Iron and the Breastfed Infant

Growth and micronutrient status parameters of Nigerian preterm infants consuming preterm formula or breastmilk

BACKGROUND

Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking.

METHODS

Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed bi-weekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks.

RESULT

Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula- and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001).

CONCLUSION

Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value.

IMPACT STATEMENT

Unfortified breastmilk resulted in adequate growth in weight, length and head circumference in Nigerian moderate to late preterm infants during an study period of 8 weeks, but status of vitamin D, vitamin A and iron needs to be monitored. The high-energy formula, developed for very preterm infants, resulted in higher growth in body weight in moderate to late preterm infants than the median of the Fenton preterm growth chart. This study supports the necessity of dedicated nutritional guidelines, and regular monitoring of growth and nutritional status of moderate to late preterm infants.

Evaluating Heavy Metals in Human Breast Milk: a Cross-Sectional Study from Mining and Agricultural Areas in Northwestern Iran

This study aimed to assess the levels of heavy metals in the breast milk of women residing in the mining and agricultural areas of East Azerbaijan province in Iran. This cross-sectional study analyzed 68 lactating mothers from mining (n = 28) and agricultural (n = 40) areas of East Azerbaijan province in Iran between June 2022 and March 2023. The study used an Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) to measure the concentrations of heavy metals, including arsenic (As), chromium (Cr), copper (Cu), and iron (Fe). A semi-quantitative food frequency questionnaire (SQ-FFQ) was used to collect data on the dietary and sociodemographic characteristics of the mothers. Although the concentration of arsenic (As) was below the limit of detection (LOD), the mean concentrations of chromium (Cr), copper (Cu), and iron (Fe) were 1.11, 0.87, and 13.25 mg/L in agricultural areas and 0.83, 0.93, and 11.35 mg/L in mining areas, respectively. The concentrations of Cr (p < 0.001) and Fe (p = 0.019) were significantly higher in the breast milk of women residing in agricultural areas. However, the concentration of Cu was significantly higher (p = 0.085) in the breast milk of women living in mining areas. Additionally, lactation age had a significant effect on Cu levels (p = 0.015), with a negative coefficient of -0.011. The study indicates that the levels of heavy metals in breast milk can be influenced by the exposure to pesticides, fertilizers, volcanic soil, and disparities in access to post-natal care and iron supplements.

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Zinc, Copper, and Iron in Selected Skin Diseases

Trace elements are essential for maintaining the body's homeostasis, and their special role has been demonstrated in skin physiology. Among the most important trace elements are zinc, copper, and iron. A deficiency or excess of trace elements can be associated with an increased risk of skin diseases, so increasing their supplementation or limiting intake can be helpful in dermatological treatment. In addition, determinations of their levels in various types of biological material can be useful as additional tests in dermatological treatment. This paper describes the role of these elements in skin physiology and summarizes data on zinc, copper, and iron in the course of selected, following skin diseases: psoriasis, pemphigus vulgaris, atopic dermatitis, acne vulgaris and seborrheic dermatitis. In addition, this work identifies the potential of trace elements as auxiliary tests in dermatology. According to preliminary studies, abnormal levels of zinc, copper, and iron are observed in many skin diseases and their determinations in serum or hair can be used as auxiliary and prognostic tests in the course of various dermatoses. However, since data for some conditions are conflicting, clearly defining the potential of trace elements as auxiliary tests or elements requiring restriction/supplement requires further research.

Early iron supplementation in exclusively breastfed Gambian infants: a randomized controlled trial

Objective

To investigate the effect of daily iron supplementation for 14 weeks on the serum iron concentration and other markers of iron status in exclusively breastfed infants in Gambia.

Methods

A placebo-controlled, randomized, double-blind trial was performed in rural Gambia between 3 August 2021 and 9 March 2022. Overall, 101 healthy, exclusively breastfed infants aged 6 to 10 weeks were recruited at vaccination clinics and through community health workers. Infants were randomized to receive iron supplementation (7.5 mg/day as ferrous sulfate in sorbitol solution) or placebo for 98 days. Venous blood samples were collected at baseline and on day 99 to assess the serum iron concentration and other markers of iron and haematological status.

