bluuebunny/crossref_metadata_2025 huggingface dataset:
Iodine Deficiency Persists in the Zanzibar Islands of Tanzania
Authors: Assey V. D. , Greiner T. , Mzee R. K. , Abuu H. , Mgoba C. , Kimboka S. , Peterson S.
Published: November 2015

Background

Iodine is an essential micronutrient for normal human growth and development. It is estimated that more than 1.6 billion people live in iodine-deficient environments, yet there are still some countries and areas where the prevalence of iodine-deficiency disorders is unknown.

Objective

To establish the prevalence of iodine-deficiency disorders in the Zanzibar Islands, a community assumed to have ready access to iodine-rich seafoods.

Methods

In a cross-sectional study, 11,967 schoolchildren were palpated for goiter prevalence, a subsample was evaluated for urinary iodine concentration, and the availability of iodated salt was assessed at the household and retail levels.

Results

The mean total goiter prevalence was 21.3% for Unguja and 32.0% for Pemba. The overall median urinary iodine concentration was 127.5 μg/L. For Unguja the median was 185.7 μg/L, a higher value than the median of 53.4 μg/L for Pemba ( p < .01). The household availability of iodated salt was 63.5% in Unguja and 1.0% in Pemba. The community was not aware of the iodine-deficiency problem and had never heard of iodated salt.

Conclusions

The inadequate intake of iodine documented in the Zanzibar Islands belies the common assumption that an island population with access to seafood is not at risk for iodine-deficiency disorders. We urge health planners to implement mandatory salt iodation and education efforts to alleviate the situation.
Maternal Income-Generating Activities, Child Care, and Child Nutrition in Mali
Authors: Pierre-Louis June N. , Sanjur Diva , Nesheim Malden C. , Bowman Dwight D. , Mohammed Hussni O.
Published: November 2015

Background

Women in sub-Saharan Africa play a key role in household food security. The income-generating activities of mothers are postulated to be related to the nutritional status of children.

Objective

The objective of the study was to examine whether maternal income-generating activities, maternal food production, and child care were determinants of the nutritional status of children in rural West Africa. The study hypotheses were that maternal income-generating activities and maternal food production are positively associated with children's dietary intake and anthropometry, and that maternal income-generating activities are not associated with child care.

Methods

Data were collected from a cross-sectional sample of mother–child pairs on maternal time use, child anthropometry, maternal food production, dietary intake, parasitic infection, and household, maternal, and child determinants of child nutritional status. The children were 12 to 36 months of age and included breastfed and nonbreastfed children. Food intake was assessed by the 24-hour recall method. The data were analyzed by multivariate regression and controlled for confounding variables.

Results

Time spent by the mother in income-generating activities was negatively associated with children's animal protein intake and height-for-age (p < .05). Maternal cash crop production was positively associated with children's weight-for-height, whereas maternal staple food production was negatively associated with energy intake from non-breastmilk foods (p < .05). The negative relationships observed for children's animal protein intake and children's height-for-age were not mediated by any child-care variable. Maternal supervision of feeding was a positive predictor of children's animal protein intake. Giardia infection was negatively related to children's weight gain (p < .05).

Conclusions

Own-account cash crop farming by mothers benefits children's nutrition. Maternal income-generating activities in the context of extended families, sibling caretaking, and prolonged breastfeeding do not adversely affect child care.
Breastfeeding and Mixed Feeding Practices in Malawi: Timing, Reasons, Decision Makers, and Child Health Consequences
Authors: Kerr Rachel Bezner , Berti Peter R. , Chirwa Marko
Published: November 2015

Background

In order to effectively promote exclusive breastfeeding, it is important to first understand who makes child-care and child-feeding decisions, and why those decisions are made; as in most parts of the world, exclusive breastfeeding until 6 months of age is uncommon in Malawi.

Objective

To characterize early infant foods in rural northern Malawi, who the decision-makers are, their motivation, and the consequences for child growth, in order to design a more effective program for improved child health and nutrition.

Methods

In a rural area of northern Malawi, 160 caregivers of children 6 to 48 months of age were asked to recall the child's age at introduction of 19 common early infant foods, who decided to introduce the food, and why. The heights and weights of the 160 children were measured.

Results

Sixty-five percent of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months. Mzuwula and dawale (two herbal infusions), water, and porridge were common early foods. Grandmothers introduced mzuwula to protect the children from illness; other foods were usually introduced by mothers or grandmothers in response to perceived hunger. The early introduction of porridge and dawale, but not mzuwula, was associated with worse anthropometric status. Mzuwula, which is not associated with poor growth, is usually made with boiled water and given in small amounts. Conversely, porridge, which is associated with poor child growth, is potentially contaminated and is served in larger amounts, which would displace breastmilk.

Conclusions

Promoters of exclusive breastfeeding should target their messages to appropriate decision makers and consider targeting foods that are most harmful to child growth.
The Human and Economic Cost of Hidden Hunger
Authors: Stein Alexander J. , Qaim Matin
Published: November 2015

Background

Micronutrient malnutrition is a public health problem in many developing countries. Its negative impact on income growth is recognized in principle, but there are widely varying estimates of the related economic cost.

