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Faustino M, Lourenço T, Strobbe S, Cao D, Fonseca A, Rocha I, Van Der Straeten D, Oliveira MM. Mathematical kinetic modelling followed by in vitro and in vivo assays reveal the bifunctional rice GTPCHII/DHBPS enzymes and demonstrate the key roles of OsRibA proteins in the vitamin B2 pathway. BMC PLANT BIOLOGY 2024; 24:220. [PMID: 38532321 DOI: 10.1186/s12870-024-04878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Riboflavin is the precursor of several cofactors essential for normal physical and cognitive development, but only plants and some microorganisms can produce it. Humans thus rely on their dietary intake, which at a global level is mainly constituted by cereals (> 50%). Understanding the riboflavin biosynthesis players is key for advancing our knowledge on this essential pathway and can hold promise for biofortification strategies in major crop species. In some bacteria and in Arabidopsis, it is known that RibA1 is a bifunctional protein with distinct GTP cyclohydrolase II (GTPCHII) and 3,4-dihydroxy-2-butanone-4-phosphate synthase (DHBPS) domains. Arabidopsis harbors three RibA isoforms, but only one retained its bifunctionality. In rice, however, the identification and characterization of RibA has not yet been described. RESULTS Through mathematical kinetic modeling, we identified RibA as the rate-limiting step of riboflavin pathway and by bioinformatic analysis we confirmed that rice RibA proteins carry both domains, DHBPS and GTPCHII. Phylogenetic analysis revealed that OsRibA isoforms 1 and 2 are similar to Arabidopsis bifunctional RibA1. Heterologous expression of OsRibA1 completely restored the growth of the rib3∆ yeast mutant, lacking DHBPS expression, while causing a 60% growth improvement of the rib1∆ mutant, lacking GTPCHII activity. Regarding OsRibA2, its heterologous expression fully complemented GTPCHII activity, and improved rib3∆ growth by 30%. In vitro activity assays confirmed that both OsRibA1 and OsRibA2 proteins carry GTPCHII/DHBPS activities, but that OsRibA1 has higher DHBPS activity. The overexpression of OsRibA1 in rice callus resulted in a 28% increase in riboflavin content. CONCLUSIONS Our study elucidates the critical role of RibA in rice riboflavin biosynthesis pathway, establishing it as the rate-limiting step in the pathway. By identifying and characterizing OsRibA1 and OsRibA2, showcasing their GTPCHII and DHBPS activities, we have advanced the understanding of riboflavin biosynthesis in this staple crop. We further demonstrated that OsRibA1 overexpression in rice callus increases its riboflavin content, providing supporting information for bioengineering efforts.
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Affiliation(s)
- Maria Faustino
- Laboratory of Plant Functional Genomics, Instituto de Tecnologia Química E Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K. L. Ledeganckstraat 35, Gent, B-9000, Belgium
| | - Tiago Lourenço
- Laboratory of Plant Functional Genomics, Instituto de Tecnologia Química E Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal
| | - Simon Strobbe
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K. L. Ledeganckstraat 35, Gent, B-9000, Belgium
- University of Geneva, Quai E. Ansermet 30, Geneva, 1211, Switzerland
| | - Da Cao
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K. L. Ledeganckstraat 35, Gent, B-9000, Belgium
| | - André Fonseca
- Laboratory of Systems and Synthetic Biology, Instituto de Tecnologia Química E Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal
| | - Isabel Rocha
- Laboratory of Systems and Synthetic Biology, Instituto de Tecnologia Química E Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal
| | - Dominique Van Der Straeten
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K. L. Ledeganckstraat 35, Gent, B-9000, Belgium.
| | - M Margarida Oliveira
- Laboratory of Plant Functional Genomics, Instituto de Tecnologia Química E Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal.
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Finkelstein JL, Fothergill A, Venkatramanan S, Layden AJ, Williams JL, Crider KS, Qi YP. Vitamin B12 supplementation during pregnancy for maternal and child health outcomes. Cochrane Database Syst Rev 2024; 1:CD013823. [PMID: 38189492 PMCID: PMC10772977 DOI: 10.1002/14651858.cd013823.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Vitamin B12 deficiency is a major public health problem worldwide, with the highest burden in elderly people, pregnant women, and young children. Due to its role in DNA synthesis and methylation, folate metabolism, and erythropoiesis, vitamin B12 supplementation during pregnancy may confer longer-term benefits to maternal and child health outcomes. OBJECTIVES To evaluate the benefits and harms of oral vitamin B12 supplementation during pregnancy on maternal and child health outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) on 2 June 2023, and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-RCTs, or cluster-RCTs evaluating the effects of oral vitamin B12 supplementation compared to placebo or no vitamin B12 supplementation during pregnancy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Four review authors independently assessed trial eligibility. Two review authors independently extracted data from included studies and conducted checks for accuracy. Three review authors independently assessed the risk of bias of the included studies using the Cochrane RoB 1 tool. We used GRADE to evaluate the certainty of evidence for primary outcomes. MAIN RESULTS The review included five trials with 984 pregnant women. All trials were conducted in low- and middle-income countries, including India, Bangladesh, South Africa, and Croatia. At enrolment, 26% to 51% of pregnant women had vitamin B12 deficiency (less than 150 pmol/L), and the prevalence of anaemia (haemoglobin less than 11.0 g/dL) ranged from 30% to 46%. The dosage of vitamin B12 supplementation varied from 5 μg/day to 250 μg/day, with administration beginning at 8 to 28 weeks' gestation through to delivery or three months' postpartum, and the duration of supplementation ranged from 8 to 16 weeks to 32 to 38 weeks. Three trials, involving 609 pregnant women, contributed data for meta-analyses of the effects of vitamin B12 supplementation compared to placebo or no vitamin B12 supplementation. Maternal anaemia: there may be little to no difference for maternal anaemia by intervention group, but the evidence is very uncertain (70.9% versus 65.0%; risk ratio (RR) 1.08, 95% confidence interval (CI) 0.93 to 1.26; 2 trials, 284 women; very low-certainty evidence). Maternal vitamin B12 status: vitamin B12 supplementation during pregnancy may reduce the risk of maternal vitamin B12 deficiency compared to placebo or no vitamin B12 supplementation, but the evidence is very uncertain (25.9% versus 67.9%; RR 0.38, 95% CI 0.28 to 0.51; 2 trials, 272 women; very low-certainty evidence). Women who received vitamin B12 supplements during pregnancy may have higher total vitamin B12 concentrations compared to placebo or no vitamin B12 supplementation (mean difference (MD) 60.89 pmol/L, 95% CI 40.86 to 80.92; 3 trials, 412 women). However, there was substantial heterogeneity (I2 = 85%). Adverse pregnancy outcomes: the evidence is uncertain about the effect on adverse pregnancy outcomes, including preterm birth (RR 0.97, 95% CI 0.55 to 1.74; 2 trials, 340 women; low-certainty evidence), and low birthweight (RR 1.50, 95% CI 0.93 to 2.43; 2 trials, 344 women; low-certainty evidence). Two trials reported data on spontaneous abortion (or miscarriage); however, the trials did not report quantitative data for meta-analysis and there was no clear definition of spontaneous abortion in the study reports. No trials evaluated the effects of vitamin B12 supplementation during pregnancy on neural tube defects. Infant vitamin B12 status: children born to women who received vitamin B12 supplementation had higher total vitamin B12 concentrations compared to placebo or no vitamin B12 supplementation (MD 71.89 pmol/L, 95% CI 20.23 to 123.54; 2 trials, 144 children). Child cognitive outcomes: three ancillary analyses of one trial reported child cognitive outcomes; however, data were not reported in a format that could be included in quantitative meta-analyses. In one study, maternal vitamin B12 supplementation did not improve neurodevelopment status (e.g. cognitive, language (receptive and expressive), motor (fine and gross), social-emotional, or adaptive (conceptual, social, practical) domains) in children compared to placebo (9 months, Bayley Scales of Infant and Toddler Development Third Edition (BSID-III); 1 trial; low-certainty evidence) or neurophysiological outcomes (72 months, event-related potential measures; 1 trial; low-certainty evidence), though children born to women who received vitamin B12 supplementation had improved expressive language domain compared to placebo (30 months, BSID-III; 1 trial; low-certainty evidence). AUTHORS' CONCLUSIONS Oral vitamin B12 supplementation during pregnancy may reduce the risk of maternal vitamin B12 deficiency and may improve maternal vitamin B12 concentrations during pregnancy or postpartum compared to placebo or no vitamin B12 supplementation, but the evidence is very uncertain. The effects of vitamin B12 supplementation on other primary outcomes assessed in this review were not reported, or were not reported in a format for inclusion in quantitative analyses. Vitamin B12 supplementation during pregnancy may improve maternal and infant vitamin B12 status, but the potential impact on longer-term clinical and functional maternal and child health outcomes has not yet been established.
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Affiliation(s)
| | - Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Alexander J Layden
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abioye AI, Hughes MD, Sudfeld CR, Noor RA, Isanaka S, Lukmanji Z, Mugusi F, Fawzi WW. Dietary Iron Intake and HIV-Related Outcomes Among Adults Initiating Antiretroviral Therapy in Tanzania. J Acquir Immune Defic Syndr 2023; 94:57-65. [PMID: 37199401 PMCID: PMC10524611 DOI: 10.1097/qai.0000000000003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/19/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Anemia is highly prevalent among people living with HIV (PLWHIV) and is often due to iron deficiency. This study evaluated the relationship of dietary iron intake levels and sources with mortality and clinical outcomes among adults initiating HAART. DESIGN We conducted a secondary analysis of a multivitamin supplementation trial among 2293 PLWHIV initiating HAART in Dar es Salaam, Tanzania. METHODS Dietary iron intake was assessed with a food frequency questionnaire at HAART initiation, and participants followed until death or censoring. Total, animal-, and plant-sourced iron were categorized into quartiles. Intake of food groups was categorized into 0-1, 2-3, and ≥4 servings/wk. Cox proportional hazards models estimated hazard ratios for mortality and incident clinical outcomes. RESULTS There were 175 deaths (8%). Red meat intake was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.35 to 0.83), AIDS-related mortality (HR: 0.49; 95% CI: 0.28 to 0.85), and severe anemia (HR: 0.57; 95% CI: 0.35 to 0.91), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Legume intake was a lower risk of associated with all-cause mortality (HR: 0.49; 95% CI: 0.31 to 0.77) and AIDS-related mortality (HR: 0.37; 95% CI: 0.23 to 0.61), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Although total dietary iron and overall plant-sourced iron intake were not associated with the risk of mortality or HIV-related outcomes, the highest quartile of animal-sourced iron intake was associated with a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.35 to 0.90) and a lower risk of AIDS-related mortality (HR: 0.50; 95% CI: 0.30 to 0.90), compared with the lowest quartile. CONCLUSION Intake of iron-rich food groups may be associated with a lower risk of mortality and critical HIV-related outcomes among adults initiating HAART. TRIAL REGISTRATION The parent trial was registered at Clinicaltrials.gov . Identifier: NCT00383669.
