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Talarico V, Giancotti L, Mazza GA, Miniero R, Bertini M. Iron Deficiency Anemia in Celiac Disease. Nutrients 2021; 13:nu13051695. [PMID: 34067622 PMCID: PMC8156426 DOI: 10.3390/nu13051695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
The iron absorption process developsmainly in the proximal duodenum. This portion of the intestine is typically destroyed in celiac disease (CD), resulting in a reduction in absorption of iron and subsequent iron deficiency anemia (IDA). In fact, the most frequent extra-intestinal manifestation (EIM) of CD is IDA, with a prevalence between 12 and 82% (in relation with the various reports) in patients with new CD diagnosis. The primary treatment of CD is the gluten-free diet (GFD), which is associated with adequate management of IDA, if present. Iron replacement treatment historically has been based on oral products containing ferrous sulphate (FS). However, the absorption of FS is limited in patients with active CD and unpredictable in patients on a GFD. Furthermore, a poor tolerability of this kind of ferrous is particularly frequent in patients with CD or with other inflammatory bowel diseases. Normalization from anemic state typically occurs after at least 6 months of GFD, but the process can take up to 2 years for iron stores to replenish.
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Affiliation(s)
- Valentina Talarico
- Department of Pediatric, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39–34–0245–7848
| | - Laura Giancotti
- Unit of Pediatrics, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Giuseppe Antonio Mazza
- Department of Pediatric Cardiology, Regina Margherita Hospital, Città della Salute e della Scienza, 10126 Torino, Italy;
| | - Roberto Miniero
- Department of Pediatric, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy;
| | - Marco Bertini
- R&D Department, Laboratori Baldacci SpA, 56121 Pisa, Italy;
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Larson LM, Cyriac S, Djimeu EW, Mbuya MNN, Neufeld LM. Can Double Fortification of Salt with Iron and Iodine Reduce Anemia, Iron Deficiency Anemia, Iron Deficiency, Iodine Deficiency, and Functional Outcomes? Evidence of Efficacy, Effectiveness, and Safety. J Nutr 2021; 151:15S-28S. [PMID: 33582785 PMCID: PMC7882357 DOI: 10.1093/jn/nxaa192] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Anemia, iron deficiency, and iodine deficiency are problems of important public health concern in many parts of the world, with consequences for the health, development, and work capacity of populations. Several countries are beginning to implement double fortified salt (DFS) programs to simultaneously address iodine and iron deficiencies. OBJECTIVE Our objective was to summarize the evidence for efficacy and effectiveness of DFS on the full range of status and functional outcomes and across different implementation and evaluation designs essential to successful interventions. METHODS We conducted a systematic review and meta-analysis of published and gray literature examining the effects of DFS on nutritional status, cognition, work productivity, development, and morbidity of all population groups. We searched for articles in Medline, Embase, CINAHL, Cochrane Central Register, and ProQuest for randomized trials, quasi-randomized trials, and program effectiveness evaluations. RESULTS A total of 22 studies (N individuals = 52,758) were included. Efficacy studies indicated a significant overall positive effect on hemoglobin concentration [standardized mean difference (95% CI): 0.33 (0.18, 0.48)], ferritin [0.42 (0.08, 0.76)], anemia [risk ratio (95% CI): 0.80 (0.70, 0.92)], and iron deficiency anemia [0.36 (0.24, 0.55)]. Effects on urinary iodine concentration were not significantly different between DFS and iodized salt. The impact on functional outcomes was mixed. Only 2 effectiveness studies were identified. They reported programmatic challenges including low coverage, suboptimal DFS quality, and storage constraints. CONCLUSIONS Given the biological benefits of DFS across several populations in efficacy research, additional evaluations of robust DFS programs delivered at scale, which consider effective implementation and measure appropriate biomarkers, are needed.
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Affiliation(s)
- Leila M Larson
- University of South Carolina, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Columbia, SC, USA
| | - Shruthi Cyriac
- Emory University, Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Atlanta, GA, USA
| | - Eric W Djimeu
- Global Alliance for Improved Nutrition, Geneva, Switzerland
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Wenting J, Junjuan C, Pingli L, Baoe J, He J, Xiuqin Z. Treatment of maternal anemia by using oral iron drugs combined with diet therapy. Pak J Pharm Sci 2020; 33:2417-2422. [PMID: 33832884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Iron deficiency anemia is a common nutritional deficiency disease in women during pregnancy, mainly due to the increased iron requirements of pregnant women and fetuses, resulting in a lack of iron elements necessary for the production of red blood cells, resulting in a decrease in the number of red blood cells and the symptoms of anemia; Causes chronic fetal hypoxia and affects the normal development of some important organs of the fetus. This article explores the clinical value of oral iron drugs combined with diet therapy for maternal anemia. Observed the changes of hemoglobin (Hb), red blood cell count (RBC), average hemoglobin concentration (McHc), serum iron (SI), transferrin saturation (TS) and other indicators of pregnant women before and after treatment and the differences in pregnancy outcomes. Compared with before treatment, the maternal Hb, RBC, McHc, SI, TS and other indicators increased to a certain extent after treatment. Among them, the increase of each indicator in the experimental group is significantly larger than that in the control group. Differences between groups are considered to be meaningful after statistical analysis. (P<0.05). Oral iron drugs combined with diet therapy can effectively improve the symptoms of anemia and have a positive impact on pregnancy outcomes.
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Affiliation(s)
- Jiang Wenting
- No.2 Obstetric, VIP Obstetric Nursing, Tengzhou Central People's Hospital, Tengzhou, China
| | - Chen Junjuan
- Mental Health Center of Tengzhou Dongguo Town, Tengzhou City, China
| | - Liu Pingli
- Static Distribution Center of Tengzhou Central People's Hospital, Tengzhou, China
| | - Jiang Baoe
- Public Health Department Preventive Health, Tengzhou Central People's Hospital, Tengzhou, China
| | - Jiang He
- Public Health Service Station of Central Hospital of Dongguo Town, Tengzhou City, China
| | - Zhang Xiuqin
- No.2 Postpartum Department, Tengzhou Central People's Hospital, Tengzhou, China
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Khan GN, Kureishy S, Ariff S, Rizvi A, Sajid M, Garzon C, Khan AA, de Pee S, Soofi SB, Bhutta ZA. Effect of lipid-based nutrient supplement-Medium quantity on reduction of stunting in children 6-23 months of age in Sindh, Pakistan: A cluster randomized controlled trial. PLoS One 2020; 15:e0237210. [PMID: 32790725 PMCID: PMC7425934 DOI: 10.1371/journal.pone.0237210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan. Objective The primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement—medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group. Design A cluster randomized controlled trial was conducted in Thatta and Sujawal districts of Sindh province, Pakistan. A total of 870 (419 in intervention; 451 in control) children between 6–18 months old were enrolled in the study. The unit of randomization was union council and considered as a cluster. A total of 12 clusters, 6 in each study group were randomly assigned to intervention and control group. All children received standard government health services, while children in the intervention group also received 50 grams/day of Wawamum. Results Children who received Wawamum were found to have a significantly reduced risk of stunting (RR = 0.91, 95% CI; 0.88–0.94, p<0.001) and wasting (RR = 0.78, 95% CI; 0.67–0.92, p = 0.004) as compared to children who received the standard government health services. There was no evidence of a reduction in the risk of underweight (RR = 0.94, 95% CI; 0.85–1.04, p = 0.235) in the intervention group compared to the control group. Statistically significant reduction in anaemia in the intervention group was also found as compared to the control group (RR = 0.97, 95% CI; 0.94–0.99, p = 0.042). The subgroup analysis by age, showed intervention effect is significant in reduction of risk of stunting in younger children of aged 6–12 month (RR = 0.83, 95% CI; 0.81–0.86, p = <0.001) and their older peers aged 13–18 month- (RR = 0.90, 95% CI; 0.83–0.97, p = 0.008). The mean compliance of Wawamum was 60% among children. Conclusions The study confirmed that the provision of Wawamum to children 6–23 months of age is effective in reducing the risk of stunting, wasting and anaemia. This approach should be scaled up among the most food insecure areas/households with a high prevalence of stunting to achieve positive outcomes for nutrition and health. This study was registered at clinicaltrials.gov as NCT02422953. Clinical Trial Registration Number: NCT02422953
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Affiliation(s)
- Gul Nawaz Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Saskia de Pee
- World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail:
| | - Zulfiqar A. Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Rizwan Ahmad AM, Ahmed W, Iqbal S, Mushtaq MH, Anis RA. Iron and prebiotic fortified flour improves the immune function of iron deficient women of childbearing age. Pak J Pharm Sci 2020; 33:253-261. [PMID: 32122856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Micronutrient deficiencies (MNDs) are common worldwide, in both developing as well as developed countries. MNDs such as Iron Deficiency not only compromise the nutritional status of individuals but can also put them at an increased risk of developing various other diseases by negatively affecting their immunity. The objective of the current research was to determine the effects of prebiotics and iron fortificants on various immunoglobulins among iron deficient women belonging to childbearing age. To serve the purpose, a total of seventy five iron deficient women were selected and randomly divided into one control and four treatment groups. Accordingly, different types of fortified wheat flour were prepared, based on varying dosage of prebiotics and iron fortificants, to be fed to anemic women on daily basis for three months. Two iron salts (FeSO4 and NaFeEDTA) and two prebiotics (Galacto oligosaccharides and Inulin) were used to fortify wheat flour during the trials. Overnight fasted women were asked to give blood samples on monthly basis, up to three months. Four types of Immunoglobulins including IgA, IgE, IgG and IgM were determined at baseline, 30th, 60th and 90th day of trials using their respective protocols. The results of the study indicated that a statistically significant declining trend for IgA, IgE, IgG and IgM was present among the treatment groups (P-value < 0.05), compared to the control group. The study concluded that provision of iron and prebiotic fortified flour improved the immune function of iron deficient women.
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Affiliation(s)
- Abdul Momin Rizwan Ahmad
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Waqas Ahmed
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sanaullah Iqbal
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Hassan Mushtaq
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Riffat Aysha Anis
- University Institute of Diet and Nutritional Sciences, The University of Lahore, Islamabad Campus, Islamabad, Pakistan
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Moreno-Fernández J, López-Aliaga I, García-Burgos M, J.M. Alférez M, Díaz-Castro J. Fermented Goat Milk Consumption Enhances Brain Molecular Functions during Iron Deficiency Anemia Recovery. Nutrients 2019; 11:nu11102394. [PMID: 31591353 PMCID: PMC6835798 DOI: 10.3390/nu11102394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
Iron deficiency anemia (IDA) is one of the most prevalent nutritional deficiencies worldwide. Iron plays critical roles in nervous system development and cognition. Despite the known detrimental consequences of IDA on cognition, available studies do not provide molecular mechanisms elucidating the role of iron in brain functions during iron deficiency and recovery with dairy components. In this study, 100 male Wistar rats were placed on a pre-experimental period of 40 days and randomly divided in two groups: a control group receiving a normal-Fe diet, (45 mg/kg), and an Fe-deficient group receiving a low-Fe diet (5 mg/kg). At day 40, 10 rats per group were sacrificed to anemia control, and 80 rats were divided into eight experimental groups fed with fermented goat or cow milk-based diets, with normal Fe content or Fe overload (450 mg/kg) for 30 days. IDA decreased most of the parameters related to brain molecular functions, namely dopamine, irisin, MAO-A, oxytocin, β-endorphin, and α-MSH, while it increased synaptophysin. These alterations result in an impairment of brain molecular functions. In general, during anemia recovery, fermented goat milk diet consumption increased dopamine, oxytocin, serotonin, synaptophysin, and α-MSH, and decreased MAO-A and MAO-B, suggesting a potential neuroprotective effect in brain functions, which could enhance brain molecular functions.