Objective

To discuss available studies that quantify the cost of micronutrient malnutrition, and to develop an alternative framework and apply it to India.

Methods

Detailed burden of disease calculations are used to estimate the economic cost of micronutri- ent malnutrition based on disability-adjusted life years (DALYs) lost.

Results

The short-term economic cost of micronutri- ent malnutrition in India amounts to 0.8% to 2.5% of the gross domestic product.

Conclusions

Although the results confirm that micro- nutrient malnutrition is a huge economic problem, the estimates are lower than those of most previous studies. The differences may be due to differences in underlying assumptions, quality of data, and precision of calculation, but also to dynamic interactions between nutrition, health, and economic productivity, which are difficult to capture. Clear explanation of all calculation details would be desirable for future studies in order to increase credibility and transparency.
Fortification of Drinking Water to Control Iron- Deficiency Anemia in Preschool Children
Authors: Dutra-de-Oliveira José Eduardo , Lamounier Joel A. , de Almeida Carlos Nogueira A. , Marchini Julio Sergio
Published: November 2015

Background

Iron-deficiency anemia is the most common type of micronutrient malnutrition in the world. Its etiology and control are well understood, but the problem persists and is increasing in some developing countries. Iron fortification of mass-consumption foods is considered one of the most viable approaches to deliver bioavailable iron to the population.

Objective

To review and analyze the use of drinking water as an iron vehicle to reduce ferropenic anemia in developing countries.

Methods

Drinking water with added iron compounds was offered to preschool children at day-care centers in Brazil. Iron solutions were prepared with 10 mg to 20 mg iron/L. Clinical and anthropometric measurements and blood hemoglobin concentrations were obtained at the beginning of each study and 4 to 8 months later.

Results

No problems with acceptability or side effects were observed. Daily water intake by children was around 500 mL. Iron-deficiency anemia was found in all studies. Control children not receiving iron sup- plementation mantained their initial hemoglobin level. Anemia was reduced in the groups receiving iron-fortified drinking water.

Conclusions

Based on physical properties, tests in rats, and studies on preschool children at Brazilian day-care centers, we have shown that drinking water locally fortified with iron compounds should be considered and used as a worldwide available vehicle to control iron-deficiency anemia. Drinking water, besides being universally available, is a locally available vehicle, easily fortified, can be a vehicle for hydrosoluble iron, and reduces iron-deficiency anemia in preschool children.
Zinc Status of Iranian Preschool Children
Authors: Safavi Sayyed Morteza , Sheikholeslam Robabeh , Naghavi Mohsen , Sadeghian Saeed , Sadeqzadeh Elham , Kolahdooz Fariba , Mohammadian Somayyeh
Published: November 2015

Background

Zinc deficiency is one of the most preva- lent micronutrient deficiencies in developing countries, including Iran. The main direct causes of zinc deficiency are insufficient zinc intake, absorption or metabolic disorder, and increase in need during acute growth periods.

Objective

To determine the prevalence of zinc defi- ciency in preschool boys and girls in urban and rural populations in order to assist policy makers. Children of preschool age (i. e., 6 years old in Iran) were studied because interventions in this age group are believed to result in greater improvement in learning skills once these children enter school.

Methods

A national cross-sectional study was carried out on 4,374 randomly selected healthy preschool children from Iranian families in 2001. Serum zinc concentration was measured by atomic absorption spectrometry. The cutoff point for zinc deficiency was set at a serum level of 10 μmol/L (65 μg/dL).

Results

The prevalence of zinc deficiency was esti- mated at approximately 19.3%. The highest preva- lence was seen in the region that includes Sistan and Baluchistan, South Khorasan, and the southeast area of Kerman and the lowest in the region of Boushehr, Hor- mozgan, and South Khoozestan. The prevalence of zinc deficiency was significantly higher in rural areas than in urban areas. No significant difference in prevalence was seen between boys and girls.

Conclusions

In the long run, nutritional security and increased access to and intake of foods with high levels of zinc are the most sustainable strategies to overcome zinc deficiency. Fortification of staple foods, improved qual- ity of traditional bread, and supplementation for at-risk population groups are considered short- and mid-term nterventions. Nutrition education and behavioral change may be long-term strategies.
Prevention of Malnutrition among Young Children in Rural Bangladesh by a Food-Health-Care Educational Intervention: A Randomized, Controlled Trial
Authors: Roy Swapan Kumar , Jolly Saira Parveen , Shafique Sohana , Fuchs George J. , Mahmud Zeba , Chakraborty Barnali , Roy Suchismita
Published: November 2015

Background

As a result of inappropriate feeding, poor health and hygiene, and poor caring practices, the nutritional status of many young infants deteriorates with advancing age.

Objective

To explore the effectiveness of a nutrition education package to prevent malnutrition among young children.

