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Seyoum Y, Greffeuille V, Kouadio DKD, Kuong K, Turpin W, M'Rabt R, Chochois V, Fortin S, Perignon M, Fiorentino M, Berger J, Burja K, Ponce MC, Chamnan C, Wieringa FT, Humblot C. Faecal microbiota of schoolchildren is associated with nutritional status and markers of inflammation: a double-blinded cluster-randomized controlled trial using multi-micronutrient fortified rice. Nat Commun 2024; 15:5204. [PMID: 38890302 PMCID: PMC11189458 DOI: 10.1038/s41467-024-49093-4] [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: 11/10/2022] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Faecal microbiota plays a critical role in human health, but its relationship with nutritional status among schoolchildren remains under-explored. Here, in a double-blinded cluster-randomized controlled trial on 380 Cambodian schoolchildren, we characterize the impact of six months consumption of two types of rice fortified with different levels of vitamins and minerals on pre-specified outcomes. We investigate the association between the faecal microbiota (16SrRNA sequencing) and age, sex, nutritional status (underweight, stunting), micronutrient status (iron, zinc and vitamin A deficiencies, anaemia, iron deficient anaemia, hemoglobinopathy), inflammation (systemic, gut), and parasitic infection. We show that the faecal microbiota is characterised by a surprisingly high proportion of Lactobacillaceae. We discover that deficiencies in specific micronutrients, such as iron and vitamin A, correlate with particular microbiota profiles, whereas zinc deficiency shows no such association. The nutritional intervention with the two rice treatments impacts both the composition and functions predicted from compositional analysis in different ways. (ClinicalTrials.gov (Identifier: NCT01706419)).
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Affiliation(s)
- Yohannes Seyoum
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Valérie Greffeuille
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Dorgeles Kouakou Dje Kouadio
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Khov Kuong
- Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Williams Turpin
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Gastroenterology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rachida M'Rabt
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Vincent Chochois
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Sonia Fortin
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Marlène Perignon
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | - Marion Fiorentino
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
- SESSTIM, INSERM, IRD, Aix Marseille Univ, Marseille, France
| | - Jacques Berger
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Kurt Burja
- United Nations World Food Programme, Phnom Penh, Cambodia
| | - Maiza Campos Ponce
- Section Infectious Diseases, department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Frank T Wieringa
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Christèle Humblot
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France.
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Sahiledengle B, Petrucka P, Desta F, Sintayehu Y, Mesfin T, Mwanri L. Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study. BMC Public Health 2024; 24:1484. [PMID: 38831296 PMCID: PMC11145842 DOI: 10.1186/s12889-024-18931-x] [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: 03/11/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children's linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia. METHODS We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders. RESULTS Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001. CONCLUSION Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yordanos Sintayehu
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Telila Mesfin
- Department of Medicine, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Lillian Mwanri
- Equity and Human Flourishing, Research Centre for Public Health Research, Torrens University Australia, Adelaide Campus, Adelaide, SA, 5000, Australia
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Let S, Tiwari S, Singh A, Chakrabarty M. Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data. BMC Public Health 2024; 24:437. [PMID: 38347505 PMCID: PMC10860231 DOI: 10.1186/s12889-024-17789-3] [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: 05/20/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts. METHODS From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15-49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia. RESULTS The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08-1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13-1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35-1.44], poorest women [AOR: 1.27, 95% CI: 1.22-1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12-1.17] were more likely to be anaemic. CONCLUSION The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India.
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Affiliation(s)
- Subhojit Let
- Department of Geography, Banaras Hindu University, Varanasi, India
| | - Seema Tiwari
- Geography Section, Mahila Maha Vidyalaya, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Aditya Singh
- Department of Geography, Banaras Hindu University, Varanasi, India.
- Girl Innovation, Research, and Learning (GIRL) Center, Population Council, New York, NY, United States of America.
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Um S, Sopheab H, Yom A, Muir JA. Anemia among pregnant women in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in pregnant women. PLoS One 2023; 18:e0274925. [PMID: 38060474 PMCID: PMC10703242 DOI: 10.1371/journal.pone.0274925] [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] [Received: 09/06/2022] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Anemia is a major public health problem for thirty-two million pregnant women worldwide. Anemia during pregnancy is a leading cause of child low birth weight, preterm birth, and perinatal/neonatal mortality. Pregnant women are at higher risk of anemia due to micronutrient deficiencies, hemoglobinopathies, infections, socio-demographic and behavioral factors. This study aimed to: 1) assess temporal and geospatial trends of anemia in Cambodia and 2) identify factors associated with anemia among pregnant women aged 15-49 years old in Cambodia. We analyzed data from the Cambodia Demographic and Health Survey (CDHS) for 2005, 2010, and 2014. Data were pooled across the three survey years for all pregnant women aged 15-49 years. Survey weights were applied to account for the complex survey design of the CDHS. Descriptive statistics were estimated for key sociodemographic characteristics of the study population. We used logistic regressions to assess factors associated with anemia among pregnant women aged 15-49 years old. Anemia in pregnant women aged 15-49 in Cambodia decreased from 56% in 2005 to 53% in 2014. With the highest in Preah Vihear and Stung Treng provinces (74.3%), in Kratie province (73%), and in Prey Veng (65.4%) in 2005, 2010, and 2014 respectively. Compared to pregnant women from the wealthiest households, women from poorest households were more likely to have anemia (AOR = 2.8; 95% CI: 1.6-4.9). Pregnant women from coastal regions were almost twice as likely of having anemia (AOR = 1.9; 95% CI: 1.2-3.0). Pregnant women were more likely anemic if they were in their 2nd trimester (AOR = 2.6; 95% CI: 1.9-3.6) or 3rd trimester (AOR = 1.6 95% CI: 1.1-2.3). Anemia remains highly prevalent among pregnant women in Cambodia. Public health interventions and policies to alleviate anemia should be prioritized and shaped to address these factors.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Heng Sopheab
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - An Yom
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Noubactep C, Kenmogne-Tchidjo JF, Vollmer S. Iron-fortified water: a new approach for reducing iron deficiency anemia in resource-constrained settings. Sci Rep 2023; 13:13565. [PMID: 37604937 PMCID: PMC10442336 DOI: 10.1038/s41598-023-40600-z] [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: 11/29/2022] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
A new approach for fortification of drinking water is presented for combating iron deficiency anemia (IDA) worldwide. The idea is to leach Fe from a bed containing granular metallic iron (Fe0), primarily using ascorbic acid (AA). AA forms very stable and bioavailable complexes with ferrous iron (FeII). Calculated amounts of the FeII-AA solution can be added daily to the drinking water of households or day-care centers for children and adults (e.g. hospitals, kindergartens/schools, refugee camps) to cover the Fe needs of the populations. Granular Fe0 (e.g., sponge iron) in filters is regarded as a locally available Fe carrier in low-income settings, and, AA is also considered to be affordable in low-income countries. The primary idea of this concept is to stabilize FeII from the Fe0 filter by using an appropriate AA solution. An experiment showed that up to 12 mg Fe can be daily leached from 1.0 g of a commercial sponge iron using a 2 mM AA solution. Fe fortification of safe drinking water is a practicable, affordable and efficient method for reducing IDA in low-income communities.
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Affiliation(s)
- Chicgoua Noubactep
- Centre for Modern Indian Studies (CeMIS), Universität Göttingen, Waldweg 26, 37073, Göttingen, Germany.
- Department of Water and Environmental Science and Engineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania.
- Faculty of Science and Technology, Campus of Banekane, Université des Montagnes, P.O. Box 208, Bangangté, Cameroon.
- School of Earth Science and Engineering, Hohai University, Fo Cheng Xi Road 8, Nanjing, 211100, China.
| | | | - Sebastian Vollmer
- Centre for Modern Indian Studies (CeMIS), Universität Göttingen, Waldweg 26, 37073, Göttingen, Germany
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Woldeyohannes M, Girma M, Petros A, Hussen A, Samuel A, Dinssa DA, Challa F, Laillou A, Chitekwe S, Baye K, Noor R, Donze AS, Tollera G, Dangiso MH, Tadesse L, Zelalem M, Tessema M. Ethiopia National Food and Nutrition Survey to inform the Ethiopian National Food and Nutrition Strategy: a study protocol. BMJ Open 2023; 13:e067641. [PMID: 37185190 PMCID: PMC10151871 DOI: 10.1136/bmjopen-2022-067641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Ethiopia has made significant progress in reducing malnutrition in the past two decades. Despite such improvements, a substantial segment of the country's population remains chronically undernourished and suffers from micronutrient deficiencies and from increasing diet-related non-communicable diseases such as diabetes, hypertension and cancer. This survey aims to assess anthropometric status, dietary intake and micronutrient status of Ethiopian children, women and adolescent girls. The study will also assess coverage of direct and indirect nutrition-related interventions and map agricultural soil nutrients. The survey will serve as a baseline for the recently developed Ethiopian Food System Transformation Plan and will inform the implementation of the National Food and Nutrition Strategy. METHODS AND ANALYSIS As a population-based, cross-sectional survey, the study will collect data from the 10 regions and 2 city administrations of Ethiopia. The study population will be women of reproductive age, children aged 0-59 months, school-aged children and adolescent girls. A total of 16 596 households will be surveyed, allowing the generation of national and regional estimates. A two-stage stratified cluster sampling procedure will be used to select households. In the first stage, 639 enumeration areas (EAs) will be selected using probability-proportional-to-size allocation. In the second stage, 26 eligible households will be selected within each EA using systematic random selection. Primary outcomes include coverage of direct and indirect nutrition interventions, infant and young child feeding (IYCF) practices, food insecurity, dietary intakes, mental health, anthropometric status, micronutrient status and soil nutrient status. ETHICS AND DISSEMINATION The protocol was fully reviewed and approved by the Institutional Review Board of the Ethiopian Public Health Institute (protocol no: EPHI-IRB-317-2020). The study is based on voluntary participation and written informed consent is required from study participants. The findings will be disseminated via forums and conferences and will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Meseret Woldeyohannes
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Meron Girma
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemnesh Petros
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemayehu Hussen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Aregash Samuel
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Danial Abera Dinssa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Feyissa Challa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | - Kaleab Baye
- Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Getachew Tollera
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Mesay Hailu Dangiso
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Lia Tadesse
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
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Sigh S, Roos N, Chhoun C, Laillou A, Wieringa FT. Ready-to-Use Therapeutic Foods Fail to Improve Vitamin A and Iron Status Meaningfully during Treatment for Severe Acute Malnutrition in 6-59-Month-old Cambodian Children. Nutrients 2023; 15:nu15040905. [PMID: 36839263 PMCID: PMC9961841 DOI: 10.3390/nu15040905] [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: 01/15/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Severe acute malnutrition (SAM) remains a global health concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on micronutrient status during SAM treatment are almost nonexistent. The objective was to investigate the impact of RUTFs on the iron and vitamin A status of 6-59-month-old children receiving SAM treatment. Biomarkers of vitamin A status (retinol-binding protein, RBP), iron status (ferritin and soluble transferrin receptor, sTfR), and inflammation (C-reactive protein, CRP, and alpha-1 acid glycoprotein, AGP) were collected at admission and discharge (week 8) during an RUTF effectiveness trial. Vitamin A deficiency was defined as RBP <0.70 µmol/L, low body iron as body iron (BI) <0 mg/kg and deficient iron stores as ferritin <12 µg/L. Data were available for 110 and 75 children at admission and discharge, respectively. There was no significant difference in haemoglobin, ferritin, sTfR, BI or RBP concentrations between admission and discharge. At discharge, BI was 0.2 mg/kg lower, and there was a tendency towards a slightly lower RBP concentration, but the prevalence of vitamin A deficiency was low at admission and discharge (6% and 3%, respectively). The small impact of both RUTFs on improving vitamin A and iron status during SAM treatment calls for further research on the bioavailability of micronutrients to enhance the effectiveness of SAM treatment on micronutrient status.