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Affiliation(s)
- Jorge Moreno-Fernández
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, E-18071 Granada, Spain; (J.M.-F.); (I.L.-A.); (M.G.-B.); (J.D.-C.)
- Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, E-18071 Granada, Spain
| | - Inmaculada López-Aliaga
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, E-18071 Granada, Spain; (J.M.-F.); (I.L.-A.); (M.G.-B.); (J.D.-C.)
- Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, E-18071 Granada, Spain
| | - María García-Burgos
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, E-18071 Granada, Spain; (J.M.-F.); (I.L.-A.); (M.G.-B.); (J.D.-C.)
- Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, E-18071 Granada, Spain
| | - María J.M. Alférez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, E-18071 Granada, Spain; (J.M.-F.); (I.L.-A.); (M.G.-B.); (J.D.-C.)
- Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, E-18071 Granada, Spain
- Correspondence: ; Tel.: +34-958-243883
| | - Javier Díaz-Castro
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, E-18071 Granada, Spain; (J.M.-F.); (I.L.-A.); (M.G.-B.); (J.D.-C.)
- Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, E-18071 Granada, Spain
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Akomo P, Bahwere P, Murakami H, Banda C, Maganga E, Kathumba S, Sadler K, Collins S. Soya, maize and sorghum ready-to-use therapeutic foods are more effective in correcting anaemia and iron deficiency than the standard ready-to-use therapeutic food: randomized controlled trial. BMC Public Health 2019; 19:806. [PMID: 31234806 PMCID: PMC6591918 DOI: 10.1186/s12889-019-7170-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of anaemia and iron deficiency (ID) among children with severe acute malnutrition (SAM) and their correction during nutritional rehabilitation are not well documented. This study assessed anaemia and ID prevalence and their predictors at start of SAM treatment, and the efficacy of their treatment and effect on gut health of two novel Ready-To-Use Therapeutic foods (RUTF) prepared from soybean, maize and sorghum (SMS) with (MSMS-RUTF) or without added milk (FSMS-RUTF) compared to those of the standard formulation prepared from peanut and milk (PM-RUTF). METHODS This was a 3-arms parallel groups, simple randomised, controlled non-inferiority trial in 6-59 months old Central Malawian children with SAM. Anaemia was defined using altitude- and ethnicity-adjusted haemoglobin. Iron status was defined using soluble transferrin receptor (sTfR) and body iron stores (BIS). We used Pearson's chi-square test, t-test for paired or unpaired data, Kruskal-Wallis test for between-arm differences as appropriate and logistic regression to identify independent predictors of anaemia or iron deficiency anaemia (IDA). RESULTS The sample size was 389. At admission, the prevalence [%(95%CI)] of anaemia was 48.9(41.4-56.5)% while that of ID and IDA were 55.7(48.6-62.5)% and 34.3(28.2-41.0)% when using sTfR criterion and 29.1(24.4-34.4)% and 28.9(23.7-34.9)% when using BIS criterion, respectively. At discharge, nutrition rehabilitation with SMS-RUTF was associated with the lowest prevalence of anaemia [12.0(6.9-20.3)% for FSMS-RUTF, 18.2(11.9-26.8)% for MSMS-RUTF and 24.5(15.8-35.9)% for PM-RUTF; p = 0.023] and IDA [7.9(3.4-17.3)% for FSMS-RUTF, 10.9(4.8-22.6)% for MSMS-RUTF and 20.5(10.7-35.5)% for PM-RUTF; p = 0.028]. SMS-RUTF was also associated with the highest increase in BIS [Change in BIS (95%CI)] among the iron deplete at admission [6.2 (3.7; 8.6), 3.2 (0.8; 5.6), 2.2 (0.2; 4.3) for the same study arms; Anova p = 0.045]. Compared to P-RUTF, FSMS-RUTF had the highest adjusted recovery rate [OR (95%CI = 0.3 (0.2-0.5) with p < 0.001 for FSMS-RUTF and 0.6 (0.3-1.0) with p = 0.068 for MSMS-RUTF]. No effect of iron content on risk of iron overload or gut inflammation was observed. CONCLUSIONS Anaemia and ID are common among children with SAM. FSMS-RUTF is more efficacious in treating anaemia and correcting BIS among this group than PM-RUTF. TRIAL REGISTRATION This study was registered on 15 April 2015 ( PACTR201505001101224 ).
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Affiliation(s)
- Peter Akomo
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland
| | - Paluku Bahwere
- Valid International, 35 Leopold Street, Oxford, OX4 1TW UK
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Hitoshi Murakami
- Nutrition Improvement Department, Ajinomoto Co., Inc., Tokyo, Japan
| | - Chrissy Banda
- Valid International, 35 Leopold Street, Oxford, OX4 1TW UK
| | | | | | - Kate Sadler
- Valid International, 35 Leopold Street, Oxford, OX4 1TW UK
| | - Steve Collins
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland
- Valid International, 35 Leopold Street, Oxford, OX4 1TW UK
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Locks LM, Dahal P, Pokharel R, Joshi N, Paudyal N, Whitehead RD, Chitekwe S, Mei Z, Lamichhane B, Garg A, Jefferds ME. Changes in growth, anaemia, and iron deficiency among children aged 6-23 months in two districts in Nepal that were part of the post-pilot scale-up of an integrated infant and young child feeding and micronutrient powder intervention. Matern Child Nutr 2019; 15:e12693. [PMID: 30226293 PMCID: PMC6585661 DOI: 10.1111/mcn.12693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/16/2018] [Accepted: 08/31/2018] [Indexed: 11/27/2022]
Abstract
There is limited research on integrated infant and young child feeding (IYCF) and micronutrient powders (MNPs) programmes operating at scale, despite widespread implementation. This study uses cross-sectional baseline (n = 2,542) and endline (n = 2,578) surveys representative of children 6-23 months in two districts in Nepal that were part of a post-pilot scale-up of a IYCF-MNP programme. Multivariable log-binomial regression models were used to estimate prevalence ratios (PRs) for stunting (length-for-age z-score <-2), wasting (weight-for-length z-score <-2), underweight (weight-for-age z-score <-2), anaemia (altitude-adjusted haemoglobin <110 μg/L), moderate or severe anaemia (altitude-adjusted haemoglobin <100 g/L), iron deficiency (inflammation-adjusted ferritin <12 μg/L), and iron deficiency anaemia (iron deficiency + anaemia [IDA]) at endline versus baseline and also to compare children in the endline survey based on frequency of mothers' interactions with female community health volunteers (FCHVs; >1× per month or monthly vs. <1× per month) and MNP coverage (1 or ≥2 distributions vs. none among children 12-23 months). Endline children were significantly less likely to be stunted than baseline children in both districts (multivariable-adjusted PR [95% CI]: 0.77 [0.69, 0.85], P < 0.001 and 0.82 [0.75, 0.91], P < 0.001 in Kapilvastu and Achham, respectively); however, only Achham had significantly lower prevalences of underweight, moderate/severe anaemia, iron deficiency, and IDA at endline. At endline, 53.5% and 71.4% of children had tried MNP in Kapilvastu and Achham districts, respectively, consuming an average of 24 sachets from the last distribution. Frequent maternal-FCHV interactions were associated with a reduced risk of stunting and underweight at endline, whereas repeat MNP coverage was associated with reduced risk of anaemia and IDA. Future research using experimental designs should verify the potential of integrated IYCF-MNP programmes to improve children's nutritional status.
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Affiliation(s)
- Lindsey M. Locks
- Department of NutritionHarvard TH Chan School of Public HealthBostonMassachusetts
- Nutrition SectionUnited Nations Children's Fund (UNICEF) HeadquartersNew YorkNew York
| | - Pradiumna Dahal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | | | | | - Naveen Paudyal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Ralph D. Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgia
| | - Stanley Chitekwe
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgia
| | | | - Aashima Garg
- Nutrition SectionUnited Nations Children's Fund (UNICEF) HeadquartersNew YorkNew York
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgia
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Li B, He H, Shi W, Hou T. Effect of duck egg white peptide-ferrous chelate on iron bioavailability in vivo and structure characterization. J Sci Food Agric 2019; 99:1834-1841. [PMID: 30255570 DOI: 10.1002/jsfa.9377] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/05/2018] [Accepted: 09/17/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND In order to utilize the industrial by-product 'salted duck egg white' as novel iron additives, the effects of desalted duck egg white peptides-ferrous chelate (DPs-Fe) on the promotion of iron uptake and the structure were investigated. RESULTS Different doses of DPs-Fe were given and iron sulfate (FeSO4 ) was used as a positive control. After three weeks, hemoglobin (Hb), hematocrit (HCT), red blood cells (RBCs), mean corpuscular volume (MCV), serum iron (SI) and serum ferritin (SF) in iron-deficiency anemia (IDA) rats could be significantly (P < 0.05) increased to the normal levels by DPs-Fe. The gene expressions of divalent metal transporter 1 (DMT1), ferroportin 1 (FPN1) and Hepcidin could be regulated by DPs-Fe. Additionally, DPs-Fe was formed during the chelation process and the structure was characterized. Eight crucial iron-chelating peptides of duck egg white peptides (DPs) were identified by HPLC-ESI-MS/MS, such as Pro-Val-Glu-Glu and Arg-Ser-Ser. It indicated that Glu, Asp, Lys, His, Ser, Cys residues might play crucial roles in the chelating of DPs with iron. CONCLUSION DPs-Fe could be a potential iron supplement, and the Glu, Asp, Lys, His played important roles in binding iron and promoting iron uptake. This research expands the understanding of iron uptake by DPs and provides an opportunity for recycling a discarded processing byproduct. © 2018 Society of Chemical Industry.
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Affiliation(s)
- Bo Li
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, PR China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, PR China
| | - Hui He
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, PR China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, PR China
| | - Wen Shi
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, PR China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, PR China
| | - Tao Hou
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, PR China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, PR China
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Bahwere P, Akomo P, Mwale M, Murakami H, Banda C, Kathumba S, Banda C, Jere S, Sadler K, Collins S. Soya, maize, and sorghum-based ready-to-use therapeutic food with amino acid is as efficacious as the standard milk and peanut paste-based formulation for the treatment of severe acute malnutrition in children: a noninferiority individually randomized controlled efficacy clinical trial in Malawi. Am J Clin Nutr 2017; 106:1100-1112. [PMID: 28814393 DOI: 10.3945/ajcn.117.156653] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Development of more cost-effective ready-to-use therapeutic food (RUTF) is a global public health priority. To date, previous lower-cost recipes have been less effective than the standard peanut and milk (PM)-based RUTF, particularly in children aged <24 mo.Objective: We aimed to compare the efficacy of the PM-RUTF to a milk-free soya, maize, and sorghum (FSMS)-RUTF enriched with crystalline amino acids without cow milk powder and a milk, soya, maize, and sorghum (MSMS)-RUTF containing 9.3% skim cow milk powder.Design: This nonblinded, 3-arm, parallel-group, simple randomized controlled trial enrolled Malawian children with severe acute malnutrition.Results: In intention-to-treat analyses, FSMS-RUTF showed noninferiority for recovery rates in children aged 24-59 mo (Δ: -1.9%; 95% CI: -9.5%, 5.6%) and 6-23 mo (Δ: -0.2%; 95% CI: -7.5%, 7.1%) compared with PM-RUTF. MSMS-RUTF also showed noninferiority for recovery rates in children aged 24-59 mo (Δ: 0.0%; 95% CI: -7.3%, 7.4%) and 6-23 mo (Δ: 0.6%; 95% CI: -4.3%, 5.5%). Noninferiority in recovery rates was also observed in per-protocol analyses. For length of stay in the program (time to cure), both FSMS-RUTF in children aged 24-59 mo (Δ: 2.8 d; 95% CI: -0.8, 6.5 d) and 6-23 mo (Δ: 3.4 d; 95% CI: -1.2, 8.0 d) and MSMS-RUTF in children aged 24-59 mo (Δ: 0.2 d; 95% CI: -3.1, 3.6 d) and 6-23 mo (Δ: 1.2 d; 95% CI: -3.4, 5.8 d) were not inferior to PM-RUTF. FSMS-RUTF was also significantly better than PM-RUTF at increasing hemoglobin and body iron stores in anemic children, with mean hemoglobin increases of 2.1 (95% CI: 1.6, 2.6) and 1.3 (95% CI: 0.9, 1.8) and mean body iron store increases of 2.0 (95% CI: 0.8, 3.3) and 0.1 (95% CI: -1.1, 1.3) for FSMS-RUTF and PM-RUTF, respectively.Conclusions: FSMS-RUTF without milk is efficacious in the treatment of severe acute malnutrition in children aged 6-23 and 24-59 mo. It is also better at correcting iron deficiency anemia than PM-RUTF. This trial was registered at www.pactr.org as PACTR201505001101224.