Methods

A community-based, randomized, controlled trial was conducted among 605 normal and mildly malnourished children aged 6 to 9 months in 121 Community Nutrition Centers (CNCs) of the Bangladesh Integrated Nutrition Project (BINP) in four regions of Bangladesh from 2000 to 2002. The intervention group received weekly nutrition education based on the nutrition triangle concept of UNICEF for 6 months, whereas the control group received regular BINP services. Both groups were observed for a further 6 months to assess the sustainability of the effects. Information on socio-economic status, feeding patterns, morbidity, and anthropometric features was collected.

Results

A significant increase in the frequency of complementary feeding was observed in the intervention group as compared with the control group, and the increase was sustained throughout the observation period. The intervention group had a higher weight gain than the control group after the end of the intervention (0.86 vs. 0.77kg, p = 0.053) and after the end of the observation period (1.81 vs. 1.39 kg, p < .001). The proportion of normal and mildly malnourished children was greater in the intervention group than in the control group after the end of the observations (88.9% vs. 61.5%, p < .001). Nutrition education successfully prevented malnutrition in all the areas. Variation in the outcome of nutrition education among the regions was observed.

Conclusions

This culturally appropriate nutrition education package based on the nutrition triangle model effectively prevented growth faltering and malnutrition among young children.
Release of Iron, Zinc, and Lead from Common Iron Construction Bars and Zinc Metallic Bars in Water Solutions and Meals
Authors: Lechtig Aarón , de Romaña Daniel Lòpez , Boy Erick , Vargas Alejandro , del Portal Mauricio Rosas , Huaylinos María Luisa
Published: November 2015

Background

The use of iron pots has decreased the prevalence of anemia.

Objective

To investigate the release of iron, zinc, and lead from metallic iron and zinc bars incubated in water and in meals.

Methods

Iron, zinc, and lead concentrations were measured at different incubation conditions in water and in meals.

Results

The iron concentration in water was 1.26 mg/L after incubation with one iron bar at pH 7 and 100°C for 20 minutes and in meals was 0.97 mg per 100 g of wet meals, rich in phytate, cooking at 100°C during 20 minutes. The maximum contents were 7,720 mg/L of iron and 1,826 mg/L of zinc in vinegar at pH 3 and 20°C after 90 and 32 days, respectively. Lead was released from the bars, but at concentrations well below the upper tolerable limits.

Discussion

In outreach populations, the use of iron and zinc metallic bars in water and meals could contribute to sustainable, very low-cost prevention of iron and zinc deficiencies, and home-fortified vinegar could be used for treatment of both deficiencies.

Conclusions

Field trials should be performed to determine the impact that the use of iron and zinc metallic bars in water and meals might have on the iron and zinc status of population groups.
Nutrient Risk Assessment: Setting Upper Levels and an Opportunity for Harmonization
Authors: Aggett Peter J.
Published: November 2015

Upper levels are estimates of the quantity of a nutrient that can be ingested daily over a lifetime without appreciable risk to health. The approach to establishing upper levels for nutrients, nutrient risk assessment, has derived from the risk assessment of foreign chemicals that are deliberately added to foods, or are in food as contaminants. This process of risk assessment is rigorous and transparent, particularly in dealing with the uncertainty arising from the data available and their assessment and extrapolation to human populations. Hazard identification and characterization, i.e., a dose—response pattern, as applied to xenobiotics, are discussed first, and then the difficulties of applying this approach to nutrients are reviewed. Nutrients, in contrast to foreign chemicals, have specific and selective metabolic pathways and homeostasis, as well as specific functions. This is the source of differences in the nutrient risk assessments produced by various national and international advisory bodies. Although the same data are used in such exercises, different judgments are made about identifying adverse effects, the nature of uncertainties in the assessment, and in matching the upper levels with exposure assessments and dietary reference values. The establishment of different upper levels for different national and international communities is a source of confusion in public health policy and practice and a barrier to trade. It is proposed that a basis for harmonizing the existing approaches used in nutrient risk assessment would be the collaborative development of the model for establishing upper levels of intake for nutrients and related substances that has been recently described by a Joint Task Force of the World Health Organization and the Food and Agriculture Organization.
From Harvest to Health: Challenges for Developing Biofortified Staple Foods and Determining Their Impact on Micronutrient Status
Authors: Hotz Christine , McClafferty Bonnie
Published: November 2015

Background

The use of conventional breeding techniques and biotechnology to improve the micronutrient quality of staple crops is a new strategy to address micronutrient deficiencies in developing countries. This strategy, referred to as “biofortification,” is being developed and implemented through the international alliance of HarvestPlus to improve iron, zinc, and vitamin A status in low-income populations.

Objective

The objective of this paper is to review the challenges faced by nutritionists to determine and demonstrate the ability of biofortified crops to have an impact on the nutritional and health status of target populations.

