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Fernández-Gaxiola AC, García-Guerra A, Neufeld LM. Persistent Challenges of Micronutrient Deficiencies in Latin America Need Action. Food Nutr Bull 2024; 45:S7-S10. [PMID: 39086004 DOI: 10.1177/03795721241262136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Micronutrient deficiencies affect growth and development and are critical for maintaining health at all ages. Their critical role in exacerbating complications of infections and chronic diseases continues to impact morbidity, mortality, and quality of life for many. Raising awareness and advocating for micronutrient deficiencies in Latin America is urgent to reduce this preventable burden. Globally, an estimated 372 million preschool-aged children and 1.2 billion non-pregnant women of reproductive age suffer deficiency from 1 or more micronutrient. Data is limited and often old, and the true burden of problem in the region remains unclear. There are also limited data on dietary intake and on the double burden of malnutrition. Latin America has been a leader in the design and implementation of innovative and effective actions to reduce excess energy intake and curb the consumption of unhealthy Actions to address deficiency have been implemented in many countries in the region over the years, but current evidence suggests that micronutrient deficiencies have fallen off the public health agenda in Latin America. Effective programming can be developed / appropriately adapted only with knowledge of the current burden. Such data can also help guide and predict future areas of risk and priorities to missing upcoming nutrition issues in the population. Renewed commitment to quantify and monitor micronutrient deficiencies in the region is essential. Abundant evidence and guidance exist to inform effective program selection, design and implementation to address this public health problem.
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Affiliation(s)
- A C Fernández-Gaxiola
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - A García-Guerra
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - L M Neufeld
- Education and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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Vassilopoulou E, Venter C, Roth-Walter F. Malnutrition and Allergies: Tipping the Immune Balance towards Health. J Clin Med 2024; 13:4713. [PMID: 39200855 PMCID: PMC11355500 DOI: 10.3390/jcm13164713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Malnutrition, which includes macro- and micronutrient deficiencies, is common in individuals with allergic dermatitis, food allergies, rhinitis, and asthma. Prolonged deficiencies of proteins, minerals, and vitamins promote Th2 inflammation, setting the stage for allergic sensitization. Consequently, malnutrition, which includes micronutrient deficiencies, fosters the development of allergies, while an adequate supply of micronutrients promotes immune cells with regulatory and tolerogenic phenotypes. As protein and micronutrient deficiencies mimic an infection, the body's innate response limits access to these nutrients by reducing their dietary absorption. This review highlights our current understanding of the physiological functions of allergenic proteins, iron, and vitamin A, particularly regarding their reduced bioavailability under inflamed conditions, necessitating different dietary approaches to improve their absorption. Additionally, the role of most allergens as nutrient binders and their involvement in nutritional immunity will be briefly summarized. Their ability to bind nutrients and their close association with immune cells can trigger exaggerated immune responses and allergies in individuals with deficiencies. However, in nutrient-rich conditions, these allergens can also provide nutrients to immune cells and promote health.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Department of Clinical Sciences and Community Health, Univertià degli Studi die Milano, 20122 Milan, Italy
| | - Carina Venter
- Pediatrics, Section of Allergy & Immunology, University of Colorado Denver School of Medicine, Children’s Hospital Colorado, Box B518, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Franziska Roth-Walter
- Messerli Research Institute, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Medical University of Vienna and University of Vienna, 1210 Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
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Bell V, Rodrigues AR, Ferrão J, Varzakas T, Fernandes TH. The Policy of Compulsory Large-Scale Food Fortification in Sub-Saharan Africa. Foods 2024; 13:2438. [PMID: 39123628 PMCID: PMC11312076 DOI: 10.3390/foods13152438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/27/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women's education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources.
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Affiliation(s)
- Victoria Bell
- Faculty of Pharmacy, University of Coimbra, Polo das Ciências da Saúde, Azinhaga de Stª Comba, 3000-548 Coimbra, Portugal; (V.B.)
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, University of Coimbra, Polo das Ciências da Saúde, Azinhaga de Stª Comba, 3000-548 Coimbra, Portugal
| | - Ana Rita Rodrigues
- Faculty of Pharmacy, University of Coimbra, Polo das Ciências da Saúde, Azinhaga de Stª Comba, 3000-548 Coimbra, Portugal; (V.B.)
| | - Jorge Ferrão
- Vice-Chancellor Office, Universidade Pedagógica de Maputo, Rua João Carlos Raposo Beirão 135, Maputo 1000-001, Mozambique;
| | - Theodoros Varzakas
- Food Science and Technology, University of the Peloponnese, GR-22100 Kalamata, Greece
| | - Tito H. Fernandes
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
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Kalayci F, Yigit M. Serum levels of zinc, folate, and vitamin B12 in healthy children aged 3-12 months: Is routine screening necessary? Saudi Med J 2024; 45:821-825. [PMID: 39074894 PMCID: PMC11288490 DOI: 10.15537/smj.2024.45.8.20240248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/24/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES To retrospectively assess the serum levels of zinc, folate, and vitamin B12 in healthy children aged between 3-12 months. METHODS This study includes healthy children aged between 3-12 months who presented to the pediatric outpatient clinics of Ankara Bilkent City Hospital, Ankara, Turkey, between January 2020 and July 2022. The levels of serum zinc, folate, and vitamin B12 were evaluated retrospectively. RESULTS Of the 495 patients enrolled in our study, 248 (50.1%) were female. The median age of the patients was 10 (range: 7-12) months. Zinc deficiency was detected in 24 (4.8%) patients, and vitamin B12 deficiency was found in 49 (9.8%) patients. No folate deficiency was observed in any patient. There was no significant correlation between the patients' height and weight percentiles and their serum levels of zinc, folate, and vitamin B12 (p>0.05 for each). CONCLUSION In conclusion, we do not recommend routine screening for zinc, folate, and vitamin B12 levels in children under 12 months of age without active issues or chronic diseases due to the associated costs. We propose that evaluating serum levels of zinc, folate, and vitamin B12 is a more appropriate clinical approach in children at risk for micronutrient deficiencies and in selected patient groups.
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Affiliation(s)
- Furkan Kalayci
- From the Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Metin Yigit
- From the Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey.
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Song M, Chen J, Si J, Man T, Yao Q, Zhu F, Lv F, Piao Y, Wan Y, Zhu C, Deng S. Selenium Supplementation Sensor Based on Direct Electrochemistry of Urinary Selenosugar and Total Selenium. Anal Chem 2024; 96:12173-12180. [PMID: 39004816 DOI: 10.1021/acs.analchem.4c02391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Emerging point-of-care testing methods are extremely beneficial for personalized assessments of trace element metabolism including selenium (Se). Given the lack of timely evaluation methods for well-received Se fortification, an electrochemical solution was developed based on the recently identified urinary selenosugar (Sel) as a marker. The Se content of crude urine was rapidly determined (∼5 min), and the square-wave voltammetric responses of a Se-selective probe (SeSE) composed of liquid metal amalgam demonstrated comparable performance (e.g., detection limit: 19 nM) to central lab benchtop equipment within the physiological range. Meanwhile, SeSE enabled total urinary Se detection via a mere one-step oxidation. Additionally, SeSE was utilized to jointly assess the apparent internalization and utilization rate of two typical nutrients, selenite and selenomethionine, in a rat nutrition model, demonstrating consistent results with those obtained by HPLC-MS and ICP-MS. Upon systematic standardization directed by Ramaley's theory, SeSE was integrated into a battery-operated portable kit (dubbed "SeEye") with a micro electrochemical drive and tablet PC console for one-stop service trials in a local commercial scenario. This study establishes (1) a nutritive value classifier in a low-cost consumer electronic format and (2) noninvasive diagnostic technology for Se supplementation.
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Affiliation(s)
- Meiyan Song
- School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Jialiang Chen
- School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Jingyi Si
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tiantian Man
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Qunyan Yao
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fulin Zhu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Fujin Lv
- School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Yuhao Piao
- School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Ying Wan
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Changfeng Zhu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shengyuan Deng
- School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
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Sachdev HS, Mondal A, Kurpad A. Contextual diets or chemical nutrient products for preventing malnutrition in low- and middle-income countries? Arch Dis Child 2024; 109:676-679. [PMID: 37890959 DOI: 10.1136/archdischild-2023-325734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Ankita Mondal
- Nutrition, St John's Research Institute, Bangalore, Karnataka, India
| | - Anura Kurpad
- Department of Physiology, St John's Medical College, Bangalore, Karnataka, India
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Rice I, Opondo C, Nyesigomwe L, Ekude D, Magezi J, Kalanzi A, Kerac M, Hayes J, Robello M, Halfman S, DeLacey E. Children with disabilities lack access to nutrition, health and WASH services: A secondary data analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13642. [PMID: 38563355 PMCID: PMC11168356 DOI: 10.1111/mcn.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.
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Affiliation(s)
- Isabel Rice
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | | | | | | | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
| | | | | | | | - Emily DeLacey
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
- Holt InternationalEugeneOregonUSA
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Thompson L, Becher E, Adams KP, Haile D, Walker N, Tong H, Vosti SA, Engle-Stone R. Modeled impacts of bouillon fortification with micronutrients on child mortality in Senegal, Burkina Faso, and Nigeria. Ann N Y Acad Sci 2024; 1537:82-97. [PMID: 38922959 DOI: 10.1111/nyas.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Micronutrient interventions can reduce child mortality. By applying Micronutrient Intervention Modeling methods in Senegal, Burkina Faso, and Nigeria, we estimated the impacts of bouillon fortification on apparent dietary adequacy of vitamin A and zinc among children and folate among women. We then used the Lives Saved Tool to predict the impacts of bouillon fortification with ranges of vitamin A, zinc, and folic acid concentrations on lives saved among children 6-59 months of age. Fortification at 250 µg vitamin A/g and 120 µg folic acid/g was predicted to substantially reduce vitamin A- and folate-attributable deaths: 65% for vitamin A and 92% for folate (Senegal), 36% for vitamin A and 74% for folate (Burkina Faso), and >95% for both (Nigeria). Zinc fortification at 5 mg/g would avert 48% (Senegal), 31% (Burkina Faso), and 63% (Nigeria) of zinc-attributable deaths. The addition of all three nutrients at 30% of Codex nutrient reference values in 2.5 g bouillon was predicted to save an annual average of 293 child lives in Senegal (3.5% of deaths from all causes among children 6-59 months of age), 933 (2.1%) in Burkina Faso, and 18,362 (3.7%) in Nigeria. These results, along with evidence on program feasibility and costs, can help inform fortification program design discussions.