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Affiliation(s)
| | | | - Christopher R Sudfeld
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Sheila Isanaka
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Wafaie W Fawzi
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Shalini T, Pullakhandam R, Ghosh S, Kulkarni B, Rajkumar H, Sachdev HS, Kurpad AV, Reddy GB. Prevalence of Vitamin B 12 and Folate Deficiencies in Indian Children and Adolescents. Nutrients 2023; 15:3026. [PMID: 37447351 DOI: 10.3390/nu15133026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Deficiencies of vitamin B12 (B12) and folate (FA) are of particular interest due to their pleiotropic role in 1-carbon metabolism. In addition to adverse birth outcomes, deficiencies of B12 and FA, or an imbalance in FA/B12 status, are linked to metabolic disorders. Indian diets that are predominantly plant food-based could be deficient in these vitamins, but there are no national estimates of the prevalence of B12 and FA deficiency in Indian children and adolescents, nor their associations with age, sex and growth indicators. The recent Comprehensive National Nutrition Survey (CNNS-2016-18) provided estimates of the prevalence of B12 and FA deficiency at the national and state levels among preschool (1-4 years: 9976 and 11,004 children, respectively), school-age children (5-9 years: 12,156 and 14,125) and adolescents (10-19 years: 11,748 and 13,621). Serum B12 and erythrocyte FA were measured by the direct chemiluminescence method and their deficiency was defined using WHO cut-offs. The prevalence of B12 and FA deficiency was high among adolescents (31.0%, CI: 28.7-33.5 and 35.6%, CI: 33.1-8.2) compared to school-age (17.3%, CI: 15.4-19.3 and 27.6%, CI: 25.5-29.9) and preschool children (13.8%, CI: 11.7-16.2 and 22.8%, CI: 20.5-25.2, respectively). The prevalence of both B12 and FA deficiency was significantly higher by 8% and 5%, respectively, in adolescent boys compared to girls. There was no association between anthropometric undernutrition and B12 and FA deficiency. There was wide regional variation in the prevalence of B12 and FA deficiency, but no rural-urban differences were observed across all age groups. The national prevalence of B12 deficiency among preschool or school-age children was <20% (the cut-off that indicates a public health problem). However, FA deficiency in these age groups and both FA and B12 deficiencies in adolescents were >20%, warranting further investigation.
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Affiliation(s)
- Tattari Shalini
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Raghu Pullakhandam
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Santu Ghosh
- St. John's Medical College, Bangalore 560034, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Hemalatha Rajkumar
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Harshpal S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi 110016, India
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Shirode PS, Parekh AD, Patel VV, Vala J, Jaimalani AM, Vora NM, Gummalla V, Patel JS, Shriram N. Early Detection of Subclinical Atherosclerosis: Hyperhomocysteinemia as a Promising Marker in Adolescents With Vitamin B Deficiency. Cureus 2023; 15:e41571. [PMID: 37554588 PMCID: PMC10406394 DOI: 10.7759/cureus.41571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
In recent decades, the increased incidence of cardiovascular disease (CVD) mortality among young adults has raised concerns. Although clinical manifestations of CVD typically occur later in life, the underlying pathological processes emerge early on. This review article summarizes the association between vitamin B deficiency-induced hyperhomocysteinemia and subclinical atherosclerosis in adolescents. Numerous studies have demonstrated that elevated homocysteine levels are an independent risk factor for endothelial dysfunction (ED) and arterial stiffness, which are key contributors to CVD. Notably, vitamin B deficiency, particularly in vitamin B9 and vitamin B12, emerges as a significant factor in childhood hyperhomocysteinemia, initiating the development of subclinical atherosclerosis in early life. A comprehensive review of relevant literature from prominent bibliographic databases, including PubMed/MEDLINE, PubMed Central, Google Scholar, and Cochrane, was performed. Four cross-sectional studies focusing on homocysteine levels as an exposure variable and markers of atherosclerosis as outcome measures were included and reviewed as part of our analysis. The reviewed studies demonstrate a positive correlation between homocysteine levels and markers of atherosclerosis, including increased carotid intima-media thickness (CIMT) and ED. Mainly, adolescents with vitamin B12 deficiency exhibit a significant positive correlation between homocysteine levels and CIMT. These findings underscore the potential of hyperhomocysteinemia as an early marker for detecting subclinical atherosclerosis in adolescents with vitamin B deficiency. Despite limited research in this area, recognizing the importance of early detection and management of subclinical atherosclerosis in adolescents can help mitigate the risk of severe cardiovascular events such as myocardial infarction and stroke in young adulthood.
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Affiliation(s)
- Parth S Shirode
- Pediatrics, Terna Speciality Hospital & Research Centre, Navi Mumbai, IND
| | - Anjali D Parekh
- Pediatrics, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Vishwa V Patel
- Internal Medicine, Pramukhswami Medical College, Anand, IND
| | - Janmay Vala
- Internal Medicine, Terna Speciality Hospital & Research Centre, Navi Mumbai, IND
| | - Aniket M Jaimalani
- Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Nilofar M Vora
- Pediatrics, Terna Speciality Hospital & Research Centre, Navi Mumbai, IND
| | - Vaishnavi Gummalla
- Internal Medicine, Gandhi Institute of Technology and Management (GITAM) Institute of Medical Sciences and Research, Visakhapatnam, IND
| | | | - Nikitha Shriram
- Internal Medicine, Terna Speciality Hospital & Research Centre, Navi Mumbai, IND
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Gebretsadik GG, Tadesse Z, Ambese TY, Mulugeta A. Trends in and predictors of animal source food consumption among 6-23 months age children in Tigrai, Northern Ethiopia: evidence from three consecutive ethiopian demographic and health surveys, EDHS 2005-2016. BMC Nutr 2023; 9:43. [PMID: 36890578 PMCID: PMC9996887 DOI: 10.1186/s40795-023-00699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Despite numerous interventions, child undernutrition continues as a problem of global concern. Although consumption of animal source foods has shown positive associations with child undernutrition, no much evidence exists on its trends and predictors among children in Tigrai. OBJECTIVES This study aimed to investigate the trends in and predictors of consumption of animal source foods among children 6-23 months of age in Tigrai. METHODOLOGY This study used complex data of 756 children extracted from three consecutive Ethiopian Demographic and Health Surveys. Data were analyzed using STATA 14.0 by accounting for sampling weight and cluster and strata variables. Multivariable logistic regression was used to determine the independent predictors of animal source foods consumption. Odds ratio and 95% confidence interval were used to measure strength of association at a statistical significance of p < 0.05. RESULTS Although statistically not significant (p-trend = 0.28), animal source foods consumption increased from 31.3% to 2005 through 35.9% in 2011 to 41.5% in 2016. For every month increase in the age of a child, a 9% increment in the odds of animal source food consumption was observed. Muslim children showed 3.1 times higher odds of animal source food consumption than Orthodox Christians. The likelihood of animal source foods consumption were 33% lower among children born to mothers who didn't attend formal education as compared to their counterparts. A unit increase in the number of household assets and number of livestock led to a 20% and 2% increase in the odds of animal source foods consumption, respectively. CONCLUSION Animal source foods consumption showed a statistically non-significant increase over the three consecutive Ethiopian Demographic and Health Surveys. This study found out that consumption of animal source foods might be increased through pro-maternal education policies, programs with household asset increasing schemes, and pro-livestock projects. Our study also highlighted the need for considering religion as one important player when planning or undertaking ASF programs.
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Affiliation(s)
| | - Zuriyash Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tesfay Yohannes Ambese
- Department of Public Health Surveillance, Ethiopian Public Health Institute Tigrai Branch, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Csölle I, Felső R, Szabó É, Metzendorf MI, Schwingshackl L, Ferenci T, Lohner S. Health outcomes associated with micronutrient-fortified complementary foods in infants and young children aged 6–23 months: a systematic review and meta-analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:533-544. [PMID: 35753314 PMCID: PMC9279162 DOI: 10.1016/s2352-4642(22)00147-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Background Appropriate feeding of infants and young children is essential for healthy growth and the prevention of stunting, wasting, and overweight. We aimed to assess the beneficial versus harmful effects of providing fortified complementary foods to children in the complementary feeding period. Methods In this systematic review and meta-analysis, we searched the databases Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, Web of Science, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to March 9, 2021. We included randomised controlled trials and controlled clinical trials done in infants and children aged 6–23 months with no identified health problems. Consumption of foods fortified centrally (ie, during industrial processing) with one micronutrient or a combination of vitamins, minerals, or both was compared with the same complementary foods, but without micronutrient fortification. Two review authors independently screened studies for eligibility, extracted data, assessed risk of bias, and rated the certainty of the evidence. The main outcomes were growth (measured by Z scores for weight for age, weight for height or length, and height or length for age, or other growth measures), stunting, wasting, nutrient adequacy or excess, anaemia, haemoglobin concentration, iron status, serum zinc concentration, and serum retinol concentration. We used a random-effects meta-analysis for combining data. This study is registered with PROSPERO, CRD42021245876. Findings We included 16 studies with 6423 participants, 13 of which were done in malaria-endemic areas. Overall, 12 studies were included in the quantitative syntheses. We identified five further ongoing studies. There was no difference between participants who received fortified complementary foods and those who received non-fortified complementary foods in weight-for-age Z scores (mean difference −0·01, 95% CI −0·07 to 0·06; five trials; 1206 participants; moderate-certainty evidence), weight-for-height or length Z scores (−0·05, −0·19 to 0·10; four trials; 1109 participants; moderate-certainty evidence), and height or length-for-age Z scores (−0·01, −0·21 to 0·20; four trials; 811 participants; low-certainty evidence); stunting and wasting were not assessed in any study as outcomes. Moderate-certainty evidence from six trials with 1209 patients showed that providing fortified complementary foods to children aged 6–23 months reduced the risk of anaemia (risk ratio 0·57, 95% CI 0·39 to 0·82). Those who received fortified complementary foods compared with those who did not had higher haemoglobin concentrations (mean difference 3·44 g/L, 95% CI 1·33 to 5·55; 11 trials; 2175 participants; moderate-certainty evidence) and ferritin concentration (0·43 μg/L on log scale, 0·14 to 0·72; six trials; 903 participants; low-certainty evidence). The intervention led to no effects on serum zinc concentration (−0·13 g/dL, −0·82 to 0·56; two trials; 333 participants; low-certainty evidence) and serum retinol concentration (0·03 μmol/L, −0·02 to 0·08; five trials; 475 participants; moderate-certainty evidence). Interpretation Fortified complementary foods are effective strategies to prevent anaemia in infants and young children aged 6–23 months in malaria-endemic regions. Effects of complementary food fortification should be further investigated in low-income and middle-income countries, but should also be assessed in high-income countries, and in regions where malaria is not endemic. Funding WHO.
