, and methods used by the 4 expert groups to set the physiological requirements for absorbed zinc, the dietary zinc requirements (termed estimated and/or average requirements), recommended dietary allowances (or recommended nutrient intakes or population reference intakes), and tolerable upper intake levels for selected age, sex, and life-stage groups. RESULTS All 4 expert groups used the factorial approach to estimate the physiological requirements for zinc. These are based on the estimates of absorbed zinc required to offset all obligatory zinc losses plus any additional requirements for absorbed zinc for growth, pregnancy, or lactation. However, discrepancies exist in the reference body weights used, studies selected, approaches to estimate endogenous fecal zinc (EFZ) losses, the adjustments applied to derive dietary zinc requirements that take into account zinc bioavailability in the habitual diets, number of dietary zinc recommendations set, and the nomenclature used to describe them. CONCLUSIONS Estimates for the physiological and dietary requirements varied across the 4 expert groups. The European Food Safety Agency was the only expert group that set dietary zinc recommendations at 4 different levels of dietary phytate for adults (but not for children) and as of yet no tolerable upper intake level for any life-stage group.
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Affiliation(s)
| | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Nicola Lowe
- University of Central Lancashire, Preston, United Kingdom
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Kovacs CS. Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. Physiol Rev 2016; 96:449-547. [PMID: 26887676 DOI: 10.1152/physrev.00027.2015] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.
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Affiliation(s)
- Christopher S Kovacs
- Faculty of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Hare DJ, Arora M, Jenkins NL, Finkelstein DI, Doble PA, Bush AI. Is early-life iron exposure critical in neurodegeneration? Nat Rev Neurol 2015; 11:536-44. [DOI: 10.1038/nrneurol.2015.100] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Shagina NB, Tolstykh EI, Degteva MO, Anspaugh LR, Napier BA. Age and gender specific biokinetic model for strontium in humans. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:87-127. [PMID: 25574605 DOI: 10.1088/0952-4746/35/1/87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A biokinetic model for strontium in humans is necessary for quantification of internal doses due to strontium radioisotopes. The ICRP-recommended biokinetic model for strontium has limitations for use in a population study, because it is not gender specific and does not cover all age ranges. The extensive Techa River data set on (90)Sr in humans (tens of thousands of measurements) is a unique source of data on long-term strontium retention for men and women of all ages at intake. These, as well as published data, were used for evaluation of age- and gender-specific parameters for a new compartment biokinetic model for strontium (Sr-AGe model). The Sr-AGe model has a similar structure to the ICRP model for the alkaline earth elements. The following parameters were mainly re-evaluated: gastrointestinal absorption and parameters related to the processes of bone formation and resorption defining calcium and strontium transfers in skeletal compartments. The Sr-AGe model satisfactorily describes available data sets on strontium retention for different kinds of intake (dietary and intravenous) at different ages (0-80 years old) and demonstrates good agreement with data sets for different ethnic groups. The Sr-AGe model can be used for dose assessment in epidemiological studies of general populations exposed to ingested strontium radioisotopes.
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Affiliation(s)
- N B Shagina
- Urals Research Center for Radiation Medicine, Chelyabinsk 454076, Russia
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Esamai F, Liechty E, Ikemeri J, Westcott J, Kemp J, Culbertson D, Miller LV, Hambidge KM, Krebs NF. Zinc absorption from micronutrient powder is low but is not affected by iron in Kenyan infants. Nutrients 2014; 6:5636-51. [PMID: 25493942 PMCID: PMC4276989 DOI: 10.3390/nu6125636] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/06/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022] Open
Abstract
Interference with zinc absorption is a proposed explanation for adverse effects of supplemental iron in iron-replete children in malaria endemic settings. We examined the effects of iron in micronutrient powder (MNP) on zinc absorption after three months of home fortification with MNP in maize-based diets in rural Kenyan infants. In a double blind design, six-month-old, non-anemic infants were randomized to MNP containing 5 mg zinc, with or without 12.5 mg of iron (MNP + Fe and MNP − Fe, respectively); a control (C) group received placebo powder. After three months, duplicate diet collections and zinc stable isotopes were used to measure intake from MNP + non-breast milk foods and fractional absorption of zinc (FAZ) by dual isotope ratio method; total absorbed zinc (TAZ, mg/day) was calculated from intake × FAZ. Mean (SEM) TAZ was not different between MNP + Fe (n = 10) and MNP - Fe (n = 9) groups: 0.85 (0.22) and 0.72 (0.19), respectively, but both were higher than C (n = 9): 0.24 (0.03) (p = 0.04). Iron in MNP did not significantly alter zinc absorption, but despite intakes over double estimated dietary requirement, both MNP groups' mean TAZ barely approximated the physiologic requirement for age. Impaired zinc absorption may dictate need for higher zinc doses in vulnerable populations.