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Affiliation(s)
- Paluku Bahwere
- Valid International, Oxford, United Kingdom;
- Center for Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Free University of Brussels, Brussels, Belgium
| | | | | | | | | | | | | | | | | | - Steve Collins
- Valid International, Oxford, United Kingdom
- Valid Nutrition, Cork, Republic of Ireland
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Angeles-Agdeppa I, Magsadia CR, Aaron GJ, Lloyd BB, Hilmers DC, Bhutta ZA. A Micronutrient Fortified Beverage Given at Different Dosing Frequencies Had Limited Impact on Anemia and Micronutrient Status in Filipino Schoolchildren. Nutrients 2017; 9:E1002. [PMID: 28895887 PMCID: PMC5622762 DOI: 10.3390/nu9091002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 01/11/2023] Open
Abstract
This study evaluated the effects of a multi-micronutrient fortified juice drink given in different frequencies of consumption on hemoglobin (Hb) concentration of schoolchildren. Hb was measured in 2423 schoolchildren aged 6- to 9-years-old at baseline. All anemic children (n = 246) were randomly allocated into groups: Daily dose (HD: high dose), 5X/week (MD: Moderate Dose), 3X/week (LD: Low Dose) and unfortified (Control). Pre- and post-study measurements of micronutrients were collected from 228 children. At the endpoint, significant Hb increases were observed in all groups, but there was no significant difference between groups. There was a significant reduction in anemia prevalence in all groups from 100% to 36% (Control), 30% (LD), 23% (MD) and 26% (HD). No dose-response effect was observed in Hb in this population. Most likely, this resulted from better than expected micronutrient status and lower than expected severity of anemia and micronutrient deficiencies in this cohort. It is unlikely that the addition of a fortified beverage to school feeding programs in this population would have a positive impact. Whether such an intervention would be cost-effective as a preventative approach needs to be assessed. This study demonstrates the importance of targeting such interventions to appropriate populations.
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Affiliation(s)
- Imelda Angeles-Agdeppa
- Food and Nutrition Research Institute, Department of Science and Technology, 1632 Taguig, Philippines.
| | - Clarita R Magsadia
- Food and Nutrition Research Institute, Department of Science and Technology, 1632 Taguig, Philippines.
| | - Grant J Aaron
- Formerly with the Global Alliance for Improved Nutrition (GAIN), Rue de Varembre 7, 1202 Geneve, Switzerland.
| | - Beate B Lloyd
- Global Scientific and Regulatory Affairs, The Coca-Cola Company, Atlanta, GA 30301, USA.
| | - David C Hilmers
- Baylor College of Medicine, Departments of Internal Medicine, Pediatrics, Global Initiatives, and Center for Space Medicine, Houston, TX 77030, USA.
| | - Zulfiqar A Bhutta
- University of Toronto, Center for Global Child Health, The Hospital for Sick Children, Toronto, ON M6S 1S6, Canada.
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12
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Abstract
RATIONALE The treatment of iron-deficiency anemia with oral iron supplements can present side-effects on the GI tract mucosa including necrosis, ulceration, or ischemia. The particular endoscopic findings and the histopathological exam will establish the diagnosis of erosive gastritis with iron deposits in the gastric mucosa. PATIENT CONCERNS We present the case of a 14-year-old female admitted in our clinic for upper digestive hemorrhage, nausea, melena, and abdominal pain. Her personal history revealed iron deficiency anemia receiving oral iron supplements for approximately 2 weeks. DIAGNOSIS The laboratory tests at the moment of admission pointed out anemia, increased level of serum iron, increased liver transaminases, a decreased level of ferritin, but with normal levels of both total iron-binding capacity and transferrin. INTERVENTIONS The eso-gastro-duodenoscopy revealed multiple brown deposits on the surface of the gastric mucosa and multiple hemorrhagic lesions, under the aspect of erosions all over the gastric mucosa, but more severe in the antral part, and the histopathological exam confirmed the presence of iron deposits at this level. CONCLUSION Iron-pill induced gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.
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Affiliation(s)
- Lorena Elena Meliţ
- Department of Pediatrics I, University of Medicine and Pharmacy Department of Pathology, County Hospital, Tîrgu Mureş, Romania
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13
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Mwangi MN, Phiri KS, Abkari A, Gbané M, Bourdet-Sicard R, Braesco VA, Zimmermann MB, Prentice AM. Iron for Africa-Report of an Expert Workshop. Nutrients 2017; 9:nu9060576. [PMID: 28587263 PMCID: PMC5490555 DOI: 10.3390/nu9060576] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue.
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Affiliation(s)
- Martin N Mwangi
- Division of Human Nutrition, Wageningen University and Research, Wageningen 6700 AA, The Netherlands.
- Nutrition and Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya.
| | - Kamija S Phiri
- Public Health Department, College of Medicine, University of Malawi, Private Bag 360, Blantyre 8, Malawi.
| | - Abdelhak Abkari
- Hassan II University, Faculty of medicine, CHU Ibn Rochd, Casablanca, Morocco.
| | - Mory Gbané
- National Public Health Institute (INSP) and Nutrition Society of Côte d'Ivoire (SIN), Adjamé BPV 47, Abidjan 01, Côte d'Ivoire.
| | | | | | - Michael B Zimmermann
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH) Schmelzbergstrasse, Zurich 78092, Switzerland.
| | - Andrew M Prentice
- MRC Unit The Gambia, Atlantic Road, Fajara, The Gambia & MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK.
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14
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Carvalho L, Brait D, Vaz M, Lollo P, Morato P, Oesterreich S, Raposo J, Freitas K. Partially Hydrolyzed Guar Gum Increases Ferroportin Expression in the Colon of Anemic Growing Rats. Nutrients 2017; 9:nu9030228. [PMID: 28273797 PMCID: PMC5372891 DOI: 10.3390/nu9030228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
Abstract
Studies have reported a positive effect of prebiotics on the bioavailability of iron. This study evaluated the effect of partially hydrolyzed guar gum (PHGG) on iron absorption mechanisms in anemic rats. Male Wistar rats were fed 75g American Institute of Nutrition Rodent Diets for growth, pregnancy and lactation (AIN93-G) without iron for three weeks in order to induce iron deficiency anemia. Then they were fed a control diet (n = 12; without fiber) or a diet with 7.5% of PHGG (n = 12), both without iron. Food intake, body growth and the feed efficiency coefficient (FEC) were measured. The animals were euthanized after two weeks of treatment. The weight of the organs, the pH of the cecal content, and the hepatic iron and ferroportin expression in the cecum, duodenum, and liver were assessed. The intake of PHGG reduced food intake without affecting body growth, and there was a difference between the groups regarding the FEC (p = 0.026), with the highest value found in the PHGG group. The weight of the cecal content increased (p ≤ 0.001) and the pH of the cecal content was significantly lower in the PHGG group. The intake of PHGG significantly increased ferroportin expression in the cecum;however, the difference was not significant in the duodenum and the liver. PHGG seems to have a positive influence on iron absorption through transporter expression, and structural and physiological changes in the colon of anemic growing animals.
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Affiliation(s)
- Luciana Carvalho
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Débora Brait
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Márcia Vaz
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Pablo Lollo
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Priscila Morato
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Silvia Oesterreich
- School of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Jorge Raposo
- School of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul 79825-070, Brazil.
| | - Karine Freitas
- Center of Biological Sciences and Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul 79825-070, Brazil.
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15
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Moreno-Fernandez J, Diaz-Castro J, Alférez MJ, Boesch C, Nestares T, López-Aliaga I. Fermented goat milk improves antioxidant status and protects from oxidative damage to biomolecules during anemia recovery. J Sci Food Agric 2017; 97:1433-1442. [PMID: 27380761 DOI: 10.1002/jsfa.7882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/02/2016] [Accepted: 06/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is one of the most common nutritional problems in the world, and it is accepted that reactive oxygen species (ROS) production is altered during IDA. The aim of this study was to assess the influence of fermented goat and cow milks on enzymatic antioxidant activities and gene expression, and their role in protecting from oxidative damage during anemia recovery. RESULTS After feeding the fermented milks-based diets (cow or goat), a significant elevation of some antioxidant endogenous enzymes was found, together with an increase in total antioxidant status (TAS), and a decrease in 8-hydroxy-2'-deoxyguanosine (8-OHdG) was recorded in animals consuming fermented goat milk-based diet. In contrast, DNA strand breaks, hydroperoxides, 15-F2t-isoprostanes and protein carbonyl groups were lower in some tissues in animals fed fermented goat milk-based diet, revealing an improvement in both systemic and cellular antioxidant activity of plasma and tissues due to fermented goat milk consumption. CONCLUSION Fermented goat milk consumption induces a protective increase in TAS together with lower oxidative damage biomarkers, revealing that the milk protects main cell bioconstituents (lipids, protein, DNA, prostaglandins) from evoked oxidative damage during anemia recovery. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Jorge Moreno-Fernandez
- Department of Physiology, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology 'José Mataix Verdú', University of Granada, Granada, Spain
| | - Javier Diaz-Castro
- Department of Physiology, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology 'José Mataix Verdú', University of Granada, Granada, Spain
| | - María Jm Alférez
- Department of Physiology, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology 'José Mataix Verdú', University of Granada, Granada, Spain
| | - Christine Boesch
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Teresa Nestares
- Department of Physiology, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology 'José Mataix Verdú', University of Granada, Granada, Spain
| | - Inmaculada López-Aliaga
- Department of Physiology, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology 'José Mataix Verdú', University of Granada, Granada, Spain
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16
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Wei Y, Huo J, Yin J, Sun J, Huang J. [Evaluation of iron fortified soy sauce on changes of anemia prevalence in 2004-2013]. Wei Sheng Yan Jiu 2017; 46:136-142. [PMID: 29903167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the role of iron fortified soy sauce( IFSS) on the decrease of anemia prevalence in Chinese population in 2004- 2013. METHODS Meta analysis was used to analyze the effect of IFSS on anemia through published randomcontrol studies on the population intervention with IFSS. Integrated with other data from IFSS statistic on IFSS production and consumption, the recovered population from IFSS was identified and anemia decrease determined, therefore, IFSS contribution to anemia change could be estimated. RESULTS By Meta analysis, the anemia rate of the population consumed IFSS was 27% compared with the anemia rate of the population non-consumed IFSS. In the past 10 years, IFSS had covered more than 186 millions population with effect validity time. A total of 28. 49 millions anemic population recovered from anemia. To recover one anemic with IFSS, the cost was 0. 12 RMB. CONCLUSION IFSS has showed effect on the decline of anemia prevalence in last decade, 23. 2% of the decrease was estimated owe to IFSS project, but there are unidentified factors which may bring bias to the result.