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Affiliation(s)
- Lauren Thompson
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
| | - Emily Becher
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
| | - Katherine P Adams
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Demewoz Haile
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Nutrition, University of California, Davis, Davis, California, USA
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Zemariam AB, Adisu MA, Habesse AA, Abate BB, Bizuayehu MA, Wondie WT, Alamaw AW, Ngusie HS. Employing advanced supervised machine learning approaches for predicting micronutrient intake status among children aged 6-23 months in Ethiopia. Front Nutr 2024; 11:1397399. [PMID: 38919392 PMCID: PMC11198118 DOI: 10.3389/fnut.2024.1397399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Background Although micronutrients (MNs) are important for children's growth and development, their intake has not received enough attention. MN deficiency is a significant public health problem, especially in developing countries like Ethiopia. However, there is a lack of empirical evidence using advanced statistical methods, such as machine learning. Therefore, this study aimed to use advanced supervised algorithms to predict the micronutrient intake status in Ethiopian children aged 6-23 months. Methods A total weighted of 2,499 children aged 6-23 months from the Ethiopia Demographic and Health Survey 2016 data set were utilized. The data underwent preprocessing, with 80% of the observations used for training and 20% for testing the model. Twelve machine learning algorithms were employed. To select best predictive model, their performance was assessed using different evaluation metrics in Python software. The Boruta algorithm was used to select the most relevant features. Besides, seven data balancing techniques and three hyper parameter tuning methods were employed. To determine the association between independent and targeted feature, association rule mining was conducted using the a priori algorithm in R software. Results According to the 2016 Ethiopia Demographic and Health Survey, out of 2,499 weighted children aged 12-23 months, 1,728 (69.15%) had MN intake. The random forest, catboost, and light gradient boosting algorithm outperformed in predicting MN intake status among all selected classifiers. Region, wealth index, place of delivery, mothers' occupation, child age, fathers' educational status, desire for more children, access to media exposure, religion, residence, and antenatal care (ANC) follow-up were the top attributes to predict MN intake. Association rule mining was identified the top seven best rules that most frequently associated with MN intake among children aged 6-23 months in Ethiopia. Conclusion The random forest, catboost, and light gradient boosting algorithm achieved a highest performance and identifying the relevant predictors of MN intake. Therefore, policymakers and healthcare providers can develop targeted interventions to enhance the uptake of micronutrient supplementation among children. Customizing strategies based on identified association rules has the potential to improve child health outcomes and decrease the impact of micronutrient deficiencies in Ethiopia.
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Affiliation(s)
- Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Molalign Aligaz Adisu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Aklilu Abera Habesse
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Molla Azmeraw Bizuayehu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Addis Wondmagegn Alamaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Habtamu Setegn Ngusie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
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Siramaneerat I, Astutik E, Agushybana F, Bhumkittipich P, Lamprom W. Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS). BMC Public Health 2024; 24:1371. [PMID: 38778326 PMCID: PMC11110397 DOI: 10.1186/s12889-024-18824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. METHODS The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. RESULTS The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. CONCLUSIONS Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.
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Affiliation(s)
- Issara Siramaneerat
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand.
| | - Erni Astutik
- Department of Epidemiology, Population Biostatistics and Health Promotion, Faculty of Public Health, Airlangga University, JI. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Farid Agushybana
- Department of Biostatistics and Demography, Faculty of Public Health, Diponegoro University, Jl. Prof. Soedarto, SH. Tembalang, Semarang, Central Java, 50275, Indonesia
| | - Pimnapat Bhumkittipich
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand
| | - Wanjai Lamprom
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand
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Proctor KB, Mansoura M, Rodrick E, Volkert V, Sharp WG, Kindler JM. The relationship between food selectivity and stature in pediatric patients with avoidant-restrictive food intake disorder - an electronic medical record review. J Eat Disord 2024; 12:64. [PMID: 38773584 PMCID: PMC11110304 DOI: 10.1186/s40337-024-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND We aimed to characterize stature in pediatric patients with avoidant/restrictive food intake disorder (ARFID), including associations between body size and nutrient intake and height. METHODS We conducted a secondary analysis of pre-treatment data from 60 patients diagnosed with ARFID that were collected from the electronic medical record. Anthropometric measurements were converted to age- and sex-specific Z-scores using pediatric CDC growth charts. Spearman correlations were performed to test the relationship between height and weight/BMI Z-scores as well as height Z-score and diet variables. RESULTS On average, height (-0.35 ± 1.38), weight (-0.58 ± 1.56), and BMI (-0.56 ± 1.48) Z-scores tended to be lower than what would be expected in a generally healthy pediatric population. Percent of individuals with height, weight, or BMI Z-score < -2.0 was 8%, 20%, and 17%, respectively. BMI (P < 0.05) and weight (P < 0.05) were positively associated with height Z-score. Further, intake of some nutrients (e.g., calcium, vitamin D) correlated positively with height Z-score (all P < 0.05). CONCLUSIONS The cross-sectional relationships reported in this study suggest that in children with ARFID, body weight and consumption of bone-augmenting nutrients such as calcium and vitamin D correlated with height. A thorough understanding of the clinical manifestations of malnutrition and longitudinal effects of restrictive eating in patients with ARFID is critical.
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Affiliation(s)
- Kaitlin B Proctor
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maryam Mansoura
- Medical College of Georgia, Augusta University, University of Georgia Medical Partnership, Augusta, GA, USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Valerie Volkert
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - William G Sharp
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA.
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12
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Berger MM, Shenkin A. Micronutrient deficiency and supplements in schoolchildren and teenagers. Curr Opin Clin Nutr Metab Care 2024; 27:266-274. [PMID: 38462972 DOI: 10.1097/mco.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW The essential micronutrients are corner stones in the functional and physical development. Early deficiency has life-long consequences. While awareness about iron deficiency is relatively high, it remains lower for other micronutrients. This review aims at reporting on recent data and attracting attention to the high prevalence of micronutrient deficiencies in school-age and adolescent individuals. RECENT FINDINGS Iron deficiency anaemia remains highly prevalent worldwide and the most frequent deficiency but can be corrected with simple tools ranging from food fortification, nutritional intervention, and to supplements. The link between micronutrient (MN) deficiency and neurobehavioral disorders is increasingly established and is worrying even in Western countries. Paediatric individuals are prone to imbalanced diets and picky eating behaviour, and their diets may then become incomplete: the highest risk for deficiency is observed for iron, zinc and vitamin D. SUMMARY There is not much new information, but rather confirmation of the importance of health policies. Well conducted randomized controlled trials confirm that deficiencies can be corrected efficiently including with food fortification, and result in clinical benefits. Individual complementation should be considered in children and adolescents with proven deficiency.
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Affiliation(s)
- Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK
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13
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Westenbrink S, Tenhagen CJ, Toxopeus I, Verkaik-Kloosterman J, Feskens EJM, Ocké M. Procedure to identify fortified foods in the Dutch branded food database. Front Nutr 2024; 11:1366083. [PMID: 38660063 PMCID: PMC11040091 DOI: 10.3389/fnut.2024.1366083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Information on fortified foods is needed for multiple purposes, including food consumption research and dietary advice. Branded food databases are a valuable source of food label data. European labeling legislation prescribes that food fortification should be indicated in the ingredient list, and nutrient values should be declared under certain conditions. This creates the potential to identify fortified foods in branded food databases, though it is not straightforward and labor-intensive. The aim of our study was to develop an automated approach to identify fortified foods in the Dutch branded food database called LEDA. Methods An automated procedure, based on a stepwise approach conforming with European labeling legislation, using a list of rules and search terms, was developed to identify fortified foods. Fortification with calcium, folic acid, vitamin B12, and zinc was studied as an example. The results of a random stratified sample with fortified and not-fortified foods were validated by two experts. Results The automated approach resulted in identifying 1,817 foods fortified with one or more of the selected nutrients in the LEDA dataset (0.94%). The proportions of fortified foods per nutrient were below 0.7%. The classification of fortified/non-fortified foods matched manual validation by experts for the majority of the foods in the sample, i.e., sensitivity and specificity indicating the probability of correctly identifying fortified and non-fortified foods was high (>94.0%). Conclusion The automated approach is capable of easily and quickly identifying fortified foods in the Dutch branded food database with high accuracy, although some improvements to the automated procedure could be made. In addition, the completeness, correctness, and consistency of the LEDA database can be improved. To fully benefit from this automated approach, it needs to be expanded to cover all micronutrients that may be added to foods.
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Affiliation(s)
- Susanne Westenbrink
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Cyrelle J. Tenhagen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Ido Toxopeus
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Marga Ocké
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
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14
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Tan X, Tan PY, Gong YY, Moore JB. Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e015135. [PMID: 38599666 PMCID: PMC11015307 DOI: 10.1136/bmjgh-2024-015135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Traditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people. METHODS Ovid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed. RESULTS After screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08). CONCLUSIONS Overnutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition. PROSPERO REGISTRATION NUMBER CRD42020221523.
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Affiliation(s)
- Xiaomian Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Pui Yee Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - J Bernadette Moore
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
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Bechensteen BT, Sithiravel C, Strøm-Roum EM, Ruud HK, Kravdal G, Winther JA, Valderhaug TG. Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy Childbirth 2024; 24:229. [PMID: 38566061 PMCID: PMC10985986 DOI: 10.1186/s12884-024-06407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
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Affiliation(s)
- Brit Torunn Bechensteen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | | | - Heidi Kathrine Ruud
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | - Jacob A Winther
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
| | - Tone G Valderhaug
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
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16
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Rosenstock TS, Yet B. Statistical modelling of determinants of child stunting using secondary data and Bayesian networks: a UKRI Global Challenges Research Fund (GCRF) Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001983. [PMID: 38519063 PMCID: PMC10961555 DOI: 10.1136/bmjpo-2023-001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/11/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Several factors have been implicated in child stunting, but the precise determinants, mechanisms of action and causal pathways remain poorly understood. The objective of this study is to explore causal relationships between the various determinants of child stunting. METHODS AND ANALYSIS The study will use data compiled from national health surveys in India, Indonesia and Senegal, and reviews of published evidence on determinants of child stunting. The data will be analysed using a causal Bayesian network (BN)-an approach suitable for modelling interdependent networks of causal relationships. The model's structure will be defined in a directed acyclic graph and illustrate causal relationship between the variables (determinants) and outcome (child stunting). Conditional probability distributions will be generated to show the strength of direct causality between variables and outcome. BN will provide evidence of the causal role of the various determinants of child stunning, identify evidence gaps and support in-depth interrogation of the evidence base. Furthermore, the method will support integration of expert opinion/assumptions, allowing for inclusion of the many factors implicated in child stunting. The development of the BN model and its outputs will represent an ideal opportunity for transdisciplinary research on the determinants of stunting. ETHICS AND DISSEMINATION Not applicable/no human participants included.