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Affiliation(s)
- Fabian Esamai
- Moi University School of Medicine, P.O. Box 4606, Eldoret 30100, Kenya; E-Mails: (F.E.); (J.I.)
| | - Edward Liechty
- Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN 46202, USA; E-Mail:
| | - Justus Ikemeri
- Moi University School of Medicine, P.O. Box 4606, Eldoret 30100, Kenya; E-Mails: (F.E.); (J.I.)
| | - Jamie Westcott
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
| | - Jennifer Kemp
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
| | - Diana Culbertson
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
| | - Leland V. Miller
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
| | - K. Michael Hambidge
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
| | - Nancy F. Krebs
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Denver, Aurora, CO 80045, USA; E-Mails: (J.W.); (J.K.); (D.C.); (L.V.M.); (K.M.H.)
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Kaushik R, Sachdeva B, Arora S, Kapila S, Wadhwa BK. Bioavailability of vitamin D2 and calcium from fortified milk. Food Chem 2014; 147:307-11. [DOI: 10.1016/j.foodchem.2013.09.150] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/04/2013] [Accepted: 09/29/2013] [Indexed: 11/26/2022]
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Finkelstein JL, O'Brien KO, Abrams SA, Zavaleta N. Infant iron status affects iron absorption in Peruvian breastfed infants at 2 and 5 mo of age. Am J Clin Nutr 2013; 98:1475-84. [PMID: 24088721 DOI: 10.3945/ajcn.112.056945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Effects of prenatal iron supplementation on maternal postpartum iron status and early infant iron homeostasis remain largely unknown. OBJECTIVE We examined iron absorption and growth in exclusively breastfed infants in relation to fetal iron exposure and iron status during early infancy. DESIGN Longitudinal, paired iron-absorption (⁵⁸Fe) studies were conducted in 59 exclusively breastfed Peruvian infants at 2-3 mo of age (2M) and 5-6 mo of age (5M). Infants were born to women who received ≥ 5100 or ≤ 1320 mg supplemental prenatal Fe. Iron status was assessed in mothers and infants at 2M and 5M. RESULTS Infant iron absorption from breast milk averaged 7.1% and 13.9% at 2M and 5M. Maternal iron status (at 2M) predicted infant iron deficiency (ID) at 5M. Although no infants were iron deficient at 2M, 28.6% of infants had depleted iron stores (ferritin concentration <12 μg/L) by 5M. Infant serum ferritin decreased (P < 0.0001), serum transferrin receptor (sTfR) increased (P < 0.0001), and serum iron decreased from 2M to 5M (P < 0.01). Higher infant sTfR (P < 0.01) and breast-milk copper (P < 0.01) predicted increased iron absorption at 5M. Prenatal iron supplementation had no effects on infant iron status or breast-milk nutrient concentrations at 2M or 5M. However, fetal iron exposure predicted increased infant length at 2M (P < 0.01) and 5M (P < 0.05). CONCLUSIONS Fetal iron exposure affected early infant growth but did not significantly improve iron status or absorption. Young, exclusively breastfed infants upregulated iron absorption when iron stores were depleted at both 2M and 5M.
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Affiliation(s)
- Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY (JLF and KOO); the USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX (SAA); and the Instituto de Investigación Nutricional, Lima, Peru (NZ)
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Palika R, Mashurabad PC, Kilari S, Kasula S, Nair KM, Raghu P. Citric acid mediates the iron absorption from low molecular weight human milk fractions. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2013; 61:11151-11157. [PMID: 24160751 DOI: 10.1021/jf403973j] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Previously, we have demonstrated increased iron absorption from low molecular weight (LMW) human milk whey fractions. In the present study, we investigated the effect of heat denaturation, zinc (a competitor of iron), duodenal cytochrome b (DcytB) antibody neutralization and citrate lyase treatment on LMW human milk fraction (>5 kDa referred as 5kF) induced ferric iron reduction, solubilization, and uptake in Caco-2 cells. Heat denaturation and zinc inhibited the 5kF fraction induced ferric iron reduction. In contrast, zinc but not heat denaturation abrogated the ferric iron solubilization activity. Despite inhibition of ferric iron reduction, iron uptake in Caco-2 cells was similar from both native and heat denatured 5kF fractions. However, iron uptake was higher from native compared to heat denatured 5kF fractions in the cells preincubated with the DcytB antibody. Citrate lyase treatment inhibited the ferric iron reduction, solubilization, and uptake in Caco-2 cells. These findings demonstrate that citric acid present in human milk solubilizes the ferric iron which could be reduced by other heat labile components leading to increased uptake in intestinal cells.
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Affiliation(s)
- Ravindranadh Palika
- Micronutrient Research Group, Biophysics Division, National Institute of Nutrition , Jamai Osmania, Hyderabad 500 007, India
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24
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New reference values for calcium. ANNALS OF NUTRITION AND METABOLISM 2013; 63:186-92. [PMID: 24356454 DOI: 10.1159/000354482] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/19/2013] [Indexed: 01/09/2023]
Abstract
The nutrition societies of Germany, Austria and Switzerland are the joint editors of the 'reference values for nutrient intake'. They have revised the reference values for the intake of calcium and published them in June 2013. The reference values for the calcium intake for infants are derived from the calcium content of breast milk. For infants from 4 to <12 months of age, the calcium intake from solid foods is included in addition to the calcium intake from breast milk. Thus, the reference values for infants are estimated values; they are 220 mg/day for infants to <4 months and 330 mg/day for infants from 4 to <12 months of age. As a parameter for determining the calcium requirement in children and adolescents, calcium retention is taken into account. The average requirement is calculated by the factorial method. A balanced calcium metabolism is calculated based upon calcium balance studies and used as a parameter for the determination of the calcium requirement in adults. On the basis of the average requirement, recommended calcium intake levels for children, adolescents and adults are derived. Depending on age, the recommended calcium intake ranges between 600 mg/day for children aged 1 to <4 years and 1,200 mg/day for adolescents aged 13 to <19 years; for adults, it is 1,000 mg/day.