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Affiliation(s)
- Sanne Sigh
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
- Correspondence: ; Tel.: +855-(0)95-201-308
| | - Nanna Roos
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
| | - Chamnan Chhoun
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
| | - Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar 29720, Senegal
| | - Frank T. Wieringa
- UMR QualiSud, Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France
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Jeng SS, Chen YH. Association of Zinc with Anemia. Nutrients 2022; 14:nu14224918. [PMID: 36432604 PMCID: PMC9696717 DOI: 10.3390/nu14224918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Zinc is an essential trace element, and anemia is the most common blood disorder. The association of zinc with anemia may be divided into three major forms: (1) zinc deficiency contributing to anemia, (2) excess intake of zinc leading to anemia, and (3) anemia leading to abnormal blood-zinc levels in the body. In most cases, zinc deficiency coexists with iron deficiency, especially in pregnant women and preschool-age children. To a lesser extent, zinc deficiency may cooperate with other factors to lead to anemia. It seems that zinc deficiency alone does not result in anemia and that it may need to cooperate with other factors to lead to anemia. Excess intake of zinc is rare. However, excess intake of zinc interferes with the uptake of copper and results in copper deficiency that leads to anemia. Animal model studies indicate that in anemia, zinc is redistributed from plasma and bones to the bone marrow to produce new red blood cells. Inadequate zinc status (zinc deficiency or excess) could have effects on anemia; at the same time, anemia could render abnormal zinc status in the body. In handling anemia, zinc status needs to be observed carefully, and supplementation with zinc may have preventive and curative effects.
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Affiliation(s)
- Sen-Shyong Jeng
- Department of Food Science, College of Life Sciences, National Taiwan Ocean University, Keelung 20224, Taiwan
- Correspondence: ; Tel.: +886-2-26326986
| | - Yen-Hua Chen
- Institute of Food Safety and Risk Management, College of Life Sciences, National Taiwan Ocean University, Keelung 20224, Taiwan
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The associations between stunting and wasting at 12 months of age and developmental milestones delays in a cohort of Cambodian children. Sci Rep 2022; 12:17859. [PMID: 36284133 PMCID: PMC9596435 DOI: 10.1038/s41598-022-22861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/20/2022] [Indexed: 01/20/2023] Open
Abstract
Worldwide, over 250 million children under 5 years do not reach their developmental potential due to several causes, including malnutrition. In Cambodia, the prevalence of stunting and wasting among children remains high. This prospective cohort study aimed to assess acquisition of motor and cognitive developmental milestones in early childhood and their associations with stunting and wasting. Children aged from 0 to 24 months were recruited from three provinces in Cambodia and followed up to seven times from March 2016 to June 2019, until their 5 years. Data collection included anthropometry and developmental milestones. Seven motor and seven cognitive milestones were evaluated using the Cambodian Development Milestone Assessment Tool. Associations were assessed with parametric survival models. Hazard ratios (HR) below 1 stood for lower probabilities for achieving developmental milestones. Data were available for 7394 children. At 12 months, the prevalence of stunting and wasting were 23.7% and 9.6% respectively. Both were consistently associated with delays in most motor and cognitive milestones. Stunting was strongly associated with delays in gross motor milestones (HR < 0.85; p < 0.001). Wasting was more strongly associated with delays in fine motor development and most cognitive milestones (HR < 0.75; p < 0.001). Promoting nutritional programs in the first 1000 days to prevent malnutrition is essential to further the optimal growth and motor and cognitive development of Cambodian children.
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Sangeetha T, Nargis Begum T, Balamuralikrishnan B, Arun M, Rengasamy KRR, Senthilkumar N, Velayuthaprabhu S, Saradhadevi M, Sampathkumar P, Vijaya Anand A. Influence of SERPINA1 Gene Polymorphisms on Anemia and Chronic Obstructive Pulmonary Disease. J Renin Angiotensin Aldosterone Syst 2022; 2022:2238320. [PMID: 36320441 PMCID: PMC9592209 DOI: 10.1155/2022/2238320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Anemia is one of the predominant hematological conditions, whereas chronic obstructive pulmonary disease (COPD) is a predominant respiratory disease. These two diseases were found to be interlinked, but the physiological pathways are still unclear. AIM The current study has been aimed at analysing the genetic interrelationship between anemia and COPD in accordance with different altitudes. Methodology. The genetic analysis was performed in the SERPINA1 gene of anemia, COPD, and healthy individuals for the analysis of single nucleotide polymorphism at rs28949274 and rs17580 locations. Result and Discussion. The single nucleotide polymorphism at the locations rs28949274 and rs17580 was present in both anemic and COPD patients. The COPD patients were more prone to mutations (63% had rs28949274, and 11% had rs17580 polymorphisms) than the anemic patients (40% had rs28949274, and 1% had rs17580 polymorphisms). On the basis of altitude, high-altitude individuals were found to be more susceptible to both the polymorphisms. CONCLUSION Based on the current findings, we suggest that the SERPINA1 gene has a positive correlation with anemia as well as COPD, and the increase in altitude also influences the diseased conditions in a positive manner.
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Affiliation(s)
- Thangavelu Sangeetha
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Tajuddin Nargis Begum
- Department of Biotechnology, Jamal Mohammed College, Tiruchirapalli, Tamil Nadu, India
| | | | - Meyyazhagan Arun
- Department of Life Sciences, Christ Deemed to be University, Bengaluru, India
| | - Kannan R. R. Rengasamy
- Laboratory of Natural Products and Medicinal Chemistry (LNPMC), Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu 600077, India
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom 2520, South Africa
| | - Natchiappan Senthilkumar
- Chemistry and Bioprospecting Division, Institute of Forest Genetics and Tree Breeding (IFGTB-ICFRE), Coimbatore, Tamil Nadu, India
| | | | | | - Palanisamy Sampathkumar
- Department of Chemistry and Biosciences, SASTRA Deemed to be University, Kumbakonam, Tamil Nadu, India
| | - Arumugam Vijaya Anand
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, Tamil Nadu, India
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The relationship between anemia and obesity. Expert Rev Hematol 2022; 15:911-926. [PMID: 36189499 DOI: 10.1080/17474086.2022.2131521] [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: 01/19/2023]
Abstract
INTRODUCTION Obesity is linked to a variety of unfavourable outcomes, including anaemia, which is a serious global public health problem. The prevalence of obesity along with anaemia suggests a relationship between obesity and anaemia. Recent studies have demonstrated strong associations between anaemia and obesity, chronic diseases, ageing, hepato-renal impairment, chronic infection, autoimmune diseases, and widespread malignancy. Thus, the intersection point of obesity and anaemia is an important area of attention. AREA COVERED This paper reviews the pathophysiology of obesity and anaemia. Then, It deliberates the relationship between obesity and different types of anaemia and other clinical forms associated with anaemia. EXPERT OPINION Obesity, especially obesity-related to excessive visceral fat distribution, is accompanied by several disturbances at the endothelial, hormonal, and inflammatory levels. These disturbances induce activation of several mechanisms that contribute to the anaemic state. Over-weight patients with chronic anaemias are required to maintain the related vitamins and minerals at optimum levels and appropriate BMI. In addition, a regular clinical follow-up is essential to be scheduled to reduce the risk of complications associated with anaemia in obese patients.
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Saha S, Puwar T, Shah K, Pandya A, Wanjari MB, Saxena D. Non-iron Deficiency Anemia in Rural Indian Women: A Cross-Sectional Study. Cureus 2022; 14:e28565. [PMID: 36185907 PMCID: PMC9520231 DOI: 10.7759/cureus.28565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Anemia is an important public health concern, affecting almost 25% of the global population. In India, these statistics are even more worrisome with more than half of the children, non-pregnant and pregnant women being affected by the disease. Though the major cause of anemia is iron deficiency, other causes cannot be neglected considering the magnitude of the problem. The present study was designed to estimate the prevalence of non-iron deficiency anemia (NIDA) in Devbhoomi Dwarka District of Gujarat. Methods For this cross-sectional study, total of 258 mothers (antenatal and postnatal) were enrolled from 27 primary health centers. Apart from demographic details and obstetric history, hemoglobin and ferritin levels were measured from the participant’s blood after obtaining consent. Clinical information such as the history of recent illness and fever were also noted through questionnaires. Prevalence was anemia was calculated using a standard threshold of blood hemoglobin and NIDM was defined using ferritin levels. Results As per hemoglobin levels, anemia was present in 65.9% of the mothers, which was relatively higher in antenatal women (90%) as compared to postnatal women (57%). Ferritin levels showed that out of this total anemic mothers, 61.8% (105/258) have normal ferritin levels indicating the presence of non-iron deficiency. Trimester-wise analysis of anemia in AN showed that NIDM prevalence increases with increasing trimester in contrast to IDA where a considerable reduction was found with iron supplementation. Conclusion The study indicated that two out of every three women were anemic and only one out of four were anemic with depleted iron storage. These findings have important policy implications as in India the anemia control programs address only iron deficiency anemia and not NIDA. The development of a framework for diagnosis and appropriate treatment can be recommended for integration into national guidelines.
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Manger MS, Brown KH, Osendarp SJM, Atkin RA, McDonald CM. Barriers to and Enablers of the Inclusion of Micronutrient Biomarkers in National Surveys and Surveillance Systems in Low- and Middle-Income Countries. Nutrients 2022; 14:nu14102009. [PMID: 35631149 PMCID: PMC9145664 DOI: 10.3390/nu14102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Including biomarkers of micronutrient status in existing or planned national surveys or surveillance systems is a critical step in improving capacity to promote, design, monitor, and evaluate micronutrient policies and programs. We aimed to identify the barriers to and enablers of the inclusion of micronutrient biomarker assessment in national surveys and surveillance systems, to identify the main challenges faced during the survey process, and to review experiences using existing platforms for micronutrient surveys. We conducted a series of key informant interviews with in-country and external representatives from six countries where national-level data on micronutrient status were collected in the past 5 years: Cambodia, Pakistan, Malawi, Uganda, Ghana, and Uzbekistan. Micronutrients associated with specific public health programs were always prioritized for inclusion in the survey. If funding, time, and/or logistics allowed, other considered micronutrients were also included. The most important and frequently reported barrier to inclusion of a more comprehensive panel of micronutrient biomarkers was inadequate funding to cover the laboratory analysis cost for all micronutrients considered at the planning stage. Government support and commitment was stressed as the most important enabling factor by all key informants. Advocacy for funding for micronutrient status assessment is needed.