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Affiliation(s)
| | - Barbaros Yet
- Department of Cognitive Science, Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
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17
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Li S, Xing W, Gang Y, Zhang M, Zhao Z, Wu H, Zhu S. Gum Arabic-Derived Hydroxyproline-Rich Peptides Stimulate Intestinal Nonheme Iron Absorption via HIF2α-Dependent Upregulation of Iron Transport Proteins. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:3622-3632. [PMID: 38347764 DOI: 10.1021/acs.jafc.3c09588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The stimulation of host iron absorption is a promising antianemia strategy adjunctive/alternative to iron intervention. Here, gum arabic (GA) containing 3.14 ± 0.56% hydroxyproline-rich protein with repetitive X-(Pro/Hyp)n motifs was found to increase iron reduction, uptake, and transport to upregulate duodenal cytochrome b (Dcytb), divalent metal transporter 1 (DMT1), ferroportin, and hephaestin to inhibit hypoxia-inducible factor (HIF) prolyl hydroxylase (PHD) and to stabilize HIF2α in polarized Caco-2 cell monolayers in a dose-dependent manner, and this was dependent on its protein fraction, rather than the polysaccharide fraction. Three abundant GA-derived hydroxyproline-containing dipeptides of Hyp-Hyp, Pro-Hyp, and Ser-Hyp were detected by liquid chromatography-mass spectrometry in the lysates of polarized Caco-2 cell monolayers at the maximum levels of 0.167 ± 0.021, 0.134 ± 0.017, and 0.089 ± 0.015 μg/mg of protein, respectively, and showed desirable docking affinity energy values of -7.53, - 7.91, and -7.39 kcal/mol, respectively, against human PHD3. GA-derived peptides also acutely increased duodenal HIF2α stability and Dcytb, DMT1, ferroportin, and hephaestin transcription in rats (P < 0.05). Overall, GA-derived hydroxyproline-rich peptides stimulated intestinal iron absorption via PHD inhibition, HIF2α stabilization, and subsequent upregulation of iron transport proteins.
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Affiliation(s)
- Shiyang Li
- State Key Laboratory of Marine Food Processing & Safety Control, College of Food Science and Engineering, Ocean University of China, 5 Yushan Road, Qingdao, Shandong Province 266003, China
| | - Wenshuo Xing
- State Key Laboratory of Marine Food Processing & Safety Control, College of Food Science and Engineering, Ocean University of China, 5 Yushan Road, Qingdao, Shandong Province 266003, China
| | - Yuxin Gang
- State Key Laboratory of Marine Food Processing & Safety Control, College of Food Science and Engineering, Ocean University of China, 5 Yushan Road, Qingdao, Shandong Province 266003, China
| | - Meichao Zhang
- Weihai Institute for Food and Drug Control, Weihai 264299, China
| | - Zifang Zhao
- Hainan/Haikou Research & Development Center for Biopeptide Engineering, Huayan Collagen Technology Co., Ltd., Haikou 571000, China
| | - Haohao Wu
- State Key Laboratory of Marine Food Processing & Safety Control, College of Food Science and Engineering, Ocean University of China, 5 Yushan Road, Qingdao, Shandong Province 266003, China
| | - Suqin Zhu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266021, China
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18
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Domellöf M, Sjöberg A. Iron - a background article for the Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10451. [PMID: 38370116 PMCID: PMC10870973 DOI: 10.29219/fnr.v68.10451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/14/2023] [Accepted: 12/20/2023] [Indexed: 02/20/2024] Open
Abstract
Iron absorption from foods is generally lower than that of most other nutrients and is highly variable depending on individual iron status and iron bioavailability in the meal. Several large population groups in the Nordic and Baltic countries are at risk of iron deficiency, including infants, young children, menstruating females, pregnant women as well as vegetarians. Iron deficiency leads to anemia, fatigue, and limited capacity for physical activity. Of particular concern is that iron deficiency anemia in young children is associated with impaired neurodevelopment. A comprehensive literature search has been performed and summarized. New factorial calculations have been performed considering iron losses, iron absorption and iron requirements in various population groups. Recent data on iron intakes and the prevalence of iron deficiency in the Nordic countries are presented. Average requirements and tentative recommended intakes are presented for 12 different population groups. Pregnant women and those with high menstrual blood losses should consume iron-rich food and undergo screening for iron deficiency. Infants should consume iron-rich complementary foods and cow's milk should be avoided as a drink before 12 months of age and limited to < 500 mL/day in toddlers. Vegetarians should consume a diet including wholegrains, legumes, seeds, and green vegetables together with iron absorption enhancers. There is no evidence that iron intake per se increases the risk of cancer or diabetes. Iron absorption from foods is generally lower than that of most other nutrients and can vary between <2 and 50% depending on individual iron status and iron bioavailability in the meal.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Agneta Sjöberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
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19
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Embling R, Neilson L, Mellor C, Durodola M, Rouse N, Haselgrove A, Shipley K, Tales A, Wilkinson L. Exploring consumer beliefs about novel fortified foods: A focus group study with UK-based older and younger adult consumers. Appetite 2024; 193:107139. [PMID: 38043697 DOI: 10.1016/j.appet.2023.107139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Consuming 'nutritionally-enhanced' food products (including those that are fortified or enriched to deliver nutritional and functional properties) may help to improve overall diet quality and combat risks associated with malnutrition. However, fortification can negatively impact consumer acceptance, particularly where expected sensory properties of 'delivery' foods are affected by target ingredients. Here, we explored factors influencing consumer acceptability for six novel food products that had been fortified, including both savoury and sweet meal components (e.g., high protein dumplings, probiotic yoghurt drink). In person focus groups (25 consumers aged between 22 and 76 years old) were conducted with two stages; firstly, participants completed a blind taste test of products without awareness of fortification. Secondly, participants discussed products with awareness of additional ingredients and food properties. Reflexive thematic analysis showed that liking of sensory properties differed between foods, but informing participants about the fortification of products highlighted potential trade-offs between taste, health, price, and familiarity. Though taste and texture were generally prioritised by participants, positive perceptions of health benefits increased consumer willingness to buy, whilst both cost and uncertainty about product use were potential barriers. Trust of information was a key concern for labelling and product claims. These results highlight product features that may be optimised to support the success of fortified foods. Greater transparency when building product brands and improving consumer knowledge of fortification may also be important for longer-term consumer acceptance.
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Affiliation(s)
- Rochelle Embling
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK
| | - Louise Neilson
- BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | - Chloe Mellor
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK; BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | - Mercy Durodola
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK
| | - Natalie Rouse
- BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | | | | | - Andrea Tales
- The Awen Institute, Talbot Building, Swansea University, Swansea, SA2 8PP, UK
| | - Laura Wilkinson
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK.
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Roth-Walter F, Berni Canani R, O'Mahony L, Peroni D, Sokolowska M, Vassilopoulou E, Venter C. Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients. Allergy 2024; 79:353-383. [PMID: 38084827 DOI: 10.1111/all.15972] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
Nutritional Immunity is one of the most ancient innate immune responses, during which the body can restrict nutrients availability to pathogens and restricts their uptake by the gut mucosa (mucosal block). Though this can be a beneficial strategy during infection, it also is associated with non-communicable diseases-where the pathogen is missing; leading to increased morbidity and mortality as micronutritional uptake and distribution in the body is hindered. Here, we discuss the acute immune response in respect to nutrients, the opposing nutritional demands of regulatory and inflammatory cells and particularly focus on some nutrients linked with inflammation such as iron, vitamins A, Bs, C, and other antioxidants. We propose that while the absorption of certain micronutrients is hindered during inflammation, the dietary lymph path remains available. As such, several clinical trials investigated the role of the lymphatic system during protein absorption, following a ketogenic diet and an increased intake of antioxidants, vitamins, and minerals, in reducing inflammation and ameliorating disease.
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Affiliation(s)
- Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Roberto Berni Canani
- Department of Translational Medical Science and ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Liam O'Mahony
- Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Diego Peroni
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Emilia Vassilopoulou
- Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
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21
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Liu R, Pi L, Leng F, Shen Q. Global disability-adjusted life years and deaths attributable to child and maternal malnutrition from 1990 to 2019. Front Public Health 2024; 12:1323263. [PMID: 38304181 PMCID: PMC10830744 DOI: 10.3389/fpubh.2024.1323263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background Child and maternal malnutrition (CMM) caused heavy disability-adjusted life years (DALY) and deaths globally. It is crucial to understand the global burden associated with CMM in order to prioritize prevention and control efforts. We performed a comprehensive analysis of the global DALY and deaths attributable to CMM from 1990 to 2019 in this study. Methods The age-standardized CMM related burden including DALY and death from 1990 to 2019 were accessed from the Global Burden of Disease study 2019 (GBD 2019). The changing trend were described by average annual percentage change (AAPC). The relationship between sociodemographic factors and burden attributable to CMM were explored by generalized linear model (GLM). Results Globally, in 2019, the age-standardized DALY and death rates of CMM were 4,425.24/100,000 (95% UI: 3,789.81/100,000-5,249.55/100,000) and 44.72/100,000 (95% UI: 37.83/100,000-53.47/100,000), respectively. The age-standardized DALY rate (AAPC = -2.92, 95% CI: -2.97% to -2.87%) and death rates (AAPC = -3.19, 95% CI: -3.27% to -3.12%) presented significantly declining trends during past 30 years. However, CMM still caused heavy burden in age group of <28 days, Sub-Saharan Africa and low SDI regions. And, low birth weight and short gestation has identified as the primary risk factors globally. The GLM indicated that the highly per capita gross domestic product, per capita current health expenditure, physicians per 1,000 people were contributed to reduce the burden attributable to CMM. Conclusion Although global burden attributable to CMM has significantly declined, it still caused severe health burden annually. To strengthen interventions and address resources allocation in the vulnerable population and regions is necessary.