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Nair KM, Brahmam GNV, Radhika MS, Dripta RC, Ravinder P, Balakrishna N, Chen Z, Hawthorne KM, Abrams SA. Inclusion of guava enhances non-heme iron bioavailability but not fractional zinc absorption from a rice-based meal in adolescents. J Nutr 2013; 143:852-8. [PMID: 23596161 PMCID: PMC3652882 DOI: 10.3945/jn.112.171702] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Assessing the bioavailability of non-heme iron and zinc is essential for recommending diets that meet the increased growth-related demand for these nutrients. We studied the bioavailability of iron and zinc from a rice-based meal in 16 adolescent boys and girls, 13-15 y of age, from 2 government-run residential schools. Participants were given a standardized rice meal (regular) and the same meal with 100 g of guava fruit (modified) with (57)Fe on 2 consecutive days. A single oral dose of (58)Fe in orange juice was given at a separate time as a reference dose. Zinc absorption was assessed by using (70)Zn, administered intravenously, and (67)Zn given orally with meals. The mean hemoglobin concentration was similar in girls (129 ± 7.8 g/L) and boys (126 ± 7.1 g/L). There were no sex differences in the indicators of iron and zinc status except for a higher hepcidin concentration in boys (P < 0.05). The regular and modified meals were similar in total iron (10-13 mg/meal) and zinc (2.7 mg/meal) content. The molar ratio of iron to phytic acid was >1:1, but the modified diet had 20 times greater ascorbic acid content. The absorption of (57)Fe from the modified meal, compared with regular meal, was significantly (P < 0.05) greater in both girls (23.9 ± 11.2 vs. 9.7 ± 6.5%) and boys (19.2 ± 8.4 vs. 8.6 ± 4.1%). Fractional zinc absorption was similar between the regular and modified meals in both sexes. Hepcidin was found to be a significant predictor of iron absorption (standardized β = -0.63, P = 0.001, R(2) = 0.40) from the reference dose. There was no significant effect of sex on iron and zinc bioavailability from meals. We conclude that simultaneous ingestion of guava fruit with a habitual rice-based meal enhances iron bioavailability in adolescents.
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Affiliation(s)
- Krishnapillai Madhavan Nair
- Divisions of Micronutrient Research, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
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Iron content and its speciation in human milk from mothers of preterm and full-term infants at early stages of lactation: A comparison with commercial infant milk formulas. Microchem J 2012. [DOI: 10.1016/j.microc.2012.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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González-Iglesias H, Fernández-Sánchez ML, López-Sastre J, Sanz-Medel A. Nutritional iron supplementation studies based on enriched57Fe, added to milk in rats, and isotope pattern deconvolution-ICP-MS analysis. Electrophoresis 2012; 33:2407-15. [DOI: 10.1002/elps.201100334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Héctor González-Iglesias
- Department of Physical and Analytical Chemistry; Faculty of Chemistry; University of Oviedo; Oviedo; Spain
| | | | - José López-Sastre
- Department of Neonatology; “Hospital Universitario Central de Asturias”; Oviedo; Spain
| | - Alfredo Sanz-Medel
- Department of Physical and Analytical Chemistry; Faculty of Chemistry; University of Oviedo; Oviedo; Spain
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Hicks PD, Hawthorne KM, Berseth CL, Marunycz JD, Heubi JE, Abrams SA. Total calcium absorption is similar from infant formulas with and without prebiotics and exceeds that in human milk-fed infants. BMC Pediatr 2012; 12:118. [PMID: 22871243 PMCID: PMC3439330 DOI: 10.1186/1471-2431-12-118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 08/02/2012] [Indexed: 12/04/2022] Open
Abstract
Background 1) To evaluate calcium absorption in infants fed a formula containing prebiotics (PF) and one without prebiotics (CF). 2) To compare calcium absorption from these formulas with a group of human milk-fed (HM) infants. Methods A dual tracer stable isotope method was used to assess calcium absorption in infants exclusively fed CF (n = 30), PF (n = 25) or HM (n = 19). Analysis of variance was used to analyze calcium intake, fractional calcium absorption, and the amount of calcium absorbed. Results Calcium intake (Mean ± SEM) for PF was 534 ± 17 mg/d and 557 ± 16 mg/d for CF (p = 0.33). Fractional calcium absorption was 56.8 ± 2.6 % for PF and 59.2 ± 2.3 % for CF (p = 0.49). Total calcium absorbed for PF was 300 ± 14 mg/d and 328 ± 13 mg/d for CF (p = 0.16). For HM infants calcium intake was 246 ± 20 mg/d, fractional calcium absorption was 76.0 ± 2.9 % and total calcium absorbed was 187 ± 16 mg/d (p <0.001, compared to either PF or CF). Conclusions Despite lower fractional calcium absorption of CF and PF compared to HM, higher calcium content in both led to higher total calcium absorption compared to HM infants. No significant effect of prebiotics was observed on calcium absorption or other markers of bone mineral metabolism.