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Font-i-Furnols M, Guerrero L. Understanding the future meat consumers. Meat Sci 2022; 193:108941. [DOI: 10.1016/j.meatsci.2022.108941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
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Dhillon P, Sahoo H, Usman M, Srivastava A, Agrawal PK, Johnston R, Unisa S. Status and correlates of micronutrient deficiencies in slum and non-slum areas of India's four metropolitan cities: Investigation from CNNS. Soc Sci Med 2022; 309:115259. [DOI: 10.1016/j.socscimed.2022.115259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/24/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
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Spacova I, Ahannach S, Breynaert A, Erreygers I, Wittouck S, Bron PA, Van Beeck W, Eilers T, Alloul A, Blansaer N, Vlaeminck SE, Hermans N, Lebeer S. Spontaneous Riboflavin-Overproducing Limosilactobacillus reuteri for Biofortification of Fermented Foods. Front Nutr 2022; 9:916607. [PMID: 35757245 PMCID: PMC9218631 DOI: 10.3389/fnut.2022.916607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/19/2022] [Indexed: 12/19/2022] Open
Abstract
Riboflavin-producing lactic acid bacteria represent a promising and cost-effective strategy for food biofortification, but production levels are typically insufficient to support daily human requirements. In this study, we describe the novel human isolate Limosilactobacillus reuteri AMBV339 as a strong food biofortification candidate. This strain shows a high natural riboflavin (vitamin B2) overproduction of 18.36 μg/ml, biomass production up to 6 × 1010 colony-forming units/ml (in the typical range of model lactobacilli), and pH-lowering capacities to a pH as low as 4.03 in common plant-based (coconut, soy, and oat) and cow milk beverages when cultured up to 72 h at 37°C. These properties were especially pronounced in coconut beverage and butter milk fermentations, and were sustained in co-culture with the model starter Streptococcus thermophilus. Furthermore, L. reuteri AMBV339 grown in laboratory media or in a coconut beverage survived in gastric juice and in a simulated gastrointestinal dialysis model with colon phase (GIDM-colon system) inoculated with fecal material from a healthy volunteer. Passive transport of L. reuteri AMBV339-produced riboflavin occurred in the small intestinal and colon stage of the GIDM system, and active transport via intestinal epithelial Caco-2 monolayers was also demonstrated. L. reuteri AMBV339 did not cause fecal microbiome perturbations in the GIDM-colon system and inhibited enteric bacterial pathogens in vitro. Taken together, our data suggests that L. reuteri AMBV339 represents a promising candidate to provide riboflavin fortification of plant-based and dairy foods, and has a high application potential in the human gastrointestinal tract.
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Affiliation(s)
- Irina Spacova
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Sarah Ahannach
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Annelies Breynaert
- Natural Products and Food Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Isabel Erreygers
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Stijn Wittouck
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Peter A Bron
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Wannes Van Beeck
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Tom Eilers
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Abbas Alloul
- Research Group of Sustainable Energy, Air and Water Technology, Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Naïm Blansaer
- Research Group of Sustainable Energy, Air and Water Technology, Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Siegfried E Vlaeminck
- Research Group of Sustainable Energy, Air and Water Technology, Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Nina Hermans
- Natural Products and Food Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Research Group Environmental Ecology and Applied Microbiology (ENdEMIC), Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
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Peterson CB, Mitloehner FM. Sustainability of the Dairy Industry: Emissions and Mitigation Opportunities. FRONTIERS IN ANIMAL SCIENCE 2021. [DOI: 10.3389/fanim.2021.760310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Dairy cattle provide a major benefit to the world through upcycling human inedible feedstuffs into milk and associated dairy products. However, as beneficial as this process has become, it is not without potential negatives. Dairy cattle are a source of greenhouse gases through enteric and waste fermentation as well as excreting nitrogen emissions through their feces and urine. However, these negative impacts vary widely due to how and what these animals are fed. In addition, there are many promising opportunities for further reducing emissions through feed and waste additives. The present review aims to further expand on where the industry is today and the potential avenues for improvement. This area of research is still not complete and additional information is required to further improve our dairy systems impact on sustainable animal products.
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Wang D, Shinde S, Young T, Fawzi WW. Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2021; 11:04051. [PMID: 34552720 PMCID: PMC8442580 DOI: 10.7189/jogh.11.04051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background School feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs. Methods Interventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible. Results Fifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001). Conclusions School feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement. Registration PROSPERO ID: CRD42020159003.
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Affiliation(s)
- Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Tara Young
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Ahern MB, Thilsted SH, Kjellevold M, Overå R, Toppe J, Doura M, Kalaluka E, Wismen B, Vargas M, Franz N. Locally-Procured Fish Is Essential in School Feeding Programmes in Sub-Saharan Africa. Foods 2021; 10:foods10092080. [PMID: 34574190 PMCID: PMC8466277 DOI: 10.3390/foods10092080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Fish make an important contribution to micronutrient intake, long-chained polyunsaturated omega-3 fatty acids (n-3 LC-PUFAS), and animal protein, as well as ensuring food and nutrition security and livelihoods for fishing communities. Micronutrient deficiencies are persistent in sub-Saharan Africa (SSA), contributing to public health issues not only in the first 1000 days but throughout adolescence and into adulthood. School feeding programs (SFPs) and home-grown school feeding programs (HGSF), which source foods from local producers, particularly fisherfolk, offer an entry point for encouraging healthy diets and delivering essential macro- and micronutrients to schoolchildren, which are important for the continued cognitive development of children and adolescents and can contribute to the realization of sustainable development goals (SDGs) 1, 2, 3, 5, and 14. The importance of HGSF for poverty alleviation (SDG1) and zero hunger (SDG 2) have been recognized by the United Nations Hunger Task Force and the African Union Development Agency-New Partnership for African Development (AUDA-NEPAD), which formulated a strategy for HGSF to improve nutrition for the growing youth population across Africa. A scoping review was conducted to understand the lessons learned from SFPs, which included fish and fish products from small-scale producers, identifying the challenges and best practices for the inclusion of fish, opportunities for improvements across the supply chain, and gaps in nutritional requirements for schoolchildren which could be improved through the inclusion of fish. Challenges to the inclusion fish in SFPs include food safety, supply and access to raw materials, organizational capacity, and cost, while good practices include the engagement of various stakeholders in creating and testing fish products, and repurposing fisheries by-products or using underutilized species to ensure cost-effective solutions. This study builds evidence of the inclusion of nutritious fish and fish products in SFPs, highlighting the need to replicate and scale good practices to ensure sustainable, community-centred, and demand-driven solutions for alleviating poverty, malnutrition, and contributing to greater health and wellbeing in adolescence.
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Affiliation(s)
- Molly B. Ahern
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
- Correspondence:
| | | | | | - Ragnhild Overå
- Department of Geography, University of Bergen, 5007 Bergen, Norway;
| | - Jogeir Toppe
- Sub-Regional Office for Mesoamerica, Food and Agriculture Organization of the United Nations (FAO), Panama City 32408, Panama;
| | - Michele Doura
- School-Based Programmes Unit, World Food Programme, 00148 Rome, Italy; (M.D.); (E.K.)
| | - Edna Kalaluka
- School-Based Programmes Unit, World Food Programme, 00148 Rome, Italy; (M.D.); (E.K.)
| | | | - Melisa Vargas
- Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
| | - Nicole Franz
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
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Vora RM, Alappattu MJ, Zarkar AD, Soni MS, Karmarkar SJ, Antony AC. Potential for elimination of folate and vitamin B 12 deficiency in India using vitamin-fortified tea: a preliminary study. BMJ Nutr Prev Health 2021; 4:293-306. [PMID: 34308138 PMCID: PMC8258070 DOI: 10.1136/bmjnph-2020-000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/14/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction The majority of Indian women have a poor dietary folate and vitamin B12 intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea-the second most common beverage worldwide (after water)-is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B12, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India. Methods Women (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate plus either 0.1 mg vitamin B12 (Group-1, n=19) or 0.5 mg vitamin B12 (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared. Results Most women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B12 levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p<0.05) and 6.69 ng/mL (95% CI 3.93 to 9.44, p<0.05), respectively; however, Group-0 experienced an insignificant rise of 1.26 ng/mL (95% CI -4.08 to 0.16). In addition, over one-half and two-thirds of women in Group-1 and Group-2, respectively, exhibited increases in serum vitamin B12 levels over 300 pg/mL. There was also a significant post-interventional increase in the mean haemoglobin concentration in Group-1 of 1.45 g/dL (95% CI 0.64 to 2.26, p=0.002) and Group-2 of 0.79 g/dL (95% CI 0.11 to 1.42, p=0.027), which reflected a bona fide clinical response. Conclusion Tea is an outstanding scalable vehicle for fortification with folate and vitamin B12 in India, and has potential to help eliminate haematological and neurological complications arising from inadequate dietary consumption or absorption of folate and vitamin B12.