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Affiliation(s)
- Rong Liu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lucheng Pi
- Shenzhen Bao’an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fangqun Leng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College, Hangzhou, China
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22
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Taslim NA, Farradisya S, Gunawan WB, Alfatihah A, Barus RIB, Ratri LK, Arnamalia A, Barazani H, Samtiya M, Mayulu N, Kim B, Hardinsyah H, Surya E, Nurkolis F. The interlink between chrono-nutrition and stunting: current insights and future perspectives. Front Nutr 2023; 10:1303969. [PMID: 38192646 PMCID: PMC10773880 DOI: 10.3389/fnut.2023.1303969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Stunting is the one factor that is responsible for the irretrievable damage to children's mental and physical health. Stunting imitates chronic undernutrition throughout the most extreme critical stages of growth and development of a child in their early life, and due to that stunted child does not completely develop and are too short for their age. Stunting is mainly linked with brain underdevelopment, along with lifelong damaging consequences, comprising weakened mental and learning capacity, deprived performance in school during childhood, and enhanced risks of nutrition linked to chronic long-lasting ailments, such as diabetes, hypertension, diabesity, and obesity in the future. In this review, the authors mainly summarize the latest studies related to chronic nutrition and how it is related to stunting. Optimal nutrition, particularly during pregnancy and the first 24 months of a child's life, is crucial in preventing stunting. Circadian rhythms play a significant role in maternal and fetal health, affecting outcomes such as premature birth and stunting. Maintaining a balanced diet, avoiding late-night carbohydrate-heavy meals during pregnancy, and promoting breastfeeding align with the body's biological clock, which can benefit newborns in various ways. Providing dedicated spaces for breastfeeding in public places is important to support infant health.
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Affiliation(s)
- Nurpudji Astuti Taslim
- Division of Clinical Nutrition, Faculty of Medicine, Department of Nutrition, Hasanuddin University, Makassar, Indonesia
| | | | - William Ben Gunawan
- Faculty of Medicine, Alumnus of Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Aulia Alfatihah
- Faculty of Health Science, Department of Nutrition Science, Muhammadiyah University of Surakarta, Surakarta, Indonesia
| | - Ria Irmelin Br Barus
- Faculty of Medicine, Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Liesty Kurnia Ratri
- Faculty of Medicine, Alumnus of Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Astri Arnamalia
- Department of Chemistry, State Islamic University of Sunan Kalijaga (UIN Sunan Kalijaga), Yogyakarta, Indonesia
| | - Hero Barazani
- Medical Programme, Faculty of Medicine Universitas Brawijaya, Malang, Indonesia
| | - Mrinal Samtiya
- Department of Nutrition Biology, Central University of Haryana, Haryana, India
| | - Nelly Mayulu
- Faculty of Medicine, Department of Nutrition, Universitas Muhammadiyah Manado, Manado, Indonesia
| | - Bonglee Kim
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hardinsyah Hardinsyah
- Senior Professor of Applied Nutrition Division, Faculty of Human Ecology, Department of Community Nutrition, IPB University, Bogor, Indonesia
| | - Ervan Surya
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fahrul Nurkolis
- Faculty of Sciences and Technology, Department of Biological Sciences, State Islamic University of Sunan Kalijaga (UIN Sunan Kalijaga), Yogyakarta, Indonesia
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Sun Y, Ma J, Wei X, Dong J, Wu S, Huang Y. Barriers to and Facilitators of the Implementation of a Micronutrient Powder Program for Children: A Systematic Review Based on the Consolidated Framework for Implementation Research. Nutrients 2023; 15:5073. [PMID: 38140331 PMCID: PMC10745920 DOI: 10.3390/nu15245073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND As one of the most cost-effective investments for improving child nutrition, micronutrient powder (MNP) has been widely used in many countries to underpin the Sustainable Development Goals, yet challenges remain regarding its implementation on a large scale. However, few studies have explored the factors that facilitate or impede the implementation process using implementation science theories and frameworks. To address this gap, we adopted the Consolidated Framework of Implementation Research (CFIR) and conducted a systematic review of studies on the implementation barriers to and facilitators of MNP interventions. METHOD Five publication databases, including EMBASE, Medline, PubMed, Web of Science, and Scopus, were searched for studies on the influencing factors of MNP interventions. Based on the CFIR framework, the facilitators and barriers for the MNP program implementation reported in the included studies were extracted and synthesized by five domains: intervention characteristics, outer setting, inner setting, individual characteristics, and process. RESULTS A total of 50 articles were eligible for synthesis. The majority of the studies were conducted in lower-middle-income countries (52%) through the free delivery model (78%). The inner setting construct was the most prominently reported factor influencing implementation, specifically including available resources (e.g., irregular or insufficient MNP supply), structural characteristics (e.g., public-driven community-based approach), and access to information and knowledge (e.g., lack of training for primary-level workers). The facilitators of the engagement of private sectors, external guidelines, and regular program monitoring were also highlighted. On the contrary, monotonous tastes and occasional side effects impede intervention implementation. Additionally, we found that the inner setting had an interrelation with other contributing factors in the MNP program implementation. CONCLUSION Our results suggest that MNP program implementation was prominently influenced by the available resources, organizational structure, and knowledge of both providers and users. Mobilizing local MNP suppliers, engaging public-driven free models in conjunction with market-based channels, and strengthening the training for primary-level health workers could facilitate MNP interventions.
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Affiliation(s)
- Yinuo Sun
- School of Public Health, Peking University, Xueyuan Rd, No. 38, Beijing 100181, China; (Y.S.); (J.M.); (J.D.)
| | - Jiyan Ma
- School of Public Health, Peking University, Xueyuan Rd, No. 38, Beijing 100181, China; (Y.S.); (J.M.); (J.D.)
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (X.W.); (S.W.)
| | - Jingya Dong
- School of Public Health, Peking University, Xueyuan Rd, No. 38, Beijing 100181, China; (Y.S.); (J.M.); (J.D.)
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (X.W.); (S.W.)
| | - Yangmu Huang
- School of Public Health, Peking University, Xueyuan Rd, No. 38, Beijing 100181, China; (Y.S.); (J.M.); (J.D.)
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Paul TL, Fleming SA. Dietary consumption of beef and red meat: a scoping review and evidence map on cognitive outcomes across the lifespan. Public Health Nutr 2023; 26:2912-2926. [PMID: 37800340 PMCID: PMC10755455 DOI: 10.1017/s1368980023001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Mixed evidence exists on the impact of beef consumption on cognition. The goal was to create an evidence map capturing studies assessing beef consumption and cognition to reveal gaps and opportunities in the body of literature. DESIGN A scoping review was conducted to locate studies up to March 2022 using PubMed and backwards citation screening. Data were extracted by two independent reviewers with conflict resolution, and a database was created and made publicly available. SETTING Intervention and observational studies. PARTICIPANTS Humans of any age, sex and/or health status, without moderate to severe cognitive impairment and/or abnormalities. RESULTS Twenty-two studies were identified that quantified beef or red meat intake and assessed cognition. Six studies assessed beef intake, with the remaining studies describing intake of red meat that may or may not include beef. Nine articles described randomised controlled trials (RCT), mostly conducted in children. Thirteen described observational studies, primarily conducted on adults and seniors. The most common cognitive domains measured included intelligence and general cognition, and memory. The majority of controlled studies were rated with high risk of bias, with the majority of observational trials rated with serious or greater risk of bias. CONCLUSIONS Red meat and beef intake and cognition is largely understudied. There is a significant lack of replication across study designs, populations, exposures and outcomes measured. The quality of the research would be considerably enhanced by focused assessments of beef intake (and not red meat in general) and specific cognitive domains, along with improved adherence to reporting standards.
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Affiliation(s)
- Tristen L Paul
- Traverse Science, 435 E Hawley Street #816, Mundelein, IL60060, USA
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25
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Lobo LMDC, Hadler MCCM. Vitamin E deficiency in childhood: a narrative review. Nutr Res Rev 2023; 36:392-405. [PMID: 35929460 DOI: 10.1017/s0954422422000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.
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Affiliation(s)
| | - Maria Claret Costa Monteiro Hadler
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás, Brazil
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26
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Loechl CU, Datta-Mitra A, Fenlason L, Green R, Hackl L, Itzkowitz L, Koso-Thomas M, Moorthy D, Owino VO, Pachón H, Stoffel N, Zimmerman MB, Raiten DJ. Approaches to Address the Anemia Challenge. J Nutr 2023; 153 Suppl 1:S42-S59. [PMID: 37714779 PMCID: PMC10797550 DOI: 10.1016/j.tjnut.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention-inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.
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Affiliation(s)
- Cornelia U Loechl
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Lindy Fenlason
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Laura Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States
| | - Laura Itzkowitz
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States.
| | | | - Helena Pachón
- Food Fortification Initiative, Emory University, Atlanta, GA, United States
| | - Nicole Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zu¨rich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Michael B Zimmerman
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
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27
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Ragsdale K, Read-Wahidi MR, Mudege NN, Iannotti LL, Muzungaire L, Funduluka P. Sensory panel results of a dried fish powder supplement among caregivers and young children in Zambia. Public Health Nutr 2023; 27:e32. [PMID: 38031467 PMCID: PMC10897570 DOI: 10.1017/s1368980023002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate the acceptability of traditional Zambian dishes fortified with Complementary Food for Africa+Dried Fish Powder (ComFA+Fish), a locally sourced protein/micronutrient blend designed to impact nutrient deficiencies among infants and young children (IYC) and improve pregnancy and birth outcomes among women of reproductive age (WRA). DESIGN During two sensory panels, caregivers evaluated: (1) the acceptability of four ComFA+Fish dishes for household consumption, including fortified chibwabwa fisashi, savory Kapenta chutney, fortified complementary maize porridge and fortified bean-vegetable soup and (2) whether their IYC found the fortified complementary maize porridge acceptable. SETTING Lake Kariba, Southern Province, Zambia. PARTICIPANTS Women of reproductive age (n 42) and their IYC aged 6-11 months (n 16) and 12-23 months (n 26) were recruited from fishing villages in Gwembe, Siavonga and Sinazongwe District. RESULTS A majority of caregivers extremely liked/liked the: (1) fortified chibwabwa fisashi's sensory attributes (94·7 %), convenience (92·8 %) and overall acceptability (100 %); (2) savory Kapenta chutney's sensory attributes (81·8 %), convenience (92·8 %) and overall acceptability (100 %); (3) fortified complementary porridge's sensory attributes (83·5 %), convenience (90·5 %) and overall acceptability (88·1 %) and (4) fortified bean-vegetable soup's sensory attributes (66·8 %), convenience (87·5 %) and overall acceptability (87·5 %). Further, a majority of caregivers evaluated the fortified complementary porridge as highly acceptable to their IYC. CONCLUSIONS Results suggest that ComFA+Fish is strategically well placed to fill nutritional gaps among IYC and WRA in Zambia and has the potential to be scaled across sub-Saharan Africa.