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Szymlek-Gay EA, Lönnerdal B, Abrams SA, Kvistgaard AS, Domellöf M, Hernell O. α-Lactalbumin and casein-glycomacropeptide do not affect iron absorption from formula in healthy term infants. J Nutr 2012; 142:1226-31. [PMID: 22623383 DOI: 10.3945/jn.111.153890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Iron absorption from infant formula is relatively low. α-Lactalbumin and casein-glycomacropeptide have been suggested to enhance mineral absorption. We therefore assessed the effect of α-lactalbumin and casein-glycomacropeptide on iron absorption from infant formula in healthy term infants. Thirty-one infants were randomly assigned to receive 1 of 3 formulas (4 mg iron/L, 13.1 g protein/L) from 4-8 wk to 6 mo of age: commercially available whey-predominant standard infant formula (standard formula), α-lactalbumin-enriched infant formula (α-LAC), or α-lactalbumin-enriched/casein-glycomacropeptide-reduced infant formula (α-LAC/RGMP). Nine breast-fed infants served as a reference. At 5.5 mo of age, (58)Fe was administered to all infants in a meal. Blood samples were collected 14 d later for iron absorption and iron status indices. Iron deficiency was defined as depleted iron stores, iron-deficient erythropoiesis, or iron deficiency anemia. Iron absorption (mean ± SD) was 10.3 ± 7.0% from standard formula, 8.6 ± 3.8% from α-LAC, 9.2 ± 6.5% from α-LAC/RGMP, and 12.9 ± 6.5% from breast milk, with no difference between the formula groups (P = 0.79) or all groups (P = 0.44). In the formula-fed infants only, iron absorption was negatively correlated with serum ferritin (r = -0.49; P = 0.005) and was higher (P = 0.023) in iron-deficient infants (16.4 ± 12.4%) compared with those with adequate iron status (8.6 ± 4.4%). Our findings indicate that α-lactalbumin and casein-glycomacropeptide do not affect iron absorption from infant formula in infants. Low serum ferritin concentrations are correlated with increased iron absorption from infant formula.
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Affiliation(s)
- Ewa A Szymlek-Gay
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
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Abrams SA. What are the risks and benefits to increasing dietary bone minerals and vitamin D intake in infants and small children? Annu Rev Nutr 2011; 31:285-97. [PMID: 21370980 DOI: 10.1146/annurev-nutr-072610-145216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bone minerals and vitamin D are crucial for infants and small children. Human milk has little vitamin D, and supplemental vitamin D must be given to all infants either via drops or as contained in infant formula or foods. The calcium and phosphorus in human milk are adequate for infants in the first six months of life, with supplemental minerals coming from weaning foods after six months. Long-term benefits to providing bone minerals at greater levels than in human milk have not been shown. There is no evidence to support high-dose bone mineral supplementation or high-dose vitamin D supplementation in infancy, and controlled trials are needed before these can be advocated.
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Affiliation(s)
- Steven A Abrams
- United States Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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Tolstykh EI, Degteva MO, Peremyslova LM, Shagina NB, Shishkina EA, Krivoshchapov VA, Anspaugh LR, Napier BA. Reconstruction of long-lived radionuclide intakes for Techa riverside residents: strontium-90. HEALTH PHYSICS 2011; 101:28-47. [PMID: 21617390 DOI: 10.1097/hp.0b013e318206d0ff] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Releases of radioactive materials from the Mayak Production Association in 1949-1956 resulted in contamination of the Techa River; a nuclide of major interest was 90Sr, which downstream residents consumed with water from the river and with milk contaminated by cows' consumption of river water and contaminated pasture. Over the years, several reconstructions of dose have been performed for the approximately 30,000 persons who make up the Extended Techa River Cohort. The purpose of the study described here was to derive a revised reference-90Sr-intake function for the members of this cohort. The revision was necessary because recently discovered data have provided a more accurate description of the time course of the releases, and more is now known about the importance of the pasture grass-cow-milk pathway for the members of this cohort. The fundamental basis for the derivation of the reference-90Sr-intake function remains the same: thousands of measurements of 90Sr content in bone with a special whole-body counter, thousands of measurements of beta-activity of front teeth with a special tooth-beta counter, and a variety of other measurements, including post mortem measurements of 90Sr in bone, measurements of 90Sr in cow's milk, and measurements of beta activity in human excreta. Results of the new analyses are that the major intake started in September 1950 and peaked somewhat later than originally postulated. However, the total intake for adult residents has not changed significantly. For children of some birth years, the intake and incorporation of Sr in bone tissue have changed substantially.
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Affiliation(s)
- E I Tolstykh
- Urals Research Center for Radiation Medicine, Vorovskogo 68 a, 454076 Chelyabinsk, Russian Federation.