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Affiliation(s)
- Ravindra M Vora
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Implementing The Lancet Commission on Global Surgery in India, Sangli, Maharashtra, India
| | - Meryl J Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Apoorva D Zarkar
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Sangli, Maharashtra, India
| | - Mayur S Soni
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Sangli, Maharashtra, India
| | - Santosh J Karmarkar
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Aśok C Antony
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Finkelstein JL, Qi YP, Fothergill A, Crider KS. Vitamin B12 supplementation during pregnancy for maternal and child health outcomes. Hippokratia 2020. [DOI: 10.1002/14651858.cd013823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta GA USA
| | - Amy Fothergill
- Division of Nutritional Sciences; Cornell University; Ithaca New York USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta GA USA
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Xu NN, Yang DT, Zhang BX, Liu JX, Ye JA, Ren DX. Short communication: Influence of intramuscular injection of vitamin B 12 in early-lactation dairy cows on Mozzarella cheese quality and vitamin B 12 stability. J Dairy Sci 2020; 103:9835-9840. [PMID: 32896413 DOI: 10.3168/jds.2020-18568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/04/2020] [Indexed: 01/09/2023]
Abstract
The current study explored the effect of intramuscular injection of vitamin B12 (VB12) in early-lactation dairy cows on subsequent low-moisture part-skim Mozzarella cheese quality and VB12 levels during cheese processing and storage. Twenty-four peripartum dairy cows were blocked based on parity and milk yield and randomly assigned into 2 treatments: basal diet (CON) and basal diet with an intramuscular injection of 10 mg of VB12 per cow per week (VB12). Raw milk was collected to determine VB12 content and then used to make low-moisture part-skim Mozzarella cheese 8 wk after injection. The VB12 content of raw milk and cheese was determined using ultra-performance liquid chromatography coupled with tandem mass spectrometry. We found that VB12 content was significantly increased in milk (15.43 vs. 3.30 ng/mL) and fresh cheese (3.72 ng/g vs. undetectable) from the VB12 group compared with the CON group. However, approximately 70% of VB12 was lost in the whey during cheese making, and no VB12 was detectable in either cheese treatment after 8 wk of storage. Furthermore, no significant differences were observed in fat and protein contents in the cheese between the 2 groups. For cheese color, the b* value increased and the a* value decreased slightly in fresh VB12 cheese. Functional properties of stretchability, flowability, and meltability of VB12 cheese were initially comparable to that of CON cheese, but higher flowability and meltability was observed in VB12 cheese after 8 wk of storage. In summary, intramuscular injection of VB12 in early-lactation dairy cows increases the content of VB12 in milk and fresh cheese with no adverse effect on cheese quality, but substantial VB12 is lost during cheesemaking and declines rapidly during storage.
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Affiliation(s)
- N N Xu
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China
| | - D T Yang
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China
| | - B X Zhang
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China
| | - J X Liu
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China
| | - J A Ye
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China
| | - D X Ren
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou 310058, P.R. China.
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Chaudhuri BP, Ceyssens F, Celen S, Bormans G, Kraft M, Puers R. In-vivo Intradermal Delivery of Co-57 labeled Vitamin B-12, and Subsequent Comparison with Standard Subcutaneous Administration .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1670-1673. [PMID: 31946217 DOI: 10.1109/embc.2019.8857543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vitamin B-12 (cobalamin) deficiency in humans is a worldwide problem emanating from varied causes such as insufficient dietary intake or malabsorption of the micronutrient due to an underlying condition (absence or failure of intrinsic factor, atrophic gastritis, post-operative bariatric surgery, inflammatory bowel disease, cobalt deficiency etc.). As oral supplementation is limited by its bioavailability due to the absorptive property of intrinsic factor, clinicians often prescribe parenteral forms of administration to replenish diminished levels rapidly. The gold standard in parenteral delivery of cobalamin is subcutaneous and/or intramuscular injections. The relatively large molecular size of cobalamin (1355.39 Da) makes passive transdermal patch-based delivery via the stratum corneum quite challenging. Hence, the primary goal of this study is to investigate the feasibility of intradermal (ID) delivery of Vitamin B-12 via an almost painless microneedle injection and subsequent comparison with standard subcutaneous (SC) delivery. This work reports on a custom-made microneedle device built from a commercial insulin needle and it's use to perform ID delivery of Co-57 radiolabeled Vitamin B-12 in-vivo in rabbits. The pharmacokinetic profile and bioavailability were studied and compared with SC delivery. It is the first comprehensive study, to our best knowledge, that compares a micronutrient (eg. Vitamin B-12) delivery via ID and SC routes in-vivo. While the bioavailability for the SC route is found to be slightly higher compared to the ID route (99% vs. 96%), the Tmax for both are almost identical. Thus, ID delivery of Vitamin B-12 using a microneedle injection could be a viable and minimally invasive alternative to existing parenteral options.
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Haileselassie M, Redae G, Berhe G, Henry CJ, Nickerson MT, Tyler B, Mulugeta A. Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study. PLoS One 2020; 15:e0225707. [PMID: 31914130 PMCID: PMC6948827 DOI: 10.1371/journal.pone.0225707] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density. OBJECTIVE Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia. METHODS A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data. RESULTS Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities. CONCLUSIONS Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.
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Affiliation(s)
- Mekonnen Haileselassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia
| | - Getachew Redae
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Carol J. Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michael T. Nickerson
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Bob Tyler
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Alonso S, Dominguez-Salas P, Grace D. The role of livestock products for nutrition in the first 1,000 days of life. Anim Front 2019; 9:24-31. [PMID: 32002271 PMCID: PMC6951902 DOI: 10.1093/af/vfz033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Silvia Alonso
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Paula Dominguez-Salas
- Faculty of Epidemiology and Population Health. London School of Hygiene and Tropical Medicine, London, UK
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Delia Grace
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
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20
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Significance of scavenging chicken production in the rural community of Africa for enhanced food security. WORLD POULTRY SCI J 2019. [DOI: 10.1017/s0043933914000646] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Titcomb TJ, Tanumihardjo SA. Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity. Compr Rev Food Sci Food Saf 2019; 18:1968-1984. [DOI: 10.1111/1541-4337.12491] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Tyler J. Titcomb
- Dept. of Nutritional SciencesUniv. of Wisconsin‐Madison Madison WI 53706 U.S.A
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Impact of Beef and Beef Product Intake on Cognition in Children and Young Adults: A Systematic Review. Nutrients 2019; 11:nu11081797. [PMID: 31382632 PMCID: PMC6722791 DOI: 10.3390/nu11081797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Undernutrition and micronutrient deficiency have been consistently linked to cognitive impairment among children and young adults. As a primary source of dietary animal protein, beef consumption holds the potential to improve diet quality and positively influence cognitive function. This study systematically reviewed evidence linking beef intake to cognition among children and young adults. (2) Methods: A literature search was conducted in seven electronic bibliographic databases for studies assessing the impact of beef consumption on cognition. (3) Results: We identified eight studies reporting results from five unique interventions. Two interventions were conducted in Kenya, two in the U.S. and one in four countries including Guatemala, Pakistan, Democratic Republic of the Congo and Zambia. Only one intervention employed a non-feeding control arm and found beef consumption to improve cognitive abilities compared to the control. However, the other interventions comparing beef consumption to other food types found no consistent result. (4) Conclusions: Evidence pertaining to the impact of beef consumption on cognition remains limited due to the small and heterogeneous set of studies. Future research should adopt a population representative sample and longer follow-up period, employ a non-feeding control arm and comprehensively measure nutrient intakes among study participants.
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Obeid R, Heil SG, Verhoeven MMA, van den Heuvel EGHM, de Groot LCPGM, Eussen SJPM. Vitamin B12 Intake From Animal Foods, Biomarkers, and Health Aspects. Front Nutr 2019; 6:93. [PMID: 31316992 PMCID: PMC6611390 DOI: 10.3389/fnut.2019.00093] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
The EAT-Lancet commission recently suggested that transformation to healthy diets by 2050 will require a reduction of at least 50% in consumption of foods such as red meat and sugar, and a doubling in the global consumption of fruits, vegetables, nuts, and legumes. A diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits. Notably, the risk of vitamin B12 deficiency increases when consuming a diet low in animal products. Humans are dependent on animal foods such as dairy products, meat, fish and eggs. Vitamin B12 deficiency is common worldwide, especially in populations with low consumption of animal foods because of low socioeconomic status, ethical reasons, or because of their lifestyle (i.e., vegans). According to the European Food Safety Authoroty, the recommended adequate intake of vitamin B12 is 4.0 μg/d for adults, and vitamin B12 requirements are higher during pregnancy and lactation. Infants and children from deficient mothers and elderly people are at risk for vitamin B12 deficiency. Diagnosis of vitamin B12 deficiency is hampered by low specificity of available biomarkers, and there is no consensus yet regarding the optimal definition of low vitamin B12 status. In general, a combination of at least two biomarkers is recommended. Therefore, this review presents an overview of vitamin B12 biochemistry and its biomarkers. We further summarize current recommendations of vitamin B12 intake, and evidence on the associations of vitamin B12 intake from different nutrient-dense animal foods with vitamin B12 status markers. Finally, potential consequences of low vitamin B12 status on different health outcomes for pregnant women, infants and elderly are presented.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maxime M A Verhoeven
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Simone J P M Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases Maastricht University, Maastricht, Netherlands
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Mani C, Kochhar P, Ravikumar G, Dwarkanath P, Sheela CN, George S, Thomas A, Crasta J, Thomas T, Kurpad AV, Mukhopadhyay A. Placental expression of ENG, VEGF, and FLT: Gender-specific associations with maternal vitamin B 12 status. Eur J Clin Nutr 2019; 74:176-182. [PMID: 31209272 DOI: 10.1038/s41430-019-0449-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 03/03/2019] [Accepted: 06/03/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Adequate vitamin B12 is a requisite during pregnancy and its deficiency is linked with increased risk for adverse outcomes, likely mediated by impaired placental angiogenesis. Thus, we aimed to test associations of maternal vitamin B12 status with the placental expression of angiogenesis-associated genes ENG, VEGF, and FLT. SUBJECTS/METHODS In this retrospective case-control study, placental and maternal trimester 1 blood samples (n = 104) were collected from small for gestational age (SGA) and appropriate for gestational age (AGA) full-term singleton pregnancies. Maternal trimester 1 vitamin B12 status was measured. Placentae and neonates were weighed at birth. Realtime quantitative PCR was performed to assess placental transcript abundance of ENG, VEGF, and FLT normalized to a panel of reference genes. Associations of placental transcript abundance of the genes with maternal trimester 1 vitamin B12 status were evaluated. RESULTS Placental ENG transcript abundance associated negatively with maternal trimester 1 vitamin B12 status (β = -0.461, P = 0.017, n = 104). This association was specific to the female births (β = -0.590, P = 0.014, n = 60). Placental VEGF transcript levels were negatively associated with maternal trimester 1 vitamin B12 status only in the female births (β = -1.995, P = 0.029). Placental FLT transcript levels were not associated with maternal trimester 1 vitamin B12 status. CONCLUSION Maternal trimester 1 vitamin B12 status was associated negatively with placental ENG and VEGF expression predominantly in the female births. Therefore, we hypothesize that the placenta adapts to low maternal vitamin B12 status by up-regulating angiogenic pathways in a gender-specific manner.