Methods

We reviewed available published and unpublished information that is needed to design and evaluate this strategy, including issues related to micronutrient retention in staple foods, micronutrient bioavailability from plant foods, and evidence for the efficacy of high-micronutrient-content staple foods to improve micronutrient status.

Results

Further information is needed on the retention of micronutrients in staple foods, in particular of provitamin A carotenoids, when stored and prepared under different conditions. The low bioavailability of iron from staple foods and the ability to demonstrate an impact on zinc status are specific challenges that need to be addressed. In target countries, infections and other micronutrient deficiencies may confound the ability to affect micronutrient status, and this must be taken into account in community-based studies.

Conclusions

Information to date suggests that biofortification has the potential to contribute to increased micronutrient intakes and improved micronutrient status. The success of this strategy will require the collaboration between health and agriculture sectors.
Linking Human Nutrition and Fisheries: Incorporating Micronutrient-Dense, Small Indigenous Fish Species in Carp Polyculture Production in Bangladesh
Authors: Roos Nanna , Wahab Md. Abdul , Hossain Mostafa Ali Reza , Thilsted Shakuntala Haraksingh
Published: November 2015

Background

Fish and fisheries are important for the livelihoods, food, and income of the rural population in Bangladesh. Increased rice production and changing agricultural patterns have resulted in a large decline in inland fisheries. Implementation of carp pond polyculture has been very successful, whereas little focus has been given to the commonly consumed small indigenous fish species, some of which are rich in vitamin A and minerals, such as calcium, iron, and zinc, and are an integral part of the rural diet.

Objective

The overall objective of the research and capacity-building activities described in this paper is to increase the production, accessibility, and intake of nutrient-dense small indigenous fish species, in particular mola ( Amblypharyngodon mola), in order to combat micronutrient deficiencies. The large contribution from small indigenous fish species to recommended intakes of vitamin A and calcium and the perception that mola is good for or protects the eyes have been well documented.

Methods

An integrated approach was conducted jointly by Bangladeshi and Danish institutions, linking human nutrition and fisheries. Activities included food-consumption surveys, laboratory analyses of commonly consumed fish species, production trials of carp–mola pond polyculture, teaching, training, and dissemination of the results.

Results

No decline in carp production and thus in income was found with the inclusion of mola, and increased intake of mola has the potential to combat micronutrient deficiencies. Teaching and training of graduates and field staff have led to increased awareness of the role of small indigenous fish species for good nutrition and resulted in the promotion of carp–mola pond polyculture and research in small indigenous fish species. The decline in accessibility, increase in price, and decrease in intake of small indigenous fish species by the rural poor, as well as the increased intake of silver carp ( Hypophthalmichthys molitrix), the most commonly cultured fish species, which is poor in micronutrients and not preferred for consumption, are being addressed, and some measures taken by inland fisheries management have been discussed.

Conclusions

The successful linking of human nutrition and fisheries to address micronutrient deficiencies has relevance for other countries with rich fisheries resources, such as Cambodia and countries in the Lake Victoria region of Africa.
Iron Metabolism in Infants and Children
Authors: Lönnerdal Bo , Kelleher Shannon L.
Published: November 2015

Meeting the iron requirements of infants and children is difficult, and supplementation or fortification of food with iron is often recommended. Although iron supplementation of infants and children with iron deficiency and iron-deficiency anemia may be beneficial, recent studies suggest that this may not be the case for those with adequate iron status, and adverse effects have been noted. The recent discoveries of proteins and peptides regulating iron absorption have enhanced our knowledge of iron metabolism in infants and children. Iron is taken up in the small intestine by divalent metal transporter-1 and is either stored by ferritin inside the mucosal cell or transported to the systemic circulation by ferroportin, while being oxidized by hephaestin to be incorporated into transferrin. Hepcidin, a small peptide synthesized by the liver, can sense iron stores and regulates iron transport by inhibition of ferroportin. However, regulation of iron transporters is immature in infants, possibly explaining the adverse effects of iron supplementation. Interactions among iron, vitamin A, zinc, and copper need to be considered when evaluating the effects of iron supplementation on infants and children.
Iron Deficiency and Child Development
Authors: Lozoff Betsy
Published: November 2015

Iron deficiency is widespread in infants and young children, especially in developing countries. Animal models provide convincing evidence that, despite iron repletion, iron deficiency during the brain growth spurt alters metabolism and neurotransmission, myelination, and gene and protein profiles. In the human, there is compelling evidence that 6- to 24-month-old infants with iron-deficiency anemia are at risk for poorer cognitive, motor, social–emotional, and neurophysiologic development in the short- and long-term outcome. In contrast to inconsistent developmental effects of iron therapy for iron-deficient infants, recent large, randomized trials of iron supplementation in developing countries uniformly show benefits of iron, especially on motor development and social–emotional behavior. These results indicate that adverse effects can be prevented and/or reversed with iron earlier in development or before iron deficiency becomes severe or chronic. New findings also point to the need for more attention to the developmental effects of prenatal iron deficiency.
Critical Review of Strategies to Prevent and Control Iron Deficiency in Children
Authors: Lynch Sean , Stoltzfus Rebecca , Rawat Rahul
Published: November 2015