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Abrams SA. Calcium absorption in infants and small children: methods of determination and recent findings. Nutrients 2010; 2:474-80. [PMID: 22254034 PMCID: PMC3257657 DOI: 10.3390/nu2040474] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 03/22/2010] [Accepted: 04/02/2010] [Indexed: 11/16/2022] Open
Abstract
Determining calcium bioavailability is important in establishing dietary calcium requirements. In infants and small children, previously conducted mass balance studies have largely been replaced by stable isotope-based studies. The ability to assess calcium absorption using a relatively short 24-hour urine collection without the need for multiple blood samples or fecal collections is a major advantage to this technique. The results of these studies have demonstrated relatively small differences in calcium absorption efficiency between human milk and currently available cow milk-based infant formulas. In older children with a calcium intake typical of Western diets, calcium absorption is adequate to meet bone mineral accretion requirements.
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Affiliation(s)
- Steven A Abrams
- Department of Agriculture, Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
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Eneroth H, El Arifeen S, Persson LA, Kabir I, Lönnerdal B, Hossain MB, Ekström EC. Duration of exclusive breast-feeding and infant iron and zinc status in rural Bangladesh. J Nutr 2009; 139:1562-7. [PMID: 19535419 DOI: 10.3945/jn.109.104919] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is a concern that exclusive breast-feeding (EBF) for 6 mo may lead to iron and zinc deficiency in low-birth weight (LBW) infants. We assessed the association between duration of EBF and infant iron and zinc status in the Maternal and Infant Nutrition Interventions in Matlab trial, Bangladesh, stratified for normal birth weigh (NBW) and LBW. Duration of EBF was classified into EBF <4 mo and EBF 4-6 mo based on monthly recalls of foods introduced to the infant. Blood samples collected at 6 mo were analyzed for plasma zinc (n = 1032), plasma ferritin (n = 1040), and hemoglobin (Hb) (n = 791). Infants EBF 4-6 mo had a higher mean plasma zinc concentration (9.9 +/- 2.3 micromol/L) than infants EBF <4mo (9.5 +/- 2.0 micromol/L) (P < 0.01). This association was apparent in only the NBW strata and was not reflected in a lower prevalence of zinc deficiency. Duration of EBF was not associated with concentration of plasma ferritin, Hb concentration, or prevalence of iron deficiency or anemia in any strata. Regardless of EBF duration, the prevalence of zinc deficiency, iron deficiency, and anemia was high in infants in this population and strategies to prevent deficiency are needed.
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Affiliation(s)
- Hanna Eneroth
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden.
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Brown KH, Engle-Stone R, Krebs NF, Peerson JM. Dietary intervention strategies to enhance zinc nutrition: promotion and support of breastfeeding for infants and young children. Food Nutr Bull 2009; 30:S144-71. [PMID: 19472605 PMCID: PMC5365150 DOI: 10.1177/15648265090301s108] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breastmilk is the only dietary source of zinc for exclusively breastfed young infants, and it remains a potentially important source of zinc for older infants and young children who continue breastfeeding beyond early infancy. Therefore, we examined available information on breastmilk zinc concentration and total milk consumption to develop estimates of the amount of zinc transferred in breastmilk to children of different ages. Breastmilk zinc concentration declines rapidly during the first few months postpartum and more slowly thereafter. Breastmilk supplies all of the theoretical zinc needs for at least the first several months of life, although the period during which breastmilk alone remains sufficient is uncertain. Breastmilk continues to provide more than half of children's estimated zinc requirements after the introduction of complementary foods, even into the second year of life. Public health programs to promote and support breastfeeding should be included among the strategies to ensure adequate zinc status of young children.
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Affiliation(s)
- Kenneth H Brown
- Department of Nutrition, University of California, Davis, California 95616, USA.
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Domellöf M, Hernell O, Abrams SA, Chen Z, Lönnerdal B. Iron supplementation does not affect copper and zinc absorption in breastfed infants. Am J Clin Nutr 2009; 89:185-90. [PMID: 19056575 DOI: 10.3945/ajcn.2008.26887] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron supplements are commonly recommended for infants but were suggested to inhibit zinc and copper absorption. OBJECTIVE The objective of this study was to investigate potential effects of iron supplementation, infant age, and mineral status on zinc and copper absorption in infants at 6 and 9 mo of age. DESIGN Twenty-five healthy breastfed term infants were recruited from a larger randomized iron supplementation trial. Six of these infants received iron supplements (1 mg . kg(-1) . d(-1)) from 4 to 9 mo, 8 were supplemented from 6 to 9 mo, and 11 received placebo only. Zinc and copper absorption was measured at 6 and 9 mo of age, using orally administered (70)Zn and (65)Cu and fecal monitoring of recovered stable isotopes. RESULTS Mean (+/-SD) zinc absorption was 51.9 +/- 17.9%, and mean copper absorption was 79.0 +/- 13.5%. No significant difference was observed in zinc or copper absorption between 6 and 9 mo of age. When combining all measurements, no significant effect of prior iron supplementation was observed on zinc or copper absorption. No significant correlation was observed between plasma zinc and zinc absorption or between plasma copper and copper absorption. No significant correlation was observed between erythrocyte copper-zinc-dependent superoxide dismutase activity and copper absorption. CONCLUSIONS The study does not support the contention that iron supplements inhibit the absorption of zinc or copper in healthy breastfed infants at 6-9 mo of age. In addition, we did not find any age-related changes in zinc or copper absorption between 6 and 9 mo of age.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
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Nichols BL. Establishment of the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine and Texas Children's Hospital in 1978. J Nutr 2009; 139:188-91. [PMID: 19056811 DOI: 10.3945/jn.108.092627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Children's Nutrition Research Center (CNRC) is a unique cooperative venture among Baylor College of Medicine, Texas Children's Hospital, and the USDA/Agricultural Research Service. The CNRC is dedicated to defining the nutrient needs of children, from conception through adolescence, and the needs of pregnant women and nursing mothers. Scientific data from the Center enable healthcare providers and policy advisors to make dietary recommendations that improve the health of today's children and that of generations to come. CNRC research has already impacted feeding guidelines for normal U.S. children and all children of the world.