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Affiliation(s)
- Kathleen Ragsdale
- Social Science Research Center, Mississippi State University, PO Box 5287, Mississippi State, MS39762, USA
| | - Mary R Read-Wahidi
- Social Science Research Center, Mississippi State University, PO Box 5287, Mississippi State, MS39762, USA
| | | | - Lora L Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Priscilla Funduluka
- School of Public Health and Environmental Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
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28
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Verbeecke V, Custódio L, Strobbe S, Van Der Straeten D. The role of orphan crops in the transition to nutritional quality-oriented crop improvement. Biotechnol Adv 2023; 68:108242. [PMID: 37640278 DOI: 10.1016/j.biotechadv.2023.108242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
Micronutrient malnutrition is a persisting problem threatening global human health. Biofortification via metabolic engineering has been proposed as a cost-effective and short-term means to alleviate this burden. There has been a recent rise in the recognition of potential that underutilized, orphan crops can hold in decreasing malnutrition concerns. Here, we illustrate how orphan crops can serve as a medium to provide micronutrients to populations in need, whilst promoting and maintaining dietary diversity. We provide a roadmap, illustrating which aspects to be taken into consideration when evaluating orphan crops. Recent developments have shown successful biofortification via metabolic engineering in staple crops. This review provides guidance in the implementation of these successes to relevant orphan crop species, with a specific focus on the relevant micronutrients iron, zinc, provitamin A and folates.
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Affiliation(s)
- Vincent Verbeecke
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Laura Custódio
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Simon Strobbe
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Dominique Van Der Straeten
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium.
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29
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Wang X, Dou Z, Feng S, Zhang Y, Ma L, Zou C, Bai Z, Lakshmanan P, Shi X, Liu D, Zhang W, Deng Y, Zhang W, Chen X, Zhang F, Chen X. Global food nutrients analysis reveals alarming gaps and daunting challenges. NATURE FOOD 2023; 4:1007-1017. [PMID: 37828076 DOI: 10.1038/s43016-023-00851-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
Eliminating both overt and hidden hunger is at the core of the global food and nutrition security agenda. Yet, the collective state of nutrition security at the population level is not known. Here we quantify food-based availability of 11 essential nutrients for 156 countries using a food production-consumption-nutrition model, followed by assessment of the nutrient availability status as a ratio of recommended intake. For the baseline year 2017, global per capita availability was adequate for calorie and protein but in severe deficit for vitamin A and calcium (intake ratios, <0.60, where 1.0 is adequate) and moderate deficit for vitamin B12 (intake ratio, 0.76). At the country level, more than half of the 156 countries were in various degrees of deficit for all nine micronutrients. Disparities across regions or countries were enormous. We explore intervention strategies from an agriculture-food system perspective and discuss the daunting challenges of addressing nutrition security broadly.
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Affiliation(s)
- Xiaozhong Wang
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China
| | - Zhengxia Dou
- Department of Clinical Studies - New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA.
| | - Shi Feng
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
| | - Yi Zhang
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
| | - Lin Ma
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Agricultural Water Resources, Hebei Key Laboratory of Soil Ecology, Center for Agricultural Resources Research, Institute of Genetic and Developmental Biology, Chinese Academy of Sciences, Shijiazhuang, China
| | - Chunqin Zou
- College of Resources and Environmental Sciences, National Academy of Agriculture Green Development, China Agricultural University, Beijing, China
| | - Zhaohai Bai
- Key Laboratory of Agricultural Water Resources, Hebei Key Laboratory of Soil Ecology, Center for Agricultural Resources Research, Institute of Genetic and Developmental Biology, Chinese Academy of Sciences, Shijiazhuang, China
| | - Prakash Lakshmanan
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Sugarcane Biotechnology and Genetic Improvement (Guangxi), Ministry of Agriculture and Rural Affairs; Guangxi Key Laboratory of Sugarcane Genetic Improvement, Sugarcane Research Institute, Guangxi Academy of Agricultural Sciences, Nanning, China
- Queensland Alliance for Agriculture and Food Innovation, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Xiaojun Shi
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China
| | - Dunyi Liu
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China
| | - Wei Zhang
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China
| | - Yan Deng
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China
| | - Wushuai Zhang
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
| | - Xuanjing Chen
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China
- College of Resources and Environmental Sciences, National Academy of Agriculture Green Development, China Agricultural University, Beijing, China
| | - Fusuo Zhang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China.
- College of Resources and Environmental Sciences, National Academy of Agriculture Green Development, China Agricultural University, Beijing, China.
| | - Xinping Chen
- College of Resources and Environment, and Academy of Agricultural Sciences, Southwest University, Chongqing, China.
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing, China.
- Key Laboratory of Low-carbon Green Agriculture in Southwestern China, Ministry of Agriculture and Rural Affairs, Southwest University, Chongqing, China.
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30
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Karlsson O, Kim R, Moloney GM, Hasman A, Subramanian SV. Patterns in child stunting by age: A cross-sectional study of 94 low- and middle-income countries. MATERNAL & CHILD NUTRITION 2023; 19:e13537. [PMID: 37276243 PMCID: PMC10483943 DOI: 10.1111/mcn.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
- Department of Economic History, School of Economics and ManagementLund UniversityLundSweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health ScienceKorea UniversitySeoulKorea
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
| | - Grainne M. Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country OfficeUN Complex GigiriNairobiKenya
| | | | - S. V. Subramanian
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
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31
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Shah N, Zaheer S, Safdar NF, Turk T, Hashmi S. Women's awareness, knowledge, attitudes, and behaviours towards nutrition and health in Pakistan: Evaluation of kitchen gardens nutrition program. PLoS One 2023; 18:e0291245. [PMID: 37708133 PMCID: PMC10501633 DOI: 10.1371/journal.pone.0291245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization's kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. MATERIALS AND METHODS A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan province of Pakistan. Nutrition and health AKAB were constructed indices. Chi-square tests compared statistical differences in AKAB by women attending against a control group who did not-attend kitchen garden interventions. Binary logistic regression analyses were performed to assess kitchen garden program outcomes against key AKAB indicators, while adjusting for covariates. RESULTS Significant differences (p<0.001) were identified between intervention and control groups with women attending kitchen garden being more aware of the components of kitchen garden (65.8% vs 36.8%), and more knowledgeable about causes of illnesses caused by poor nutrition including, iron deficiency anemia, pregnancy, and unborn child health complications, compared to women not attending kitchen gardens program. Logistic regression analysis identified women attending kitchen gardens also had higher odds of being more knowledgeable (OR = 1.59, 95%CI 1.27-1.99, p<0.001), having improved attitudes (OR = 4.86, 95%CI 2.77-8.53, p <0.001), and behavioural intentions/behaviours (OR = 1.98, 95%CI 1.26-3.12, p = 0.003) towards improved nutrition and health. CONCLUSIONS Substantial opportunities exist for achieving improved nutrition and health outcomes with vulnerable groups in Balochistan, through greater participation in kitchen gardens behavioural change programs and interventions. As part of scaling-up efforts, academically rigorous project evaluations should be institutionalized for continuous improvement of nutrition programs to address micronutrient deficiencies in rural communities.
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Affiliation(s)
- Nadia Shah
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Tahir Turk
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
- Communication Partners International (CPI), Springfield, NSW, Australia
| | - Shahkamal Hashmi
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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32
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Sady H, Chaima D, Hallamaa L, Kortekangas E, Ashorn U, Banda J, Mangani C, Maleta K, Ashorn P, Fan YM. Effect of dietary intervention on the prevalence of asymptomatic malaria among 6-18-month-old children in rural Malawi. Malar J 2023; 22:266. [PMID: 37697296 PMCID: PMC10496296 DOI: 10.1186/s12936-023-04701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The complex interaction between malaria and undernutrition leads to increased mortality and morbidity rate among young children in malaria-endemic regions. Results from previous interventions suggest that improving nutritional status of young children may reduce the burden of malaria. This study tested a hypothesis that provision of lipid-based nutrient supplements (LNS) or corn-soy blend (CSB) supplementation to 6-18-month-old children in Malawi would reduce the prevalence of asymptomatic malaria among them. METHODS A total of 840 6-month-old children were enrolled in a randomized trial. The participants received 12-month supplementation with three different daily dietary supplementations: CSB, soy-LNS, or milk-LNS, and one control group without supplementation. The prevalence rate of asymptomatic Plasmodium falciparum was determined by real-time PCR from the participant's dried blood spots (DBS) collected at the baseline and every 3 months. The global null hypothesis was tested using modified Poisson regression to estimate the prevalence ratio (PR) between the control group and three intervention groups at all ages combined. All the models were adjusted for malaria at baseline, season of DBS sample collection, site of enrolment, and household asset Z-score. RESULTS All children combined, the prevalence of P. falciparum was 14.1% at enrollment, 8.7% at 9 months, 11.2% at 12 months, 13.0% at 15 months and 22.4% at 18 months of age. Among all samples that were taken after enrolment, the prevalence was 12.1% in control group, 12.2% in milk-LNS, 14.0% in soy-LNS, and 17.2% in CSB group. Compared to children in the control group the prevalence ratio of positive malaria tests was 1.19 (95% CI 0.81-1.74; P = 0.372) in the milk-LNS group, 1.32 (95% CI 0.88-1.96; P = 0.177) in the soy-LNS group and 1.72 (95% CI 1.19-2.49; P = 0.004) in the CSB group. CONCLUSION The study findings do not support a hypothesis that LNS or CSB supplementation would reduce the prevalence of asymptomatic malaria among Malawian children. In contrast, there was a signal of a possible increase in malaria prevalence among children supplemented with CSB.
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Affiliation(s)
- Hany Sady
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland.
- Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.
| | - David Chaima
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Jomo Banda
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
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Prado EL, Adu-Afarwuah S, Arnold CD, Adjetey E, Amponsah B, Bentil H, Dewey KG, Guyer AE, Manu A, Mensah M, Oaks BM, Ocansey M, Tan X, Hastings PD. Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social-emotional difficulties at ages 9-11 y in Ghana: follow-up of a randomized controlled trial. Am J Clin Nutr 2023; 118:433-442. [PMID: 37257564 PMCID: PMC10447494 DOI: 10.1016/j.ajcnut.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD-Ghana trial, prenatal and postnatal SQ-LNS reduced social-emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments. OBJECTIVES We aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social-emotional problems at age 9-11 y. METHODS In 2009-2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social-emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management. RESULTS We assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social-emotional difficulties at 9-11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (-0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047). CONCLUSIONS Overall positive effects of SQ-LNS on social-emotional development previously found at age 5 y are not sustained to age 9-11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social-emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights. This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866.
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Affiliation(s)
- Elizabeth L Prado
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA.
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Ebenezer Adjetey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | | | - Helena Bentil
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Amanda E Guyer
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; Department of Human Ecology, University of California-Davis, Davis, CA, USA
| | - Adom Manu
- Public Health, University of Ghana, Accra, Ghana
| | - Mavis Mensah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | - Xiuping Tan
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Paul D Hastings
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; Department of Psychology, University of California-Davis, Davis, CA, USA
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Littlejohn PT, Bar-Yoseph H, Edwards K, Li H, Ramirez-Contreras CY, Holani R, Metcalfe-Roach A, Fan YM, Yang TMS, Radisavljevic N, Hu X, Johnson JD, Finlay BB. Multiple micronutrient deficiencies alter energy metabolism in host and gut microbiome in an early-life murine model. Front Nutr 2023; 10:1151670. [PMID: 37497061 PMCID: PMC10365968 DOI: 10.3389/fnut.2023.1151670] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Micronutrients perform a wide range of physiological functions essential for growth and development. However, most people still need to meet the estimated average requirement worldwide. Globally, 2 billion people suffer from micronutrient deficiency, most of which are co-occurring deficiencies in children under age five. Despite decades of research, animal models studying multiple micronutrient deficiencies within the early-life period are lacking, which hinders our complete understanding of the long-term health implications and may contribute to the inefficacy of some nutritional interventions. Evidence supporting the Developmental Origins of Health and Disease (DOHaD) theory demonstrates that early-life nutritional deficiencies carry life-long consequences mediated through various mechanisms such as abnormal metabolic programming, stunting, altered body composition, and the gut microbiome. However, this is largely unexplored in the multiple micronutrient deficient host. Methods we developed a preclinical model to examine undernutrition's metabolic and functional impact on the host and gut microbiome early in life. Three-week-old weanling C57BL/6N male mice were fed a low-micronutrient diet deficient in zinc, folate, iron, vitamin A, and vitamin B12 or a control diet for 4-weeks. Results Our results showed that early-life multiple micronutrient deficiencies induced stunting, altered body composition, impaired glucose and insulin tolerance, and altered the levels of other micronutrients not depleted in the diet within the host. In addition, functional metagenomics profiling and a carbohydrate fermentation assay showed an increased microbial preference for simple sugars rather than complex ones, suggestive of a less developed microbiome in the low-micronutrient-fed mice. Moreover, we found that a zinc-only deficient diet was not sufficient to induce these phenotypes, further supporting the importance of studying co-occurring deficiencies. Discussion Together, these findings highlight a previously unappreciated role of early-life multiple micronutrient deficiencies in shaping the metabolic phenome of the host and gut microbiome through altered glucose energy metabolism, which may have implications for metabolic disease later in life in micronutrient-deficient survivors.
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Affiliation(s)
- Paula T. Littlejohn
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Haggai Bar-Yoseph
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Karlie Edwards
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hong Li
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Ravi Holani
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Avril Metcalfe-Roach
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Yiyun M. Fan
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tom Min-Shih Yang
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Nina Radisavljevic
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Xiaoke Hu
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James D. Johnson
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - B. Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
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Harrison L, Padhani Z, Salam R, Oh C, Rahim K, Maqsood M, Ali A, Charbonneau K, Keats EC, Lassi ZS, Imdad A, Owais A, Das J, Bhutta ZA. Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence. Nutrients 2023; 15:3041. [PMID: 37447369 PMCID: PMC10346638 DOI: 10.3390/nu15133041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.
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Affiliation(s)
- Leila Harrison
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zahra Padhani
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Rehana Salam
- The Daffodil Centre—A Joint Venture of Cancer Council and The University of Sydney, Sydney, NSW 2006, Australia
| | - Christina Oh
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Komal Rahim
- Internal Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Maria Maqsood
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Kimberly Charbonneau
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily C. Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Jai Das
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
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Ababneh FA. Toxic elements in children's multivitamin-multimineral supplements and the health risks they pose. Regul Toxicol Pharmacol 2023; 141:105409. [PMID: 37187403 DOI: 10.1016/j.yrtph.2023.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/15/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
This work aimed to determine the levels of toxic elements (As, Cd, Hg, and Pb) and their risks in children's multivitamin-multimineral (CMVM) supplements. An inductively coupled plasma-mass spectrometer (ICP-MS) was used to quantify the studied elements. The mean concentrations and ranges (μg/kg) of the toxic elements in the CMVM products were as follows: As (32.4, 5.3-90); Cd (58.2, 6-129); Hg (42.2, 6-108); and Pb (231,8.6-541). The estimated oral daily intakes (EODI) were determined to be in the range of 0.01-0.31 g/day, 0.01-0.64 g/day, 0.02-0.53 g/day, and 0.01-2.36 g/day for As, Cd, Hg, and Pb, respectively. All the EODI values were below the tolerable intake limits set for each element. The chronic non-cancer risks associated with oral exposure to studied elements were evaluated using the target hazard quotient (THQ) and the hazard index (HI). The THQ and HI values were below 1, indicating that these products were safe for consumption by children. The potential cancer risks associated with exposure to As and Pb through the consumption of CMVM products were determined using the Incremental Lifetime Cancer Risk (ILCR) and the total cancer risks (TCR). The ILCR and TCR values were below the threshold value of 1 × 10-4, indicating that the risk of developing cancer was very low and ignorable.
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Affiliation(s)
- Fuad A Ababneh
- Department of Chemistry, Al-Hussein Bin Talal University, P.O. Box 20, Ma'an, Jordan.
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37
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Kowalski AJ, Mayen VA, de Ponce S, Lambden KB, Tilton N, Villanueva LM, Palacios AM, Reinhart GA, Hurley KM, Black MM. The Effects of Multiple Micronutrient Fortified Beverage and Responsive Caregiving Interventions on Early Childhood Development, Hemoglobin, and Ferritin among Infants in Rural Guatemala. Nutrients 2023; 15:2062. [PMID: 37432191 DOI: 10.3390/nu15092062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6-18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was 13.0 (4.6) months, including 49% males, 32% who were stunted, 55% who were anemic, and 58% who were iron deficient. At the endline (n = 328/386, 85% retention), there was no synergistic effect on the fortified beverage and responsive caregiving intervention. Compared to the non-fortified beverage group, socioemotional development improved in the fortified beverage group. There were no intervention effects on other measures of child development, hemoglobin, or ferritin. In a setting with high rates of anemia and iron deficiency, a multiple micronutrient-fortified beverage improved infants' socioemotional development.
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Affiliation(s)
- Alysse J Kowalski
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Victor Alfonso Mayen
- Asociación para la Prevención y Estudio del VIH/Sida, Retalhuleu 11001, Guatemala
| | - Silvia de Ponce
- Asociación para la Prevención y Estudio del VIH/Sida, Retalhuleu 11001, Guatemala
| | - Kaley B Lambden
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Nick Tilton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21202, USA
| | - Lisa M Villanueva
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
| | - Ana M Palacios
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | - Gregory A Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- RTI International, Research Triangle Park, NC 27709, USA
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Lowe NM, Qualter P, Sinclair JK, Gupta S, Zaman M. School Feeding to Improve Cognitive Performance in Disadvantaged Children: A 3-Arm Parallel Controlled Trial in Northwest Pakistan. Nutrients 2023; 15:nu15071768. [PMID: 37049608 PMCID: PMC10097018 DOI: 10.3390/nu15071768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Malnutrition is associated with reduced learning aptitude and growth during childhood. We examined the impact of providing two school lunch variants, a standard school meal (school feeding, n = 70), or the standard meal with additional micronutrients (school feeding + micronutrient powder (MNP), n = 70), in children attending two schools in northwest Pakistan. A third local government school, where no lunch was provided (no school feeding, n = 70), served as the control. The primary outcome, cognitive function, was assessed using the Raven’s Coloured Progressive Matrices (RCPM) test, alongside haemoglobin, at three-time points: T1 (baseline, before the initiation of the school lunch programme), T2 and T3 (5 and 12 months, respectively, after the introduction of the school lunch). Data were analysed using linear mixed-effects models to contrast between trial groups, the changes from T1 to T2 and T3. Adjusted for T1 and other co-variates, improvements in the RCPM scores were significantly greater in the school feeding group at T2 (b = 1.61, (95% CI = 0.71–2.52), t = 3.52, p = 0.001) and T3 (b = 1.28, (95% CI = 0.22–2.35), t = 2.38, p = 0.019) compared with no school feeding. In addition, at T2 (b = 1.63, (95% CI = −0.10–3.37), t = 1.86, p = 0.065), there were no significant differences between school feeding + MNP and no school feeding groups. However, improvements in the RCPM scores were significantly greater in the school feeding + MNP group at T3 (b = 2.35, (95% CI = 0.51–4.20), t = 2.53, p = 0.013) compared with no school feeding. The findings indicate an improvement in cognitive performance in children who received a school meal with and without MNP, over a 12-month period. Currently there is no operational school feeding programme at the national or provincial level in Pakistan. Our findings, therefore, highlight the need for school feeding programmes to improve learning opportunities for children from underprivileged communities.