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Affiliation(s)
- Yanli Wei
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Junsheng Huo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiyong Yin
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jing Sun
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jian Huang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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17
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Flemmer A. [Not Available]. Kinderkrankenschwester 2017; 36:5-7. [PMID: 30388332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
In light of evidence that high-dose iron supplements lead to a range of adverse events in low-income settings, the safety and efficacy of lower doses of iron provided through biological or industrial fortification of foodstuffs is reviewed. First, strategies for point-of-manufacture chemical fortification are compared with biofortification achieved through plant breeding. Recent insights into the mechanisms of human iron absorption and regulation, the mechanisms by which iron can promote malaria and bacterial infections, and the role of iron in modifying the gut microbiota are summarized. There is strong evidence that supplemental iron given in nonphysiological amounts can increase the risk of bacterial and protozoal infections (especially malaria), but the use of lower quantities of iron provided within a food matrix, ie, fortified food, should be safer in most cases and represents a more logical strategy for a sustained reduction of the risk of deficiency by providing the best balance of risk and benefits. Further research into iron compounds that would minimize the availability of unabsorbed iron to the gut microbiota is warranted.
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Affiliation(s)
- Andrew M Prentice
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Yery A Mendoza
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dora Pereira
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Carla Cerami
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rita Wegmuller
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Anne Constable
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jörg Spieldenner
- A.M. Prentice, D. Pereira, C. Cerami, and R. Wegmuller are with the Medical Research Council (MRC) Unit The Gambia, Fajara, Banjul, The Gambia. A.M. Prentice and R. Wegmuller are with the MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. Y.A. Mendoza, A. Constable, and J. Spieldenner are with the Nestlé Research Centre, Lausanne, Switzerland. D. Pereira is with the Department of Pathology, University of Cambridge, Cambridge, United Kingdom. C. Cerami is with the Division of Infectious Diseases, Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Sihag MK, Sharma V, Goyal A, Arora S, Kapila R. In vivo assessment of iron bioavailability from fortified pearl millet based weaning food. J Sci Food Agric 2016; 96:4410-5. [PMID: 26831255 DOI: 10.1002/jsfa.7651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/23/2016] [Accepted: 01/24/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Iron is an essential micronutrient required for normal growth and development of the body. Infants are more vulnerable to develop iron-deficiency anaemia due to inadequate iron supply in early stages. The objective of the study was in vivo assessment of iron bioavailability from pearl millet based weaning food fortified with iron and vitamin A, and to investigate the role of vitamin A in iron absorption in animal models. RESULTS Results revealed that anaemic group showed significantly (P < 0.05) higher bioavailability than that of normal rat models. Animals fed vitamin A supplemented pearl-millet diet exhibited comparable results with a sub-group provided commercially available weaning diet in both normal and anaemic groups, but significantly (P < 0.05) higher values for studied biological indices than that of a sub-group provided iron fortified pearl-millet or synthetic diet. When the anaemic rats were provided iron + vitamin A fortified diet, iron bioavailability increased and liver iron stores returned to the normal levels after 30 days, indicating a promoter role of vitamin A in intestinal iron absorption. CONCLUSIONS Overall, bioavailability of electrolytic iron could be improved by supplementation of vitamin A, and this mixture can be considered as a useful fortificant for pearl millet based complementary foods fortification designed to prevent iron deficiency. © 2016 Society of Chemical Industry.
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MESH Headings
- Anemia, Iron-Deficiency/blood
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/metabolism
- Anemia, Iron-Deficiency/prevention & control
- Animals
- Digestion
- Disease Models, Animal
- Feces/chemistry
- Female
- Food Handling
- Food, Fortified/adverse effects
- Food, Fortified/analysis
- Humans
- Infant
- Infant Food/adverse effects
- Infant Food/analysis
- Intestinal Absorption
- Iron/analysis
- Iron/metabolism
- Iron/urine
- Iron, Dietary/administration & dosage
- Iron, Dietary/analysis
- Iron, Dietary/metabolism
- Iron, Dietary/therapeutic use
- Liver/metabolism
- Male
- Nutritive Value
- Pennisetum/chemistry
- Random Allocation
- Rats, Wistar
- Renal Elimination
- Seeds/chemistry
- Vitamin A/administration & dosage
- Vitamin A/adverse effects
- Vitamin A/metabolism
- Vitamin A/therapeutic use
- Weaning
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Affiliation(s)
- Manvesh Kumar Sihag
- Dairy Chemistry Division, National Dairy Research Institute, Karnal, Haryana, India-132001
| | - Vivek Sharma
- Dairy Chemistry Division, National Dairy Research Institute, Karnal, Haryana, India-132001
| | - Ankit Goyal
- Dairy Chemistry Division, National Dairy Research Institute, Karnal, Haryana, India-132001
| | - Sumit Arora
- Dairy Chemistry Division, National Dairy Research Institute, Karnal, Haryana, India-132001
| | - Rajeev Kapila
- Animal Biochemistry Division, National Dairy Research Institute, Karnal, Haryana, India-132001
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20
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Yu F, Hao S, Yang B, Zhao Y, Yang J. Low Iron Diet Increases Susceptibility to Noise-Induced Hearing Loss in Young Rats. Nutrients 2016; 8:nu8080456. [PMID: 27483303 PMCID: PMC4997371 DOI: 10.3390/nu8080456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/25/2022] Open
Abstract
We evaluated the role of iron deficiency (ID) without anemia on hearing function and cochlear pathophysiology of young rats before and after noise exposure. We used rats at developmental stages as an animal model to induce ID without anemia by dietary iron restriction. We have established this dietary restriction model in the rat that should enable us to study the effects of iron deficiency in the absence of severe anemia on hearing and ribbon synapses. Hearing function was measured on Postnatal Day (PND) 21 after induction of ID using auditory brainstem response (ABR). Then, the young rats were exposed to loud noise on PND 21. After noise exposure, hearing function was again measured. We observed the morphology of ribbon synapses, hair cells and spiral ganglion cells (SGCs), and assessed the expression of myosin VIIa, vesicular glutamate transporter 3 and prestin in the cochlea. ID without anemia did not elevate ABR threshold shifts, but reduced ABR wave I peak amplitude of young rats. At 70, 80, and 90 dB SPL, amplitudes of wave I (3.11 ± 0.96 µV, 3.52 ± 1.31 µV, and 4.37 ± 1.08 µV, respectively) in pups from the ID group were decreased compared to the control (5.92 ± 1.67 µV, 6.53 ± 1.70 µV, and 6.90 ± 1.76 µV, respectively) (p < 0.05). Moreover, ID without anemia did not impair the morphology hair cells and SGCs, but decreased the number of ribbon synapses. Before noise exposure, the mean number of ribbon synapses per inner hair cell (IHC) was significantly lower in the ID group (8.44 ± 1.21) compared to that seen in the control (13.08 ± 1.36) (p < 0.05). In addition, the numbers of ribbon synapses per IHC of young rats in the control (ID group) were 6.61 ± 1.59, 3.07 ± 0.83, 5.85 ± 1.63 and 12.25 ± 1.97 (3.75 ± 1.45, 2.03 ± 1.08, 3.81 ± 1.70 and 4.01 ± 1.65) at 1, 4, 7 and 14 days after noise exposure, respectively. Moreover, ABR thresholds at 4 and 8 kHz in young rats from the ID group were significantly elevated at 7 and 14 days after noise exposure compared to control (p < 0.05). The average number of young rat SGCs from the ID group were significantly decreased in the basal turn of the cochlea compared to the control (p < 0.05). Therefore, ID without anemia delayed the recovery from noise-induced hearing loss and ribbon synapses damage, increased SGCs loss, and upregulated prestin after noise exposure. Thus, the cochleae in rat pups with ID without anemia were potentially susceptible to loud noise exposure, and this deficit may be attributed to the reduction of ribbon synapses and SGCs.
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MESH Headings
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/metabolism
- Anemia, Iron-Deficiency/pathology
- Anemia, Iron-Deficiency/physiopathology
- Animals
- Auditory Cortex/metabolism
- Auditory Cortex/physiopathology
- Auditory Cortex/ultrastructure
- Auditory Threshold/radiation effects
- Brain Stem/metabolism
- Brain Stem/physiopathology
- Brain Stem/ultrastructure
- Cochlea/innervation
- Cochlea/metabolism
- Cochlea/physiopathology
- Cochlea/ultrastructure
- Cochlear Nerve/metabolism
- Cochlear Nerve/physiopathology
- Cochlear Nerve/radiation effects
- Cochlear Nerve/ultrastructure
- Disease Models, Animal
- Disease Susceptibility
- Female
- Gene Expression Regulation, Developmental/radiation effects
- Hearing Loss, Noise-Induced/etiology
- Hearing Loss, Noise-Induced/prevention & control
- Iron, Dietary/therapeutic use
- Male
- Microscopy, Electron, Scanning
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
- Noise/adverse effects
- Nutritional Status
- Random Allocation
- Rats, Sprague-Dawley
- Spiral Ganglion/metabolism
- Spiral Ganglion/physiopathology
- Spiral Ganglion/ultrastructure
- Weaning
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Affiliation(s)
- Fei Yu
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China.
| | - Shuai Hao
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Bo Yang
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Yue Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China.
| | - Jun Yang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China.
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Abstract
PURPOSE OF REVIEW Iron is essential for normal cellular function and many diseases result from disturbances in iron homeostasis. This review describes some of the recent key advances in iron transport and its regulation, how this relates to iron-related disorders, and emerging therapies for these diseases. RECENT FINDINGS The iron-regulatory hormone hepcidin and its target, the iron exporter ferroportin (FPN), play central roles in iron homeostasis. Recent studies have expanded our understanding of how hepcidin is regulated in response to stimulated erythropoiesis and have added some new players to the complex network of factors that influences hepcidin expression. Novel structural insights into how FPN transports iron have been an important addition to the field, as has the recognition that some zinc transporters such as ZIP14 can transport iron. Investigations into cardiac iron homeostasis have revealed a key role for FPN, and transferrin receptor 1, which is essential for cellular iron uptake, has been shown to be critical for normal immune function. SUMMARY The increased understanding of mechanisms of iron homeostasis that has resulted from recent research has greatly improved our ability to diagnose and manage iron-related disorders, and has offered new therapies for this important class of human diseases.