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Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr 2008; 138:2529-33. [PMID: 19022984 DOI: 10.1093/jn/138.12.2529] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Iron deficiency is estimated to be the most common nutritional deficiency worldwide and is particularly persistent among infants and children. The high prevalence of anemia in 6- to 9-mo-old children raises the concern that birth iron stores in some infants are inadequate to sustain growth and development through the first 6 mo of life, and postnatal factors are contributing to early depletion of iron stores and development of anemia. At the same time, there are concerns about negative effects of excess iron in infants. Maternal iron status, infant birth weight and gestational age, as well as the timing of umbilical cord clamping at birth all contribute to the establishment of adequate total body iron at birth. Postnatally, feeding practices and growth rate are factors that will affect how quickly birth iron is depleted during the first 6 mo of life. Under conditions in which maternal iron status, birth weight, gestational age, and umbilical cord clamping time are optimal, and exclusive breast-feeding is practiced, infants should have adequate iron stores for the first 6-8 mo of life. Under suboptimal conditions, infants may not reach this goal and may need to be targeted for iron supplementation before 6 mo of age.
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Ferric reductase activity of low molecular weight human milk fraction is associated with enhanced iron solubility and uptake in Caco-2 cells. Biochem Biophys Res Commun 2008; 374:369-72. [DOI: 10.1016/j.bbrc.2008.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/08/2008] [Indexed: 11/24/2022]
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Lunney KM, Jenkins AL, Tavengwa NV, Majo F, Chidhanguro D, Iliff P, Strickland GT, Piwoz E, Iannotti L, Humphrey JH. HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate. J Nutr 2008; 138:351-7. [PMID: 18203903 DOI: 10.1093/jn/138.2.351] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.
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Abstract
The assessment of dietary zinc intakes is an important component of evaluating the risk of zinc deficiency in populations, and for designing appropriate food-based interventions, including fortification, to improve zinc intakes. The prevalence of inadequate zinc intakes can describe the relative magnitude of the risk of zinc deficiency in the population and identify subpopulations at elevated risk. As a cornerstone to evaluating the adequacy of population zinc intakes globally, a set of internationally appropriate dietary reference intakes must be defined. The World Health Organization/Food and Agriculture Organization/International Atomic Energy Agency (WHO/FAO/IAEA) and the Food and Nutrition Board/US Institute of Medicine (FNB/IOM) have presented estimated average requirements (EAR) for dietary zinc intake, and, more recently, the International Zinc Nutrition Consultative Group (IZiNCG) presented a revised set of recommendations for international use. A prevalence of inadequate zinc intakes greater than 25% is considered to represent an elevated risk of population zinc deficiency. As the requirement estimates are derived from smaller, clinical studies and, for children, most components of the estimates are extrapolated from data for adults, it was desirable to evaluate their internal validity. The estimated physiological requirements for adult men and women appear to adequately predict zinc status as determined by biochemical indicators of status and/or zinc balance. With the use of data from available studies, the reported prevalence of low serum zinc concentration and the estimated prevalence of inadequate zinc intakes predict similar levels of risk of zinc deficiency, particularly among pregnant and nonpregnant women. Conformity between these two indicators is less consistent for children, suggesting that further data and/or direct studies of zinc requirements among children are needed.
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Dewey KG, Chaparro CM. Session 4: Mineral metabolism and body composition Iron status of breast-fed infants. Proc Nutr Soc 2007; 66:412-22. [PMID: 17637094 DOI: 10.1017/s002966510700568x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Fe deficiency is a common nutritional disorder during infancy, particularly in low-income countries. The Fe status of a breast-fed infant is strongly influenced by the body Fe content at birth, which is determined by factors that operate before birth (maternal Fe status before and during pregnancy; infant gestational age and birth weight) and at the time of delivery (the timing of umbilical cord clamping). Delaying the clamping of the umbilical cord for 2 min can increase body Fe content by approximately 33% (75 mg), and results in greater Fe stores at 6 months of age. After birth, male gender and a rapid rate of weight gain are associated with lower Fe status. During the first half of infancy dietary Fe requirements depend on Fe stores at birth. For an exclusively-breast-fed full-term normal-birth-weight infant with delayed umbilical cord clamping, whose mother had adequate Fe status during pregnancy, the Fe provided from stores and breast milk is sufficient for ≥6 months, but before this time higher-risk infants may become Fe deficient. Fe supplementation can be beneficial for high-risk infants, but can have adverse effects on growth and morbidity of Fe-replete infants. After 6 months most breast-fed infants will require complementary foods that are rich in Fe.