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Affiliation(s)
- C Mani
- Division of Nutrition, St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, India
| | - P Kochhar
- Division of Nutrition, St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, India
| | - G Ravikumar
- Department of Pathology, St John's Medical College Hospital, Bangalore, India
| | - P Dwarkanath
- Division of Nutrition, St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, India
| | - C N Sheela
- Department of Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, India
| | - S George
- Department of Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, India
| | - A Thomas
- Department of Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, India
| | - J Crasta
- Department of Pathology, St John's Medical College Hospital, Bangalore, India
| | - T Thomas
- Department of Biostatistics, St. John's Medical College, St. John's Academy of Health Sciences, Bangalore, India
| | - A V Kurpad
- Division of Nutrition, St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, India
| | - A Mukhopadhyay
- Division of Nutrition, St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, India.
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Adelman S, Gilligan DO, Konde-Lule J, Alderman H. School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda. J Nutr 2019; 149:659-666. [PMID: 30926996 PMCID: PMC6461720 DOI: 10.1093/jn/nxy305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Food for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited. OBJECTIVE This study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children. METHODS Through the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6-17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat. RESULTS Adolescent girls aged 10-13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: -0.43, -0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10-11 y; Hb <12 g/dL, age 12-13 y] and a significant 19.5 percentage point reduction (95% CI: -0.35, -0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: -0.24, -0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6-59 mo by 22.1 percentage points (95% CI: -0.42, -0.02). CONCLUSIONS FFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.
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Affiliation(s)
| | - Daniel O Gilligan
- International Food Policy Research Institute, Washington, DC,Address correspondence to DOG (e-mail: )
| | | | - Harold Alderman
- International Food Policy Research Institute, Washington, DC
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26
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Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H, Raiten DJ. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J Nutr 2018; 148:1995S-2027S. [PMID: 30500928 PMCID: PMC6297555 DOI: 10.1093/jn/nxy201] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/06/2017] [Accepted: 08/02/2018] [Indexed: 12/31/2022] Open
Abstract
This report on vitamin B-12 (B12) is part of the Biomarkers of Nutrition for Development (BOND) Project, which provides state-of-the art information and advice on the selection, use, and interpretation of biomarkers of nutrient exposure, status, and function. As with the other 5 reports in this series, which focused on iodine, folate, zinc, iron, and vitamin A, this B12 report was developed with the assistance of an expert panel (BOND B12 EP) and other experts who provided information during a consultation. The experts reviewed the existing literature in depth in order to consolidate existing relevant information on the biology of B12, including known and possible effects of insufficiency, and available and potential biomarkers of status. Unlike the situation for the other 5 nutrients reviewed during the BOND project, there has been relatively little previous attention paid to B12 status and its biomarkers, so this report is a landmark in terms of the consolidation and interpretation of the available information on B12 nutrition. Historically, most focus has been on diagnosis and treatment of clinical symptoms of B12 deficiency, which result primarily from pernicious anemia or strict vegetarianism. More recently, we have become aware of the high prevalence of B12 insufficiency in populations consuming low amounts of animal-source foods, which can be detected with ≥1 serum biomarker but presents the new challenge of identifying functional consequences that may require public health interventions.
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Affiliation(s)
- Lindsay H Allen
- USDA, Agricultural Research Service Western Human Nutrition Research Center, University of California, Davis, CA
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD
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Layden AJ, Täse K, Finkelstein JL. Neglected tropical diseases and vitamin B12: a review of the current evidence. Trans R Soc Trop Med Hyg 2018; 112:423-435. [PMID: 30165408 DOI: 10.1093/trstmh/try078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/30/2018] [Indexed: 12/15/2022] Open
Abstract
Vitamin B12 deficiency is an urgent public health problem that disproportionately affects individuals in low- and middle-income settings, where the burden of neglected tropical diseases (NTDs) is also unacceptably high. Emerging evidence supports a potential role of micronutrients in modulating the risk and severity of NTDs. However, the role of vitamin B12 in NTD pathogenesis is unknown. This systematic review was conducted to evaluate the evidence on the role of vitamin B12 in the etiology of NTDs. Ten studies were included in this review: one study using an in vitro/animal model, eight observational human studies and one ancillary analysis conducted within an intervention trial. Most research to date has focused on vitamin B12 status and helminthic infections. One study examined the effects of vitamin B12 interventions in NTDs in animal and in vitro models. Few prospective studies have been conducted to date to examine the role of vitamin B12 in NTDs. The limited literature in this area constrains our ability to make specific recommendations. Larger prospective human studies are needed to elucidate the role of vitamin B12 in NTD risk and severity in order to inform interventions in at-risk populations.
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Affiliation(s)
| | - Kristos Täse
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.,St. John's Research Institute, Bangalore, India
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28
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Kujinga P, Borgonjen‐van den Berg KJ, Superchi C, ten Hove HJ, Onyango EO, Andang'o P, Galetti V, Zimmerman MB, Moretti D, Brouwer ID. Combining food-based dietary recommendations using Optifood with zinc-fortified water potentially improves nutrient adequacy among 4- to 6-year-old children in Kisumu West district, Kenya. MATERNAL & CHILD NUTRITION 2018; 14:e12515. [PMID: 28925036 PMCID: PMC6866207 DOI: 10.1111/mcn.12515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 07/09/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
Abstract
Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6 years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.
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Affiliation(s)
- Prosper Kujinga
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | | | - Cecilia Superchi
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | | | | | | | - Valeria Galetti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Michael B. Zimmerman
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Inge D. Brouwer
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
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29
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Antony AC. Evidence for potential underestimation of clinical folate deficiency in resource-limited countries using blood tests. Nutr Rev 2018; 75:600-615. [PMID: 28969365 DOI: 10.1093/nutrit/nux032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children. Of significance, without due consideration of a chronically inadequate dietary folate intake, authors of influential studies have likely wrongly judged these populations to have an adequate folate status. Through repetition, this error has led to a dangerous entry into the contemporary medical literature that folate deficiency is rare in women and children. As a consequence, many millions of under-resourced women and children with mild to moderate tissue folate deficiency may have been deprived of folate replacement. This review uses historical documents to challenge earlier conclusions and re-emphasizes the need for contextual integration of clinical information in resource-limited settings.
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Affiliation(s)
- Asok C Antony
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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30
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Obeid R, Murphy M, Solé-Navais P, Yajnik C. Cobalamin Status from Pregnancy to Early Childhood: Lessons from Global Experience. Adv Nutr 2017; 8:971-979. [PMID: 29141978 PMCID: PMC5683008 DOI: 10.3945/an.117.015628] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Low cobalamin intake and status during pregnancy or lactation have been linked to adverse maternal and perinatal health outcomes, whereas low cobalamin status during early childhood is associated with impaired development in children. Women who begin pregnancy with depleted stores (low or very low plasma cobalamin) will give birth to depleted infants who are likely to develop deficiency symptoms during the first few weeks or months postpartum. Newly ingested cobalamin during pregnancy and lactation (from diet or supplements) is transferred to the child and is not likely to correct cobalamin status in depleted women. The prevalence of low cobalamin status is high especially in low-income settings or in populations with a low intake of animal products. Folate and cobalamin play interdependent roles in one-carbon metabolism. Although folic acid supplementation during early pregnancy is widely recommended and practiced, cobalamin supplementation during pregnancy and lactation has received little attention. Furthermore, the intake recommendations for pregnant and lactating women and in early life need reevaluation in the light of newly available evidence in the field.
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Affiliation(s)
- Rima Obeid
- Aarhus Institute of Advanced Studies, University of Aarhus, Aarhus, Denmark
| | - Michelle Murphy
- Area of Preventive Medicine and Public Health, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Pere Virgili Institute for Health Research, Reus, Spain;,Centros de Investigación Biomédica en Red (CB06/03), Instituto de Salud Carlos III; and
| | - Pol Solé-Navais
- Area of Preventive Medicine and Public Health, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Pere Virgili Institute for Health Research, Reus, Spain
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31
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The potential contribution of yellow cassava to dietary nutrient adequacy of primary-school children in Eastern Kenya; the use of linear programming. Public Health Nutr 2017; 21:365-376. [PMID: 28965533 DOI: 10.1017/s1368980017002506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Introduction of biofortified cassava as school lunch can increase vitamin A intake, but may increase risk of other deficiencies due to poor nutrient profile of cassava. We assessed the potential effect of introducing a yellow cassava-based school lunch combined with additional food-based recommendations (FBR) on vitamin A and overall nutrient adequacy using Optifood (linear programming tool). DESIGN Cross-sectional study to assess dietary intakes (24 h recall) and derive model parameters (list of foods consumed, median serving sizes, food and food (sub)group frequency distributions, food cost). Three scenarios were modelled, namely daily diet including: (i) no school lunch; (ii) standard 5d school lunch with maize/beans; and (iii) 5d school lunch with yellow cassava. Each scenario and scenario 3 with additional FBR were assessed on overall nutrient adequacy using recommended nutrient intakes (RNI). SETTING Eastern Kenya. SUBJECTS Primary-school children (n 150) aged 7-9 years. RESULTS Best food pattern of yellow cassava-based lunch scenario achieved 100 % RNI for six nutrients compared with no lunch (three nutrients) or standard lunch (five nutrients) scenario. FBR with yellow cassava and including small dried fish improved nutrient adequacy, but could not ensure adequate intake of fat (52 % of average requirement), riboflavin (50 % RNI), folate (59 % RNI) and vitamin A (49 % RNI). CONCLUSIONS Introduction of yellow cassava-based school lunch complemented with FBR potentially improved vitamin A adequacy, but alternative interventions are needed to ensure dietary adequacy. Optifood is useful to assess potential contribution of a biofortified crop to nutrient adequacy and to develop additional FBR to address remaining nutrient gaps.