Findings

At day 99, the serum iron concentration was significantly higher in the iron supplementation group than the placebo group (crude difference in means: 2.5 µmol/L; 95% confidence interval: 0.6 to 4.3) and there were significant improvements in other iron and haematological markers. There were 10 serious adverse events (five in each group), 106 non-serious adverse events (54 with iron supplementation; 52 with placebo) and no deaths. There was no marked difference between the groups in maternally reported episodes of diarrhoea, fever, cough, skin infection, eye infection or nasal discharge.

Conclusion

In exclusively breastfed Gambian infants, iron supplementation from 6 weeks of age was associated with a significant improvement in markers of iron status at around 6 months of age. There was no indication of adverse effects on growth or infections.

Micronutrients in infants suffering from cow's milk allergy fed with dietary formulas and breast milk

INTRODUCTION

Cow's milk allergy (CMA) is the most common food allergy in infants. As this food allergy indicates a wide range of clinical syndromes due to immunological reactions to cow's milk proteins, we aimed to evaluate the status of micronutrients in infants suffering from cow's milk allergy.

METHODS

In this historical cohort study, infants with CMA were divided into two equal groups: breastfeeding and diet formula feeding. Data were gathered by a form, including the micronutrients such as iron, selenium, calcium, phosphorus, zinc, and vitamin D. Groups were compared and data were analyzed by the IBM SPSS version 21.

RESULTS

This study involved 60 six-month-old infants, and the findings revealed no significant difference between the two groups concerning magnesium, phosphorus, zinc, and vitamin D. However, infants in the formula-feeding group exhibited significantly elevated mean serum levels of iron and selenium, whereas breastfed infants displayed higher levels of calcium.

CONCLUSION

The findings of this research revealed a significant difference in calcium, selenium, and iron levels between formula-fed and breastfed infants, even though all variables were within the normal range for both groups. In light of these results, conducting further studies with a larger sample size and extended follow-up periods becomes imperative.

Trace elements status in human breast milk of mothers from Île-de-France region

Breastfeeding is the main source of nutrition during first months of life. Its composition varies according to parameters like mother's diet and health, living area, number of pregnancies and lactation duration… Trace-elements concentration in breastmilk is then an important parameter that can affect infant's health, growth or immune system and organ functions. Few data are available on this topic, and results are often very variable. The aim of this work is to determine reference values of Copper (Cu), Zinc (Zn), Selenium (Se), Cobalt (Co), Iron (Fe) and Iodine (I) in human breastmilk according to lactation duration and to study influencing parameters on its elementary composition. Regional Human Milk Bank of Necker Enfants Malades Hospital provided samples that came from breastfeeding woman involved in voluntary milk donation and epidemiologic data. Two hundred thirty-two breastmilk were analysed. After nitric acid mineralization of milk samples, Cu, Zn, Se, Co and I were determined by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in a standard mode. Fe was measured by Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES). Both assays were validated in terms of sensitivity, repeatability and accuracy.Studied breast milks came from mothers with an average age of 32 years and donation time ranged from one day after childbirth to 974 days (> 2.5 years); mean lactation duration is 59 days (> 8 weeks) while median duration is 29 days (around 4 weeks). In all studied samples, mean results and reference values are for Cu: 6.02 (1.71-13.23), Zn: 43.86 (7.3-107.0), Se: 0.12 (0.07-0.24), I: 0.29 (0.07-1.01) and Fe: 4.72 (1.25-11.49) µmol/L and for Co: 12.28 (5.27-25.82) nmol/L. Important number of studied milks allowed their distribution into seven classes of lactation durations. Samples were divided into four successive classes of fifteen days after childbirth, two other classes corresponding to the 3rd and 4th months and a last class for milks sampled after 4 months of lactation. Results were analysed in each class allowing study of evolution during lactation. That was particularly interesting for Zn, that presented an important variability in the total population (4-132 µmol/L) explained by variation along lactation evolution decreasing from 48 to 17 µmol/L in first and last duration classes respectively. In addition, Cu and Fe concentrations were also significantly correlated with lactation duration while Se and I were in a lesser extent (p = 0.002). In this study, we present reference values for studied trace elements at different lactation stages, allowing a fine interpretation of future breast milk samples results according to their sampling time. By continuing this study, we plan to increase number of samples in some of the classes and to study the influence of premature birth or twin pregnancy on breast milk elementary composition.