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Affiliation(s)
- Mari S. Manger
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Correspondence:
| | - Kenneth H. Brown
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, CA 95616, USA;
| | | | - Reed A. Atkin
- Micronutrient Forum, Washington, DC 20005, USA; (S.J.M.O.); (R.A.A.)
| | - Christine M. McDonald
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
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14
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Depenbusch L, Schreinemachers P, Brown S, Roothaert R. Impact and distributional effects of a home garden and nutrition intervention in Cambodia. Food Secur 2022. [DOI: 10.1007/s12571-021-01235-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractHome garden interventions combining training in agriculture and nutrition have the potential to increase vegetable production and consumption in lower-income countries, but there remains a need for better evidence for impact. This study contributes to filling this gap by evaluating the impact and distributional effects of a home garden intervention in Cambodia. We used a cluster randomized controlled trial with before and after data for a sample of 500 rural households with children under five and women 16–49 years old. Impact was estimated using analysis of covariance (ANCOVA) and conditional quantile regressions with non-parametric bounds. The results show that the intervention significantly increased the adoption of nearly all promoted gardening methods. More households (+ 35%; p < 0.01) produced vegetables, and the production period was extended by five months on average. One-month recall data show an increase in vegetables harvested (+ 25 kg; p < 0.01) and consumed (+ 10 kg; p < 0.01) from the garden. Quantile regressions confirm these findings and show that nearly all households benefitted, but households that were already doing better at baseline tended to benefit more. Seven-day recall data show an increase in the quantity of vegetables consumed (+ 61 g/day/capita; p < 0.01) and an increased quantity of vitamin A, folate, iron, and zinc contained in these vegetables. Women contributed more to the garden work than men and their time spent in the garden increased by 29 min/day on average. These results add further evidence that integrated home garden interventions can contribute to nutrition outcomes and that almost all participants can benefit.
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15
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Sophâl C. Thalassemia Status in Cambodia. Hemoglobin 2022; 46:10-11. [PMID: 35950584 DOI: 10.1080/03630269.2021.2008956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The population of Cambodia (in 2019) was approximately 16 million with an annual growth rate of 1.4% in which the prevalence of hemoglobinopathies was estimated at about 40.0% (range 30.0-50.0%) to be carriers, and 2240 annual births for β-thalassemia major (β-TM). The overall prevalence of β-thalassemia (β-thal) and α-thalassemia (α-thal) were 40.9 and 39.6%, respectively. Currently, the specific epidemiological data regarding the abnormal gene frequency/mutations among different ethnic groups is unknown. In 2011, national guidelines for the Clinical Management of Patients with Thalassemia in Cambodia were developed and published by the Ministry of Health (MoH). Packed red cells (PRCs) are available at most referral hospitals (provincial hospitals). Oral iron chelators [deferiprone (DFP) and deferasirox (DFX)] are only available from a private pharmaceutical company. The future needs for Cambodia are to develop a national policy on the prevention or control of β-thal and α-thal, and a national registry of patients with thalassemia, to determine the gene frequency of α- and β-thal in different regions of the country, and to place the iron chelators on the list of essential medicines.
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Affiliation(s)
- Chean Sophâl
- Department of Pediatric Hemato-Immunology, National Pediatric Hospital, Phnom Penh, Cambodia
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16
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Murphy T, Phan K, Irvine KN, Lean D. The Role of Micronutrients and Toxic Metals in the Management of Epidemics in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11446. [PMID: 34769963 PMCID: PMC8582812 DOI: 10.3390/ijerph182111446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
The illegal trade of wildlife in SE Asia has been identified as the likely cause of the COVID-19 pandemic. We reviewed 198 papers on the current COVID pandemic in Cambodia, diseases such as avian influenza and Nipah virus, most likely to develop into a new pandemic in Cambodia, and common features of disease that require mitigation. Artisanal goldmining uses pure mercury in the areas where wildlife is smuggled to China. Moreover, 30-40% of Cambodians are zinc deficient. High levels of arsenic in irrigation water (>1000 µg/L) are associated with very low levels of zinc in rice (5 µg/g) and rice is the primary staple food for the region. Brown rice from nine of 15 paddy fields in the arsenic zone of Cambodia had double the new guidelines of 100 µg/kg inorganic arsenic for children's food in the EU and USA. The combination of deficiencies of essential micronutrients like zinc and pervasive presence of arsenic and mercury has the potential to compromise the immunity of many Cambodians. Innovative solutions are suggested to improve micronutrient nutrition. Toxins that suppress the immune system must be better managed to reduce the virulence of pathogens. Cambodia was not likely the source of the COVID-19 but does have problems that could result in a new pandemic.
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Affiliation(s)
- Thomas Murphy
- Faculty of Science and Technology, International University, Phnom Penh 12000, Cambodia;
| | - Kongkea Phan
- Faculty of Science and Technology, International University, Phnom Penh 12000, Cambodia;
| | - Kim Neil Irvine
- Faculty of Architecture & Planning, Rangsit Campus, Thammasat University, Khlong Nueng 12121, Thailand;
| | - David Lean
- Lean Environmental, Apsley, ON K0L1A0, Canada;
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Adewale B, Heintz JR, Pastore CF, Rossi HL, Hung LY, Rahman N, Bethony J, Diemert D, Babatunde JA, Herbert DR. Parasitic helminth infections in humans modulate Trefoil Factor levels in a manner dependent on the species of parasite and age of the host. PLoS Negl Trop Dis 2021; 15:e0009550. [PMID: 34662329 PMCID: PMC8553090 DOI: 10.1371/journal.pntd.0009550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/28/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
Helminth infections, including hookworms and Schistosomes, can cause severe disability and death. Infection management and control would benefit from identification of biomarkers for early detection and prognosis. While animal models suggest that Trefoil Factor Family proteins (TFF2 and TFF3) and interleukin-33 (IL-33) -driven type 2 immune responses are critical mediators of tissue repair and worm clearance in the context of hookworm infection, very little is known about how they are modulated in the context of human helminth infection. We measured TFF2, TFF3, and IL-33 levels in serum from patients in Brazil infected with Hookworm and/or Schistosomes, and compared them to endemic and non-endemic controls. TFF2 was specifically elevated by Hookworm infection in females, not Schistosoma or co-infection. This elevation was correlated with age, but not worm burden. TFF3 was elevated by Schistosoma infection and found to be generally higher in females. IL-33 was not significantly altered by infection. To determine if this might apply more broadly to other species or regions, we measured TFFs and cytokine levels (IFNγ, TNFα, IL-33, IL-13, IL-1β, IL-17A, IL-22, and IL-10) in both the serum and urine of Nigerian school children infected with S. haematobium. We found that serum levels of TFF2 and 3 were reduced by infection, likely in an age dependent manner. In the serum, only IL-10 and IL-13 were significantly increased, while in urine IFN-γ, TNF-α, IL-13, IL-1β, IL-22, and IL-10 were significantly increased in by infection. Taken together, these data support a role for TFF proteins in human helminth infection. Billions of people are infected with parasitic helminths across the globe, especially in resource poor regions. These infections can result in severe developmental delay, disability, and death. Adequate management of helminth infection would benefit from the identification of host biomarkers in easily obtained samples (e.g. serum or urine) that correlate to infection state. Our goal was to determine if specific proteins involved in tissue repair and immune modulation are altered by infection with specific helminth species in Brazil (hookworm and S. mansoni species of blood fluke) or Nigeria (S. haematobium species of blood fluke). One of these proteins, Trefoil Factor 2 (TFF2), was elevated in the serum of hookworm infected women from Brazil, while another, TFF3 is higher in women than men, but also increased by S. mansoni blood fluke infection. In contrast, both TFFs were decreased in the serum of Nigerian children infected by S. haematobium, while many pro-inflammatory cytokines were increased in the urine, where the eggs emerge from host tissue.
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Affiliation(s)
- Babatunde Adewale
- Public Health Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Jonathan R. Heintz
- University of Pennsylvania, Perlman School of Medicine Biostatistics Analysis Center, Philadelphia, Pennsylvania, United States of America
| | - Christopher F. Pastore
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of Amerca
| | - Heather L. Rossi
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of Amerca
| | - Li-Yin Hung
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of Amerca
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, United States of Amerca
| | - Nurudeen Rahman
- Public Health Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Jeff Bethony
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University Medical Center, Washington, District of Columbia, United States of Amerca
| | - David Diemert
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University Medical Center, Washington, District of Columbia, United States of Amerca
| | - James Ayorinde Babatunde
- Department of Biochemistry & Nutrition, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - De’Broski R. Herbert
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of Amerca
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, United States of Amerca
- * E-mail:
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Hailu BA, Laillou A, Chitekwe S, Beyene J, Baye K. Subnational mapping for targeting anaemia prevention in women of reproductive age in Ethiopia: A coverage-equity paradox. MATERNAL & CHILD NUTRITION 2021:e13277. [PMID: 34624171 DOI: 10.1111/mcn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Anaemia in women of reproductive age (WRA) can be effectively addressed if supported by a better understanding of the spatial variations, magnitude, severity and distribution of anaemia. This study aimed to map the subnational spatial distribution of anaemia (any, moderate and severe forms) among WRA in Ethiopia. We identified and mapped (any, moderate and severe) anaemia hotspots in WRA (n = 14,923) at the subnational level and identified risk factors using multilevel logistic regression. Kulldorff scan statistics were used to identify hotspot regions. Ordinary kringing was used to predict the anaemia prevalence in unmeasured areas. The overall anaemia prevalence increased from 16.6% in 2011 to 23.6% in 2016, a rise that was mostly related to the widening of existing hotspot areas. The primary clusters of (any) anaemia were in Somali and Afar regions. The horn of the Somali region represented a cluster of 330 km where 10% of WRA were severely anaemic. The Oromia-Somali border represented a significant cluster covering 247 km, with 9% severe anaemia. Population-dense areas with low anaemia prevalence had high absolute number of cases. Women education, taking iron-folic-acid tablets during pregnancy and birth-delivery in health facilities reduced the risk of any anaemia (P < 0.05). The local-level mapping of anaemia helped identify clusters that require attention but also highlighted the urgent need to study the aetiology of anaemia to improve the effectiveness and safety of interventions. Both relative and absolute anaemia estimates are critical to determine where additional attention is needed.
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Affiliation(s)
| | - Arnaud Laillou
- Nutrition Section, UNICEF Ethiopia, Addis Ababa, Ethiopia
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Research Center for Inclusive Development in Africa (RIDA), Addis Ababa, Ethiopia
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Iron nanoparticles as a promising compound for food fortification in iron deficiency anemia: a review. Journal of Food Science and Technology 2021; 59:3319-3335. [PMID: 34219805 PMCID: PMC8234770 DOI: 10.1007/s13197-021-05184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
Abstract Iron deficiency anemia (IDA) is a global health concern that is affecting all age groups significantly. Among many of the existing methods, the fortification of foods with iron salts is the best and most cost-effective strategy for targeting large-scale populations to provide nutritional security. The fortification of foods with iron salts is a challenging task because most iron complexes (ferrous sulfate, ferrous chloride) used in fortification are highly water-soluble, which impart unacceptable organoleptic changes in food vehicles and also causes gastrointestinal problems. However, insoluble iron salts (ferric pyrophosphate) do not cause unacceptable taste or color in food vehicles but low bioavailable. Nanosized iron salts can overcome these concerns. The particle size of iron salts has been reported to play an important role in the absorption of iron. Reduction in the particle size of iron compounds increases its surface area, which in turn improves its solubility in the gastric juice leading to higher absorption. Nanosized iron compound produces minimal organoleptic changes in food vehicles compared to water-soluble iron complexes. Thus nanosized iron salts find potential applications in food fortification to reduce IDA. This paper focuses on providing a complete review of the various iron salts used in IDA, including their bioavailability, the challenges to food fortification, the effects of nanosized iron salts on IDA, and their applications in food fortification. ![]() Graphic abstract Fortification of foods with water-soluble Fe salts imparts unacceptable organoleptic changes in food vehicle and adverse impact on health. However, insoluble iron salts do not cause unacceptable taste or color in food vehicles but low bioavailable. Using Nano-sized iron compound produces minimal organoleptic changes in food vehicles compared to changes produced by water-soluble iron complexes, improves Fe absorption in the gastrointestinal tract and does not cause any health issues.