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MESH Headings
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/immunology
- Anemia, Iron-Deficiency/metabolism
- Anemia, Iron-Deficiency/therapy
- Animals
- Biological Transport
- Cation Transport Proteins/genetics
- Cation Transport Proteins/metabolism
- Erythropoiesis
- Gene Expression Regulation, Developmental
- Hepcidins/genetics
- Hepcidins/metabolism
- Homeostasis
- Humans
- Intestinal Absorption
- Iron Overload/immunology
- Iron Overload/metabolism
- Iron Overload/therapy
- Iron, Dietary/adverse effects
- Iron, Dietary/metabolism
- Iron, Dietary/therapeutic use
- Metal Metabolism, Inborn Errors/genetics
- Metal Metabolism, Inborn Errors/immunology
- Metal Metabolism, Inborn Errors/metabolism
- Metal Metabolism, Inborn Errors/therapy
- Mutation
- Organ Specificity
- Peptide Hormones/genetics
- Peptide Hormones/metabolism
- Receptors, Transferrin/genetics
- Receptors, Transferrin/metabolism
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Affiliation(s)
- Shanshan Guo
- aIron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia bCAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
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22
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Chen D, Sun J, Huang J, Wang L, Piao W, Tang Y, Li J, Gao J, Huo J. [Effects of the iron fortified soy sauce on improving students' anemia in boarding schools]. Wei Sheng Yan Jiu 2016; 45:221-225. [PMID: 27301218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect of iron fortified soy sauce on improving the anemia of boarding school students. METHODS A total of 3029 students of the boarding schools in the 27 provinces in China including 1576 boys and 1453 girls were treat with the iron-fortified soy sauce for 12 months. The concentration of hemoglobin was detected before and after intervention. The statistical analysis was conducted to analyze the anemia rate and the hemoglobin concentration in boarding school students. RESULTS After the intervention, the average hemoglobin of students were increased from 142.1 g/L to 146.5 g/L compared to the baseline. The boys average haemoglobin concentration increased 6.7 g/L, girls average haemoglobin concentration increased 1.9 g/L. They were significantly higher than those of the baseline (P < 0.001 ). The total anemia prevalence were significantly difference than the baseline (P < 0.001). Anemia among both boys and girls fell to 1.1% and 4.7% respectively. CONCLUSION Iron-fortified soy sauce could be effective for the improvement the hemoglobin level of boarding school students, reduce anemia prevalence of students significantly.
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Hess S, Tecklenburg L, Eichler K. Micronutrient Fortified Condiments and Noodles to Reduce Anemia in Children and Adults--A Literature Review and Meta-Analysis. Nutrients 2016; 8:88. [PMID: 26891319 PMCID: PMC4772051 DOI: 10.3390/nu8020088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/18/2016] [Accepted: 02/04/2016] [Indexed: 12/02/2022] Open
Abstract
Micronutrient deficiencies impose a considerable burden of disease on many middle and low income countries. Several strategies have been shown to be effective in improving micronutrient deficiencies. However, the impact of fortified condiments as well as fortified noodles is less well documented. We aimed to investigate existing evidence on the impact of micronutrient fortified condiments and noodles on hemoglobin, anemia, and functional outcomes in children and adults (age: 5 to 50 years). We conducted a literature review in electronic databases. In addition, we screened the homepages of relevant organizations and journals. We included randomized controlled trials (RCT). Of 1046 retrieved studies, 14 RCT provided data for the meta-analysis. Micronutrient fortification of condiments and noodles increased hemoglobin concentrations by 0.74 g/dL (95%-confidence intervals (95%-CI): 0.56 to 0.93; 12 studies) and 0.3 g/dL (95%-CI: 0.12 to 0.48; 1 study), respectively. Micronutrient fortification also led to a reduced risk of having anemia (risk ratio 0.59 (95%-CI 0.44 to 0.80)). Ferritin concentrations increased with fortified condiments. Functional outcomes were rarely assessed and showed mixed results. The use of micronutrient fortified condiments can be a strategy to reduce anemia in children and adults due to micronutrient deficiencies. The effect of fortified noodles seems to be smaller.
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Affiliation(s)
- Sascha Hess
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur 8401, Switzerland.
| | - Linda Tecklenburg
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur 8401, Switzerland.
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur 8401, Switzerland.
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Serrano Reina JA, Nestares Pleguezuelo T, Muñoz Alférez MJ, Díaz Castro J, López Aliaga MI. [EFFICIENCY OF HAEMOGLOBIN REGENERATION IN THE NUTRITIONAL FERROPENIC ANAEMIA RECOVERY WITH GOAT MILK-BASED DIETS]. NUTR HOSP 2015; 32:1813-1819. [PMID: 26545555 DOI: 10.3305/nh.2015.32.4.9501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE in spite of the high incidence/prevalence of iron deficiency anemia (IDA) and the beneficial effects derived from the consumption of goat milk, scarce is known about the recovery of the anemia following a balanced diet accompanied by the intake of goat milk of goat. The aim of the current study is to assess, in rats with experimentally induced nutritional iron deficiency anemia, the effects of goat or cow milk-based diets, supplied during 30 days, on the recovery of the anemia and the efficiency of regeneration of the hemoglobin. MATERIAL AND METHODS 40 male Wistar albino rats newly weaned were divided at random in two experimental groups and they were fed ad libitum for 40 days with AIN-93G diet, either with normal iron content (control group, 45 mg/kg diet), or low iron content (anaemic group, 5 mg/kg diet). Samples of blood form the caudal vein were collected for the hematologic control of the anemia. Later, both experimental groups (control and iron deficient) were fed for 30 days with goat or cow milk- based diets. After finishing the experimental period and previous anesthesia the animals were withdrawn by canulation of the abdominal aorta, and the obtained blood was gathered in tubes with EDTA as anticoagulant for the later determination of hematologic parameters and the efficiency of regeneration of the hemoglobin. RESULTS AND DISCUSSION after the consumption of a diet with low iron content during 40 days, the rats were anaemic, with a concentration of hemoglobin, hematocrit, serum iron, mean corpuscular volume (MCV), serum ferritin and low transferrin (p < 0.001), whereas the levels of platelets and the total iron binding capacity (TIBC) were raised (p < 0.001), findings consistent with the anemia induced experimentally in the animals. The efficiency of regeneration of the hemoglobin was higher in control and anaemic rats fed goat milk-based diet in comparison with those fed cow milk-based diet (p < 0.001) due to, partly, to the major levels of serum iron and hemoglobin, and to the best nutritive utilization of iron in the animals that consumed the goat milk-based diet thanks to the excellent nutritional characteristics of this type of milk. CONCLUSION the consumption during 30 days of goat or cow milk-based diets favors the recovery of the iron deficiency anemia, especially with the goat milk, due to the major efficiency of regeneration of the hemoglobin, index that shows the quantity of iron of the diet used for the synthesis of hemoglobin. Therefore, it would be recommendable the consumption of goat milk in the context of a balanced diet in healthy populations and, especially in those at risk of suffering iron deficiency.
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Affiliation(s)
- José Antonio Serrano Reina
- Departamento de Fisiología, Facultad de Farmacia e Instituto de Nutrición y Tecnología de los Alimentos "José Mataix", Universidad de Granada, España..
| | - Teresa Nestares Pleguezuelo
- Departamento de Fisiología, Facultad de Farmacia e Instituto de Nutrición y Tecnología de los Alimentos "José Mataix", Universidad de Granada, España..
| | - Ma José Muñoz Alférez
- Departamento de Fisiología, Facultad de Farmacia e Instituto de Nutrición y Tecnología de los Alimentos "José Mataix", Universidad de Granada, España..
| | - Javier Díaz Castro
- Departamento de Fisiología, Facultad de Farmacia e Instituto de Nutrición y Tecnología de los Alimentos "José Mataix", Universidad de Granada, España..
| | - Ma Inmaculada López Aliaga
- Departamento de Fisiología, Facultad de Farmacia e Instituto de Nutrición y Tecnología de los Alimentos "José Mataix", Universidad de Granada, España..
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25
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Chatterjee R, Shand A, Nassar N, Walls M, Khambalia AZ. Iron supplement use in pregnancy - Are the right women taking the right amount? Clin Nutr 2015; 35:741-7. [PMID: 26070630 DOI: 10.1016/j.clnu.2015.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/15/2015] [Accepted: 05/24/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements. METHODS A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014. RESULTS Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. Overall iron-containing supplement use was 88.0%, of which 70.1% was multivitamin (MV) only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as non-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (<30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking <30 mg/day. CONCLUSION Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.
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Affiliation(s)
- Rahul Chatterjee
- Clinical and Population Perinatal Research, Kolling Institute, University of Sydney, NSW, Australia
| | - Antonia Shand
- Clinical and Population Perinatal Research, Kolling Institute, University of Sydney, NSW, Australia; Department of Obstetrics and Gynecology, Royal Hospital for Women, Randwick, NSW, Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Research, Kolling Institute, University of Sydney, NSW, Australia
| | - Mariyam Walls
- Department of Obstetrics and Gynecology, Royal Hospital for Women, Randwick, NSW, Australia
| | - Amina Z Khambalia
- Clinical and Population Perinatal Research, Kolling Institute, University of Sydney, NSW, Australia.
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26
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Bal D, Nagesh K, Surendra HS, Chiradoni D, Gomathy G. Effect of supplementation with iron fortified biscuits on the hemoglobin status of children in rural areas of Shimoga, Karnataka. Indian J Pediatr 2015; 82:253-9. [PMID: 24944143 DOI: 10.1007/s12098-014-1483-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 05/01/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the efficacy of iron fortified biscuits, in high and low dosages, on the hemoglobin levels of anemic school going children aged 6 to 12 y. METHODS The nutrition intervention was conducted in primary schools located in villages at Shimoga district, Karnataka. School children aged 6 to 12 y who were anemic, with hemoglobin level <11.5 g/dl were considered for the nutrition intervention. The sampling design undertaken was quasi experimental with pre and post stages of outcome. The children enrolled were divided into two groups. One group received high dosage of iron fortified biscuits (30 mg of elemental iron/6 biscuits) and the second group received a relatively lower dosage of iron fortified biscuits (1.8 mg of elemental iron/6 biscuits) for a period of 120 d. The hemoglobin levels were estimated pre and post fortified biscuit supplementation by cyanomethemoglobin method. RESULTS There was an increase in the mean hemoglobin level of children which was found to be higher in group I (high iron fortified biscuits) (1.06 g/dl) compared to group II (low iron fortified biscuits) (0.41 g/dl), significant at 0.01 level (t = 3.84**). CONCLUSIONS In the current nutrition intervention, both high and low iron fortified biscuits led to a significant enhancement in the body weight and hemoglobin status of anemic school children in a rural setup. The nutrition intervention clearly highlights biscuits as an ideal fortification vehicle for addressing anemia.
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Affiliation(s)
- Dhruti Bal
- Britannia Industries Limited, Research and Development, Britannia Gardens, Old Airport Road, Bangalore, 560017, India,
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27
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Tayupova IM. [To the question of rational nutrition, micronutrient status correction, prevention and treatment of iron deficiency in pregnancy]. Vopr Pitan 2015; 84:25-33. [PMID: 26841553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the article the features of healthy nutrition in pregnant women suffering from iron deficiency has been discussed. The criteria for diagnosis of anemia during pregnancy, the stage of the disease development, the specifics of iron deficiency during gestation, the need in this trace element in pregnant women have been defined. The necessity of an adequate selection of a balanced diet during pregnancy complicated with anemia has been based. Iron content in food products along with the extent of absorption depending upon the origin of the product have been considered. The compounds that contribute to a better absorption of iron, as well as medicinal substances that prevent its absorption have been presented. Special attention is paid to the questions of preventative measures in preventing anemia in pregnant women. In addition to a balanced diet and iron preparations for treatment and prevention of anemia, the appointment of vitamin-mineral supplements and specialized foods for pregnant enriched with micronutrients has been substantiated.