Breastfeeding and Complementary Feeding Practices among Caregivers at Seshego Zone 4 Clinic in Limpopo Province, South Africa

Breastfeeding and complementary feeding are key components of infant and young child feeding that ensure healthy growth, survival, and development. Initiating breastfeeding within an hour after delivery, exclusively breastfeeding for six months, and introducing complementary feeding at six months while continuing breastfeeding up to 24 months or beyond, helps in the prevention of malnutrition, which is a public health problem. The aim of this study was to determine breastfeeding and complementary feeding practices among caregivers of children under 24 months in Seshego, Limpopo Province. A quantitative and cross-sectional design was applied to collect data from 86 caregivers using convenience sampling. A structured questionnaire was utilised to gather data and analysed through statistical software, using descriptive and inferential statistics. Chi-square tests were used to determine associations at a 95% confidence interval where a p-value of <0.05 was considered statistically significant. The findings show that 55% of participants had good breastfeeding and complementary feeding practices. Moreover, 94.2% of participants breastfeed within an hour after delivery at a healthcare facility. Only 43.6% of children were exclusively breastfed. Most participants (52.3%) gave children food before six months and 45.1% introduced complementary feeding at the appropriate age. Also, 69.7% of children across all age groups were not given infant formula. No statistical association was observed between feeding practices and sociodemographic. Breastfeeding was initiated within an hour after delivery at the healthcare facilities, however, post discharge exclusive breastfeeding maintenance remains a challenge. Few infants were introduced to complementary feeding at the appropriate age. A post discharge intervention to practice exclusive breastfeeding, continued breastfeeding, and introduction of appropriate complementary feeding is recommended.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND

Breast milk is the best and principal nutritional source for neonates and infants. It may protect infants against many metabolic diseases, predominantly obesity and type 2 diabetes. Diabetes mellitus (DM) is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood. Breastfeeding protects against infant mortality and diseases, such as necrotizing enterocolitis, diarrhoea, respiratory infections, viral and bacterial infection, eczema, allergic rhinitis, asthma, food allergies, malocclusion, dental caries, Crohn's disease, and ulcerative colitis. It also protects against obesity and insulin resistance and increases intelligence and mental development. Gestational diabetes has short and long-term impacts on infants of diabetic mothers (IDM). Breast milk composition changes in mothers with gestational diabetes.

AIM

To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.

METHODS

We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15, 2022, in this review.

RESULTS

Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms. Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM. Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term, the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.

CONCLUSION

We need more comprehensive research to prove these effects. Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding, every effort should be made to encourage them to breastfeed.

Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs

We estimated how micronutrient needs of young children, aged 6-24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in three age groups (6-8, 9-12, and 13-24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin D and iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin.

Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases

Micronutritional deficiencies are common in atopic children suffering from atopic dermatitis, food allergy, rhinitis, and asthma. A lack of iron, in particular, may impact immune activation with prolonged deficiencies of iron, zinc, vitamin A, and vitamin D associated with a Th2 signature, maturation of macrophages and dendritic cells (DCs), and the generation of IgE antibodies. In contrast, the sufficiency of these micronutrients establishes immune resilience, promotion of regulatory cells, and tolerance induction. As micronutritional deficiencies mimic an infection, the body's innate response is to limit access to these nutrients and also impede their dietary uptake. Here, we summarize our current understanding of the physiological function of iron, zinc, and vitamins A and D in relation to immune cells and the clinical consequences of deficiencies in these important nutrients, especially in the perinatal period. Improved dietary uptake of iron is achieved by vitamin C, vitamin A, and whey compounds, whereas zinc bioavailability improves through citrates and proteins. The addition of oil is essential for the dietary uptake of beta-carotene and vitamin D. As for vitamin D, the major source comes via sun exposure and only a small amount is consumed via diet, which should be factored into clinical nutritional studies. We summarize the prevalence of micronutritional deficiencies of iron, zinc, and vitamins in the pediatric population as well as nutritional intervention studies on atopic diseases with whole food, food components, and micronutrients. Dietary uptake via the lymphatic route seems promising and is associated with a lower atopy risk and symptom amelioration. This review provides useful information for clinical studies and concludes/emphasizes that a healthy, varied diet containing dairy products, fish, nuts, fruits, and vegetables as well as supplementing foods or supplementation with micronutrients as needed is essential to combat the atopic march.