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20
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Daily Oral Supplementation with 60 mg of Elemental Iron for 12 Weeks Alters Blood Mitochondrial DNA Content, but Not Leukocyte Telomere Length in Cambodian Women. Nutrients 2021; 13:nu13061877. [PMID: 34072630 PMCID: PMC8227094 DOI: 10.3390/nu13061877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
There is limited evidence regarding the potential risk of untargeted iron supplementation, especially among individuals who are iron-replete or have genetic hemoglobinopathies. Excess iron exposure can increase the production of reactive oxygen species, which can lead to cellular damage. We evaluated the effect of daily oral supplementation on relative leukocyte telomere length (rLTL) and blood mitochondrial DNA (mtDNA) content in non-pregnant Cambodian women (18-45 years) who received 60 mg of elemental iron as ferrous sulfate (n = 190) or a placebo (n = 186) for 12 weeks. Buffy coat rLTL and mtDNA content were quantified by monochrome multiplex quantitative polymerase chain reaction. Generalized linear mixed-effects models were used to predict the absolute and percent change in rLTL and mtDNA content after 12 weeks. Iron supplementation was not associated with an absolute or percent change in rLTL after 12 weeks compared with placebo (ß-coefficient: -0.04 [95% CI: -0.16, 0.08]; p = 0.50 and ß-coefficient: -0.96 [95% CI: -2.69, 0.77]; p = 0.28, respectively). However, iron supplementation was associated with a smaller absolute and percent increase in mtDNA content after 12 weeks compared with placebo (ß-coefficient: -11 [95% CI: -20, -2]; p = 0.02 and ß-coefficient: -11 [95% CI: -20, -1]; p= 0.02, respectively). Thus, daily oral iron supplementation for 12 weeks was associated with altered mitochondrial homeostasis in our study sample. More research is needed to understand the risk of iron exposure and the biological consequences of altered mitochondrial homeostasis in order to inform the safety of the current global supplementation policy.
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Swamy BPM, Marathi B, Ribeiro-Barros AIF, Calayugan MIC, Ricachenevsky FK. Iron Biofortification in Rice: An Update on Quantitative Trait Loci and Candidate Genes. FRONTIERS IN PLANT SCIENCE 2021; 12:647341. [PMID: 34122472 PMCID: PMC8187908 DOI: 10.3389/fpls.2021.647341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/15/2021] [Indexed: 05/06/2023]
Abstract
Rice is the most versatile model for cereals and also an economically relevant food crop; as a result, it is the most suitable species for molecular characterization of Fe homeostasis and biofortification. Recently there have been significant efforts to dissect genes and quantitative trait loci (QTL) associated with Fe translocation into rice grains; such information is highly useful for Fe biofortification of cereals but very limited in other species, such as maize (Zea mays) and wheat (Triticum aestivum). Given rice's centrality as a model for Poaceae species, we review the current knowledge on genes playing important roles in Fe transport, accumulation, and distribution in rice grains and QTLs that might explain the variability in Fe concentrations observed in different genotypes. More than 90 Fe QTLs have been identified over the 12 rice chromosomes. From these, 17 were recorded as stable, and 25 harbored Fe-related genes nearby or within the QTL. Among the candidate genes associated with Fe uptake, translocation, and loading into rice grains, we highlight the function of transporters from the YSL and ZIP families; transporters from metal-binding molecules, such as nicotianamine and deoxymugineic acid; vacuolar iron transporters; citrate efflux transporters; and others that were shown to play a role in steps leading to Fe delivery to seeds. Finally, we discuss the application of these QTLs and genes in genomics assisted breeding for fast-tracking Fe biofortification in rice and other cereals in the near future.
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Affiliation(s)
| | - Balram Marathi
- Agricultural College, Warangal, Professor Jayashankar Telangana State Agricultural University, Hyderabad, India
| | - Ana I. F. Ribeiro-Barros
- Forest Research Centre (CEF), Instituto Superior de Agronomia, Universidade de Lisboa, Lisbon, Portugal
| | - Mark Ian C. Calayugan
- Institute of Crop Science, University of the Philippines Los Baños, Laguna, Philippines
| | - Felipe Klein Ricachenevsky
- Departamento de Botânica, Instituto de Biociências, e Programa de Pós-Graduação em Biologia Celular e Molecular, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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22
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Greffeuille V, Fortin S, Gibson R, Rohner F, Williams A, Young MF, Houghton L, Ou J, Dijkhuizen MA, Wirth JP, Lander RL, McDonald CM, Suchdev PS, Berger J, Wieringa FT. Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. J Nutr 2021; 151:1277-1285. [PMID: 33693923 PMCID: PMC8454198 DOI: 10.1093/jn/nxaa444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anemia is a worldwide concern. Nutritional deficiencies and inflammation are considered main contributors, but zinc deficiency has only recently been associated with anemia. OBJECTIVES In this study we assessed associations between zinc status and hemoglobin (Hb) concentrations and anemia in preschool children 6-59 mo old (PSC) and nonpregnant women of reproductive age 15-49 y old (WRA) in population-based nutrition surveys. METHODS Cross-sectional data from 13 (PSC) and 12 (WRA) countries within the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were used. Multivariable linear models were constructed that included zinc status (plasma/serum zinc concentrations), Hb concentrations and anemia, iron status, age, sex, and inflammation (C-reactive protein and α-1-acid glycoprotein). Zinc was adjusted for inflammation in PSC according to the BRINDA algorithm. RESULTS Data were available for 18,658 PSC and 22,633 WRA. Prevalence of anemia ranged from 7.5% to 73.7% and from 11.5% to 94.7% in PSC and WRA, respectively. Prevalence of zinc deficiency ranged from 9.2% to 78.4% in PSC and from 9.8% to 84.7% in WRA, with prevalence of zinc deficiency >20% in all countries except Azerbaijan (PSC), Ecuador (PSC), and the United Kingdom (WRA). Multivariable linear regression models showed that zinc concentrations were independently and positively associated with Hb concentrations in 7 of 13 countries for PSC and 5 of 12 countries for WRA. In the same models, ferritin concentration was also significantly associated with Hb among PSC and WRA in 9 and 10 countries, respectively. Zinc deficiency was significantly associated with anemia in PSC and WRA in 5 and 4 countries respectively. CONCLUSIONS Zinc deficiency was prevalent in most countries and associations between zinc and Hb in roughly half of the countries examined suggesting that strategies to combat zinc deficiency may help reduce anemia prevalence. More research on mechanisms by which zinc deficiency is associated with anemia and the reasons for the heterogeneity among countries is warranted.
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Affiliation(s)
- Valerie Greffeuille
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
| | - Sonia Fortin
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
| | - Rosalind Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand,South Australian Health and Medical Institute, Adelaide, Australia
| | | | - Anne Williams
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Lisa Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jiangda Ou
- McKing Consulting Corporation, Atlanta, GA, USA
| | | | | | - Rebecca L Lander
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Christine M McDonald
- UCSF Benioff Children's Hospital Oakland, Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Parminder S Suchdev
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Jacques Berger
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
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Alarcón-Guevara S, Peñafiel-Sam J, Chang-Cabanillas S, Pereyra-Elías R. Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015. Child Care Health Dev 2021; 47:228-242. [PMID: 33150967 DOI: 10.1111/cch.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. METHODS Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. RESULTS Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition. CONCLUSIONS There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
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Affiliation(s)
| | | | | | - Reneé Pereyra-Elías
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Yuniati T, Judistiani RTD, Natalia YA, Irianti S, Madjid TH, Ghozali M, Sribudiani Y, Indrati AR, Abdulah R, Setiabudiawan B. First trimester maternal vitamin D, ferritin, hemoglobin level and their associations with neonatal birthweight: Result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia. J Neonatal Perinatal Med 2021; 13:63-69. [PMID: 31609704 DOI: 10.3233/npm-180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Vitamin D deficiency and anemia are examples of nutritional problems of global health significance. When these health issues effect pregnant women, they may become a threat to the fetus' potention for intrauterine growth. It has been known that the first trimester is the golden period of fetal programming which influences the fetuses and their life after birth. This study was aiming to analyze the association between first trimester maternal vitamin D, serum ferritin, hemoglobin level and neonatal birth weight. METHODS From July 2016 a prospective cohort of pregnant women had been observed in four cities in West Java, Indonesia. Two hundred ninety four pregnant women were recuited in the first trimester and 203 of them had complete follow up until delivery. Collected data included maternal demography, blood analysis for ferritin, 25(OH) vitamin D in the first trimester of pregnancy and the birth weight of neonates. Associations were analyzed with multiple regression models. RESULTS Vitamin D deficiency was highly prevalent among pregnant women in this study (approximately 75%) while anemia was found in 7.5 %, a little above the target of 5 %. However, no significant association was found between maternal serum vitamin D, serum ferritin, hemoglobin level in the first trimester and birth weight of the neonates, before and after adjustment for maternal age, pre-pregnancy body mass index, and parity. CONCLUSION There were no associations found between vitamin D, ferritin, and hemoglobin level in the first trimester and neonatal birth weight. The negative results in this study should not diminish the benefit of nutritional supplementation during pregnancy. The possibility of other explanatory variables that influence these associations warrants further studies.
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Affiliation(s)
- T Yuniati
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R T Dewi Judistiani
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Adelwin Natalia
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - S Irianti
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - T Husnitawati Madjid
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - M Ghozali
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Sribudiani
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - A Rengga Indrati
- Clinical Pathology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Padjadjaran, Sumedang, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
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Muleta A, Hailu D, Belachew T. Camel milk consumption was associated with lower prevalence of anemia among preschool children in rural pastoral districts of Somali, eastern Ethiopia. Nutrition 2021; 86:111170. [PMID: 33601123 DOI: 10.1016/j.nut.2021.111170] [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: 06/01/2020] [Revised: 01/09/2021] [Accepted: 01/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate association between consumption of camel milk (CaM) and childhood anemia. METHODS A community-based cross-sectional study was conducted with 388 preschool children (24-59 mo of age) in rural pastoral districts of Somali, eastern Ethiopia. We sampled 185 consumers of CaM and 203 who consumed bovine milk (BM). Children were selected from random households with lactating camels or cattle. Hemoglobin (Hb) was measured in the field using a HemoCue instrument. A multivariable logistic regressions model was used in SPSS version 20 to examine association between type of milk consumption and anemia. RESULTS Anemia (Hb <11 g/dL) was found in 59.8% of the overall sample, whereas it was 42.7% and 75.4% among CaM and BM consumers, respectively. The odds of anemia among BM consumers (adjusted odds ratio [aOR], 3.12; 95% confidence interval [CI], 1.27-7.66) and children with intestinal parasites (aOR: 3.32; 95% CI, 1.39-7.91) was compared with CaM consumers and children without intestinal parasites, respectively. Increasing age and height-for-age z-score of children were associated with decreased childhood anemia (P < 0.001). Children with anemia consumed a higher volume of BM compared with non-anemic and CaM consumers, too but the consumption was not statistically significant. CONCLUSION CaM consumption was associated with lower prevalence of anemia compared with consumption of BM. Promoting use of CaM as complementary food for preschool children in pastoralist areas might be considered an intervention toward reducing anemia.