Iron deficiency is prevalent in infants and young children in developing countries and is associated with adverse developmental outcomes. The routine provision of additional iron by food fortification or the use of iron supplements is generally recommended. The wisdom of this approach in regions where the transmission of Plasmodium falciparum malaria is perennial and intense is now being questioned, because a large trial in Pemba, Tanzania, demonstrated an increased risk of serious morbidity among children under the age of 3 years who were given routine daily iron and folic acid supplements. However, the results of a concurrent substudy suggest that the untoward effects occurred in children who were not iron deficient, and that iron deficiency itself is associated with an increased risk of severe morbidity that can be reduced by iron and folic acid supplementation. There is an urgent need for additional research to confirm these observations, to establish the role, if any, of the concurrent folic acid supplementation, to evaluate the risk of alternative methods for delivering iron that, on theoretical grounds, could be safer, and to establish the programmatic feasibility of targeting iron fortificants or supplements to iron-deficient children. It is evident that a single strategy for ensuring adequate iron nutrition in young children in different parts of the world is no longer likely to be satisfactory. Moreover, integration with other health-related strategies, particularly malaria control programs, will be essential.
Evaluation of the Potential Effectiveness of Wheat Flour and Salt Fortification Programs in Five Central Asian Countries and Mongolia, 2002–2007
Authors: Tazhibayev Shamil , Dolmatova Oksana , Ganiyeva Galina , Khairov Khotambek , Ospanova Feruza , Oyunchimeg Dalkhjav , Suleimanova Dilorom , Scrimshaw Nevin
Published: November 2015

Background

A project for universal salt iodation with potassium iodate and wheat flour fortification with a vitamin-mineral premix was implemented in Azerbaijan, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, and Uzbekistan between 2002 and 2007.

Objective

To determine the potential effectiveness of the food fortification programs in improving the micronutrient status of selected families in a sentinel population in each country.

Methods

An area was selected in each country in a sentinel population expected to have early access to iodated salt and fortified wheat flour. Within this area, an average of 40 families with a woman of reproductive age and two children between 2 and 15 years old were sampled at baseline. All the rounds of the study were carried out in women and children in the same households. Hemoglobin, serum ferritin, folic acid, and urinary iodine excretion were analyzed at baseline, one year, and three years later.

Results

In the third round in 2007 significant increases were observed in the average levels of blood hemoglobin, serum ferritin and folic acid, and urinary iodine. Corresponding decreases in the prevalence of anemia and increases in serum ferritin levels, folic acid, and iodine were found.

Conclusions

Salt and wheat flour fortification resulted in a significant improvement in the micronutrient status of children and women living in sentinel households in the countries participating in the Asian Development Bank project. Sentinel studies were a cost-effective way of determining potential national effectiveness.
Uncultivated Brazilian Green Leaves are Richer Sources of Carotenoids than are Commercially Produced Leafy Vegetables
Authors: Kobori Cintia Nanci , Amaya Delia B. Rodriguez
Published: November 2015

Background

With the continuing problem of vitamin A deficiency, the recognition of the role of carotenoids in disease prevention, and international programs promoting biodiversity, determination of the carotenoid content of indigenous Brazilian foods is needed.

Objective

To determine the principal carotenoids in native leaves and compare the levels with those in commercially produced leafy vegetables.

Methods

The indigenous Brazilian leafy vegetables caruru, mentruz, taioba, serralha, and beldroega were analyzed with the use of a previously developed and validated high-performance liquid chromatography (HPLC) method. Parsley and coriander leaves, which were previously shown to be the richest in carotenoids among commercially produced leaves, were analyzed for comparison. Five sample lots of each vegetable collected at different times during the year were analyzed immediately after harvest.

Results

Lutein concentrations were 119 ± 21, 111 ± 48, 104 ± 44, 87 ± 7, and 34 ± 14 μg/g, and β-carotene contents were 114 ± 22, 97 ± 40, 66 ± 18, 72 ± 9, and 32 ± 14 μg/g for caruru, mentruz, taioba, serralha, and beldroega, respectively. Except for beldroega, these values were higher than those for commercial leaves. Parsley had 88 ± 18 μg/g of lutein and 65 ± 13 μg/g of β-carotene. Coriander leaves contained 74 ± 6 μg/g of lutein and 55 ± 5 μg/g of β-carotene. The violaxanthin and neoxanthin concentrations were also higher in the native leaves. Comparison with values for previously analyzed commercial leafy vegetables confirmed the higher carotenoid levels of the native leaves.

Conclusions

The indigenous leaves investigated are richer sources of carotenoids than are commercially produced leafy vegetables.
Gestational Weight Gain as Predicted by Pregestational Body Mass Index and Gestational Age in Mexican Women
Authors: Casanueva Esther , Flores-Quijano María Eugenia , Roselló-Soberón María Emila , De-Regil Luz María , Sámano Reyna
Published: November 2015

Objective

To develop a reference pattern to evaluate gestational weight according to pregestational body mass index (BMI) and gestational age, using current longitudinal information from healthy pregnant women.