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Affiliation(s)
- Nicola M. Lowe
- Centre for Global Development, University of Central Lancashire, Preston PR1 2HE, UK
| | - Pamela Qualter
- Institute of Education, School of Environment, Education and Development, University of Manchester, Manchester M13 9PL, UK
| | - Jonathan K. Sinclair
- Centre for Global Development, University of Central Lancashire, Preston PR1 2HE, UK
| | - Swarnim Gupta
- Centre for Global Development, University of Central Lancashire, Preston PR1 2HE, UK
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Khan A, Ul-Haq Z, Fatima S, Ahmed J, Alobaid HM, Fazid S, Muhammad N, Garzon C, Ihtesham Y, Habib I, Tanimoune M, Iqbal K, Arshad M, Safi SZ. Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan. Nutrients 2023; 15:nu15071690. [PMID: 37049531 PMCID: PMC10096793 DOI: 10.3390/nu15071690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24–48 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng/mL (95% CI 5.11–9.92, p-value < 0.001) increase in the plasma level of vitamin A, 4.80 ng/mL (95% CI 1.63–7.95, p-value < 0.002) increase in vitamin D levels and 33.85 µg/dL (95% CI 24.40–43.30, p-value < 0.001) increase in the plasma zinc level, as well as a 2.0g/dL (95% CI 1.64–2.40, p-value < 0.001) increase in hemoglobin level. Statistically significant improvement was observed in the weight-for-height z-score (WHZ) (from −1.0 ± 0.88 to −0.40 ± 1.01, p < 0.001) and weight-for-age z-score (WAZ) (from −1.40 ± 0.50 to −1.05 ± 0.49, p < 0.001) in the intervention group compared to the control group. No statistically significant change was observed in the height-for-age z-score (HAZ) in the intervention group (p = 0.93). In conclusion, micronutrient powder supplementation is a cost-effective intervention to improve the micronutrient status, hemoglobin level, and growth parameters in under-five children, which can be scaled up in the existing health system to address the alarming rates of undernutrition in Pakistan and other developing countries.
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40
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Kudapa H, Barmukh R, Vemuri H, Gorthy S, Pinnamaneni R, Vetriventhan M, Srivastava RK, Joshi P, Habyarimana E, Gupta SK, Govindaraj M. Genetic and genomic interventions in crop biofortification: Examples in millets. FRONTIERS IN PLANT SCIENCE 2023; 14:1123655. [PMID: 36950360 PMCID: PMC10025513 DOI: 10.3389/fpls.2023.1123655] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Micronutrient malnutrition is a serious threat to the developing world's human population, which largely relies on a cereal-based diet that lacks diversity and micronutrients. Besides major cereals, millets represent the key sources of energy, protein, vitamins, and minerals for people residing in the dryland tropics and drought-prone areas of South Asia and sub-Saharan Africa. Millets serve as multi-purpose crops with several salient traits including tolerance to abiotic stresses, adaptation to diverse agro-ecologies, higher productivity in nutrient-poor soils, and rich nutritional characteristics. Considering the potential of millets in empowering smallholder farmers, adapting to changing climate, and transforming agrifood systems, the year 2023 has been declared by the United Nations as the International Year of Millets. In this review, we highlight recent genetic and genomic innovations that can be explored to enhance grain micronutrient density in millets. We summarize the advances made in high-throughput phenotyping to accurately measure grain micronutrient content in cereals. We shed light on genetic diversity in millet germplasm collections existing globally that can be exploited for developing nutrient-dense and high-yielding varieties to address food and nutritional security. Furthermore, we describe the progress made in the fields of genomics, proteomics, metabolomics, and phenomics with an emphasis on enhancing the grain nutritional content for designing competitive biofortified varieties for the future. Considering the close genetic-relatedness within cereals, upcoming research should focus on identifying the genetic and genomic basis of nutritional traits in millets and introgressing them into major cereals through integrated omics approaches. Recent breakthroughs in the genome editing toolbox would be crucial for mainstreaming biofortification in millets.
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Affiliation(s)
- Himabindu Kudapa
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Rutwik Barmukh
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Hindu Vemuri
- International Maize and Wheat Improvement Center (CIMMYT), Patancheru, Telangana, India
| | - Sunita Gorthy
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | | | - Mani Vetriventhan
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Rakesh K. Srivastava
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Priyanka Joshi
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Ephrem Habyarimana
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - S. K. Gupta
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Mahalingam Govindaraj
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
- HarvestPlus Program, Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT), Cali, Colombia
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Hounkpatin WA, Koukou E, Termote C, Ntandou-Bouzitou G, Mitchodigni I, Bodjrènou S, Alaofè H. Dietary Diversity Predicts the Adequacy of Micronutrient Intake in 6- to 23-Month-Old Children Regardless of the Season in Rural Southern Benin. Food Nutr Bull 2023; 44:39-50. [PMID: 37183410 DOI: 10.1177/03795721231164085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Infants and Young Children Dietary Diversity Score (IYC-DDS-7) has been validated to assess dietary quality in children. However, its applicability to predict the adequacy of micronutrient intake remains a challenge in all contexts. DESIGN AND METHODS A 24-hour dietary recall assessment was conducted on a sample of 628 children aged 6 to 23 months in the plenty season (PS) as well as in the lean season (LS). The IYC-DDS-7 was calculated based on 7 food groups, whereas the mean micronutrient density adequacy (MMDA) for 11 micronutrients. The β regression models were used to assess the relationship between IYC-DDS and MMDA and differences in nutrient intake between the 2 seasons. A receiver-operating characteristic curve analysis was also performed to determine IYC-DDS-7 cutoff levels that maximized sensitivity and specificity in assessing dietary quality and predicting MMDA below- or above-selected cutoff levels. RESULTS Participating children's MMDA was 56.9% ± 12.8% versus 61.9% ± 8.6% and IYC-DDS-7 was 3.43 ± 1.5 versus 3.77 ± 1.0 in the PS and LS. The IYC-DDS-7 had a positive correlation with MMDA, irrespective of the season. For a 1-unit increase in IYC-DDS-7, MMDA increased by a mean of 10.7% (CI, 8.3%-13.1%; P < .001). The minimum threshold of the 4 food groups corresponded to a sensitivity of 76% and 61% and a specificity of 75% and 70% for the prediction of inadequate diet in the PS and LS, respectively. CONCLUSIONS The IYC-DDS-7 predicted MMDA, regardless of seasons for infants and young children. The IYC-DDS-7 cutoff of 4 groups performed well in classifying children with low-diet quality.
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Affiliation(s)
- Waliou Amoussa Hounkpatin
- Ecole de Nutrition et des Sciences & Technologies Alimentaires, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi, Benin
| | - Elie Koukou
- Ecole de Nutrition et des Sciences & Technologies Alimentaires, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi, Benin
| | - Céline Termote
- Alliance Bioversity International-CIAT, Regional Office for Africa, Kenya
| | - Gervais Ntandou-Bouzitou
- Food and Nutrition Security Impact, Resilience, Sustainability and Transformation Programme/FAO, Niger
| | - Irène Mitchodigni
- Ecole de Nutrition et des Sciences & Technologies Alimentaires, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi, Benin
| | - Sam Bodjrènou
- Ecole de Nutrition et des Sciences & Technologies Alimentaires, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi, Benin
| | - Halima Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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Environmental factors related to children diagnosed with stunting 3 years ago in Salatiga City, Central Java, Indonesia. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [DOI: 10.1016/j.toxac.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Dwivedi SL, Garcia-Oliveira AL, Govindaraj M, Ortiz R. Biofortification to avoid malnutrition in humans in a changing climate: Enhancing micronutrient bioavailability in seed, tuber, and storage roots. FRONTIERS IN PLANT SCIENCE 2023; 14:1119148. [PMID: 36794214 PMCID: PMC9923027 DOI: 10.3389/fpls.2023.1119148] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Malnutrition results in enormous socio-economic costs to the individual, their community, and the nation's economy. The evidence suggests an overall negative impact of climate change on the agricultural productivity and nutritional quality of food crops. Producing more food with better nutritional quality, which is feasible, should be prioritized in crop improvement programs. Biofortification refers to developing micronutrient -dense cultivars through crossbreeding or genetic engineering. This review provides updates on nutrient acquisition, transport, and storage in plant organs; the cross-talk between macro- and micronutrients transport and signaling; nutrient profiling and spatial and temporal distribution; the putative and functionally characterized genes/single-nucleotide polymorphisms associated with Fe, Zn, and β-carotene; and global efforts to breed nutrient-dense crops and map adoption of such crops globally. This article also includes an overview on the bioavailability, bioaccessibility, and bioactivity of nutrients as well as the molecular basis of nutrient transport and absorption in human. Over 400 minerals (Fe, Zn) and provitamin A-rich cultivars have been released in the Global South. Approximately 4.6 million households currently cultivate Zn-rich rice and wheat, while ~3 million households in sub-Saharan Africa and Latin America benefit from Fe-rich beans, and 2.6 million people in sub-Saharan Africa and Brazil eat provitamin A-rich cassava. Furthermore, nutrient profiles can be improved through genetic engineering in an agronomically acceptable genetic background. The development of "Golden Rice" and provitamin A-rich dessert bananas and subsequent transfer of this trait into locally adapted cultivars are evident, with no significant change in nutritional profile, except for the trait incorporated. A greater understanding of nutrient transport and absorption may lead to the development of diet therapy for the betterment of human health.
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Affiliation(s)
| | - Ana Luísa Garcia-Oliveira
- International Maize and Wheat Research Center, Centro Internacional de Mejoramiento de Maíz. y Trigo (CIMMYT), Nairobi, Kenya
- Department of Molecular Biology, College of Biotechnology, CCS Haryana Agricultural University, Hissar, India
| | - Mahalingam Govindaraj
- HarvestPlus Program, Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Rodomiro Ortiz
- Swedish University of Agricultural Sciences, Lomma, Sweden
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Melatonin Repairs Osteoporotic Bone Defects in Iron-Overloaded Rats through PI3K/AKT/GSK-3 β/P70S6k Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:7718155. [PMID: 36703914 PMCID: PMC9873465 DOI: 10.1155/2023/7718155] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
It was found recently that iron overload can cause osteoporosis in rats. Through in vitro and in vivo experimentations, the purpose of the present study was to validate and confirm the inhibitory effects of melatonin on iron death of osteoporosis and its role in bone microstructure improvements. Melatonin (100 mol/L) was administered to MC3T3-E1 cells induced by iron overload in vitro for 48 hours. The expression of cleaved caspase-3 and cleaved PARP and the production of ROS (reactive oxygen species) and mitochondrial damage were all exacerbated by iron overload. On the other hand, melatonin restored these impacts in MC3T3-E1 cells produced by iron overload. By evaluating the expression of PI3K/AKT/GSK-3β/P70S6k signaling pathway-related proteins (RUNX2, BMP2, ALP, and OCN) using RT-PCR and Western blot, osteogenic-related proteins were identified. Alizarin red S and alkaline phosphatase were utilized to evaluate the osteogenic potential of MC3T3-E1 cells. Melatonin significantly improved the osteogenic ability and phosphorylation rates of PI3K, AKT, GSK-3β, and P70S6k in iron overload-induced MC3T3-E1 cells. In vivo, melatonin treated iron overload-induced osteoporotic bone defect in rats. Rat skeletal microstructure was observed using micro-CT and bone tissue pathological section staining. ELISA was utilized to identify OCN, PINP, CTX-I, and SI in the serum of rats. We discovered that melatonin increased bone trabecular regeneration and repair in osteoporotic bone defects caused by iron overload. In conclusion, melatonin enhanced the osteogenic ability of iron overload-induced MC3T3-E1 cells by activating the PI3K/AKT/GSK-3β/P70S6k signaling pathway and promoting the healing of iron overload-induced osteoporotic bone defects in rats.