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Affiliation(s)
- Anbissa Muleta
- Hawassa University, School of Nutrition, Food Science and Technology, Hawassa, Ethiopia; Jigjiga University, Department of Food Science and Nutrition, Jigjiga, Ethiopia.
| | - Dejene Hailu
- Hawassa University, Department of Public and Environmental Health, College of Health Sciences, Hawassa, Ethiopia
| | - Tefera Belachew
- Jimma University, Department of Nutrition and Dietetics, Jimma, Ethiopia
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Mahapatra S, Parker ME, Dave N, Zobrist SC, Shajie Arul D, King A, Betigeri A, Sachdeva R. Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study. Int J Food Sci Nutr 2021; 72:690-703. [PMID: 33427528 DOI: 10.1080/09637486.2020.1855126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6-12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25-33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.
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Affiliation(s)
- Sudip Mahapatra
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Niraj Dave
- Nielsen India Pvt. Ltd., Gurugram, India
| | - Stephanie C Zobrist
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Danie Shajie Arul
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Allie King
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Arvind Betigeri
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Ruchika Sachdeva
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
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First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia. Anemia 2020; 2020:8880045. [PMID: 33101731 PMCID: PMC7568146 DOI: 10.1155/2020/8880045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting. Objective This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (SysmexR). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR). Result One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, p < 0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml. Conclusion This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.
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Chronic inflammation was a major predictor and determinant factor of anemia in lactating women in Sidama zone southern Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0240254. [PMID: 33017433 PMCID: PMC7535025 DOI: 10.1371/journal.pone.0240254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected for measuring hemoglobin, iron biomarkers, zinc, selenium, and inflammation markers. The median (IQR) hemoglobin (Hb) was 132 (123, 139) g/L. Of the women, 19% were anemic and 7% had iron deficiency anemia; 31% were iron deficient and 2% had iron overload. Also, 8% had functional iron deficit, 6% had acute inflammation, 13% had chronic inflammation, and 16% had tissue iron deficiency. The majority (78%) of the women had low plasma zinc out of which more than 16% were anemic. Hb was positively associated with plasma iron and plasma zinc and negatively associated with transferrin receptor (TfR) and α-1-acid glycoprotein (AGP). Plasma iron, AGP, TfR, hepcidin and plasma zinc were significant predictors of maternal anemia. Additionally MUAC and level of education were associated positively with maternal hemoglobin. This study showed that maternal anemia was associated with multiple factors including nutritional deficiencies, inflammation and limited education.
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Gupta S, Brazier AKM, Lowe NM. Zinc deficiency in low- and middle-income countries: prevalence and approaches for mitigation. J Hum Nutr Diet 2020; 33:624-643. [PMID: 32627912 DOI: 10.1111/jhn.12791] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
This review addresses the prevalence of zinc deficiency in Low- and Middle-income Countries (LMICs) and assesses the available strategies for its alleviation. The paucity of national-level data on the zinc deficiency in LMICs is partially a result of the lack of a reliable biomarker. Zinc deficiency appears to be a public health problem in almost all the LMICs, irrespective of the recommended indicators (plasma zinc concentration, dietary zinc adequacy and stunting prevalence) used. Based on plasma/serum zinc concentration (PZC), which is the most appropriate indicator at present, the prevalence of zinc deficiency in LMICs is of concern. Among the 25 countries for which national PZC data were available, 23 had a zinc deficiency prevalence of >20% for at least one physiological group. Zinc supplementation is largely restricted as an adjunct therapy for diarrhoea management in children, and the best platform and the most effective way of preventive zinc supplementation delivery remains to be established. Impact assessment for current zinc fortification programmes in LMICs and the effectiveness of zinc supplementation as part of a multi-micronutrient powder is to be determined. Dietary diversification, though promising for LMICs, is in the nascent stages of development at present. Inclusion of meat and animal products can be an important way of improving zinc status. Programmatic experience with the promotion of home processing techniques to increase absorbable zinc in the diet is lacking. Conventional biofortification techniques are gaining recognition in LMICs; however, transgenic biofortification as a strategy remains controversial.
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Affiliation(s)
- S Gupta
- Lancashire Research Centre for Global Development, University of Central Lancashire, Preston, UK
| | - A K M Brazier
- Lancashire Research Centre for Global Development, University of Central Lancashire, Preston, UK
| | - N M Lowe
- Lancashire Research Centre for Global Development, University of Central Lancashire, Preston, UK
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Prevalence of short stature and malnutrition among Egyptian primary school children and their coexistence with Anemia. Ital J Pediatr 2020; 46:91. [PMID: 32600418 PMCID: PMC7325115 DOI: 10.1186/s13052-020-00855-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background Under nutrition and overweight typically occur during nutritional transition periods in developing countries including Egypt. Short stature and anemia are public health concern due to its strong link with malnutrition which is a preventable risk factor. Objectives to estimate the prevalence of overweight, obesity, underweight and short stature and its concurrence with anemia, also to determine the etiological profile of short stature among primary school children in Egypt. Methods A cross-sectional study was carried out on 33,150 Egyptian children aged 6–11 years old from January 2018 to January 2020, allocated in 59 primary schools from diverse geographical districts in Egypt. Complete anthropometric measurements were conducted and applied according to WHO growth charts. Hemoglobin level was measured. Systematic approach to detect the etiology of short stature was applied randomly to a sample of 380 stunted children. Results The prevalence of underweight was 8.2%, while obesity and overweight represented 21.8% (9.6 and 12.2% respectively). Overall short stature constituted 17%. The main etiologies of short stature were familial (40.8%) and constitutional (24.2%). Anemia was diagnosed in 26% of children; while concurrent anemia and stunting was reported in 9.9%. Regarding anemia and anemia with stunting were more common among girls (30.0% (OR = 1.50, CI95%: 1.43–1.58) and 11.4% (OR = 1.39, CI95%:1.29–1.49) respectively), who were living in rural areas (33.4% (OR = 1.96, CI 95%:1.87–2.06) &12.7% (OR = 1.72, CI 95%:1.60–1.85)) and those who had low socioeconomic status)34.6% (OR = 2.54, CI 95%:2.29–2.82) & 17.2% (OR = 3.32, CI 95%:2.85–3.88() respectively. Anemia with stunting was significantly higher among children aged ≥9 years old representing 12% (OR = 1.40, CI 95%:1.30–1.51). Conclusion Prevalence of short stature, obesity and anemia was high among primary school children in Egypt with a strong concurrence between anemia and stunting. Intensive parental health education and in-depth nutritional assessment are required.
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Murphy T, Irvine K, Phan K, Lean D, Yumvihoze E, Wilson K. Interactions of Dimethylarsinic Acid, Total Arsenic and Zinc Affecting Rice Crop Management and Human Health in Cambodia. J Health Pollut 2020; 10:200612. [PMID: 32509413 PMCID: PMC7269330 DOI: 10.5696/2156-9614-10.26.200612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/21/2020] [Indexed: 04/18/2023]
Abstract
BACKGROUND In parts of Cambodia and in many other parts of the world, irrigation of rice with groundwater results in arsenic (As) accumulation in soil and rice, leading to health concerns associated with rice consumption. At times, some As is present as relatively nontoxic, non-regulated, dimethylarsinic acid (DMA). Low levels of zinc (Zn) have been found in rice from Bangladesh, Cambodia, and China where As levels in rice are high. Furthermore, there have been claims that Zn deficiency is responsible for stunting the growth of children in Cambodia and elsewhere, however in rural Asia, rice is the major source of Zn. Current data are inadequate for both Zn and DMA in Cambodian rice. OBJECTIVES The present study aimed to provide a preliminary evaluation of the relationship between the content of Zn and DMA in rice grain in Preak Russey, an area with elevated levels of As in groundwater and to improve the management of Zn deficiency in rice. METHODS Rice agriculture was evaluated along the Mekong River in Cambodia. Analyses for metals, total As, and As species in rice and water were conducted by inductively coupled plasma mass spectrometry. Analysis of total Zn and As in soils and total Zn in rice were analyzed using X-ray fluorescence (XRF) spectrometry. RESULTS Rice in Preak Russey had Zn concentrations less than a third the level recommended by the United Nations World Food Programme. There was a significant (p < 0.05) negative correlation between the Zn content of rice and DMA in rice with the lowest Zn and highest DMA levels occurring near irrigation wells, the source of As. CONCLUSIONS The highest levels of DMA in rice were associated with Zn deficiency in rice. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Tom Murphy
- International University, Phnom Penh, Cambodia
| | | | | | - David Lean
- Lean Environmental, Apsley, Ontario, Canada
| | | | - Ken Wilson
- Texas State University, San Marcos, Texas, USA
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Ford ND, Bichha RP, Parajuli KR, Paudyal N, Joshi N, Whitehead RD, Chitekwe S, Mei Z, Flores-Ayala R, Adhikari DP, Rijal S, Jefferds ME. Factors associated with anaemia among adolescent boys and girls 10-19 years old in Nepal. MATERNAL AND CHILD NUTRITION 2020; 18 Suppl 1:e13013. [PMID: 32338438 PMCID: PMC8770652 DOI: 10.1111/mcn.13013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 12/26/2022]
Abstract
We used data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia (World Health Organization cut-points using altitude- and smoking-adjusted haemoglobin [Hb]) among nationally representative samples of adolescents 10-19 years. Hb, biomarkers of micronutrients, infection and inflammation were assessed from venous blood. Sociodemographic and household characteristics, dietary diversity, pica and recent morbidity were ascertained by interview. We explored bivariate relationships between candidate predictors and anaemia among boys (N = 967) and girls (N = 1,680). Candidate predictors with P < 0.05 in bivariate analyses were included in sex-specific multivariable logistic regression models. Anaemia prevalence was 20.6% (95% confidence interval [CI] [17.1, 24.1]) among girls and 10.9% (95% CI [8.2, 13.6]) among boys. Among girls, living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.28, 95% CI [0.15, 0.52] and AOR 0.42, 95% CI [0.25, 0.73], respectively), ln ferritin (μg/L) (AOR 0.53, 95% CI [0.42, 0.68]) and ln retinol binding protein (RBP) (μmol/L) (AOR 0.08, 95% CI [0.04, 0.16]) were associated with reduced anaemia odds. Older age (age in years AOR 1.19, 95% CI [1.12, 1.27]) and Janajati ethnicity relative to the Muslim ethnicity (AOR 3.04, 95% CI [1.10, 8.36]) were associated with higher anaemia odds. Among boys, ln RBP [μmol/L] (AOR 0.25, 95% CI [0.10, 0.65]) and having consumed flesh foods (AOR 0.57, 95% CI [0.33, 0.99]) were associated with lower anaemia odds. Open defecation (AOR 2.36, 95% CI [1.15, 4.84]) and ln transferrin receptor [mg/L] (AOR 3.21, 95% CI [1.25, 8.23]) were associated with increased anaemia odds. Anaemia among adolescents might be addressed through effective public health policy and programs targeting micronutrient status, diet and sanitation.