Subjects and methods

We followed 438 women with singleton pregnancies between weeks 16 and 36 of pregnancy. Women were excluded if they developed pathologic conditions during gestation, delivered malformed or dead fetuses, or delivered babies with a birthweight of less than 2500 or more than 4200 g or with a gestational age of less than 37 or more than 41 weeks. Weight, biochemical indicators, and clinical indicators were recorded every 4 weeks throughout the pregnancy. Data were analyzed by sequential regressions.

Results

Four equations for maternal predicted weight across categories of pregestational BMI (underweight, normal, overweight, and obese) and gestational ages were developed and synthesized in a table of reference values.

Conclusions

Optimal weight and weight gain during pregnancy can be estimated with our equations, which are corrected for pregestational BMI and gestational age.
Folate and Vitamin B12 Metabolism: Overview and Interaction with Riboflavin, Vitamin B6, and Polymorphisms
Authors: Shane Barry
Published: November 2015

This paper provides a general review on folate and vitamin B12 nutrition and metabolism and the metabolic interrelationship between these vitamins. The effects of some common polymorphisms in folate and vitamin B12 genes and the influence of vitamin B6 and riboflavin status on folate and vitamin B12 metabolism are also discussed.
Causes of Vitamin B12 and Folate Deficiency
Authors: Allen Lindsay H.
Published: November 2015

This review describes current knowledge of the main causes of vitamin B12 and folate deficiency. The most common explanations for poor vitamin B12 status are a low dietary intake of the vitamin (i.e., a low intake of animal-source foods) and malabsorption. Although it has long been known that strict vegetarians (vegans) are at risk for vitamin B12 deficiency, evidence now indicates that low intakes of animal-source foods, such as occur in some lacto-ovo vegetarians and many less-industrialized countries, cause vitamin B12 depletion. Malabsorption of the vitamin is most commonly observed as food-bound cobalamin malabsorption due to gastric atrophy in the elderly, and probably as a result of Helicobacter pylori infection. There is growing evidence that gene polymorphisms in transcobalamins affect plasma vitamin B12 concentrations. The primary cause of folate deficiency is low intake of sources rich in the vitamin, such as legumes and green leafy vegetables, and the consumption of these foods may explain why folate status can be adequate in relatively poor populations. Other situations in which the risk of folate deficiency increases include lactation and alcoholism.
The use of Blood Concentrations of Vitamins and their Respective Functional Indicators to Define Folate and Vitamin B12 Status
Authors: Selhub Jacob , Jacques Paul F. , Dallal Gerard , Choumenkovitch Silvina , Rogers Gail
Published: November 2015

In recent years there has been growing interest in the vitamins folic acid and vitamin B12 because of the realization that the status of these vitamins in populations is less than adequate, and that such inadequacy may be linked to adverse public health outcomes. This concern has prompted the United States, Canada, and other countries to fortify grain products with folic acid, while additional countries are considering doing so in the near future. This presentation provides a new approach which relies on the combination of the concentrations in blood of vitamins and their respective functional indicators to establish cutoff points for assessing folate and vitamin B12 status in populations. The premise is based on the fact that the relationship between plasma vitamin concentrations and their respective functional indicators is inverse and biphasic, with a steep slope at low concentrations of the vitamin and a more moderate slope at higher plasma vitamin concentrations. We propose that the intersection of these two slopes be used as a guideline for assessing the status of these vitamins and the adequacy of fortification programs. The cutoff would be 10 nmol/L for serum folate and 340 nmol/L for red blood cell folate, based on lowest plasma homocysteine. For serum vitamin B12, the cutoff would be 150 pmol/L based on lowest methylmalonic acid and 300 pmol/L based on lowest homocysteine.
Effects of Folate and Vitamin B12 Deficiencies During Pregnancy on Fetal, Infant, and Child Development
Authors: Molloy Anne M. , Kirke Peadar N. , Brody Lawrence C. , Scott John M. , Mills James L.
Published: November 2015

The importance of folate in reproduction can be appreciated by considering that the existence of the vitamin was first suspected from efforts to explain a potentially fatal megaloblastic anemia in young pregnant women in India. Today, low maternal folate status during pregnancy and lactation remains a significant cause of maternal morbidity in some communities. The folate status of the neonate tends to be protected at the expense of maternal stores; nevertheless, there is mounting evidence that inadequate maternal folate status during pregnancy may lead to low infant birthweight, thereby conferring risk of developmental and long-term adverse health outcomes. Moreover, folate-related anemia during childhood and adolescence might predispose children to further infections and disease. The role of folic acid in prevention of neural tube defects (NTD) is now established, and several studies suggest that this protection may extend to some other birth defects. In terms of maternal health, clinical vitamin B12 deficiency may be a cause of infertility or recurrent spontaneous abortion. Starting pregnancy with an inadequate vitamin B12 status may increase risk of birth defects such as NTD, and may contribute to preterm delivery, although this needs further evaluation. Furthermore, inadequate vitamin B12 status in the mother may lead to frank deficiency in the infant if sufficient fetal stores of vitamin B12 are not laid down during pregnancy or are not available in breastmilk. However, the implications of starting pregnancy and lactation with low vitamin B12 status have not been sufficiently researched.
Review of Interventions for the Prevention and Control of Folate and Vitamin B12 Deficiencies
Authors: Cordero José F. , Do Ann , Berry R. J.
Published: November 2015