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Finkelstein JL, Kurpad AV, Thomas T, Srinivasan K, Duggan C. Vitamin B 12 status in pregnant women and their infants in South India. Eur J Clin Nutr 2017; 71:1046-1053. [PMID: 28402324 DOI: 10.1038/ejcn.2017.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/19/2016] [Accepted: 02/14/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Vitamin B12 deficiency during pregnancy has been associated with increased risk of adverse perinatal outcomes. However, few studies have investigated the burden and determinants of vitamin B12 status in young infants. This study was conducted to determine the associations between maternal and infant vitamin B12 status. SUBJECTS/METHODS Pregnant women participating in a vitamin B12 supplementation trial in Bangalore, India, were randomized to receive vitamin B12 (50 μg) or placebo supplementation daily during pregnancy through 6 weeks postpartum. All women received 60 mg of iron and 500 μg of folic acid daily during pregnancy, as per standard of care. This prospective analysis was conducted to determine the associations between maternal vitamin B12 biomarkers (that is, plasma vitamin B12, methylmalonic acid (MMA) and tHcy) during each trimester with infant vitamin B12 status (n=77) at 6 weeks of age. RESULTS At baseline (⩽14 weeks of gestation), 51% of mothers were vitamin B12 deficient (vitamin B12<150 pmol/l) and 43% had impaired vitamin B12 status (vitamin B12<150 pmol/l and MMA>0.26 μmol/l); 44% of infants were vitamin B12 deficient at 6 weeks of age. After adjusting for vitamin B12 supplementation, higher vitamin B12 concentrations in each trimester were associated with increased infant vitamin B12 concentrations and lower risk of vitamin B12 deficiency in infants (P<0.05). After adjusting for vitamin B12 supplementation, infants born to women with vitamin B12 deficiency had a twofold greater risk of vitamin B12 deficiency (P<0.01). Higher maternal folate concentrations also predicted lower risk of vitamin B12 deficiency in infants (P<0.05). Impaired maternal vitamin B12 status, which combined both circulating and functional biomarkers, was the single best predictor of infant vitamin B12 status. CONCLUSIONS Impaired maternal vitamin B12 status throughout pregnancy predicted higher risk of vitamin B12 deficiency in infants, after adjusting for vitamin B12 supplementation. Future interventions are needed to improve vitamin B12 status periconceptionally, and to ensure optimal vitamin B12 status and health outcomes in pregnant women and their children.
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Affiliation(s)
- J L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.,Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - A V Kurpad
- Division of Nutrition, St. John's Research Institute, Bangalore, India.,Department of Physiology, St. John's Medical College, Bangalore, India
| | - T Thomas
- Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, India
| | - K Srinivasan
- Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India.,Department of Psychiatry, St. John's Medical College, Bangalore, India
| | - C Duggan
- Division of Nutrition, St. John's Research Institute, Bangalore, India.,Department of Nutrition, Harvard T.H. Chan School of Public Health and Center for Nutrition, Boston Children's Hospital, Boston, MA, USA
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Ferguson E, Chege P, Kimiywe J, Wiesmann D, Hotz C. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 3:6-20. [PMID: 26778799 PMCID: PMC5066654 DOI: 10.1111/mcn.12243] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 01/24/2023]
Abstract
Poor quality infant and young child (IYC) diets contribute to chronic under‐nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food‐based strategies can improve dietary adequacy is required. We collected 24‐h dietary recalls from children 6–23 months of age (n = 401) in two rural agro‐ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food‐based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6–8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12–23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3–5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6–11 and 12–23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level.
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Affiliation(s)
- Elaine Ferguson
- London School of Hygiene and Tropical Medicine, Department of Population Health, London, UK
| | - Peter Chege
- Kenyatta University, Department of Food, Nutrition and Dietetics, Nairobi, Kenya
| | - Judith Kimiywe
- Kenyatta University, Department of Food, Nutrition and Dietetics, Nairobi, Kenya
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Child height gain is associated with consumption of animal-source foods in livestock-owning households in Western Kenya. Public Health Nutr 2016; 20:336-345. [PMID: 27515059 DOI: 10.1017/s136898001600210x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To clarify the pathways between household livestock and child growth by assessing the relationships between consumption of animal-source foods (ASF) and child growth and evaluating the household livestock correlates of child consumption of ASF. DESIGN We conducted a longitudinal cohort study of anthropometry and 3 d feeding recalls among children <5 years old between June 2014 and May 2015. In addition, we collected data on wealth, livestock ownership and livestock diseases in the same households. We used linear and negative binomial mixed models to evaluate the relationships between household livestock characteristics, reported consumption of ASF and child growth. SETTING An 1800-household surveillance catchment area in Western Kenya within the structure of human and animal health surveillance systems. SUBJECTS Children (n 874) <5 years old. RESULTS Among children >6 months old, reported frequency of egg and milk consumption was associated with increased monthly height gain (for each additional report of consumption over 3 d: adjusted β (95 % CI)=0·010 (0·002, 0·019) cm/month and 0·008 (0·004, 0·013) cm/month, respectively). Poultry ownership was associated with higher reported frequency of egg, milk and chicken consumption (adjusted incidence rate ratio (95 % CI)=1·3 (1·2, 1·4), 1·4 (1·1, 1·6) and 1·3 (1·1, 1·4), respectively). Some livestock diseases were associated with lower reported frequency of ASF intake (livestock digestive diseases-adjusted incidence rate ratio (95 % CI)=0·89 (0·78, 1·00)). CONCLUSIONS Child height gain was associated with milk and egg consumption in this cohort. ASF consumption was related to both household livestock ownership and animal health.
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Kupka R. The role of folate in malaria - implications for home fortification programmes among children aged 6-59 months. MATERNAL & CHILD NUTRITION 2015; 11 Suppl 4:1-15. [PMID: 26756732 PMCID: PMC6860232 DOI: 10.1111/mcn.12102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Folic acid and iron supplementation has historically been recommended as the preferred anaemia control strategy among preschoolers in sub-Saharan Africa and other resource-poor settings, but home fortification of complementary foods with multiple micronutrient powders (MNPs) can now be considered the preferred approach. The World Health Organization endorses home fortification with MNPs containing at least iron, vitamin A and zinc to control childhood anaemia, and calls for concomitant malaria control strategies in malaria endemic regions. Among other micronutrients, current MNP formulations generally include 88 μg folic acid (corresponding to 100% of the Recommended Nutrient Intake). The risks and benefits of providing supplemental folic acid at these levels are unclear. The limited data available indicate that folate deficiency may not be a major public health problem among children living in sub-Saharan Africa and supplemental folic acid may therefore not have any benefits. Furthermore, supraphysiological, and possibly even physiological, folic acid dosages may favour Plasmodium falciparum growth, inhibit parasite clearance of sulphadoxine-pyrimethamine (SP)-treated malaria and increase subsequent recrudescence. Even though programmatic options to limit prophylactic SP use or to promote the use of insecticide treated bed nets may render the use of folic acid safer, programmatic barriers to these approaches are likely to persist. Research is needed to characterise the prevalence of folate deficiency among young children worldwide and to design safe MNP and other types of fortification approaches in sub-Sahara Africa. In parallel, updated global guidance is needed for MNP programmes in these regions.
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Affiliation(s)
- Roland Kupka
- UNICEF Regional Office for West and Central AfricaDakarSenegal
- Department of NutritionHarvard School of Public HealthBostonMassachusettesUSA
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36
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Abstract
Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions.
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Affiliation(s)
- Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Patrick J Stover
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
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Kavle JA, El-Zanaty F, Landry M, Galloway R. The rise in stunting in relation to avian influenza and food consumption patterns in Lower Egypt in comparison to Upper Egypt: results from 2005 and 2008 Demographic and Health Surveys. BMC Public Health 2015; 15:285. [PMID: 25884171 PMCID: PMC4405853 DOI: 10.1186/s12889-015-1627-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/09/2015] [Indexed: 11/29/2022] Open
Abstract
Background A 2006 avian influenza (AI) outbreak resulted in mass removal of chickens in Lower Egypt, which decreased the household supply of poultry. Poultry, a key animal-source food, contains nutrients critical for child growth. This paper examines determinants of stunting between 2006 and 2008 in children 6 to 59 months of age within the context of the AI outbreak. Methods The 2005 and 2008 nationally representative Egypt Demographic and Health Surveys (EDHS) were used to analyse anthropometric data from 7,794 children in 2005 and 6,091 children in 2008. Children, 6–59 months of age, with length for age Z-score < −2 S.D. were categorized as stunted. Predictors of stunting were examined by bivariate and multivariable analyses, focusing on Lower Egypt, where a rise in stunting occurred, and Upper Egypt, where stunting declined. Results Between 2005 and 2008, Upper Egypt experienced a significant decline in stunting (28.8 to 21.8%, P < 0.001). Lower Egypt experienced a significant rise in stunting (16.6 to 31.5%, P < 0.001), coinciding with the 2006 AI outbreak. In Lower Egypt (2008), households owning poultry were 41.7% less likely to have a stunted child [aOR 0.58; 95% CI (0.42, 0.81) P = 0.002], and 12–47 month old children were 2.12-2.34 times [95% CI (1.39 – 3.63) P ≤ 0.001] more likely to be stunted than 6–11 month old children. Older children were likely affected by AI, as these children were either in-utero or toddlers in 2006. In Upper Egypt, stunting peaked at 12–23 months [aOR 2.62, 95% CI (1.73-3.96), P < 0.001], with lowered risk (22-32%) of stunting in 24–47 month old children [aOR1.65, 95% 1.07-2.53, P = 0.022, 24–35 month old] and [aOR 1.57, 95% CI 1.01-2.43, P = 0.043 36–47 months old]. A two-fold increase in child consumption of sugary foods between 2005 and 2008 was found in Lower Egypt (24.5% versus 52.7%; P < .001). Conclusions Decreased dietary diversity, reduced poultry consumption, substitution of nutritious foods with sugary foods paralleled a reduction in household raising of birds, following the AI outbreak in Lower Egypt and not Upper Egypt. Increased feeding of sugary foods due to fear of illness or greater penetration of these foods may be related to stunting. Advice on infant and young child feeding is needed to improve dietary intake and reduce sugary food consumption. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1627-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justine A Kavle
- Maternal and Child Health Integrated Program (MCHIP), 1776 Massachusetts Ave NW, Suite 300, Washington DC, USA. .,PATH, Maternal, Child Health and Nutrition (MCHN), 455 Massachusetts Ave NW, Suite 1000, Washington DC, 20001, USA.