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Affiliation(s)
- Nicole D Ford
- McKing Consulting Corporation, Fairfax, Virginia.,Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Naveen Paudyal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | | | - Ralph D Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rafael Flores-Ayala
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debendra P Adhikari
- United States Agency for International Development (USAID), Kathmandu, Nepal
| | - Sanjay Rijal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, Atlanta, Georgia
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Artificial Intelligence-Enabled Predictive Insights for Ameliorating Global Malnutrition: A Human-Centric AI-Thinking Approach. AI 2020. [DOI: 10.3390/ai1010004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
According to the World Health Organization (WHO) and the World Bank, malnutrition is one of the most serious but least-addressed development challenges in the world. Malnutrition refers to the malfunction or imbalance of nutrition, which could be influenced not only by under-nourishment, but also by over-nourishment. The significance of this paper is that it shows how artificial intelligence (AI) can be democratized to enable analysts who are not trained in computer science to also use human-centric explainable-AI to simulate the possible dynamics between malnutrition, health and population indicators in a dataset collected from 180 countries by the World Bank. This AI-based human-centric probabilistic reasoning approach can also be used as a cognitive scaffold to educe (draw out) AI-Thinking in analysts to ask further questions and gain deeper insights. In this study, a rudimentary beginner-friendly AI-based Bayesian predictive modeling approach was used to demonstrate how human-centric probabilistic reasoning could be utilized to analyze the dynamics of global malnutrition and optimize conditions for achieving the best-case scenario. Conditions of the worst-case “Black Swan” scenario were also simulated, and they could be used to inform stakeholders to prevent them from happening. Thus, the nutritional and health status of vulnerable populations could be ameliorated.
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Whole-blood PUFA and associations with markers of nutritional and health status in acutely malnourished children in Cambodia. Public Health Nutr 2020; 23:974-986. [PMID: 31973779 DOI: 10.1017/s1368980019003744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status. DESIGN PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts. SETTING Cambodia. PARTICIPANTS The study was conducted with 174 children aged 0·5-18 years with acute malnutrition. RESULTS Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA. CONCLUSIONS Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.
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Kuong K, Tor P, Perignon M, Fiorentino M, Chamnan C, Berger J, Burja K, Dijkhuizen MA, Parker M, Roos N, Wieringa FT. Multi-Micronutrient Fortified Rice Improved Serum Zinc and Folate Concentrations of Cambodian School Children. A Double-Blinded Cluster-Randomized Controlled Trial. Nutrients 2019; 11:E2843. [PMID: 31756911 PMCID: PMC6949998 DOI: 10.3390/nu11122843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Within Cambodia, micronutrient deficiencies continue to be prevalent in vulnerable groups, such as women and children. Fortification of staple foods such as rice could be a promising strategy for Cambodia to improve micronutrient status. OBJECTIVE Our objective was to investigate the impact of multiple-micronutrient fortified rice (MMFR), distributed through a World Food Program school-meals program (WFP-SMP) on serum zinc concentrations and folate status in a double-blind, cluster-randomized, placebo-controlled trial. METHODS Sixteen schools were randomly assigned to receive one of three different types of extruded-fortified rice (UltraRice Original (URO), UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. A total of 1950 schoolchildren (6-16 years old) participated in the study. Serum zinc (all groups) and folate (only in NutriRice and placebo group) concentrations were assessed from morning non-fasting antecubital blood samples and were measured at three time points (baseline and after three and six months). RESULTS After six months of intervention, serum zinc concentrations were significantly increased in all fortified rice group compared to placebo and baseline (0.98, 0.85 and 1.40 µmol/L for URO, URN and NutriRice, respectively) (interaction effect: p < 0.001 for all). Children in the intervention groups had a risk of zinc deficiencies of around one third (0.35, 039, and 0.28 for URO, URN, and NutriRice, respectively) compared to the placebo (p < 0.001 for all). The children receiving NutriRice had higher serum folate concentrations at endline compared to children receiving normal rice (+ 2.25 ng/mL, p = 0.007). CONCLUSIONS This study showed that the high prevalence of zinc and folate deficiency in Cambodia can be improved through the provision of MMFR. As rice is the staple diet for Cambodia, MMFR should be considered to be included in the school meal program and possibilities should be explored to introduce MMFR to the general population.
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Affiliation(s)
- Khov Kuong
- Department of Fisheries Post-Harvest Technologies and Quality control (DFPTQ), Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia;
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Pety Tor
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Marlene Perignon
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Marion Fiorentino
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality control (DFPTQ), Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia;
| | - Jacques Berger
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Kurt Burja
- World Food Programme (WFP), Phnom Penh, Cambodia;
| | - Marjoleine A. Dijkhuizen
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Megan Parker
- PATH (Program for Appropriate Technology in Health), 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA;
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Frank T. Wieringa
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
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Barffour MA, Schulze KJ, Kalungwana N, Moss WJ, West KP, Chileshe J, Siamusantu W, Palmer AC. Relative Contributions of Malaria, Inflammation, and Deficiencies of Iron and Vitamin A to the Burden of Anemia during Low and High Malaria Seasons in Rural Zambian Children. J Pediatr 2019; 213:74-81.e1. [PMID: 31402145 DOI: 10.1016/j.jpeds.2019.06.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children. STUDY DESIGN From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions for anemia (hemoglobin of <110 or 115 g/L, by age) owing to current malaria or inflammation (C-reactive protein of >5 mg/L, or α-1 acid glycoprotein of >1 g/L, or both), and current or prior iron deficiency (ID; defined as low ferritin [<12 or 15 μg/L for age <5 or >5 years] or functional ID [soluble transferrin receptor of >8.3 mg/L] or both) and vitamin A deficiency (retinol of <0.7 μmol/L), during low and high malaria seasons, using multivariate logistic regression. Serum ferritin, soluble transferrin receptor, and retinol were adjusted for inflammation. RESULTS The burden of anemia independently associated with current malaria, inflammation, ID, and vitamin A deficiency in the low malaria season were 12% (P < .001), 6% (P = .005), 14% (P = .001), and 2% (P = .07), respectively, and 32% (P < .001), 15% (P < .001), 10% (P = .06), and 2% (P = .06), respectively, in the high malaria season. In both seasons, functional ID was independently associated with more anemia (approximately 11%) than low ferritin (approximately 4%). Anemia and ID in the low malaria season, accounted for 20% (P < .001) and 4% (P = .095) of the anemia in the subsequent high malaria season. CONCLUSIONS Anemia in this population is strongly linked to malaria, inflammation, and functional ID, and to a lesser extent, low iron stores. Integrated control strategies are needed.
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Affiliation(s)
- Maxwell A Barffour
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD; College of Health and Human Services, Public Health Program, Missouri State University, Springfield, MO; Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.
| | - Kerry J Schulze
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | | | - William J Moss
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | - Keith P West
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | | | | | - Amanda C Palmer
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
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Leonardo L, Bergquist R, Olveda R, Satrija F, Sripa B, Sayasone S, Khieu V, Willingham AL, Utzinger J, Zhou XN. From country control programmes to translational research. ADVANCES IN PARASITOLOGY 2019; 105:69-93. [PMID: 31530396 DOI: 10.1016/bs.apar.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
From the time it was conceptualized in 1998 to the present, RNAS+ has largely concentrated on research that will generate results to facilitate control, prevention and elimination of its target diseases. Diagnostics has remained an active field of research in order to develop tools that are appropriate for each stage from the first efforts until attempts to block transmission. For example, with regard to schistosomiasis, chemotherapy has excellent impact on morbidity, while better diagnostics and vaccine research have been promoted to complement the other components of the control programme. The need for surveillance in areas where the prevalence has been brought down to very low levels necessitated development of spatio-temporal tools and ecological models based on geographical information systems (GIS) to produce risk and distribution maps for monitoring and evaluation of programme success. New knowledge and experiences in management of the diseases contribute to the formulation of new schemes in management and treatment. Ways of drawing attention to the disease, such as determining disability weights for use in computation of burden of disease, updating epidemiological profile and unravelling new aspects of the disease provide bases for modifying the operation of control programmes as we move forward. Programme evaluation based on reports of actual implementation of activities brought to the fore problems related to the distribution of chemotherapy as well as social, cultural and behavioural aspects of endemic communities. Importantly, this highlighted the necessity of adapting control activities to specific situations of the endemic areas. New models evolving from reviews of this kind and success stories, such us the elimination of lymphatic filariasis (LF) in PR China and Cambodia are presented.
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Affiliation(s)
- Lydia Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman and University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines
| | | | - Remigio Olveda
- Asian Tropical Foundation, Filinvest Corporate City, Research Institute for Tropical Medicine Compound, Muntinlupa, Philippines
| | - Fadjar Satrija
- Bogor Agricultural University (IPB), JL. Agatis, Kampus IPB, Bogor, Indonesia
| | - Banchob Sripa
- Department of Pathology, Khon Kaen University, Khon Kaen, Thailand
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientianne, Lao People's Democratic Republic
| | - Virak Khieu
- National Helminth Control Program, National Center for Parasitology, Entomology and Malaria Control Ministry of Health, Phnom Penh, Cambodia
| | - Arve Lee Willingham
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Juerg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, China; National Center for International Research on Tropical Diseases, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, China, Shanghai, China.
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Holmes JB, Kroeun H, Houghton LA, Gibson RS, Harding KB, De-Regil LM, Kraemer K, Barr SI, Karakochuk CD. Including 60 mg Elemental Iron in a Multiple Micronutrient Supplement Blunts the Increase in Serum Zinc after 12 Weeks of Daily Supplementation in Predominantly Anemic, Nonpregnant Cambodian Women of Reproductive Age. J Nutr 2019; 149:1503-1510. [PMID: 31174215 DOI: 10.1093/jn/nxz097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Multiple micronutrient (MMN) supplementation may result in interaction effects due to competing absorptive pathways of trace elements. OBJECTIVES The aim of this study was to investigate the effect of MMN supplementation with or without iron on serum zinc, selenium, and copper concentrations in Cambodian women. METHODS In a 2 × 2 factorial double-blind randomized 12-wk trial, predominantly anemic, nonpregnant women (aged 18-45 y) received daily 60 mg of iron (Fe; n = 201); 14 other micronutrients including zinc (15 mg), selenium (65 μg), and copper (2 mg), but no iron (MMN; n = 202); 60 mg iron plus MMN (Fe + MMN; n = 206); or a placebo (n = 200). Fasting morning blood was collected at baseline and 12 wk from women in 26 villages in Kampong Chhnang province. Serum zinc, selenium, and copper concentrations (secondary outcomes of the randomized controlled trial) were measured using inductively coupled plasma mass spectrometry. Generalized linear regression was used to estimate intervention effects [β coefficient (95% CI)] for Fe (with or without MMN) and MMN (with or without Fe) after testing for the presence of an Fe × MMN interaction. RESULTS A total of 760 women completed the trial. Zinc deficiency prevalence at baseline was 45% (inflammation-adjusted serum zinc <10.7 μmol/L). A significant Fe × MMN interaction (P = 0.02) was detected in the 2 × 2 analysis with serum zinc concentration as the outcome: the MMN group had a higher mean serum zinc concentration at 12 wk (12.3 μmol/L; 95% CI: 12.2, 12.4 μmol/L) compared with all other groups, and the Fe + MMN group had a higher mean serum zinc concentration (11.6 μmol/L; 95% CI: 11.5, 11.7 μmol/L) compared with the Fe group (11.0 μmol/L; 95% CI: 10.9, 11.0 μmol/L) and the placebo group (11.2 μmol/L; 95% CI: 11.1, 11.4 μmol/L). CONCLUSIONS The inclusion of 60 mg iron in the daily MMN formulation may be interfering with the absorption and/or metabolism of supplemental zinc in Cambodian women. This is of particular concern when MMN supplementation is implemented in populations with risk of zinc deficiency. This trial was registered at clinicaltrials.gov as NCT-02481375.