Folate and vitamin B12 deficiencies represent important and evolving global health challenges that contribute to the global burden of anemia, neurologic conditions, neurodevelopmental disorders, and birth defects. We present a review of population-based programs designed to increase consumption of folates and vitamin B12.

A folic acid supplementation program targeting couples prior to marriage in China has led to optimal consumption of supplements containing folic acid and a significant reduction of neural tube defects (NTD). Supplementation programs that use mass community education show some promise, but have not been shown to be as effective as targeted education. The success of supplementation programs hinges on a strong and persistent educational component and access to the supplements.

Fortification with folic acid has been shown to reduce the prevalence of NTD in the countries where it has been implemented. Challenges to fortification programs include identifying the appropriate delivery vehicles, setting the optimal fortification level, sustaining the quality assurance of the fortification level, and addressing regulatory challenges and trade barriers of commercially fortified flours.

Supplementation and fortification are cost-effective and viable approaches to reducing the burden of NTD, anemia, and other conditions resulting from folate deficiency. The experience with interventions involving folic acid could provide a model for the subsequent development of supplementation and fortification programs involving vitamin B12.
National Neural Tube Defects Prevention Program in China
Authors: Zhu Li , Ling Hao
Published: November 2015

Neural tube defects (NTD) are among the most common and devastating birth defects. Annually, in China, between 80,000 and 100,000 pregnancies result in children born with NTD. Northern China has the highest known rate of NTD in the world. Birth defects are becoming the leading cause of infant mortality in the urban and developed areas in China. The results of studies conducted in the early 1990s and early 2000s showed significant geographic and seasonal variations of folate status among Chinese women of childbearing age, with lower serum and red blood cell folate levels in northern China. In the north, 32% to 35% of women had low plasma folate and low red blood cell folate, and folate levels were significantly lower in spring than in fall. Since 1993, Peking University Health Science Center (formerly Beijing Medical University), collaborating with the US Centers for Disease Control and Prevention (CDC), has conducted a large-scale study to evaluate a public health campaign in China among women preparing for marriage in order to determine the effectiveness of daily supplementation of 400 μg of folic acid alone in preventing NTD in both the north and the south of China. The results showed that among the fetuses or infants of the women who took periconceptional folic acid, the reduction in risk of NTD was 85% in the northern region and 40% in the southern region. Daily intake of 400 μg of folic acid may also reduce the risk of nonsyndromic orofacial clefts. We found no evidence that daily consumption of folic acid before and during early pregnancy influenced the risk of miscarriage or twinning. In 2001, the Chinese Ministry of Health and the Chinese Disabled Person Federation released a National Action Plan for Reducing Birth Defects and Disabilities in China for 2002–2010. The Action Plan aims to improve birth outcomes, to reduce infant mortality by reducing the risk of birth defects and disabilities, and to ensure that every baby is born healthy.
Folic Acid for the Prevention of Neural Tube Defects: The Danish Experience
Authors: Olsen Sjurdur F. , Knudsen Vibeke Kildegaard
Published: November 2015

Evidence from controlled trials suggests that ingestion of 0.4 mg of folic acid per day in the periconceptional period is effective in preventing neural tube defects (NTD). For this reason, most countries recommend that women planning pregnancy take folic acid supplements in the periconceptional period, and some countries even fortify stable foods with folic acid. Denmark exemplifies a country with a relatively conservative attitude with respect to taking action in these matters. In 1999, a national information campaign was launched that recommended women planning pregnancy take 0.4 mg of folic acid periconceptionally, but with the moderation that women who eat a healthy diet do not need to take folic acid supplement. The campaign was repeated during 2001. The results of the latter campaign were evaluated by using data from a national survey among pregnant women conducted simultaneously with the campaign by the Danish National Birth Cohort. An increase in the proportion of folic acid users took place concomitantly with the launching of the information events, but the increase was limited. Among women who did not plan their pregnancy, a small proportion had taken folic acid supplements periconceptionally, and this proportion did not change concomitantly with the campaign. Young age and low education were factors associated with low likelihood of taking folic acid. It seems that different and more efficient actions are needed if a more substantial proportion of Danish women and their fetuses are going to benefit from the knowledge that folic acid supplementation in the periconceptional period can prevent NTD.
Contribution of Natural Resources to Nutritional Status in a Protected Area of Gabon
Authors: Blaney Sonia , Beaudry Micheline , Latham Michael
Published: November 2015

Background

In protected areas, legislation restricts the population's access to natural food resources, which might have an impact on their welfare.