| | | | - Megan Landry
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington DC, USA.
| | - Rae Galloway
- Maternal and Child Health Integrated Program (MCHIP), 1776 Massachusetts Ave NW, Suite 300, Washington DC, USA. .,PATH, Maternal, Child Health and Nutrition (MCHN), 455 Massachusetts Ave NW, Suite 1000, Washington DC, 20001, USA.
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Sevuk U, Baysal E, Ay N, Altas Y, Altindag R, Yaylak B, Alp V, Demirtas E. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery. Neuropsychiatr Dis Treat 2015; 11:2033-9. [PMID: 26300642 PMCID: PMC4535547 DOI: 10.2147/ndt.s87888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12) deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG) surgery. MATERIAL AND METHODS A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98. RESULTS Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017) and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034) than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004). Delirium severity score showed a moderate correlation with cobalamin levels (ρ=-0.27; P=0.024). Logistic regression analysis demonstrated that cobalamin deficiency was independently associated with postoperative delirium (OR 1.93, 95% CI 1.03-3.6, P=0.038). CONCLUSION The results of our study suggest that cobalamin deficiency may be associated with increased risk of delirium in patients undergoing CABG. In addition, we found that preoperative cobalamin levels were associated with the severity of delirium. This report highlights the importance of investigation for cobalamin deficiency in patients undergoing cardiac surgery, especially in the elderly.
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Affiliation(s)
- Utkan Sevuk
- Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Nurettin Ay
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Yakup Altas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Rojhat Altindag
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Baris Yaylak
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Vahhac Alp
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Ertan Demirtas
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
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Herrador Z, Sordo L, Gadisa E, Buño A, Gómez-Rioja R, Iturzaeta JM, de Armas LF, Benito A, Aseffa A, Moreno J, Cañavate C, Custodio E. Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State. PLoS One 2014; 9:e112858. [PMID: 25546056 PMCID: PMC4278675 DOI: 10.1371/journal.pone.0112858] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/15/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The present study describes the distribution of selected micronutrients and anaemia among school-aged children living in Libo Kemkem and Fogera (Amhara State, Ethiopia), assessing differences by socio-demographic characteristics, health status and dietary habits. METHODS A cross-sectional survey was carried out during May-December 2009. Socio-demographic characteristics, health status and dietary habits were collected. Biomarkers were determined for 764 children. Bivariate and multivariable statistical methods were employed to assess micronutrient deficiencies (MD), anaemia, and their association with different factors. RESULTS More than two thirds of the school-aged children (79.5%) had at least one MD and 40.5% had two or more coexisting micronutrient deficiencies. The most prevalent deficiencies were of zinc (12.5%), folate (13.9%), vit A (29.3%) and vit D (49%). Anaemia occurred in 30.9% of the children. Children living in rural areas were more likely to have vit D insufficiency [OR: 5.9 (3.7-9.5)] but less likely to have folate deficiency [OR: 0.2 (0.1-0.4)] and anaemia [OR: 0.58 (0.35-0.97)]. Splenomegaly was positively associated with folate deficiency and anaemia [OR: 2.77 (1.19-6.48) and 4.91 (2.47-9.75)]. Meat and fish consumption were inversely correlated with zinc and ferritin deficiencies [OR: 0.2 (0.1-0.8) and 0.2 (0.1-0.9)], while oil consumption showed a negative association with anaemia and deficiencies of folate and vitamin A [0.58 (0.3-0.9), OR: 0.5 (0.3-0.9) and 0.6 (0.4-0.9)]. Serum ferritin levels were inversely correlated to the presence of anaemia (p<0.005). CONCLUSION There is a high prevalence of vitamin A deficiency and vitamin D insufficiency and a moderate prevalence of zinc and folate deficiencies in school-aged children in this area. The inverse association of anaemia and serum ferritin levels may be due to the presence of infectious diseases in the area. To effectively tackle malnutrition, strategies should target not only isolated micronutrient supplementation but also diet diversification.
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Affiliation(s)
- Zaida Herrador
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Luis Sordo
- National Centre of Epidemiology, ISCIII, Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain
- Network Biomedical Research Centers, Epidemiology and Public Health (CIBERESP in Spanish), Madrid, Spain
| | | | | | | | | | | | - Agustín Benito
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Javier Moreno
- National Centre of Microbiology, ISCIII, Madrid, Spain
| | | | - Estefania Custodio
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
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Ernst J, Ettyang G, Neumann CG. High-nutrition biscuits to increase animal protein in diets of HIV-infected Kenyan women and their children: a study in progress. Food Nutr Bull 2014; 35:S198-204. [PMID: 25639139 PMCID: PMC4459502 DOI: 10.1177/15648265140354s306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preliminary evidence suggests that improved nutrition early in HIV infection may delay progression to AIDS and delay the initiation or improve the effectiveness of antiretroviral drug therapy. There are few studies that evaluate food-based interventions in drug-naïve, HIV-infected women and their children. Meat provides several nutrients identified as important in maintaining immune function and lean body mass. OBJECTIVE To design supplemental meat and soybean biscuits for use in a randomized trial examining the effect of meat in the diet of drug-naïve, HIV-infected rural Kenyan women on changes in weight, lean body mass, morbidity, nutritional status, and activities of daily living of the women and growth and development of their children. METHODS We designed three supplemental biscuits: one with added dried beef another with added soybean flour, and a wheat biscuit to serve as a control biscuit to be used in a randomized feeding intervention in drug-naïve, HIV-infected rural Kenyan women and their children. The nutritional contents of the different types of biscuit were examined and compared. RESULTS The three biscuits were isocaloric. Meat biscuits provided more lysine, vitamin B12, and bioavailable zinc. Soybean biscuits provided more total and absorbable iron; however, higher fiber and phytate contents may inhibit nutrient absorption. Data analysis for clinical outcomes of the trial is ongoing. CONCLUSIONS The "biscuit model" is useful for nutrition supplementation studies because it can be provided in a blinded and randomized fashion, safely and privately in a home under directly observed consumption by a highly stigmatized population. It is well received by adults and children, and the biscuits can be produced locally with available, simple, affordable technology.
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Gibson RS, Heath ALM, Szymlek-Gay EA. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am J Clin Nutr 2014; 100 Suppl 1:459S-68S. [PMID: 24871479 DOI: 10.3945/ajcn.113.071241] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.
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Affiliation(s)
- Rosalind S Gibson
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
| | - Anne-Louise M Heath
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
| | - Ewa A Szymlek-Gay
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
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Duggan C, Srinivasan K, Thomas T, Samuel T, Rajendran R, Muthayya S, Finkelstein JL, Lukose A, Fawzi W, Allen LH, Bosch RJ, Kurpad AV. Vitamin B-12 supplementation during pregnancy and early lactation increases maternal, breast milk, and infant measures of vitamin B-12 status. J Nutr 2014; 144:758-64. [PMID: 24598885 PMCID: PMC3985831 DOI: 10.3945/jn.113.187278] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 11/16/2013] [Accepted: 02/12/2014] [Indexed: 11/14/2022] Open
Abstract
Pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and indicators of low vitamin B-12 status have been associated with adverse pregnancy outcomes, including anemia, low birth weight, and intrauterine growth retardation. To evaluate whether daily oral vitamin B-12 supplementation during pregnancy increases maternal and infant measures of vitamin B-12 status, we performed a randomized, placebo-controlled clinical trial. Pregnant women <14 wk of gestation in Bangalore, India, were randomly assigned to receive daily oral supplementation with vitamin B-12 (50 μg) or placebo through 6 wk postpartum. All women were administered iron and folic acid supplements throughout pregnancy. One hundred eighty-three women were randomly assigned to receive vitamin B-12 and 183 to receive placebo. Compared with placebo recipients, vitamin B-12-supplemented women had significantly higher plasma vitamin B-12 concentrations at both the second (median vitamin B-12 concentration: 216 vs. 111 pmol/L, P < 0.001) and third (median: 184 vs. 105 pmol/L, P < 0.001) trimesters. At 6 wk postpartum, median breast milk vitamin B-12 concentration was 136 pmol/L in vitamin B-12-supplemented women vs. 87 pmol/L in the placebo group (P < 0.0005). Among vitamin B-12-supplemented women, the incidence of delivering an infant with intrauterine growth retardation was 33 of 131 (25%) vs. 43 of 125 (34%) in those administered placebo (P = 0.11). In a subset of infants tested at 6 wk of age, median plasma vitamin B-12 concentration was 199 pmol/L in those born to supplemented women vs. 139 pmol/L in the placebo group (P = 0.01). Infant plasma methylmalonic acid and homocysteine concentrations were significantly lower in the vitamin B-12 group as well. Oral supplementation of urban Indian women with vitamin B-12 throughout pregnancy and early lactation significantly increases vitamin B-12 status of mothers and infants. It is important to determine whether there are correlations between these findings and neurologic and metabolic functions. This trial was registered at clinicaltrials.gov as NCT00641862.