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Martorell R, Ascencio M, Tacsan L, Alfaro T, Young MF, Addo OY, Dary O, Flores-Ayala R. Effectiveness evaluation of the food fortification program of Costa Rica: impact on anemia prevalence and hemoglobin concentrations in women and children. Am J Clin Nutr 2015; 101:210-7. [PMID: 25527765 PMCID: PMC5884061 DOI: 10.3945/ajcn.114.097709] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Food fortification is one approach for addressing anemia, but information on program effectiveness is limited. OBJECTIVE We evaluated the impact of Costa Rica's fortification program on anemia in women aged 15-45 y and children aged 1-7 y. DESIGN Reduced iron, an ineffective fortificant, was replaced by ferrous fumarate in wheat flour in 2002, and ferrous bisglycinate was added to maize flour in 1999 and to liquid and powdered milk in 2001. We used a one-group pretest-posttest design and national survey data from 1996 (baseline; 910 women, 965 children) and 2008-2009 (endline; 863 women, 403 children) to assess changes in iron deficiency (children only) and anemia. Data were also available for sentinel sites (1 urban, 1 rural) for 1999-2000 (405 women, 404 children) and 2008-2009 (474 women, 195 children), including 24-h recall data in children. Monitoring of fortification levels was routine. RESULTS Foods were fortified as mandated. Fortification provided about one-half the estimated average requirement for iron in children, mostly and equally through wheat flour and milk. Anemia was reduced in children and women in national and sentinel site comparisons. At the national level, anemia declined in children from 19.3% (95% CI: 16.8%, 21.8%) to 4.0% (95% CI: 2.1%, 5.9%) and in women from 18.4% (95% CI: 15.8%, 20.9%) to 10.2% (95% CI: 8.2%, 12.2%). In children, iron deficiency declined from 26.9% (95% CI: 21.1%, 32.7%) to 6.8% (95% CI: 4.2%, 9.3%), and iron deficiency anemia, which was 6.2% (95% CI: 3.0%, 9.3%) at baseline, could no longer be detected at the endline. CONCLUSIONS A plausible impact pathway suggests that fortification improved iron status and reduced anemia. Although unlikely in the Costa Rican context, other explanations cannot be excluded in a pre/post comparison.
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Affiliation(s)
- Reynaldo Martorell
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Melany Ascencio
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Luis Tacsan
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Thelma Alfaro
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Melissa F Young
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - O Yaw Addo
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Omar Dary
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
| | - Rafael Flores-Ayala
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A)
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Beck KL, Conlon CA, Kruger R, Coad J. Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: a review. Nutrients 2014; 6:3747-76. [PMID: 25244367 PMCID: PMC4179187 DOI: 10.3390/nu6093747] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 12/21/2022] Open
Abstract
Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency.
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Affiliation(s)
- Kathryn L Beck
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Cathryn A Conlon
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Rozanne Kruger
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Jane Coad
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
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Khan WU, Shafique S, Shikder H, Shakur YA, Sellen DW, Chowdhury JS, Zlotkin SH. Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi-micronutrient powder formulation. Public Health Nutr 2014; 17:1578-86. [PMID: 23816321 PMCID: PMC10282337 DOI: 10.1017/s1368980013001742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate whether the recommended dietary intake of Ca in anaemic infants compromises the expected Hb response, via home fortification with a new Ca- and Fe-containing Sprinkles™ micronutrient powder (MNP). DESIGN A double-blind, randomized controlled, 2-month trial was conducted in Bangladesh. Infants were randomized to one of two MNP intervention groups containing Fe and other micronutrients, with or without Ca. Hb, anthropometrics and dietary intake were measured pre- and post-intervention while family demographics were collected at baseline. SETTING Twenty-six rural villages in the Kaliganj sub-district of Gazipur, Bangladesh. SUBJECTS One hundred infants aged 6-11 months. RESULTS A significant increase in Hb (MNP, 13·3 (sd 12·6) g/l v. Ca-MNP, 7·6 (sd 11·6) g/l; P < 0·0001) was noted in infants from both groups. However, infants receiving MNP without Ca had a significantly higher end-point Hb concentration (P = 0·024) and rate of anaemia recovery (P = 0·008). Infants receiving MNP with Ca were more likely to remain anaemic (OR 3·2; 95 % CI 1·4, 7·5). Groups did not differ in dietary intake or demographic and anthropometric indicators. CONCLUSIONS Although both groups showed significant improvement in Hb status, the nutrient-nutrient interaction between Fe and Ca may have diminished the Hb response in infants receiving the Ca-containing MNP.
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Affiliation(s)
- Waqas Ullah Khan
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, 555 University Avenue, Room 8263, Toronto, ON M5G 1X8, Canada
| | - Sohana Shafique
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, 555 University Avenue, Room 8263, Toronto, ON M5G 1X8, Canada
| | | | - Yaseer Abdul Shakur
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, 555 University Avenue, Room 8263, Toronto, ON M5G 1X8, Canada
| | - Daniel W Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Anthropology, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Stanley H Zlotkin
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, 555 University Avenue, Room 8263, Toronto, ON M5G 1X8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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Zielińska-Dawidziak M, Hertig I, Staniek H, Piasecka-Kwiatkowska D, Nowak KW. Effect of iron status in rats on the absorption of metal ions from plant ferritin. Plant Foods Hum Nutr 2014; 69:101-7. [PMID: 24729039 PMCID: PMC4032463 DOI: 10.1007/s11130-014-0413-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An isolate of lead-ferritin obtained from soybean seeds sprouted in 25 mM of PbNO3 was introduced into the diet of both iron-deficient and iron non-deficient male rats. After a 21-day administration period, statistical differences in the lead accumulation in the femurs of the rats were noted. Iron-deficient rats accumulated more than four times the amount of lead in their bones than rats without iron-deficiency. No further decrease was observed in haemoglobin concentrations in the groups of animals fed with lead isolates, either iron-deficient or iron non-deficient. Also, no differences in the mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) were observed at the end of the experiment in the group of iron non-deficient rats fed with lead-ferritin isolate compared to the control group of iron non-deficient rats. In the iron-deficient group fed with lead-ferritin isolate, a small increase in haemoglobin concentrations, MCH, MCV and mean corpuscular haemoglobin concentrations (MCHC) was recorded. The results presented in this paper confirm that lead from the tested preparation-lead ferritin isolate-was better absorbed by those rats with induced iron deficiency anaemia. Additionally, we may also suspect based on the obtained results that absorption of ferritin-iron depends on iron status in the body.
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Affiliation(s)
- Magdalena Zielińska-Dawidziak
- Department of Food Biochemistry and Analysis, Poznań University of Life Sciences, Mazowiecka 48, 60-623, Poznań, Poland,
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Rao S, Joshi S, Bhide P, Puranik B, Asawari K. Dietary diversification for prevention of anaemia among women of childbearing age from rural India. Public Health Nutr 2014; 17:939-47. [PMID: 23594695 PMCID: PMC10282298 DOI: 10.1017/s1368980013001006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the impact of an intervention modifying dietary habits for the prevention of anaemia in rural India. DESIGN Intervention study with data on anthropometric (weight, height) measurements, Hb and diet pattern. As per the cut-off for Hb in the government programme, women with Hb <11 g/dl had to be given Fe tablets and formed the supplemented group while those with Hb > 11 g/dl formed the non-supplemented group. Settings Three villages near Pune city, Maharashtra, India. SUBJECTS Rural non-pregnant women (n 317) of childbearing age (15-35 years). RESULTS After 1 year of intervention, mean Hb increased (from 10.94 (sd 1.22) g/dl to 11.59 (sd 1.11) g/dl) significantly (P < 0.01) with a consequent reduction in the prevalence of anaemia (from 82.0% to 55.4%) as well as Fe-deficiency anaemia (from 30.3% to 10.8%). Gain in Hb was inversely associated with the initial level of Hb. Significant gain in Hb (0.57 g/dl) was observed among women attending >50% of the meetings or repeating >50% of the recipes at home (0.45 g/dl) in the non-supplemented group and was smaller than that observed in the supplemented group. Consumption of green leafy vegetables more than twice weekly increased substantially from 44.7% to 60.6%, as did consumption of seasonal fruits. Logistic regression showed that women with lower participation in the intervention had three times higher risk (OR = 3.08; 95% CI 1.04, 9.13; P = 0.04) for no gain in Hb compared with those having high participation. CONCLUSIONS Developing action programmes for improving nutritional awareness to enhance the consumption of Fe-rich foods has great potential for preventing anaemia in rural India.
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Affiliation(s)
- Shobha Rao
- Biometry & Nutrition Unit, Agharkar Research Institute, GG Agarkar Road, Pune 411030, India
| | - Smita Joshi
- Biometry & Nutrition Unit, Agharkar Research Institute, GG Agarkar Road, Pune 411030, India
| | - Pradnya Bhide
- Biometry & Nutrition Unit, Agharkar Research Institute, GG Agarkar Road, Pune 411030, India
| | - Bhairavi Puranik
- Biometry & Nutrition Unit, Agharkar Research Institute, GG Agarkar Road, Pune 411030, India
| | - Kanade Asawari
- Biometry & Nutrition Unit, Agharkar Research Institute, GG Agarkar Road, Pune 411030, India
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Derovs A, Pokrotnieks J, Derova J, Danilans A, Pukitis A, Dombure P, Leiniece S. Current opinion on the management of iron deficiency anaemia in gastrointestinal diseases. Eksp Klin Gastroenterol 2014:97-105. [PMID: 25911939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Iron deficiency is the most common cause of anaemia in the world. Despite frequently weak and masked clinical presentation of iron deficiency anaemia (IDA), this disease is very serious with complications leading to early mortality. In the developed countries IDA is predominantly diagnosed as the complication of another disease or as the result of major bleeding events. Diagnosis of IDA should be based on laboratory findings i.e. haemoglobin, mean corpuscular hemoglobin concentration and ferritin. Latter is the most sensitive marker for iron deficiency. Anaemia of chronic disease should be taken into an account as a potential differential diagnosis or coexisting state. For women in fertility age with IDA, gynaecological disorders should be ruled out first. Males and postmenopausal women with IDA should undergo upper, lower and in certain cases capsule endoscopy and/or enteroscopy to find a plausible cause of IDA. The ultimate goal of therapy is to find out and treat the primary cause of IDA. Iron body stores should be restored using either oral or parenteral iron preparations. The use of parenteral iron preparations in patients with gastrointestinal pathologies is often clinically substantiated for the treatment of IDA. Red blood cell transfusion should be administered in emergency cases only.
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Abstract
Two hundred and thirty-eight subjects of both sexes, age range 7.5 months-16 years, with iron deficiency (ID), were included in a retrospective review of ID causes, to determine the best treatment. Inadequate iron intake was the cause of ID or iron deficiency anemia (IDA) in 59 subjects from the first months of life to adolescence. Blood loss linked to cow's milk intolerance was the cause of ID or IDA in 37 younger children. Meckel's diverticulum (MD) (6 cases), reflux esophagitis (RE) (10 cases), some drugs such as acetyl salicylic acid (11 cases) induced bleeding with ID or IDA in children and adolescents. In pubertal females with ID or IDA, polymenorrhea was observed in 16 cases. Coelic disease (CD) (37 cases), Helicobacter pylori infection (HPI) (39 cases), association of HPI and CD (8 cases), enteromonas infection (15 cases), determining particularly malabsorption, were causes of ID or IDA in patients of a wide age range, unresponsive to iron therapy. Our findings show that iron replacement therapy was not always required and should not be prescribed until the diagnosis is certain.
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Affiliation(s)
- M Ferrara
- Department of pediatrics, The 2nd university of naples, Naples, Italy.