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Affiliation(s)
- Kathryn G Dewey
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, CA 95616-8669, USA.
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Singh G, Arora S, Sharma G, Sindhu J, Kansal V, Sangwan R. Heat stability and calcium bioavailability of calcium-fortified milk. Lebensm Wiss Technol 2007. [DOI: 10.1016/j.lwt.2006.03.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Krebs NF, Hambidge KM. Complementary feeding: clinically relevant factors affecting timing and composition. Am J Clin Nutr 2007; 85:639S-645S. [PMID: 17284770 DOI: 10.1093/ajcn/85.2.639s] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Exclusive breastfeeding for the first 6 mo of life followed by optimal complementary feeding are critical public health measures for reducing and preventing morbidity and mortality in young children. Clinical factors, such as birth weight, prematurity, and illness, that affect the iron and zinc requirements of younger infants are discussed. Maternal diet and nutritional status do not have a strong effect on the mineral content of human milk, but physiologic changes in milk and the infants' status determine the dependence of the infant on complementary foods in addition to human milk to meet iron and zinc requirements after 6 mo. The nature of zinc absorption, which is suitably characterized by saturation response modeling, dictates that plant-based diets, which are low in zinc, are associated with low absolute daily absorbed zinc, which is inadequate to meet requirements. Foods with a higher zinc content, such as meats, are much more likely to be sufficient to meet dietary requirements. Current plant-based complementary feeding patterns for older fully breastfed infants in both developed and developing countries pose a risk of zinc deficiency. The strong rationale for the potential benefits of providing meat as an early complementary food, and the examples of successful intervention programs, provide potent incentives to pursue broader implementation programs, with concurrent rigorous evaluation of both efficacy and effectiveness.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80252, USA.
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Schümann K, Ettle T, Szegner B, Elsenhans B, Solomons NW. On risks and benefits of iron supplementation recommendations for iron intake revisited. J Trace Elem Med Biol 2007; 21:147-68. [PMID: 17697954 DOI: 10.1016/j.jtemb.2007.06.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 06/04/2007] [Accepted: 06/11/2007] [Indexed: 12/24/2022]
Abstract
Iron is an essential trace element with a high prevalence of deficiency in infants and in women of reproductive age from developing countries. Iron deficiency is frequently associated with anaemia and, thus, with reduced working capacity and impaired intellectual development. Moreover, the risk for premature delivery, stillbirth and impaired host-defence is increased in iron deficiency. Iron-absorption and -distribution are homeostatically regulated to reduce the risk for deficiency and overload. These mechanisms interact, in part, with the mechanisms of oxidative stress and inflammation and with iron availability to pathogens. In the plasma, fractions of iron may not be bound to transferrin and are hypothesised to participate in atherogenesis. Repleted iron stores and preceding high iron intakes reduce intestinal iron absorption which, however, offers no reliable protection against oral iron overload. Recommendations for dietary iron intake at different life stages are given by the US Food and Nutrition Board (FNB), by FAO/WHO and by the EU Scientific Committee, among others. They are based, on estimates for iron-losses, iron-bioavailability from the diet, and iron-requirements for metabolism and growth. Differences in choice and interpretation of these estimates lead to different recommendations by the different panels which are discussed in detail. Assessment of iron-related risks is based on reports of adverse health effects which were used in the attempts to derive an upper safe level for dietary iron intake. Iron-related harm can be due to direct intestinal damage, to oxidative stress, or to stimulated growth of pathogens. Unfortunately, it is problematic to derive a reproducible cause-effect and dose-response relationship for adverse health effects that suggest a relationship to iron-intake, be they based on mechanistic or epidemiological observations. Corresponding data and interpretations are discussed for the intestinal lumen, the vascular system and for the intracellular and interstitial space, considering interference of the mechanisms of iron homoeostasis as a likely explanation for differences in epidemiological observations.
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Affiliation(s)
- Klaus Schümann
- Science Center Weihenstephan, Technical University Munich, Am Forum 5, D-85350, Freising, Germany.
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Lynch MF, Griffin IJ, Hawthorne KM, Chen Z, Hamzo MG, Abrams SA. Iron absorption is more closely related to iron status than to daily iron intake in 12- to 48-mo-old children. J Nutr 2007; 137:88-92. [PMID: 17182806 DOI: 10.1093/jn/137.1.88] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Few studies have evaluated iron absorption in small children after the first year of life. Our objectives were to examine the relations among iron intake, iron absorption, and iron status in a group of healthy children. We studied 28 children, ages 12 to 48 mo, after a 7-d home adaptation to a diet representative of their usual daily mineral intake. A multi-tracer stable isotope study was performed to assess iron absorption both from a meal ((58)Fe) and from a reference iron dose ((57)Fe) given with ascorbic acid without a meal. Iron intake was 6.9 +/- 2.4 mg, approximately the 35th percentile of typical U.S. intakes. Absorption of (58)Fe was related to serum ferritin (r(2) = 0.319, P = 0.0018) and more so to reference dose iron absorption (r(2) = 0.653, P < 0.0001). Iron absorption was negatively correlated with zinc intake (r(2) = 0.090, P = 0.0049) but was not correlated with iron intake (P = 0.20). However, zinc intake was not correlated with measures of iron status, including reference dose iron absorption and serum ferritin (r(2) < 0.1, P > 0.25). Total absorbed iron was similar to needs estimated by the Institute of Medicine. We conclude that iron absorption in young children is more closely related to iron status than to iron intake. Reference dose iron absorption may be superior to serum ferritin as a surrogate measure for iron status in this age group. Although zinc intake may affect iron absorption from a meal, it does not appear to have a detectable effect on overall iron status in otherwise well-nourished children.