Breastfeeding in the Modern World

BACKGROUND

Social changes in the 20th century resulted in substantial reductions in the prevalence of breastfeeding in many countries but especially in those with high and increasing wealth. Concerns about this decline prompted widespread research to quantify the benefits of breastfeeding and the mechanisms by which it exerts protective effects for mothers and children. Pro-breastfeeding advocacy resulted in the WHO International Code of Marketing of Breastmilk Substitutes in 1981 and the Innocenti Declaration on Breastfeeding in 1990, which, together with numerous other initiatives, have helped to turn the tide.

SUMMARY

A tranche of recent meta-analyses of dozens of individual studies provide very strong evidence that breastfeeding has substantial benefits to babies, infants, and young children. The benefits and strengths of association vary according to the background environmental and hygiene conditions in different settings. In low-income settings, the chief measurable benefits for the child are in respect of reductions in diarrhea and respiratory infections, and in mortality. In high-income settings, breastfeeding protects against otitis media, likely protects against type 2 diabetes and overweight and obesity, and possibly protects against type 1 diabetes. It likely improves IQ by 2-3 percentage points. In mothers, breastfeeding reduces a mother's likelihood of breast and ovarian cancers. Feeding these data into the Lives Saved Tool suggests that these benefits could prevent 823,000 deaths in children and 22,000 among women.

Dietary Micronutrients from Zygote to Senility: Updated Review of Minerals' Role and Orchestration in Human Nutrition throughout Life Cycle with Sex Differences

Micronutrients such as selenium, fluoride, zinc, iron, and manganese are minerals that are crucial for many body homeostatic processes supplied at low levels. The importance of these micronutrients starts early in the human life cycle and continues across its different stages. Several studies have emphasized the critical role of a well-balanced micronutrient intake. However, the majority of studies looked into or examined such issues in relation to a specific element or life stage, with the majority merely reporting the effect of either excess or deficiency. Herein, in this review, we will look in depth at the orchestration of the main element requirements across the human life cycle beginning from fertility and pregnancy, passing through infancy, childhood, adolescence, and reaching adulthood and senility, with insight on the interactions among them and underlying action mechanisms. Emphasis is given towards approaches to the role of the different minerals in the life cycle, associated symptoms for under- or overdoses, and typical management for each element, with future perspectives. The effect of sex is also discussed for each micronutrient for each life stage as literature suffice to highlight the different daily requirements and or effects.

Breastmilk Feeding during the First 4 to 6 Months of Age and Childhood Disease Burden until 10 Years of Age

BACKGROUND

Breastfeeding is recommended due to its beneficial effects on human health. However, the effect of breastfeeding on health differs, resulting in various childhood diseases.

OBJECTIVE

Our purpose was to investigate the association between breastfeeding at least in the first 4 months and the subsequent development of 15 certainly defined childhood diseases until 10 years of age, the all-cause hospitalization rate and growth at 6-7 years of age.

METHODS

Participants included propensity-score matched 188,052 children born between January 2008 and December 2009, who were followed up till 10 years of age. Data were taken from the National Investigation of birth Cohort in Korea study 2008 database. Risk ratios were obtained using a modified Poisson regression and weighted risk differences using binomial regression.

RESULTS

Compared to formula feeding, breastfeeding was associated with decreased risks of febrile convulsion, attention deficit hyperactivity disorder and autism spectrum disorder, pneumonia, acute bronchiolitis, hypertrophic pyloric stenosis, asthma, all-cause hospitalization, overweight/obesity and short stature. Exclusive breastfeeding at 4 to 6 months of age had similar results to exclusive breastfeeding over 6 months of age.

