Intervenções nutricionais na anemia ferropriva

Blood markers among residents from a coal mining area

Coal extraction and processing generate environmental contamination, which has several negative impacts on human health. Hematological and biochemical parameters are effective biomarkers of the exposure of a population to air pollutants. Thus, this study aimed to evaluate hematological and biochemical parameters in adult residents in a coal mining region in the largest national reserve in Brazil, as well as to investigate their relations with air quality. The study included three cities in the south of Brazil, which are located near an important power plant and coal mine. The air quality was analyzed by PM10, NOx, and SO₂ at five air quality monitoring stations, socioeconomic and demographic characteristics were evaluated with a questionnaire, and biochemical parameters were assessed in blood samples. The mean PM10 in the study area was 19.18 μg/m³. The air quality varied among the five monitoring stations, and the Candiota station exceeded the reference limit by 63.3%. In general, participants had lived more than 10 years in the municipality and had hepatic and renal parameters within the reference values. A higher prevalence of alterations was found in hematological parameters (43.1%) and liver function (30%). Among the three cities, the population of Pedras Altas seems to have a greater impairment of the blood parameters evaluated. The only parameter that was correlated with PM10 was the hematocrit level (r = 0.33; P < 0.001).

Fortifying pork liver mixture: Evaluation of protein quality and iron bioavailability – Part 2

ABSTRACT Objective To evaluate the protein quality and iron bioavailability of a fortifying mixture based on pork liver. Methods Determinations of protein efficiency ratio, net protein utilization, true digestibility and hemoglobin regeneration efficiency by depletion and repletion were performed. In the depletion phase, the animals (male Wistar rats) received an iron-free AIN–93G diet and in the repletion phase they received the following diets: standard AIN–93G diet, fortifying mixture and standard diet containing heptahydrated ferrous sulfate for comparison. Results For standard AIN–93G diet and fortifying mixture the results were 3.75 and 4.04 for protein efficiency ratio and 3.53 and 3.63 for net protein retention, showing that the presence of pork liver in the diet promoted an increase in protein efficiency ratio and net protein retention (not statistically significant). True digestibility results obtained with the fortifying mixture (97.16%) were higher than those obtained with the standard AIN–93G diet (casein), but without significant difference. The hemoglobin regeneration efficiency values obtained for standard AIN–93G diet, fortifying mixture and standard diet containing heptahydrated ferrous sulfate were 50.69, 31.96 and 29.96%, respectively, showing a statistically significant difference between the control (standard AIN–93G diet) and test (fortifying mixture and standard diet containing heptahydrated ferrous sulfate) samples, but not between the test samples. Conclusion The fortifying mixture showed a high protein efficiency ratio value of 4.04 and a high relative biological value (108%) and it can be added to soups, creams and meats in day-care centers for the prevention of iron-deficiency in children of school age.

A Micronutrient Fortified Beverage Given at Different Dosing Frequencies Had Limited Impact on Anemia and Micronutrient Status in Filipino Schoolchildren

This study evaluated the effects of a multi-micronutrient fortified juice drink given in different frequencies of consumption on hemoglobin (Hb) concentration of schoolchildren. Hb was measured in 2423 schoolchildren aged 6- to 9-years-old at baseline. All anemic children (n = 246) were randomly allocated into groups: Daily dose (HD: high dose), 5X/week (MD: Moderate Dose), 3X/week (LD: Low Dose) and unfortified (Control). Pre- and post-study measurements of micronutrients were collected from 228 children. At the endpoint, significant Hb increases were observed in all groups, but there was no significant difference between groups. There was a significant reduction in anemia prevalence in all groups from 100% to 36% (Control), 30% (LD), 23% (MD) and 26% (HD). No dose-response effect was observed in Hb in this population. Most likely, this resulted from better than expected micronutrient status and lower than expected severity of anemia and micronutrient deficiencies in this cohort. It is unlikely that the addition of a fortified beverage to school feeding programs in this population would have a positive impact. Whether such an intervention would be cost-effective as a preventative approach needs to be assessed. This study demonstrates the importance of targeting such interventions to appropriate populations.

Effects of cooking methods on the iron and zinc contents in cowpea (Vigna unguiculata) to combat nutritional deficiencies in Brazil

Background

Because iron deficiency anemia is prevalent in developing countries, determining the levels of iron and zinc in beans, the second most consumed staple food in Brazil, is essential, especially for the low-income people who experience a deficiency of these minerals in their diet.

Objectives

This study aimed to evaluate the effect of cooking methods by measuring the iron and zinc contents in cowpea cultivars before and after soaking to determine the retention of these minerals.

Methods

The samples were cooked in both regular pans and pressure cookers with and without previous soaking. Mineral analyses were carried out by Spectrometry of Inductively Coupled Plasma (ICP).

Results

The results showed high contents of iron and zinc in raw samples as well as in cooked ones, with the use of regular pan resulting in greater percentage of iron retention and the use of pressure cooker ensuring higher retention of zinc.

Conclusions

The best retention of iron was found in the BRS Aracê cultivar prepared in a regular pan with previous soaking. This cultivar may be indicated for cultivation and human consumption. The best retention of zinc was found for the BRS Tumucumaque cultivar prepared in a pressure cooker without previous soaking.

Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials

The objective of this study was to analyze adherence and side effects of three iron supplement regimens (ferrous sulfate) on anemic pregnant women. The clinical trial involved 150 women between the 16th and 20th gestational weeks, at low obstetric risk and with hemoglobin concentration of between 8.0 and 11.0 g/dL. Treatment was provided by ferrous sulfate with 60 mg of elemental iron during 16 (+/- 1) weeks, in three regimens: single tablet a week (n = 48); single tablet twice a week (n = 53) or single tablet a day (n = 49). The outcomes were adherence, assessed through interviews and by counting tablets, and side effects, according to patient information. The adherence showed a declining trend (92%, 83% and 71%; p = 0.010) and the side effects revealed a growing trend (40%, 45% and 71%; p = 0.002) as the dosage increased. Diarrhea and epigastric pain were significantly associated with the dose administered (p = 0.002). These results suggest that in anemic pregnant women, complaints are directly proportional and the compliance is inversely proportional to the amount of medicinal iron.

Anemia e deficiência de ferro em gestantes adolescentes

Por meio de dosagem de ferritina sérica, transferrina sérica, hemoglobina e hematócrito, caracterizou-se o estado nutricional de ferro de 79 gestantes adolescentes de primeira consulta pré-natal (<FONT FACE=Symbol>£ </FONT>20 semanas de gestação), atendidas na Rede Básica de Saúde de um Município da Grande São Paulo. Todos os valores hematológicos estudados foram menores entre as gestantes do segundo trimestre gestacional em relação às do primeiro, sendo as diferenças estatisticamente significativas (p<0,05) apenas para hemoglobina. Verificou-se que 64,3% e 32,1% possuíam, respectivamente, menos de 500 mg e 300 mg de ferro em suas reservas, sendo que 5,4% apresentavam carência grave do mineral. Segundo critério da Organização Mundial da Saúde 19,0% das gestantes eram ferro-deficientes (saturação da transferrina < 16,0 %) e 13,9% eram anêmicas (Hemoglobina < 11 g/dl).

Padrão alimentar de lactentes residentes em áreas periféricas de Fortaleza

Este estudo caracterizou o padrão alimentar de 96 crianças menores de um ano assistidas pelo Fundo Cristão para Crianças nos bairros Álvaro Weyne e Presidente Kennedy, na cidade de Fortaleza, Brasil. Os dados foram levantados por meio de entrevista domiciliar, utilizando o método recordatório 24h para conhecimento das quantidades dos alimentos consumidos, e um formulário contendo perguntas estruturadas sobre a prática do aleitamento materno e idade de introdução dos alimentos de desmame. Os resultados indicaram que o aleitamento materno misto predomina (68%) sobre o aleitamento artificial (32%) e exclusivo (10%) e que 7% das crianças nunca receberam leite materno. Porém, até o final do décimo mês de vida, 53% das crianças ainda são amamentadas. Mingau lácteo, preparado com leite de vaca não modificado, constitui a alimentação básica de desmame. Do ponto de vista nutricional, as dietas são desbalanceadas, sendo o ferro o nutriente mais deficiente. Devem ser intensificados os esforços na promoção da alimentação infantil apropriada.

[Use of daily and weekly ferrous sulfate to treat anemic childbearing-age women]

A blind randomized trial was conducted in a low-income community in the city of Recife, Pernambuco, Brazil, with 193 anemic (Hb <12 mg/dl) and "menstruating" women (age range: 15-45 years) to compare daily and weekly doses of ferrous sulfate (60 mg elemental iron) and treatment compliance. Blood samples were taken from 484 women to determine hemoglobin levels before and after the trial and mean corpuscular volume (MCV) at end of treatment. After 12 weeks' follow-up, 150 women completed the trial, 79 on the alternative weekly regimen and 71 on the conventional daily regimen. Mean corpuscular hemoglobin concentrations (MCHC) prior to treatment were 10.52 g/dl (DP=1.13) and 10.72 g/dl (DP=0.92), respectively, for the alternative and conventional regimens. After the intervention they were 11.83 g/dl (DP=0.97) for the weekly regimen and 11.62 g/dl (DP=1.39) for the daily one. The alternative regimen was better accepted than the conventional one. There was no significant difference (p=0.22) between differences in the mean values of the two regimens, although the cure rate was higher after the alternative treatment. The study concluded that the weekly regimen was no less effective than daily treatment.

[Prevalence of iron deficiency anemia in female adolescents in Taboaoa da Serro, SP. Brazil]

It was studied an equiprobabilistic sample of 262 female teenagers living in the city of Taboão da Serra, Brazil, with the aim of evaluating the prevalence of anemia and iron-deficiency. Anemia was identified by the hemoglobin level and the prevalence of iron-deficiency was determined through the concentration of free erythrocyte protoporphyrin. It was observed a prevalence of 17.6% of anemia, and its occurrence was inversely related to factors indicative of the economic-social level: income, schooling of parents and home's characteristics. The presence of anemia was higher in the group that did not have reached menarche, and its occurrence did not show relation with the interval between menstrual cycle. The prevalence of iron-deficiency was of 29,4% and it was not verified correlation between the bloody hemoglobin and the free erythrocyte protoporphyrin, except in severe cases of anemia.

Prevenção e tratamento da anemia nutricional ferropriva: novos enfoques e perspectivas

Os autores descrevem sumariamente o quadro epidemiológico das anemias, as propostas programáticas estabelecidas pelas Nações Unidas para a reversão do problema em escala internacional e as dificuldades atuais para a aplicação de estratégias de reconhecida efetividade na área da saúde para a prevenção e cura das anemias nos segmentos populacionais mais expostos, as crianças e as gestantes. Analisam o estágio atual das pesquisas dirigidas para quatro objetivos simultâneos: aumento da eficácia e efetividade, redução de custos e de efeitos colaterais dos esquemas medicamentosos de prevenção e tratamento. Consideram que as pesquisas em curso podem melhorar radicalmente as perspectivas de uma intervenção bem sucedida no enfrentamento do problema através do setor saúde.