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Affiliation(s)
- Mary Frances Lynch
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
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Abrams SA. Building Bones in Babies: Can and Should We Exceed the Human Milk-Fed Infant's Rate of Bone Calcium Accretion? Nutr Rev 2006; 64:487-94. [PMID: 17131944 DOI: 10.1111/j.1753-4887.2006.tb00181.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Increasing calcium absorption and bone calcium accretion to levels above those achieved by human milk-fed, full-term infants is possible with infant formulas. However, no data support such a goal or suggest that it is beneficial to short- or long-term bone health. Small differences in the bioavailability of calcium between infant formulas are unlikely to have long-term consequences. Long-term studies of the effects of infant feeding type on ultimate bone mass are needed. For now, the vitamin-replete breast-fed infant's rate of calcium accretion during the first year of life should be the standard targeted for infant formulas.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
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Hicks PD, Zavaleta N, Chen Z, Abrams SA, Lönnerdal B. Iron deficiency, but not anemia, upregulates iron absorption in breast-fed peruvian infants. J Nutr 2006; 136:2435-8. [PMID: 16920866 DOI: 10.1093/jn/136.9.2435] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Iron absorption in adults is regulated by homeostatic mechanisms that decrease absorption when iron status is high. There are few data, however, regarding the existence of a similar homeostatic regulation in infants. We studied 2 groups of human milk-fed infants using (57)Fe (given as ferrous sulfate without any milk) and (58)Fe (given at the time of a breast-milk feeding) stable isotopes to determine whether healthy infants at risk for iron deficiency would regulate their iron absorption based on their iron status. We studied 20 Peruvian infants at 5-6 mo of age and 18 infants at 9-10 mo of age. We found no effect of infant hemoglobin concentration on iron absorption with 5-6 mo-old infants absorbing 19.2 +/- 2.1% and 9- to 10-mo-old infants absorbing 25.8 +/- 2.6% of the (57)Fe dose. For (58)Fe, 5- to 6-mo-old infants absorbed 42.6 +/- 5.0% and 9 to 10-mo-old infants absorbed 51.9 +/- 10.3%. Following log transformation, iron absorption from (57)Fe (r = -0.61, P = < 0.001) and (58)Fe (r = -0.61, P = < 0.001) were inversely correlated to serum ferritin (S-Ft). For both the (57)Fe and (58)Fe doses, infants with S-Ft <12 mg/L (n = 11) had significantly higher iron absorption than those with S-Ft >12 mg/L. We concluded that iron absorption in infants is related to iron status as assessed by serum ferritin but not hemoglobin concentration. Infants with low iron status upregulate iron absorption from breast milk at both 5-6 and 9-10 mo of age.
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Affiliation(s)
- Penni D Hicks
- U.S. Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
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Chen Z, Griffin IJ, Plumlee LM, Abrams SA. High resolution inductively coupled plasma mass spectrometry allows rapid assessment of iron absorption in infants and children. J Nutr 2005; 135:1790-5. [PMID: 15987866 DOI: 10.1093/jn/135.7.1790] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stable isotope absorption studies of iron have been limited by the high cost and limited availability of isotope ratio analysis using thermal ionization MS (TIMS). The development of high-resolution double focusing inductively coupled plasma MS (ICP-MS) may permit more cost-efficient sample analysis due to its high throughput, lower cost, easy sample pretreatment, and greater availability. Our objective was to develop an ICP-MS methodology for the measurement of iron isotope ratios using very small blood volumes. We developed a technique using multiple iron-nickel mixing standard solutions to adjust for nickel interference calibration. RBC samples from human subjects previously given 58Fe and 57Fe were analyzed for iron isotope ratios and compared with our current methodology (TIMS). Reproducibility of iron isotope ratios provided external relative SD < 0.5 and 0.7% (1 SD) for 57Fe/54Fe and 58Fe/54Fe, respectively. Iron isotope ratios from ICP-MS analysis did not differ from those from TIMS based on statistical analyses, nor did the calculated iron absorption values. The mean and SD of iron absorption did not differ when measured by TIMS or ICP-MS. A 2-microL RBC sample was sufficient for ICP-MS iron isotope ratio analysis with an internal relative SD < 0.5% and analytical time < 5 min. This technique may assist groups in increasing their use of stable isotope methods to assess iron absorption in infants and children.
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Affiliation(s)
- Zhensheng Chen
- U.S. Department of Agriculture/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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