CONCLUSIONS

Breastfeeding in early infancy reduces the risk for various childhood diseases, all-cause hospitalization rate, obesity, and short stature during childhood.

Effect of using commercial pre-packaged baby foods on the Fe intake of 7-8 months old infants

OBJECTIVES

To examine the potential effect on Fe intake of 7-8 months old infants if pre-packaged baby foods (PBF) were used as the sole source of complementary foods.

DESIGN

Based on the 7-d recommended feeding plan for 7-8 months old infants in Hong Kong (moderate Fe-fortified rice cereal with home-cooked meals), twenty-four modelling scenarios were created which comprised of two milk use modes (breastmilk v. infant formula), three modes of rice cereal use (no-rice cereal; non-Fe-fortified rice cereal and Fe-fortified rice cereal) and four baby foods usage modes (home-cooked meals; low-Fe PBF only; high-Fe PBF only and mixed PBF). The PBF were randomly selected in each of the models and substituted the original meals/snacks. The average daily Fe intakes of the modelled meal plans were compared with the Chinese estimated average requirement (EAR) and recommended nutrient intake (RNI) for Fe.

SETTING

Modelling study.

PARTICIPANTS

Not applicable.

RESULTS

In general, the infant-formula-based complementary feeding pattern (CFP) had higher average daily Fe intake when compared with breastmilk-based CFP. The Fe intakes of all scenarios under the breastmilk-based CFP were below the RNI and EAR, except for the fortified rice cereal meal plans with high-Fe or mixed PBF. For infant-formula-based CFP, the Fe intakes were close to or above the RNI regardless of types of PBF or rice cereal used.

CONCLUSIONS

The inclusion of fortified rice cereal was important in maintaining adequate Fe intake for infants, especially for breast-fed infants. The replacement of home-cooked meals by low-Fe PBF could potentially put infants at risk of Fe deficiency.

Prevalence of anemia and its associated factors among children aged 6-59 months in the Lao People's Democratic Republic: A multilevel analysis

Anemia is a major public health concern among children aged <5 years in the Lao People’s Democratic Republic. Thus far, no study has determined the factors associated with anemia among children aged <5 years in the Lao People’s Democratic Republic using a nationwide representative sample. Therefore, this study aimed to evaluate the prevalence of anemia and its associated factors with multilevel variations among children aged 6–59 months. This quantitative, cross-sectional study used a nationally representative sample from the Lao Social Indicator Survey II, 2017. Children aged 6–59 months tested for anemia were included in this study through multistage sampling approaches. Anemia was defined as a hemoglobin level of <11.0 g/dL. Multilevel binary logistic regression analyses were used to determine the adjusted effect of the factors associated with anemia. Among the 5,087 children included, the overall prevalence of anemia was 43.0%. Three factors were associated with higher odds of developing anemia—male sex (adjusted odds ratio, 1.16; 95% confidence interval, 1.01–1.34), underweight (adjusted odds ratio, 1.30; 95% confidence interval, 1.09–1.55), and residence in central provinces (adjusted odds ratio, 1.59; 95% confidence interval, 1.30–1.95) and southern provinces (adjusted odds ratio, 1.42; 95% confidence interval, 1.11–1.81). However, the other three factors—age, educational level of the household head, and Hmong-Mien ethnicity—were inversely associated with anemia. To resolve the problem regarding the severity of the anemia among children aged <5 years in the Lao People’s Democratic Republic. Our findings highlight the need for designing an effective approach to address each factor associated with childhood anemia. Interventions should focus on the prevention of childhood anemia, which is considered a major priority of public health intervention in the Lao People’s Democratic Republic.

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon

BACKGROUND

Voluntarily fortified snack products are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so potential impacts on population micronutrient intake adequacy are uncertain.

OBJECTIVES

We modeled the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake in children and women of reproductive age (WRA) in Cameroon.

METHODS

In a nationally representative survey stratified by macro-region (North, South, and Yaoundé/Douala), 24-h dietary recall data were collected from 883 children aged 12-59 mo and from 912 WRA. We estimated usual nutrient intake by the National Cancer Institute method for vitamin A, folate, vitamin B-12, zinc, and iron. We simulated the impact of biscuit fortification on prevalence of micronutrient intake below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs.