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Affiliation(s)
- Jeffrey B Holmes
- Food, Nutrition, and Health, University of British Columbia, Vancouver, Canada
| | - Hou Kroeun
- Helen Keller International, Phnom Penh, Cambodia
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | | | | | - Klaus Kraemer
- Sight and Life Foundation, Basel, Switzerland, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan I Barr
- Food, Nutrition, and Health, University of British Columbia, Vancouver, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
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Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci 2019; 1450:15-31. [PMID: 31008520 PMCID: PMC6697587 DOI: 10.1111/nyas.14092] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. Understanding anemia's varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia and for monitoring anemia control programs. We outline definitions and classifications of anemia, describe the biological mechanisms through which anemia develops, and review the variety of conditions that contribute to anemia development. We emphasize the risk factors most prevalent in low- and middle-income countries, including nutritional deficiencies, infection/inflammation, and genetic hemoglobin disorders. Recent work has furthered our understanding of anemia's complex etiology, including the proportion of anemia caused by iron deficiency (ID) and the role of inflammation and infection. Accumulating evidence indicates that the proportion of anemia due to ID differs by population group, geographical setting, infectious disease burden, and the prevalence of other anemia causes. Further research is needed to explore the role of additional nutritional deficiencies, the contribution of infectious and chronic disease, as well as the importance of genetic hemoglobin disorders in certain populations.
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Affiliation(s)
| | - Parminder S. Suchdev
- Department of Pediatrics, Emory University, Atlanta, Georgia
- Emory Global Health Institute, Emory University, Atlanta, Georgia
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Impact of lunch provision on anthropometry, hemoglobin, and micronutrient status of female Cambodian garment workers: exploratory randomized controlled trial. BMC Nutr 2019; 5:36. [PMID: 32153949 PMCID: PMC7050856 DOI: 10.1186/s40795-019-0297-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Lunch provision is expected to improve the nutritional status of Cambodian garment workers. The objective of this study is to evaluate the effects of a model lunch provision through a canteen on anthropometry, hemoglobin, and micronutrient status in female garment workers in Cambodia. Methods This exploratory randomized controlled trial was implemented at a garment factory in Phnom Penh, Cambodia. Female workers (nulliparous, non-pregnant) were recruited and randomly allocated into an intervention arm (workday’s lunch provision) and a control arm. Served lunch sets (~ 700 kcal on average) included diverse local dishes. Anthropometry (body mass index, weight, triceps skinfold thickness, and mid-upper arm muscle circumference), as well as hemoglobin, serum ferritin and soluble transferrin receptor, serum retinol binding protein, and serum folate concentrations were assessed at baseline and after 5 months of lunch provision. A general linear model with adjustments for baseline values was used to estimate intervention effects for each outcome variable. Results Two hundred twenty-three women were recruited (n = 112 control and n = 111 intervention). 172 (n = 86 in each arm) completed the study. Baseline prevalence of underweight, anemia, depleted iron stores, and marginal iron stores, were 31, 24, 21, and 50%, respectively. Subjects were not affected by frank vitamin A or folate deficiency, whereas 30% showed a marginal folate status. Overall, mean changes in anthropometric variables, hemoglobin, and retinol binding protein were marginal and not significant among intervention subjects. Mean folate concentration increased insignificantly by + 1.1 ng/mL (− 0.02, 2.2) (p = 0.054). On the other hand, mean ferritin decreased by − 6.6 μg/L (− 11.9, − 1.3) (p = 0.015). Subgroup analysis prompts that effects are differently pronounced according to the baseline status of workers. Conclusions Findings indicate that model lunch sets provided a beneficial amount of dietary folate, but need to be revisited for iron content and/or iron bioavailability. It is believed that distinct positive effects on anthropometry, hemoglobin, and micronutrient status can solely be expected in malnourished individuals. The authors suggest that similar larger trials, which include sets adapted to the concrete needs of workers affected by underweight, anemia and/or definite micronutrient deficiencies, should be performed. Trial registration The trial was registered at the German Clinical Trials Register (9 January 2015, Identifier: DRKS00007666).
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Williams AM, Addo OY, Grosse SD, Kassebaum NJ, Rankin Z, Ballesteros KE, Olsen HE, Sharma AJ, Jefferds ME, Mei Z. Data needed to respond appropriately to anemia when it is a public health problem. Ann N Y Acad Sci 2019; 1450:268-280. [PMID: 31267542 DOI: 10.1111/nyas.14175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.
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Affiliation(s)
- Anne M Williams
- McKing Consulting Corporation, Atlanta, Georgia.,Department of Global Health, Emory University, Atlanta, Georgia.,Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - O Yaw Addo
- Department of Global Health, Emory University, Atlanta, Georgia.,Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Nicholas J Kassebaum
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington
| | - Zane Rankin
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Katherine E Ballesteros
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Andrea J Sharma
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Zuguo Mei
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Murphy T, Irvine K, Phan K, Lean D, Wilson K. Environmental and Health Implications of the Correlation Between Arsenic and Zinc Levels in Rice from an Arsenic-Rich Zone in Cambodia. J Health Pollut 2019; 9:190603. [PMID: 31259079 PMCID: PMC6555249 DOI: 10.5696/2156-9614-9.22.190603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/01/2019] [Indexed: 04/29/2023]
Abstract
BACKGROUND In parts of Cambodia, irrigation of rice with groundwater results in arsenic accumulation in soils and rice, leading to health concerns associated with rice consumption. In Bangladesh and China, low zinc levels in rice have been found in regions where arsenic levels in rice are high. Furthermore, there have been claims that zinc deficiency is responsible for stunting of children in Cambodia. There are limited data on zinc in Cambodian rice, but in rural Asia, rice is the major source of zinc. OBJECTIVES To provide a preliminary evaluation of the zinc content in rice grain in Preak Russey, an area with elevated levels of arsenic. The importance of zinc in rice for infants was also assessed. METHODS Rice cultivation was evaluated in sixty farms along the Mekong River in Cambodia. Analyses for metals, total arsenic, and arsenic species in the water and rice were conducted at the University of Ottawa, Canada by inductively coupled plasma - mass spectrometry. Analysis of total zinc and arsenic in soils were analyzed in Phnom Penh using X-ray fluorescence spectrometry (XRF). Total zinc in rice was also measured by XRF analysis. RESULTS Rice in the Preak Russey area contained zinc with ½ to ¼ of the 1987 Codex standard for rice in Infant Formula. Moreover, our average zinc concentration in rice samples was less than a third that recommended for zinc fortification in rice by the United Nations World Food Programme. There was a significant (α=0.05) negative correlation between the arsenic and zinc content of rice with the lowest zinc levels occurring near the irrigation wells, the source of arsenic. There was a significantly higher content of zinc in rice from farms that fertilized with cow manure. CONCLUSIONS Handheld XRF spectrometers are useful tools for detection of zinc levels in rice. The potential for zinc deficiency in farmers in areas of Cambodia with arsenic toxicity is high. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Tom Murphy
- International University, Phnom Penh, Cambodia
| | - Kim Irvine
- Nanyang Technological University, Singapore
| | | | - David Lean
- Lean Environmental, Apsley, Ontario, Canada
| | - Ken Wilson
- Texas State University, San Marcos, Texas, USA
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Wesley AS, De Plaen R, Michaux KD, Whitfield KC, Green TJ. Integrating nutrition outcomes into agriculture development for impact at scale: Highlights from the Canadian International Food Security Research Fund. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 3:e12812. [PMID: 31148402 PMCID: PMC6593440 DOI: 10.1111/mcn.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/21/2019] [Accepted: 03/13/2019] [Indexed: 11/27/2022]
Abstract
The Canadian International Food Security Research Fund programme supported research and scaling up of nutrition‐ and gender‐sensitive agriculture innovations from 2009 to 2018. Women and girls were identified as agents of change and were targeted as the main programme beneficiaries. Projects were implemented in 25 countries through multistakeholder partnerships among universities, research institutions, public and private sectors, and civil society groups, reaching over 78 million people, mainly women and children. Approaches specific to nutrition included growing more nutritious crops, improving dietary diversity, value added processing, food fortification, and nutrition education. Scale‐up for impact was achieved through a number of pathways that started with evidence through rigorous research, followed by a combination of elements such as understanding local and regional contexts to identify specific bottlenecks and opportunities for the deployment and adoption of successful innovations, selecting politically effective or influential partners to lead the scaling up process, and investing in long‐term local capacity and leadership building. Overall, the knowledge generated in the programme indicate that well‐designed nutrition‐sensitive agriculture and food‐based interventions can have meaningful impacts on pathways that will lead to better health and well‐being of women and children through improving household and individual access to nutrient‐rich foods. Longer intervention times are needed to demonstrate changes in health indicators such as reduced stunting. This overview paper summarises the programme and showcases examples from studies that demonstrate the impact pathway for nutrition interventions that encompass efficacy and effectiveness studies, value‐added processing, cost effectiveness of interventions, and bringing a proven intervention to scale.
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Affiliation(s)
- Annie S Wesley
- Agriculture and Food Security Program, International Development Research Centre, Ottawa, Ontario, Canada
| | - Renaud De Plaen
- Agriculture and Food Security Program, International Development Research Centre, Ottawa, Ontario, Canada
| | - Kristina D Michaux
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Timothy J Green
- Department of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.,Healthy Mothers, Babies, Children Research Theme, South Australia Health and Medical Research Institute, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Diana A, Purnamasari DM, Rahmannia S, Luftimas DE, Haszard JJ, Gibson RS, Houghton LA. Multimicronutrient Biomarkers Are Related to Anemia during Infancy in Indonesia: A Repeated Cross-Sectional Study. Curr Dev Nutr 2019; 3:nzz022. [PMID: 31037278 PMCID: PMC6483051 DOI: 10.1093/cdn/nzz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Anemia during infancy in Indonesia is common, with iron deficiency (ID) assumed to be the major cause. Other micronutrients besides iron may have a role in determining hemoglobin (Hb) but have not yet been explored in Indonesia. OBJECTIVE We investigated 7 micronutrient biomarkers and selected nonnutritional factors as potential predictors of Hb and anemia at ages 6, 9, and 12 mo in a cohort of Indonesian infants at risk of coexisting micronutrient deficiencies. METHODS Apparently healthy breastfed infants were randomly selected from birth registries at 6 mo (n = 230) and followed-up at 9 mo (n = 202) and 12 mo (n = 190). Hb, serum micronutrient biomarkers-iron [as ferritin and serum soluble transferrin receptor (sTfR)], zinc, selenium, folate, vitamin A [as retinol-binding protein (RBP)], vitamin B-12, and vitamin D (as 25-hydroxyvitamin D) (adjusted for inflammation, where appropriate)-and maternal sociodemographic status, health, BMI, heminthiasis, and selected Hb genetic disorders were measured. Multivariate analysis examined relations between micronutrient biomarkers and nonnutritional factors (except helminthiasis and genetic Hb disorders) with Hb and anemia at 6 and 12 mo. RESULTS ID (based on ferritin) was a predictor of lower Hb and anemia at both 6 and 12 mo of age (P < 0.02). Additional predictors at 6 mo were tertiary education and higher maternal Hb for higher Hb, sex (being male) and inflammation (P < 0.05) for both lower Hb and anemia, and greater maternal height (P = 0.036) for anemia only. At 12 mo, a significant biomarker predictor besides ID was RBP (P = 0.035) for Hb. CONCLUSION ID was a major contributor to lower Hb and anemia, although RBP was also associated.