Objective

To assess the contribution of the individual use of natural resources to nutritional status in the rural population of the Gamba Complex of Gabon.

Methods

Four villages were selected to represent the rural population. All households were invited to participate, and 95% agreed. In each of the two major seasons, data were collected from all individuals ( n = 637) in these 95 households during a 7-day period using a weighed food-consumption survey, observations, interviews, and anthropometric measures.

Results

Among children 5 to 9 years of age ( n = 82) and adolescents ( n = 169), their use of natural resources was the best predictor of nutritional status (explaining 8% of the variance), mainly via its contribution to the achievement of nutrient requirements. The use of natural resources was not a predictor for children 6 to 23 months ( n = 28) or 24 to 59 months of age ( n = 63), where the best predictors were access to care (26%) and health status (15%), respectively. Household food security predicted nutritional status in women caregivers ( n = 96), although negatively.

Conclusions

Natural resources contribute to the nutritional status of children 5 to 9 years of age and adolescents but not of other groups. The intrahousehold allocation of food, particularly of natural food resources, needs to be investigated to better appreciate the contribution of natural resources to the population's well-being. Women seem particularly vulnerable. Other than activities related to conservation, work is needed to understand the role of natural resources for populations living within and around protected areas.
Nutritional and Immunological Status and their Associations among HIV-Infected Adults in Addis Ababa, Ethiopia
Authors: Fufa Habtamu , Umeta Melaku , Taffesse Samson , Mokhtar Najat , Aguenaou Hassan
Published: November 2015

Background

In the search for cost-effective interventions to reduce morbidity and mortality in HIV disease, the identification of nutritional status and levels of micronutrients is very important.

Objective

To generate information on the level of energy malnutrition and on vitamin A, zinc, and hemoglobin levels and their relationships with disease status in HIV-infected adults in Addis Ababa, Ethiopia.

Methods

A cross-sectional study was carried out on 153 HIV-positive adults (19% male, 81% female) living in Addis Ababa. The nutritional status and the levels of zinc, retinol, and hemoglobin were determined by anthropometric and biochemical methods. CD4+ counts and C-reactive protein levels were measured by standard methods.

Results

Of the patients, 18% were chronically energy deficient, 71% were normal, and 11% were overweight. Serum zinc levels were low (< 10.7 μmol/L) in 53% of subjects, and serum retinol levels were low (< 30 μg/dL) in 47% of subjects. Low hemoglobin levels (< 12 g/dL) were observed in only 4.72% of the study population. CD4+ counts under 200/mm3 and elevated C-reactive protein levels were both found in 21% of the subjects. CD4+ counts were positively and significantly correlated with hemoglobin ( r = 0.271, p < .001), zinc ( r = 0.180, p < .033), and body mass index ( r = 0.194, p < .017). There were significant negative associations between levels of C-reactive protein and levels of zinc ( r = −0.178, p < 0.036 and hemoglobin ( r = −0.253, p < .002).

Conclusions

Our results provide evidence that compromised nutritional and micronutrient status begins early in the course of HIV-1 infection. Low serum zinc and vitamin A levels were observed in almost half of the subjects. The clinical significance of low serum zinc and vitamin A levels is unclear, and more research is required.
Iodine Nutrition Status of Pregnant Women in an Iodine-Sufficient Area
Authors: Tahirović Husref , Toromanović Alma , Balić Adem , Grbić Sanja , Gnat Daniella
Published: November 2015

Background

Iodine is necessary for the synthesis of thyroid hormones, which play a decisive role in the development of the brain during fetal and early postnatal life.

Objective

To evaluate whether prophylaxis with 20 to 30 mg of iodine per kilogram of salt is enough to ensure optimal iodine nutrition during pregnancy in an iodinesufficient area.

Methods

A cross-sectional study of pregnant women was conducted in 2007. The urinary iodine concentration (UIC) was measured in 300 randomly selected women in Tuzla, Bosnia, and Herzegovina, in all three trimesters of pregnancy.

Results

The median UIC of the pregnant women was 142 μg/L, ranging from 27 to 1,080 μg/L. The median UIC of the pregnant women in each trimester of pregnancy who were not restricting their salt intake was consistent with adequate iodine nutrition, as defined by the World Health Organization Technical Consultation, whereas the median UIC of women who were restricting their salt intake was insufficient.

Conclusions

Pregnant women in the urban area of Tuzla had adequate iodine status except for those with restricted salt intake, which presents an increased risk to the mother as well to as the unborn child. Women in the rural area of Tuzla were found to be iodine-deficient, regardless of whether they had restricted their salt intake or not. However, for those pregnant women who have been advised to restrict their salt intake and who thus face the risk of iodine deficiency, the use of salt with higher concentrations of iodine could be advised.