RESULTS

Biscuit consumption in the prior 24-h by children and WRA, respectively, ranged from 4.5% and 1.5% in the South, to 20.7% and 5.9% in Yaoundé/Douala. In the absence of LSFF programs, biscuits fortified with retinol (600 μg/100 g), folic acid (300 μg/100 g), and zinc (8 mg/100 g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2, and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when existing vitamin A-fortified oil, and folic acid-fortified and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impact on dietary inadequacy in WRA, with or without LSFF programs.

CONCLUSIONS

Given observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients in children in urban areas in the absence of LSFF programs. As voluntary fortification becomes increasingly common, modeling studies could help guide efforts to ensure that fortified products align with public health goals.

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

Iron is an essential micronutrient for early development, being involved in several cellular processes and playing a significant role in neurodevelopment. Prematurity may impact on iron homeostasis in different ways. On the one hand, more than half of preterm infants develop iron deficiency (ID)/ID anemia (IDA), due to the shorter duration of pregnancy, early postnatal growth, insufficient erythropoiesis, and phlebotomy losses. On the other hand, the sickest patients are exposed to erythrocytes transfusions, increasing the risk of iron overload under conditions of impaired antioxidant capacity. Prevention of iron shortage through placental transfusion, blood-sparing practices for laboratory assessments, and iron supplementation is the first frontier in the management of anemia in preterm infants. The American Academy of Pediatrics recommends the administration of 2 mg/kg/day of oral elemental iron to human milk-fed preterm infants from one month of age to prevent ID. To date, there is no consensus on the type of iron preparations, dosages, or starting time of administration to meet optimal cost-efficacy and safety measures. We will identify the main determinants of iron homeostasis in premature infants, elaborate on iron-mediated redox unbalance, and highlight areas for further research to tailor the management of iron metabolism.

Iron Status of Infants in the First Year of Life in Northern Taiwan

Iron deficiency (ID) and iron deficiency anemia (IDA) typically occur in developing countries. Notably, ID and IDA can affect an infant’s emotion, cognition, and development. Breast milk is considered the best food for infants. However, recent studies have indicated that breastfeeding for more than six months increases the risk of ID. This study investigated the prevalence of ID and IDA, as well as the association between feeding type and iron nutritional status in northern Taiwan. A cross-sectional study was conducted on infants who returned to the well-baby clinic for routine examination from October 2012 to January 2014. Overall, 509 infants aged 1–12 months completed the iron nutritional status analysis, anthropometric measurement, and dietary intake assessment, including milk and complementary foods. The results revealed that 49 (10%) and 21 (4%) infants in their first year of life had ID and IDA, respectively, based on the World Health Organization criteria. Breastfed infants had a higher prevalence rate of ID and IDA than mixed-fed and formula-fed infants (p < 0.001). Regarding biomarkers of iron status, plasma hemoglobin (Hb), ferritin, and transferrin saturation (%) levels were significantly lower in ID and IDA groups. The prevalence of ID and IDA were 3.7% and 2.7%, respectively, in infants under six months of age, but increased to 20.4% and 6.6%, respectively, in infants above six months of age. The healthy group had a higher total iron intake than ID and IDA groups, mainly derived from infant formula. The total dietary iron intake was positively correlated with infants’ Hb levels. Compared with formula-fed infants, the logistic regression revealed that the odds ratio for ID was 2.157 (95% confidence interval [CI]: 1.369–3.399) and that for IDA was 4.196 (95% CI: 1.780–9.887) among breastfed infants (p < 0.001) after adjusted for all confounding factors (including gestational week, birthweight, sex, body weight percentile, body length percentile, age of infants, mothers’ BMI, gestational weight gain, education level, and hemoglobin level before delivery). In conclusion, our results determined that breastfeeding was associated with an increased the prevalence of ID and/or IDA, especially in infants above six months. This suggests that mothers who prolonged breastfeed after six months could provide high-quality iron-rich foods to reduce the prevalence of ID and IDA.