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Bertinato J, Aroche C, Plouffe LJ, Lee M, Murtaza Z, Kenney L, Lavergne C, Aziz A. Diet-induced obese rats have higher iron requirements and are more vulnerable to iron deficiency. Eur J Nutr 2013; 53:885-95. [PMID: 24096586 DOI: 10.1007/s00394-013-0592-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/24/2013] [Indexed: 01/27/2023]
Abstract
PURPOSE Since obesity is associated with poorer iron status, the effects of diet-induced obesity on iron status and iron-regulatory pathways were examined. METHODS Weanling male diet-induced obese sensitive (n = 12/diet group) and resistant (n = 12/diet group) rats were fed one of four high-fat, high-energy diets supplemented with 5 (5Fe, low), 15 (15Fe, marginal), 35 (35Fe, normal) or 70 (70Fe, high) mg iron/kg diet for 12 weeks. At the end of the study, rats in each diet group were categorised as obese (>19 %) or lean (<17 %) based on percentage body fat. RESULTS Obese rats gained more weight, had larger total lean mass, consumed more food and showed greater feed efficiency compared with lean rats. Obese rats fed the 5Fe and 15Fe diets had poorer iron status than lean rats fed the same diet. Obese 5Fe rats had lower serum iron and more severe iron-deficiency anaemia. Obese 15Fe rats had lower mean corpuscular haemoglobin and liver iron concentrations. Hepcidin mRNA expression in liver and adipose tissue was similar for obese and lean rats. Iron concentration and content of the iron transporters divalent metal transporter 1 and ferroportin 1 in duodenal mucosa were also similar. CONCLUSIONS Obese rats that were larger, regardless of adiposity, had higher iron requirements compared with lean rats that appeared independent of hepcidin, inflammation and intestinal iron absorption. Higher iron requirements may have resulted from larger accretion of body mass and blood volume. Greater food consumption did not compensate for the higher iron needs, indicating increased susceptibility to iron deficiency.
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Affiliation(s)
- Jesse Bertinato
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Sir Frederick G. Banting Research Centre, 251 Sir Frederick Banting Driveway, PL 2203E, Ottawa, ON, K1A 0K9, Canada,
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Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, Zaidi AKM, Bhutta ZA. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lancet 2013; 382:29-40. [PMID: 23602230 DOI: 10.1016/s0140-6736(13)60437-7] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children. We assessed the effects of provision of two micronutrient powder formulations, with or without zinc, to children in Pakistan. METHODS We did a cluster randomised trial in urban and rural sites in Sindh, Pakistan. A baseline survey identified 256 clusters, which were randomly assigned (within urban and rural strata, by computer-generated random numbers) to one of three groups: non-supplemented control (group A), micronutrient powder without zinc (group B), or micronutrient powder with 10 mg zinc (group C). Children in the clusters aged 6 months were eligible for inclusion in the study. Powders were to be given daily between 6 and 18 months of age; follow-up was to age 2 years. Micronutrient powder sachets for groups B and C were identical except for colour; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion. Parents knew whether their child was receiving supplementation, but did not know whether the powder contained zinc. Primary outcomes were growth, episodes of diarrhoea, acute lower respiratory tract infection, fever, and incidence of admission to hospital. This trial is registered with ClinicalTrials.gov, number NCT00705445. RESULTS The trial was done between Nov 1, 2008, and Dec 31, 2011. 947 children were enrolled in group A clusters, 910 in group B clusters, and 889 in group C clusters. Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group (odds ratio [OR] for micronutrient powder without zinc=0·20, 95% CI 0·11-0·36; OR for micronutrient powder with zinc=0·25, 95% CI 0·14-0·44). Compared with the control group, children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm (95% CI 0·03-0·59) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm (0·29-0·84). We recorded strong evidence of an increased proportion of days with diarrhoea (p=0·001) and increased incidence of bloody diarrhoea (p=0·003) between 6 and 18 months in the two micronutrient powder groups, and reported chest indrawing (p=0·03). Incidence of febrile episodes or admission to hospital for diarrhoea, respiratory problems, or febrile episodes did not differ between the three groups. INTERPRETATION Use of micronutrient powders reduces iron-deficiency anaemia in young children. However, the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in populations with malnourished children and high diarrhoea burdens. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sajid Soofi
- Department of Paediatrics and Child Health, Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013; 346:f3443. [PMID: 23794316 PMCID: PMC3689887 DOI: 10.1136/bmj.f3443] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes; and to evaluate potential exposure-response relations of dose of iron, duration of use, and haemoglobin concentration in prenatal period with pregnancy outcomes. DESIGN Systematic review and meta-analysis DATA SOURCES Searches of PubMed and Embase for studies published up to May 2012 and references of review articles. STUDY SELECTION CRITERIA Randomised trials of prenatal iron use and prospective cohort studies of prenatal anaemia; cross sectional and case-control studies were excluded. RESULTS 48 randomised trials (17 793 women) and 44 cohort studies (1 851 682 women) were included. Iron use increased maternal mean haemoglobin concentration by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59), iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to 0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort studies showed a significantly higher risk of low birth weight (adjusted odds ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in the first or second trimester. Exposure-response analysis indicated that for every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trend<0.001). Birth weight increased by 15.1 (6.0 to 24.2) g (P for linear trend=0.005) and risk of low birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg increase in dose/day (P for linear trend<0.001). Duration of use was not significantly associated with the outcomes after adjustment for dose. Furthermore, for each 1 g/L increase in mean haemoglobin, birth weight increased by 14.0 (6.8 to 21.8) g (P for linear trend=0.002); however, mean haemoglobin was not associated with the risk of low birth weight and preterm birth. No evidence of a significant effect on duration of gestation, small for gestational age births, and birth length was noted. CONCLUSIONS Daily prenatal use of iron substantially improved birth weight in a linear dose-response fashion, probably leading to a reduction in risk of low birth weight. An improvement in prenatal mean haemoglobin concentration linearly increased birth weight.
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Affiliation(s)
- Batool A Haider
- Departments of Epidemiology and Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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Collins N, Schnitzer A. Nutrition 411: understanding iron deficiency and anemia. Ostomy Wound Manage 2013; 59:12-16. [PMID: 23749658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Zielińska-Dawidziak M, Hertig I, Piasecka-Kwiatkowska D, Staniek H, Nowak KW, Twardowski T. Study on iron availability from prepared soybean sprouts using an iron-deficient rat model. Food Chem 2012; 135:2622-7. [PMID: 22980850 DOI: 10.1016/j.foodchem.2012.06.113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/02/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022]
Abstract
During soya seeds germination in FeSO(4) solutions their phytoferritin content is multiplied. Prepared soybean sprouts have been proposed as a safe and easily available source of iron supplementation. The preparation was compared with FeSO(4) and ferritin isolates, using rats with induced iron deficiency anaemia. After the end of the 2-week supplementation experiment, it was observed that no statistically significant differences in haemoglobin concentration, mean corpuscular volume, mean corpuscular haemoglobin, and mean corpuscular haemoglobin concentration existed between those animals supplemented with sprouts enriched in ferritin, ferritin isolate and FeSO(4) and healthy animals forming the control group. Moreover, the examined preparation had a beneficial influence on the recreation of ferritin reserves in both the liver and the blood serum, and also did not induce negative alterations in general growth parameters of animals. Use of an easily obtainable ferritin iron source may be a profitable alternative in supplementation due to its wide availability and food preservative properties.
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Affiliation(s)
- Magdalena Zielińska-Dawidziak
- Department of Food Biochemistry and Analysis, Poznan University of Life Sciences, Mazowiecka 48, 60-623 Poznań, Poland.
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Cediel G, Olivares M, Gaitán D, Flores S, Brito A, Pizarro F. Effect of trypsin and mucin on heme iron bioavailability in humans. Biol Trace Elem Res 2012; 150:37-41. [PMID: 23011661 DOI: 10.1007/s12011-012-9483-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/27/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED In the human gastrointestinal tract, trypsin and mucin may affect the absorption of heme iron. However, these interactions have not been well-established. We determined the effect of trypsin and mucin on heme iron absorption in humans. DESIGN Twenty-eight apparently healthy females participated in two studies (14 per study). Study A evaluated the effect of trypsin on iron bioavailability. Subjects ingested 100 mg trypsin and 1.7 g mucin on 5 mg heme iron bioavailability on days 1, 2, 14, and 15, respectively. In study B, which assessed the effect of mucin on heme iron bioavailability, the subjects ingested hemin, hemin plus mucin, hemoglobin (Hb), and Hb plus mucin, on days 1, 2, 14, and 15, respectively. RESULTS In study A, the geometric means ± 1 SD of heme iron absorption were 5.1 % (3.1-8.3), 2.9 % (1.6-5.1), 7.3 % (4.1-13.1), and 6 % (2.7-13) for hemin, hemin plus trypsin, Hb plus trypsin, and Hb plus mucin plus trypsin, respectively. In study B, the geometric means ± 1 SD of heme iron absorption were 16.4 % (10.5-25.7), 13.1 % (9.0-18.9), 13.7 % (9.0-20.7), and 11.8 % (7.6-18.3) for hemin, hemin plus mucin, Hb, and Hb plus mucin, respectively. The ratio increased when Hb plus trypsin was ingested and decreased when hemin plus trypsin was ingested. There were no differences in other ratios with respect to the ratio on day 1 (P < 0.05). CONCLUSION Trypsin is the only human gastrointestinal protein that evaluated the affects of heme iron absorption. However, this effect depends on how heme iron is ingested.
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Affiliation(s)
- Gustavo Cediel
- Micronutrients Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Avda El Líbano 5524, Casilla 13811, Santiago, Chile
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Bucca C, Culla B, Brussino L, Ricciardolo FL, Cicolin A, Heffler E, Bugiani M, Rolla G. Effect of iron supplementation in women with chronic cough and iron deficiency. Int J Clin Pract 2012; 66:1095-100. [PMID: 23067033 DOI: 10.1111/ijcp.12001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Chronic cough is more frequent and severe in women than in men. Women often have decreased iron stores, because of menses and pregnancies. We investigated if iron deficiency has a role in chronic cough by increasing airway sensitivity to inhaled irritants. METHODS Twenty-two non-smoking women with chronic unexplained cough and iron deficiency (serum ferritin below 15 ng/ml) were examined in baseline, after 2 months empiric treatment with anti H1-histaminic drug and proton pump inhibitor, and after iron supplementation (330-660 mg iron sulphate tablets daily) for 2 months. Outcome measures were cough visual analogue scale (VAS), and histamine thresholds of the larynx (PC25MIF50, concentration causing 25% in MIF50), bronchi (PC20FEV1) and cough (PC5cough). RESULTS Mean serum ferritin was 9.3 ng/ml (95% CI 7.7-10.9), 13 patients had mild anaemia. All the patients had laryngeal and cough hyperresponsiveness,12 had also bronchial hyperresponsiveness. Empiric treatment produced no significant effect, whereas iron supplementation improved cough VAS from 4.03 (3.6-4.47) to 2.6 (1.9-3.27), p < 0.0001, PC20FEV1 from 10.04 mg/ml (5.37-18.77) to 22.2 (11.7-41.8), p < 0.001, PC25MIF50 from 3.09 mg/ml (1.9-4.9) to 11.9 (7.3-19.4), p < 0.001 and PC5cough from 2.1 mg/ml (1.2-3.6) to 8.8 (5.2-15.1), p < 0.001. CONCLUSION In women with unexplained chronic cough unresponsive to targeted treatment, airway and cough hyperresponsiveness may be sustained by iron deficiency. Healthy women with chronic cough should be checked for iron deficiency as iron repletion may resolve such disturbing symptom.
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Affiliation(s)
- C Bucca
- Department of Clinical Pathophysiology, Respiratory Pathophysiology Unit, University of Turin, Turin, Italy.
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Krebs NF, Mazariegos M, Chomba E, Sami N, Pasha O, Tshefu A, Carlo WA, Goldenberg RL, Bose CL, Wright LL, Koso-Thomas M, Goco N, Kindem M, McClure EM, Westcott J, Garces A, Lokangaka A, Manasyan A, Imenda E, Hartwell TD, Hambidge KM. Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings. Am J Clin Nutr 2012; 96:840-7. [PMID: 22952176 PMCID: PMC3441111 DOI: 10.3945/ajcn.112.041962] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/03/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested. OBJECTIVE The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal. DESIGN This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion. RESULTS A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ) <-2.0] rates increased from ~33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P < 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group. CONCLUSION The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods.
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Affiliation(s)
- Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver, Aurora, CO 80045, USA.