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Peroni DG, Hufnagl K, Comberiati P, Roth-Walter F. Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases. Front Nutr 2023; 9:1032481. [PMID: 36698466 PMCID: PMC9869175 DOI: 10.3389/fnut.2022.1032481] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Diego G. Peroni
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Karin Hufnagl
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University of Vienna and University of Vienna, Vienna, Austria,Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University of Vienna and University of Vienna, Vienna, Austria,Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria,*Correspondence: Franziska Roth-Walter, ;
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Vosti SA, Adams KP, Michuda A, Ortiz-Becerra K, Luo H, Haile D, Chou VB, Clermont A, Teta I, Ndjebayi A, Kagin J, Guintang J, Engle-Stone R. Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon. Ann N Y Acad Sci 2023; 1519:199-210. [PMID: 36471541 DOI: 10.1111/nyas.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.
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Affiliation(s)
- Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Aleksandr Michuda
- Center for Data Science for Enterprise and Society, Cornell University, Ithaca, New York, USA
| | - Karen Ortiz-Becerra
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Demewoz Haile
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Victoria B Chou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrienne Clermont
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ismael Teta
- Helen Keller International, Yaoundé, Cameroon
| | | | | | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
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Tunkara-Bah H. Hepcidin-guided screen-and-treat for iron-deficiency anaemia in young children. Lancet Glob Health 2023; 11:e12-e13. [PMID: 36521943 DOI: 10.1016/s2214-109x(22)00470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Haddy Tunkara-Bah
- Department of Nursing and Reproductive Health, University of The Gambia, Serrekunda, The Gambia.
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48
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Nogueira-de-Almeida CA, Prozorovscaia D, Mosquera EMB, Ued FDV, Campos VC. Low bioavailability of dietary iron among Brazilian children: Study in a representative sample from the Northeast, Southeast, and South regions. Front Public Health 2023; 11:1122363. [PMID: 36891331 PMCID: PMC9987336 DOI: 10.3389/fpubh.2023.1122363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Background Despite all efforts, iron deficiency anemia remains a serious public health problem among Brazilian children. Objective To evaluate dietary iron intake and dietary practices that interfere with the absorption of this nutrient from three regions of Brazil. Methods Brazil Kids Nutrition and Health Study is a cross-sectional dietary intake study in children aged 4-13.9 years old designed to investigate nutrient intakes and gaps of Brazilian children in a representative sample of households from Northeast, Southeast and South regions. Nutrient intake was assessed based on multiple-pass 24-h dietary recall and U.S. National Cancer Institute method was used to estimate usual micronutrients intakes and compliance with Dietary Reference Intakes. Results Five hundred sixteen individuals participated in the study (52.3% male). The top three most consumed food sources of iron were products of plant origin. Food sources of animal origin contributed with <20% of the total iron intake. Vitamin C intake was adequate, but the concomitant consumption of food sources of vitamin C with plant food sources of iron was not common. On the other hand, the concomitant intake of plant food sources of iron with food sources of iron chelators (e.g., coffee and teas) was frequent. Conclusions Adequate iron intake was observed in all three regions in Brazil. Children's diet showed low iron bioavailability and insufficient consumption of food sources of iron absorption stimulants. Frequent presence of iron chelators and inhibitors of iron absorption might help to explain the high prevalence of iron deficiency in the country.
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Affiliation(s)
| | | | - Elaine M Bento Mosquera
- Federal University of São Paulo, São Paulo, Brazil.,Medical, Scientific and Regulatory Affairs - Nestlé Nutrition/Nestlé Brazil Ltda, São Paulo, Brazil
| | - Fábio da Veiga Ued
- FMRP - Nutrition Department, University of São Paulo, São Paulo, São Paulo, Brazil
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Wegmüller R, Bah A, Kendall L, Goheen MM, Sanyang S, Danso E, Sise EA, Jallow A, Verhoef H, Jallow MW, Wathuo M, Armitage AE, Drakesmith H, Pasricha SR, Cross JH, Cerami C, Prentice AM. Hepcidin-guided screen-and-treat interventions for young children with iron-deficiency anaemia in The Gambia: an individually randomised, three-arm, double-blind, controlled, proof-of-concept, non-inferiority trial. Lancet Glob Health 2023; 11:e105-e116. [PMID: 36521942 PMCID: PMC9764454 DOI: 10.1016/s2214-109x(22)00449-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Iron deficiency is the most prevalent nutritional disorder worldwide. Iron supplementation has modest efficacy, causes gastrointestinal side-effects that limit compliance, and has been associated with serious adverse outcomes in children across low-income settings. We aimed to compare two hepcidin-guided screen-and-treat regimens designed to reduce overall iron dosage by targeting its administration to periods when children were safe and ready to receive iron supplementation, with WHO's recommendation of universal iron supplementation. METHODS We conducted an individually randomised, three-arm, double-blind, controlled, proof-of-concept, non-inferiority trial in 12 rural communities across The Gambia. Eligible participants were children aged 6-23 months with anaemia. Participants were randomly assigned (1:1:1) to either the WHO recommended regimen of one sachet of multiple micronutrient powder (MMP) daily containing 12·0 mg iron as encapsulated ferrous fumarate (control group); to MMP with 12·0 mg per day iron for the next 7 days if plasma hepcidin concentration was less than 5·5 μg/L, or to MMP without iron for the next 7 days if plasma hepcidin concentration was at least 5·5 μg/L (12 mg screen-and-treat group); or to MMP with 6·0 mg per day iron for the next 7 days if plasma hepcidin concentration was less than 5·5 μg/L, or to MMP without iron for the next 7 days if plasma hepcidin concentration was at least 5·5 μg/L (6 mg screen-and-treat group). Randomisation was done by use of a permuted block design (block size of 9), with stratification by haemoglobin and age, using computer-generated numbers. Participants and the research team (except for the data manager) were masked to group allocation. The primary outcome was haemoglobin concentration, with a non-inferiority margin of -5 g/L. A per-protocol analysis, including only children who had consumed at least 90% of the supplements (ie, supplement intake on ≥75 days during the study), was done to assess non-inferiority of the primary outcome at day 84 using a one-sided t test adjusted for multiple comparisons. Safety was assessed by use of ex-vivo growth tests of Plasmodium falciparum in erythrocytes and three species of sentinel bacteria in plasma samples from participants. This trial is registered with the ISRCTN registry, ISRCTN07210906. FINDINGS Between April 23, 2014, and Aug 7, 2015, we prescreened 783 children, of whom 407 were enrolled into the study: 135 were randomly assigned to the control group, 136 to the 12 mg screen-and-treat group, and 136 to the 6 mg screen-and-treat group. 345 (85%) children were included in the per-protocol population: 115 in the control group, 116 in the 12 mg screen-and-treat group, and 114 in the 6 mg screen-and-treat group. Directly observed adherence was high across all groups (control group 94·8%, 12 mg screen-and-treat group 95·3%, and 6 mg screen-and-treat group 95·0%). 82 days of iron supplementation increased mean haemoglobin concentration by 7·7 g/L (95% CI 3·2 to 12·2) in the control group. Both screen-and-treat regimens were significantly less efficacious at improving haemoglobin (-5·6 g/L [98·3% CI -9·9 to -1·3] in the 12 mg screen-and-treat group and -7·8 g/L [98·3% CI -12·2 to -3·5] in the 6 mg screen-and-treat group) and neither regimen met the preset non-inferiority margin of -5 g/L. The 12 mg screen-and-treat regimen reduced iron dosage to 6·1 mg per day and the 6 mg screen-and-treat regimen reduced dosage to 3·0 mg per day. 580 adverse events were observed in 316 participants, of which eight were serious adverse events requiring hospitalisation mainly due to diarrhoeal disease (one [1%] participant in the control group, three [2%] in the 12 mg screen-and-treat group, and four [3%] in the 6 mg screen-and-treat group). The most common causes of non-serious adverse events (n=572) were diarrhoea (145 events [25%]), upper respiratory tract infections (194 [34%]), lower respiratory tract infections (62 [11%]), and skin infections (122 [21%]). No adverse events were deemed to be related to the study interventions. INTERPRETATION The hepcidin-guided screen-and-treat strategy to target iron administration succeeded in reducing overall iron dosage, but was considerably less efficacious at increasing haemoglobin and combating iron deficiency and anaemia than was WHO's standard of care, and showed no differences in morbidity or safety outcomes. FUNDING Bill & Melinda Gates Foundation and UK Medical Research Council.
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Affiliation(s)
- Rita Wegmüller
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; GroundWork, Fläsch, Switzerland
| | - Amat Bah
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; National Nutrition Agency, Bakau, The Gambia
| | - Lindsay Kendall
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Morgan M Goheen
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Saikou Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ebrima Danso
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ebrima A Sise
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Amadou Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Hans Verhoef
- Wageningen University & Research, Wageningen, Netherlands
| | - Momodou W Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Regeneron Genetics Center, Tarrytown, NY, USA
| | - Miriam Wathuo
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; One Acre Fund, Kigali, Rwanda
| | - Andrew E Armitage
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Hal Drakesmith
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Sant-Rayn Pasricha
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - James H Cross
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Carla Cerami
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
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Tong H, Piwoz E, Ruel MT, Brown KH, Black RE, Walker N. Maternal and child nutrition in the Lives Saved Tool: Results of a recent update. J Glob Health 2022; 12:08005. [PMID: 36583418 PMCID: PMC9801341 DOI: 10.7189/jogh.12.08005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model. Methods An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus. Results Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation. Conclusions For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes available. The present updates will enable LiST users to better estimate the potential health, nutrition, and survival benefits of investing in nutrition.
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Affiliation(s)
- Hannah Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ellen Piwoz
- Independent Consultant, Annapolis, Maryland, USA
| | - Marie T Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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