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Affiliation(s)
- Christopher Duggan
- Divisions of Nutrition
- Nutrition
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | | | - Tinku Thomas
- Epidemiology, Biostatistics and Population Health of St. John’s Research Institute, Bangalore, India; Departments of
| | | | | | | | | | | | | | - Lindsay H. Allen
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA; and
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Pachón H, Simondon KB, Fall ST, Menon P, Ruel MT, Hotz C, Creed-Kanashiro H, Arce B, Domínguez MRL, Frongillo EA, Brown DL. Constraints on the delivery of animal-source foods to infants and young children: case studies from five countries. Food Nutr Bull 2014; 28:215-29. [PMID: 24683681 DOI: 10.1177/156482650702800211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED BACKGROUND. Optimal feeding of infants and young children in developing countries includes daily feeding of animal-source foods. OBJECTIVE. To evaluate constraints on the availability of animal-source foods at the community level, access to animal-source foods at the household level, and intake of animal-source foods at the individual level among children under 3 years of age in case studies in five developing countries: Mexico, Peru, Haiti, Senegal, and Ethiopia. METHODS Data were obtained from published and unpublished research and from program experiences of health and agriculture specialists. RESULTS In Ethiopia, 27% to 51% of case-study children had consumed an animal-source food on the previous day; from 56% to 87% of children in the other case-study sites had consumed an animal-source food on the previous day. Data on intake of animal-source foods in grams were only available for the Latin American case-study sites, where daily milk intake was high in Mexico and Peru (195 and 180 g/day, respectively) and the intakes of meat, fish, and poultry (MFP) (29.0 and 13.6 g/day) and of egg (18.4 and 4.9 g/day) were low. The conceptual model guiding this work identified more constraining factors at the community and household levels than at the individual level. The most common constraints on feeding animal-source foods to young children were poverty, animal health, and land degradation at the community level; cost of animal-source foods and limited livestock holdings at the household level; and caregivers' perceptions of giving animal-source foods to children at the individual level. CONCLUSIONS For program planning, it is useful to simultaneously consider factors that affect community availability of household access to, and children's intake of animal-source foods. Efforts to overcome individual-level constraints on intake of animal-source foods should be coupled with activities to address community and household constraints.
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Mearns GJ, Koziol-McLain J, Obolonkin V, Rush EC. Preventing vitamin B12 deficiency in South Asian women of childbearing age: a randomised controlled trial comparing an oral vitamin B12 supplement with B12 dietary advice. Eur J Clin Nutr 2014; 68:870-5. [PMID: 24736677 DOI: 10.1038/ejcn.2014.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/20/2014] [Accepted: 02/28/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the effectiveness, acceptability and sustainability of interventions to reduce vitamin B12 (B12) deficiency in South Asian women before conception. SUBJECTS/METHODS A 6-month randomised controlled trial conducted in Auckland, New Zealand. Participants (62 South Asian women, 18-50 years old) were stratified by dietary practices, then randomised to three treatment groups: B12 Supplement (oral cyanocobalamin 6 μg/day) (n=21), Placebo (n=21), or B12 Dietary Advice (n=20). Primary outcome measures were changes in B12 biomarkers (serum B12 and holotranscobalamin (holoTC)) at 6 months. Dietary B12 intake was estimated from a B12 food-specific frequency questionnaire (B12FFQ). Intention-to-treat analysis was applied using 'last observation carried forward' method. Changes in B12 biomarkers by treatment were compared using analysis of variance. Pearson's correlations tested relationships between dietary B12 intake and B12 biomarkers. RESULTS At baseline, 48% of women tested as insufficient or deficient in serum B12 (<222 pmol/l) and 51% as insufficient or deficient in holoTC (<45 pmol/l). B12 status was moderately correlated with dietary B12 intake (r=0.5, 95% confidence interval (CI) (0.3-0.7)) and 44% of women reported insufficient dietary intake (<2.4 μg/day). B12 Supplement was the only treatment group to record a significant increase in B12 biomarkers over 6 months: serum B12 by 30% (95% CI (11-48%)) and holoTC by 42% (12-72%). CONCLUSIONS The prevalence of B12 insufficiency among Auckland South Asian women is high and moderately correlated with inadequate intake of foods that contain B12. Cyanocobalamin supplementation (6 μg/day) was associated with improved B12 biomarkers, with a potential to improve preconception B12 status in South Asian women.
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Affiliation(s)
- G J Mearns
- School of Health Care Practice, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - J Koziol-McLain
- Interdisciplinary Trauma Research Centre, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - V Obolonkin
- Centre for Child Health Research, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - E C Rush
- Centre for Child Health Research, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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Walton C, Taylor J, VanLeeuwen J, Yeudall F, Mbugua S. Associations of diet quality with dairy group membership, membership duration and non-membership for Kenyan farm women and children: a comparative study. Public Health Nutr 2014; 17:307-16. [PMID: 23195285 PMCID: PMC10282484 DOI: 10.1017/s1368980012005010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/19/2012] [Accepted: 09/14/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine associations among diet quality and dairy group membership, membership duration and non-member status for women and school-aged children in rural Kenya. DESIGN A cross-sectional survey, using chain referral sampling, was conducted and diet quality indices and prevalence of inadequate intake (PII) were estimated using the 'estimated average requirement' cut-off point method from single 24 h recalls, using a Kenyan nutrient database. PII was compared among members and non-members and among membership-duration groups. SUBJECTS Women and children of dairy group members (n 88), across membership-duration groups (1-3, 4-6, 7-9 and 10+ years), and non-members (n 23) living among members. SETTING Small farms in central Kenya. RESULTS Members had higher energy, percentage of energy from animal-source foods and dietary diversity. Member women and children had lower PII for respectively seven and three of eleven micronutrients. Reduced PII for milk-source micronutrients was associated with membership duration for women. Many member women (38%) had inadequate vitamin A intake and 39% of member children had inadequate Zn intake. Members' PII was also high (>45%) for Fe, Ca and vitamin B12. A higher prevalence of being overweight among member women compared with non-member women suggested nutrition transition effects of higher farm productivity. CONCLUSIONS Dairy group membership was positively associated with adequate quantity and quality of diets for women and children. Long-term membership was insufficient to address micronutrient deficiencies. Understanding and addressing barriers to better diet quality and strategies to mitigate negative nutrition transition effects are needed to optimize nutritional outcomes of dairy group membership.
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Affiliation(s)
- Colleen Walton
- Centre for Veterinary Epidemiological Research, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Canada, C1A 4P3
| | - Jennifer Taylor
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - John VanLeeuwen
- Centre for Veterinary Epidemiological Research, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Canada, C1A 4P3
| | - Fiona Yeudall
- School of Nutrition, Centre for Studies in Food Security, Ryerson University, Toronto, Canada
| | - Samwel Mbugua
- Department of Food Nutrition and Dietetics, Faculty of Health Sciences, Egerton University, Egerton, Kenya
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Neumann CG, Oace SM, Chaparro MP, Herman D, Drorbaugh N, Bwibo NO. Low vitamin B12 intake during pregnancy and lactation and low breastmilk vitamin 12 content in rural Kenyan women consuming predominantly maize diets. Food Nutr Bull 2013; 34:151-9. [PMID: 23964388 DOI: 10.1177/156482651303400204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vitamin B12 deficiency during pregnancy and lactation may negatively affect fetal growth, brain development, pregnancy outcome, and breastmilk vitamin B12 content. OBJECTIVE To examine associations between pregnant and lactating women's vitamin B12 intake and pregnancy outcomes, breastmilk vitamin B12 concentration, and growth and development of breastfed infants from birth to 6 months. METHODS One hundred thirty-eight Kenyan women were followed during pregnancy, with 98 followed through 6 months of lactation and providing 294 randomly collected breastmilk samples. Maternal hematologic analyses were performed for erythrocyte morphology, erythrocyte size, and serum vitamin B12 concentration. Women's and infants'food intake was assessed. Breastmilk vitamin B12 was measured by a competitive binding isotope dilution technique. Infant anthropometric data and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were assessed within 3 days after birth. The Infant Bayley Motor Scale was assessed at 6 months. Statistical analyses included simple regression and correlation analyses in relation to vitamin B12 status and gestational age. RESULTS Intrauterine growth restriction and stillbirths were correlated with maternal macrocytic anemia and hypersegmented polymorphonuclear nuclei. Postpartum maternal vitamin B12 intake influenced breastmilk vitamin B12 levels 1 to 6 months postpartum. No associations were found between vitamin B12 intake during pregnancy or vitamin B12 levels in breastmilk and infant length, weight, or head circumference at birth or 6 months. Vitamin B12 intake during pregnancy was correlated with improved scores on infants' BNBAS reflex subscale (R = -0.19, p = .05) with adjustment for gestational age. Bayley Motor Scale results at 6 months were not significantly associated with breastmilk or supplemental feeding vitamin B12 content. CONCLUSIONS Vitamin B12 deficiency may adversely affect pregnancy outcome, infant reflexes at birth, and breastmilk vitamin B12 content.
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Affiliation(s)
- Charlotte G Neumann
- Department of Community Health Sciences, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA 90095, USA.
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Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial. Br J Nutr 2013; 111:875-86. [PMID: 24168874 DOI: 10.1017/s0007114513003310] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B₁₂, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.
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School snacks decrease morbidity in Kenyan schoolchildren: a cluster randomized, controlled feeding intervention trial. Public Health Nutr 2013; 16:1593-604. [PMID: 23537728 DOI: 10.1017/s1368980013000876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the effects of three different school snacks on morbidity outcomes. DESIGN Twelve schools were randomized to either one of three feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years. SETTING Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency. SUBJECTS Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart. RESULTS The Meat and Plain Githeri (i.e. githeri+oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time. CONCLUSIONS The intervention study showed beneficial effects of both animal source foods and of vitamin A-fortified oil on morbidity status.
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Benson J, Phillips C, Kay M, Webber MT, Ratcliff AJ, Correa-Velez I, Lorimer MF. Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS One 2013; 8:e57998. [PMID: 23469126 PMCID: PMC3585239 DOI: 10.1371/journal.pone.0057998] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/30/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. METHODS In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. RESULTS 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. CONCLUSION Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.
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Affiliation(s)
- Jill Benson
- Discipline of General Practice, University of Adelaide, South Australia, Australia.
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