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Abstract
The resurgence in interest and concern regarding the potentially malign interactions between iron administration and malaria infections, especially in young children and pregnant women, has generated a research agenda that is both broad and deep. This paper highlights some of the key questions under 5 headings: basic science; clinical science and epidemiology; technological developments; country level planning; and global policy. At a time of unparalleled progress in basic science, which is illuminating the mechanisms by which iron interacts with infectious organisms, it is concluded that there are good medium-term prospects for achieving policy breakthroughs based on a secure foundation of disease-nutrient interactions. However, it is also stressed that there is much that can be done in the interim, especially in relation to health systems and implementation research that can empower systems to integrate iron interventions with programs for malaria prevention, surveillance, and treatment.
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Affiliation(s)
- Andrew M Prentice
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
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Abstract
Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas. Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract. Results from 6 home fortification studies in malaria-endemic areas showed no increased risk of morbidity (including malaria), but these studies were not powered to rule out a modest increase in the risk of severe adverse events. At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.
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Affiliation(s)
- Kathryn G Dewey
- Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, Davis, CA, USA.
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Nakajima VM, Costa NMB, Martino HSD, Queiroz VAV, Guimarães PEDO, Oliveira PV. Iron bioavailability of different maize genotypes developed in a breeding program: in vitro and in vivo studies. Arch Latinoam Nutr 2012; 62:103-111. [PMID: 23610896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to evaluate iron bioavailability of maize genotypes, and analyze the correlation between in vitro and in vivo methods. Dialysable iron was analyzed in 13 genotypes from which 5 were selected for the biological assay. Mean iron content of the genotypes (n = 13) was 17.93 +/- 2.93 mg kg(-1). Phytate varied from 0.77% to 1.03%; phytate: iron molar ratio from 30.64 to 55.41; and soluble iron from 13.17 to 39.63%. The highest value for dialysable iron was 19.14%. In the biological assay, the control group, that received ferrous sulphate, did not present significant difference between the genotypes for Hb gain, Hb gain per gram of iron consumed and HRE. Hb gain did not present a significant correlation with in vitro assay. However, there were positive correlations varying from 0.653 to 0.809. The maize genotypes evaluated presented a good bioavailability since the genotypes showed the same result in hemoglobin gain than control group.
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Rafat D, Rabbani TK, Ahmad J, Ansari MA. Influence of iron metabolism indices on HbA1c in non-diabetic pregnant women with and without iron-deficiency anemia: effect of iron supplementation. Diabetes Metab Syndr 2012; 6:102-105. [PMID: 23153978 DOI: 10.1016/j.dsx.2012.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Condition that influence erythrocyte turnover also affect HbA1c. Although many forms of anemia are associated with lowering of HbA1c, iron-deficiency anemia (IDA) tends to increase HbA1c. In this study, we examined the relationship between HbA1c and erythrocyte indices in non-diabetic pregnancy and assessed the effect of iron supplementation on HbA1c. MATERIALS AND METHODS 150 women were studied (30 non-diabetic), non-pregnant, non-anemic women in child bearing women with varying parity as controls (Gp 1); 30 non-diabetic, non-anemic pregnant women in first trimester of pregnancy (Gp 2a); 30 non-diabetic, non-anemic pregnant women in second trimester of pregnancy (Gp 2b); 30 non-diabetic, non-anemic pregnant women in third trimester of pregnancy (Gp 2c) and 30 non-diabetic pregnant women with IDA (Gp 2d). HbA1c, OGTT, erythrocyte indices and iron metabolic indices were determined in Gp 2d subjects not supplemented with iron and repeated these indices after 3 months of iron-supplementation. RESULTS The mean fasting and postprandial blood glucose levels (79.9±8.0mg/dl, 108.1±14.1mg/dl) in Gp 1 were found to be significantly lower in first trimester among Gp 2a (74.4±5.3mg/dl and 97.2±11.1mg/dl), in second trimester among Gp 2b (76.2±5.2mg/dl and 103.4±7.9mg/dl) followed by increase in IIIrd trimester among Gp 2c (82.3±5.7mg/dl and 112.5±8.5mg/dl) subjects. A significant difference in HbA1c was also observed among the groups (HbA1c 4.7±0.3% in Gp 1; 4.6±0.4% in Gp 2a; 4.5±0.3 in Gp 2b; 4.7±0.3 in Gp 2c). Among Gp 2d subjects, HbA1c was 5.2±0.3% and the level decreased after iron supplementation to 5.1±0.3%. Significant correlation between erythrocyte indices, iron metabolic indices and HbA1c was also observed. CONCLUSION We conclude that consideration should be given for performing glucose testing in patients with IDA to ascertain the reliability of HbA1c in the diagnosis of diabetes. HbA1c concentrations in diabetic patients with IDA should be interpreted with caution.
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MESH Headings
- Adolescent
- Adult
- Anemia, Iron-Deficiency/blood
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/epidemiology
- Dietary Supplements
- Erythrocyte Indices
- Fasting/blood
- Female
- Glucose Tolerance Test
- Glycated Hemoglobin/metabolism
- Humans
- India/epidemiology
- Iron/administration & dosage
- Maternal-Child Health Centers
- Postprandial Period
- Prediabetic State/blood
- Prediabetic State/diet therapy
- Prediabetic State/epidemiology
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/diet therapy
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Trimester, First
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
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Affiliation(s)
- D Rafat
- Obstetrics and Gynaecology, J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, UP, India
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Tran PV, Fretham SJB, Wobken J, Miller BS, Georgieff MK. Gestational-neonatal iron deficiency suppresses and iron treatment reactivates IGF signaling in developing rat hippocampus. Am J Physiol Endocrinol Metab 2012; 302:E316-24. [PMID: 22068601 PMCID: PMC3287363 DOI: 10.1152/ajpendo.00369.2011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gestational-neonatal iron deficiency, a common micronutrient deficiency affecting the offspring of more than 30% of pregnancies worldwide, leads to long-term cognitive and behavioral abnormalities. Preclinical models of gestational-neonatal iron deficiency result in reduced energy metabolism and expression of genes critical for neuronal plasticity and cognitive function, which are associated with a smaller hippocampal volume and abnormal neuronal dendrite growth. Because insulin-like growth factor (IGF) modulates early postnatal cellular growth, differentiation, and survival, we used a dietary-induced rat model to assess the effects of gestational iron deficiency on activity of the IGF system. We hypothesized that gestational iron deficiency attenuates postnatal hippocampal IGF signaling and results in downstream effects that contribute to hippocampal anatomic and functional deficits. At postnatal day (P) 15 untreated gestational-neonatal iron deficiency markedly suppressed hippocampal IGF activation and protein kinase B signaling, and reduced neurogenesis, while elevating extracellular signal-regulated kinase 1/2 signaling and hypoxia-inducible factor-1α expression. Iron treatment beginning at P7 restored IGF signaling, increased neurogenesis, and normalized all parameters by the end of rapid hippocampal differentiation (P30). Expression of the neuron-specific synaptogenesis marker, disc-large homolog 4 (PSD95), increased more rapidly than the glia-specific myelination marker, myelin basic protein, following iron treatment, suggesting a more robust response to iron therapy in IGF-I-dependent neurons than IGF-II-dependent glia. Collectively, our findings suggest that IGF dysfunction is in part responsible for hippocampal abnormalities in untreated iron deficiency. Early postnatal iron treatment of gestational iron deficiency reactivates the IGF system and promotes neurogenesis and differentiation in the hippocampus during a critical developmental period.
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MESH Headings
- Anemia, Iron-Deficiency/diet therapy
- Anemia, Iron-Deficiency/metabolism
- Anemia, Iron-Deficiency/pathology
- Animals
- Female
- Gene Expression Regulation, Developmental
- Hippocampus/metabolism
- Hippocampus/pathology
- Insulin-Like Growth Factor Binding Protein 3/genetics
- Insulin-Like Growth Factor Binding Protein 3/metabolism
- Insulin-Like Growth Factor I/genetics
- Insulin-Like Growth Factor I/metabolism
- Insulin-Like Growth Factor II/genetics
- Insulin-Like Growth Factor II/metabolism
- Iron, Dietary/administration & dosage
- Iron, Dietary/therapeutic use
- Lactation
- Male
- Maternal Nutritional Physiological Phenomena
- Neurogenesis
- Neurons/metabolism
- Pregnancy
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptor, IGF Type 1/genetics
- Receptor, IGF Type 1/metabolism
- Receptor, Insulin/genetics
- Receptor, Insulin/metabolism
- Signal Transduction
- Somatomedins/genetics
- Somatomedins/metabolism
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Affiliation(s)
- Phu V Tran
- Center for Neurobehavioral Development, University of Minnesota, Minneapolis MN, USA.
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Barbosa TNN, Taddei JADAC, Palma D, Ancona-Lopez F, Braga JAP. Double-blind randomized controlled trial of rolls fortified with microencapsulated iron. Rev Assoc Med Bras (1992) 2012; 58:118-124. [PMID: 22392326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/16/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the impact of the fortification of rolls with microencapsulated iron sulfate with sodium alginate on the hemoglobin levels in preschoolers as compared to controls. METHODS Double-blind randomized controlled trial comprised of children aged 2 to 6 years with initial hemoglobin exceeding 9 g/dL from four not-for-profit daycares randomly selected in the city of São Paulo - Brazil. Children of 2 daycares (n = 88) received rolls with fortified wheat flour as the exposed group (EC) and children of 2 daycares (n = 85) received rolls without fortification as the control group (CG) over a 24-week period. Rolls with 4 mg iron each were offered once a day, five days a week. Hemoglobin concentrations were determined in capillary blood by HemoCue® at three moments of trial: baseline (Ml), after 12 and 24 weeks of intervention (M2, M3). RESULTS Hemoglobin concentration presented significant increase up to M3 in EG (11.7-12.5-12.6 g/dL) and in CG (11.1-12.4-12.3 g/dL) with higher elevations in children initially with anemia. There was significant reduction in the occurrence of anemia from 22% to 9% in EG and from 47% to 8.2% in CG at M3. CONCLUSION Rolls fortified with microencapsulated iron sulfate were well tolerated, increased hemoglobin levels and reduced the occurrence of anemia, but with no difference compared to the control group.
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50
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Nagata JM, Gatti LR, Barg FK. Social determinants of iron supplementation among women of reproductive age: a systematic review of qualitative data. Matern Child Nutr 2012; 8:1-18. [PMID: 21978181 PMCID: PMC6860632 DOI: 10.1111/j.1740-8709.2011.00338.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Iron supplementation for women of reproductive age is a main part of an interdisciplinary strategy recommended for the control and prevention of iron deficiency and the treatment of mild-to-moderate iron-deficiency anaemia. This systematic review reports the findings from a meta-synthesis of qualitative data concerning the experiences and perceptions of iron supplementation among women of reproductive age and health service providers worldwide. Qualitative systematic review methods were used to conduct a search of published literature, define inclusion and exclusion criteria, appraise quality of studies and extract data on the use of iron supplementation among women of reproductive age. Coding, thematic analysis, reciprocal translation and line of argument synthesis were used to synthesize data. Twelve studies spanning 17 countries met inclusion criteria and were included in the analysis. Seven domains emerged from the review: cultural norms and societal values including explanatory models and medical pluralism; political and socio-economic circumstances; education and communication; social organization and social relationships; health care access and supplement supply; food and nutrition availability; and adherence. In addition, 16 sub-domains are highlighted. Connecting review findings to a conceptual framework of social determinants of health highlights salient issues that policy makers must consider when adapting global iron supplementation recommendations to the local context.
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Affiliation(s)
- Jason M Nagata
- School of Medicine, University of California, San Francisco, California 94122, USA.
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