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Affiliation(s)
- Aly Diana
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | | | - Sofa Rahmannia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dimas E Luftimas
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Effects of Daily Zinc, Daily Multiple Micronutrient Powder, or Therapeutic Zinc Supplementation for Diarrhea Prevention on Physical Growth, Anemia, and Micronutrient Status in Rural Laotian Children: A Randomized Controlled Trial. J Pediatr 2019; 207:80-89.e2. [PMID: 30580974 PMCID: PMC6448681 DOI: 10.1016/j.jpeds.2018.11.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/25/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the optimal zinc supplementation strategy for improving growth and hematologic and micronutrient status in young Laotian children. STUDY DESIGN In total, 3407 children aged 6-23 months were randomized to receive either daily preventive zinc tablets (7 mg/d), high-zinc, low-iron micronutrient powder (10 mg/d zinc, 6 mg/d iron, and 13 other micronutrients), therapeutic zinc supplementation for diarrhea (20 mg/d for 10 days per episode), or daily placebo powder; all were followed for ~9 months. Anthropometry, hemoglobin, zinc, and iron status were assessed at baseline and endline. Analyses were by intention-to-treat, using linear and modified Poisson regression. RESULTS At baseline, mean (±SD) age was 14.2 ± 5.1 months and stunting and anemia prevalence were 37.9% and 55.6%, respectively. At endline, zinc deficiency in the preventive zinc (50.7%) and micronutrient powder (59.1%) groups were significantly lower than in the therapeutic zinc (79.2%) and control groups (78.6%; P < .001), with no impact on stunting (37.1%-41.3% across the groups, P = .37). The micronutrient powder reduced iron deficiency by 44%-55% compared with other groups (P < .001), with no overall impact on anemia (P = .14). Micronutrient powder tended to reduce anemia by 11%-16% among children who were anemic at baseline (P = .06). CONCLUSIONS Despite improving zinc status, preventive zinc and micronutrient powder had no impact on growth. The micronutrient powder improved iron status and tended to reduce anemia among the subset of previously anemic children. TRIAL REGISTRATION ClinicalTrials.govNCT02428647.
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Key Words
- agp, alpha-1-glycoacid protein
- crp, c-reactive protein
- laz, length and length-for-age z scores
- muac, mid-upper arm circumference
- ors, oral rehydration salts
- rbp, retinol binding protein
- stfr, soluble transferrin receptor
- waz, weight and weight-for-age z scores
- who, world health organization
- wlz, weight-for-length z scores
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Berger J, Roos N, Greffeuille V, Dijkhuizen M, Wieringa F. Driving Policy Change to Improve Micronutrient Status in Women of Reproductive Age and Children in Southeast Asia: The SMILING Project. Matern Child Health J 2019; 23:79-85. [DOI: 10.1007/s10995-018-02730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Roos N, Ponce MC, Doak CM, Dijkhuizen M, Polman K, Chamnan C, Khov K, Chea M, Prak S, Kounnavong S, Akkhavong K, Mai LB, Lua TT, Muslimatun S, Famida U, Wasantwisut E, Winichagoon P, Doets E, Greffeuille V, Wieringa FT, Berger J. Micronutrient status of populations and preventive nutrition interventions in South East Asia. Matern Child Health J 2018; 23:29-45. [DOI: 10.1007/s10995-018-2639-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wessells KR, Brown KH, Kounnavong S, Barffour MA, Hinnouho GM, Sayasone S, Stephensen CB, Ratsavong K, Larson CP, Arnold CD, Harding KB, Reinhart GA, Lertmemongkolchai G, Fucharoen S, Bernstein RM, Hess SY. Comparison of two forms of daily preventive zinc supplementation versus therapeutic zinc supplementation for diarrhea on young children's physical growth and risk of infection: study design and rationale for a randomized controlled trial. BMC Nutr 2018; 4:39. [PMID: 32153900 PMCID: PMC7050875 DOI: 10.1186/s40795-018-0247-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/13/2018] [Indexed: 12/04/2022] Open
Abstract
Background Zinc is an essential nutrient that is required for children’s normal growth and resistance to infections, including diarrhea and pneumonia, two major causes of child mortality. Daily or weekly preventive zinc supplementation has been shown to improve growth and reduce the risk of infection, while therapeutic zinc supplementation for 10–14 days is recommended for the treatment of diarrhea. The overall objective of the present study is to compare several regimens for delivering zinc to young children, both for the prevention of zinc deficiency and the treatment of diarrhea. Methods The present study is a community-based, randomized controlled trial in the Lao People’s Democratic Republic (PDR). Three thousand, four hundred children 6–23 months of age will be randomized to one of four intervention groups (daily preventive zinc dispersible tablet, daily preventive multiple micronutrient powder, therapeutic zinc dispersible tablet for diarrhea, or placebo control); interventions will be delivered for 9 months and outcomes measured at pre-determined intervals. Primary outcomes include physical growth (length and weight), diarrhea incidence, hemoglobin and micronutrient status, and innate and adaptive immune function. Secondary outcomes include mid-upper-arm circumference, neuro-behavioral development, hair cortisol concentrations, markers of intestinal inflammation and parasite burden. Incidence of adverse events and the modifying effects of inherited hemoglobin disorders and iron status on the response to the intervention will also be examined. We will estimate unadjusted effects and effects adjusted for selected baseline covariates using ANCOVA. Discussion Many countries are now rolling out large-scale programs to include therapeutic zinc supplementation in the treatment of childhood diarrhea, but few have established programs demonstrated to be effective in the prevention of zinc deficiency. This study will address how best to deliver supplemental zinc to prevent zinc deficiency and reduce the severity of diarrhea-related health complications. Trial registration Trial registration identifier (NCT02428647) ; Date of registration: April 29, 2015.
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Affiliation(s)
- K Ryan Wessells
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
| | - Kenneth H Brown
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA.,2Nutrition and Global Development, Bill & Melinda Gates Foundation, Seattle, WA USA
| | - Sengchanh Kounnavong
- 3National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Maxwell A Barffour
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
| | - Guy-Marino Hinnouho
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
| | - Somphou Sayasone
- 3National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Charles B Stephensen
- 4United States Department of Agriculture, Western Human Nutrition Research Center, Davis, CA USA
| | - Kethmany Ratsavong
- 3National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Charles D Arnold
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
| | - Kimberly B Harding
- 6Nutrition International, formerly The Micronutrient Initiative, Ottawa, Canada
| | - Gregory A Reinhart
- 7The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH USA
| | - Ganjana Lertmemongkolchai
- 8Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Supan Fucharoen
- 8Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Robin M Bernstein
- 9Department of Anthropology, University of Colorado, Boulder, CO USA
| | - Sonja Y Hess
- 1Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
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Rogers LM, Cordero AM, Pfeiffer CM, Hausman DB, Tsang BL, De‐Regil LM, Rosenthal J, Razzaghi H, Wong EC, Weakland AP, Bailey LB. Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues. Ann N Y Acad Sci 2018; 1431:35-57. [PMID: 30239016 PMCID: PMC6282622 DOI: 10.1111/nyas.13963] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/06/2018] [Accepted: 08/15/2018] [Indexed: 01/21/2023]
Abstract
Inadequate folate status in women of reproductive age (WRA) can lead to adverse health consequences of public health significance, such as megaloblastic anemia (folate deficiency) and an increased risk of neural tube defect (NTD)-affected pregnancies (folate insufficiency). Our review aims to evaluate current data on folate status of WRA. We queried eight databases and the World Health Organization Micronutrients Database, identifying 45 relevant surveys conducted between 2000 and 2014 in 39 countries. Several types of folate assays were used in the analysis of blood folate, and many surveys used folate cutoffs not matched to the assay. To allow better comparisons across surveys, we attempted to account for these differences. The prevalence of folate deficiency was >20% in many countries with lower income economies but was typically <5% in countries with higher income economies. Only 11 surveys reported the prevalence of folate insufficiency, which was >40% in most countries. Overall, folate status data for WRA globally are limited and must be carefully interpreted due to methodological issues. Future surveys would benefit from using the microbiologic assay to assess folate status, along with assay-matched cutoffs to improve monitoring and evaluation of folic acid interventions, thus informing global efforts to prevent NTDs.
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Affiliation(s)
- Lisa M. Rogers
- Evidence and Programme Guidance, Department of Nutrition for Health and DevelopmentWorld Health OrganizationGenevaSwitzerland
| | - Amy M. Cordero
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Christine M. Pfeiffer
- National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | | | | | | | - Jorge Rosenthal
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Hilda Razzaghi
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Eugene C. Wong
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
- Oak Ridge Institute for Science and EducationOak RidgeTennessee
| | | | - Lynn B. Bailey
- Foods and Nutrition DepartmentUniversity of GeorgiaAthensGeorgia
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Menasria L, Blaney S, Main B, Vong L, Hun V, Raminashvili D, Chhea C, Chiasson L, Leblanc CP. Mitigated Impact of Provision of Local Foods Combined with Nutrition Education and Counseling on Young Child Nutritional Status in Cambodia. Nutrients 2018; 10:nu10101450. [PMID: 30301233 PMCID: PMC6212877 DOI: 10.3390/nu10101450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Cambodia, stunting and wasting affect, respectively, 32% and 10% of children 0⁻59 months while 55% are anemic. Our research aims to assess the efficiency of two local foods combined with nutritional education and counseling (CEN) activities as compared to CEN alone on improving child nutritional status and dietary intake. METHODS A cluster-randomized controlled trial was conducted in Soth Nikum area over a six-month period among children 6⁻23 months (n = 360) assigned to receive either moringa +CEN, cricket +CEN or CEN alone. Anthropometric measurements were performed and hemoglobin and ferritin levels assessed. RESULTS Overall, no significant increase in the mean length/height-for-age z-score was observed, although a small increase of the weight-for-length/height was noted in intervention groups. Hemoglobin and ferritin mean values increased in all groups. The degree of satisfaction of energy, proteins, iron, and zinc requirements improved in all groups, but to a greater extent in the intervention groups and more children were healthy. CONCLUSION Our research shows no significant impact of the provision of two local foods combined with CEN on the improvement of child nutritional status as compared to CEN alone. However, children consuming them better fulfilled their energy, iron, and zinc requirements and were healthier.
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Affiliation(s)
- Lylia Menasria
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
| | - Sonia Blaney
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
| | - Barbara Main
- International Programs, World Vision Canada, 1 World Drive, Mississauga, ON L5T 2Y4, Canada.
| | - Lenin Vong
- Independent consultant, Phnom Penh 12203, Cambodia.
| | - Vannary Hun
- World Vision Cambodia, Phnom Penh 12203, Cambodia.
| | | | - Chhorvann Chhea
- National Institute of Public Health (NIPH), Ministry of Health, Phnom Penh 12203, Cambodia.
| | - Lucie Chiasson
- Direction du mieux-être, Ministère du développement social, Miramichi, NB E1N 1B6, Canada.
| | - Caroline P Leblanc
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
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