High Prevalence Of Micronutrient Deficiencies Research Articles

Micronutrient deficiency and supplements in schoolchildren and teenagers.

The essential micronutrients are corner stones in the functional and physical development. Early deficiency has life-long consequences. While awareness about iron deficiency is relatively high, it remains lower for other micronutrients. This review aims at reporting on recent data and attracting attention to the high prevalence of micronutrient deficiencies in school-age and adolescent individuals. Iron deficiency anaemia remains highly prevalent worldwide and the most frequent deficiency but can be corrected with simple tools ranging from food fortification, nutritional intervention, and to supplements. The link between micronutrient (MN) deficiency and neurobehavioral disorders is increasingly established and is worrying even in Western countries. Paediatric individuals are prone to imbalanced diets and picky eating behaviour, and their diets may then become incomplete: the highest risk for deficiency is observed for iron, zinc and vitamin D. There is not much new information, but rather confirmation of the importance of health policies. Well conducted randomized controlled trials confirm that deficiencies can be corrected efficiently including with food fortification, and result in clinical benefits. Individual complementation should be considered in children and adolescents with proven deficiency.

Development of micronutrient dense composite flour for routine enrichment of complementary foods for children 6–24 months old in Acholi sub-region of Uganda

BackgroundThe use of local foods has been widely recognized as a sustainable strategy to address micronutrient deficiencies among resource-constrained households in rural areas in developing countries. Acholi sub-region of Uganda has recently recorded a high prevalence of micronutrient deficiencies due to inadequate iron, zinc, and calcium contents in complementary foods. Thus the sub-region was used as a case study to examine the potential of amaranth grain-silverfish-iron rich beans micronutrient dense composite flour in improving nutritional quality of complementary foods.DesignMicrosoft Excel was used to derive ingredient combinations based on the micronutrient requirements. Laboratory analyses were used to determine (1) nutritional quality; (2) functional properties and; (3) storage stability of the micronutrient-dense composite flour. Data was analysed using a one-sample t-test and analysis of variance by Statistical Package for Social Sciences (SPSS) version 25.ResultsThe micronutrient-dense composite flour contained 19 mg/100 g, 13 mg/100 g, and 354 mg/100 g of iron, zinc, and calcium, respectively. The cost (0.037–0.058 USD) of the micronutrient-dense composite flour required to meet the RDA for iron and zinc among children 6–24 months old was found lower than the cost (4.81 USD) of a sachet of standard micronutrient powder equivalent to RDA. The product exhibited low bulk density (0.68 g/l), high water solubility index (25.56–29.16%), and short reconstitution time (40.00–45.00 s), and remained safe during the entire 70 days of storage. Theoretically, daily enrichment of complementary foods for children 6–11 and 12–24 months old with 58 and 37 g of the composite, respectively would contribute 100% of the recommended dietary allowance for iron and zinc and 50% for calcium.ConclusionThe developed micronutrient-dense composite flour has the potential to improve the micronutrient quality of complementary foods. A concerted effort is required to promote its use as a strategy to address micronutrient deficiencies among children 6–24 months in resource-constrained settings.

A one size vial does not fit all: An evaluation of the micronutrient status of adult patients receiving home parenteral nutrition (HPN)

Patients with chronic intestinal failure require HPN. Previous studies have reported a high prevalence of micronutrient deficiencies. We examined the micronutrient status of our patients receiving. We measured vitamins A, E, D, B12, Folate, Zinc, Selenium and Copper. Patients were excluded if they had undergone surgery or amendments in IV or oral micronutrient provision in the past six months. Blood samples were excluded if C-reactive protein was >15mg/L. Univariate and multivariate analyses were performed on concentrations below normal to determine if clinical or demographic categories were significant. 93 samples were included (33 males:60 females). Samples were excluded due to surgery (n=8) amendment in micronutrient provision (n=42) or if C-reactive protein >15mg/L (n=18). Vitamins A, D and E were below normal in 26%, 33% and 13% of patients respectively. Lower vitamin A was more likely in patients >50 years (P=0.02) and lower vitamin E was more likely in men (P=0.02). No patients had low vitamin B12 or folate whereas 29% and 9% had concentrations above the normal range respectively. Zinc and selenium were below normal in 19% and 13% respectively. Patients with surgical complications were more likely to have lower zinc (P=0.007) and selenium (P=0.04). Lower zinc was more likely in patients with a BMI of >25kg/m2 (P=0.01) and those who received Additrace® ≤3day/week (P=0.06). Low and high concentrations were observed in our patients but clinical and demographic factors did not impact consistently on micronutrient concentrations highlighting the importance of ongoing monitoring and adequate supplementation as per ESPEN guidelines. Current micronutrient preparations may be inadequate for some patients with dependent on HPN. Our results indicate a need for a preparation with higher amounts of vitamin D.

Micronutrient intake inadequacies in different types of milk consumers in Indonesian children 1-5 years: dietary modeling with young child milk improved nutrient intakes.

Indonesian children under-five have a high prevalence of micronutrient deficiencies. Improving young child feeding practices may be the solution. Increasing the consumption of appropriate milk products could help to reduce nutrient inadequacy. The objective of this study was to assess nutrient inadequacy in Indonesian children to evaluate the potential improvement using dietary modeling analysis. Data from children aged 1-5 years from the Indonesian Individual Dietary Consumption Survey in 2014 were used in this analysis (n = 11,020). Diet modeling was conducted in two scenarios, substitution volume to volume and calories to calories. The proportion of children consuming young child milk (YCM) was the highest compared to other milk types across all age groups, followed by condensed milk and cow's milk. YCM, also called "Growing-Up Milk" (GUM), are marketed as a product specifically formulated for the nutritional needs of young children. YCM consumers had lower prevalence of inadequate intakes in iron, zinc, vitamins A, C and D across age groups when compared to condensed milk consumers. The prevalence of inadequate intakes of nutrients in condensed milk consumers was Vitamin A (67, 64%), folate (92, 91%), Vitamin D (87, 84%), iron (84, 76%), and zinc (76, 76%) in 1-2y and 3-4y, respectively. The substitution of condensed milk with a YCM reduced the prevalence of inadequate intakes of micronutrients, such as Vitamin A, vitamin D, folate, iron and zinc, which are important for immune function. YCM reduced the prevalence of inadequate intakes of micronutrients by 20-40% (Vit A and folate) and 40-50% (Vit D and zinc). The reduction of prevalence of inadequate iron intake was 31% in 1-2y and 63% in 3-4y. The prevalence of inadequate micronutrient intakes was high among children aged 1-5 years old in Indonesia. YCM consumers had better nutrient intake. The substitution of condensed milk with a YCM reduced the prevalence of inadequate of micronutrient intake. Thus, nutrient intakes could be improved by YCM consumption in 1-5 years old children in Indonesia, along with nutrition education on feeding practices.

Bio-fortification of Cereals Based Bread Using Orange Fleshed Sweet Potato for Alleviating of Vitamin-A Deficiency

Ethiopia is one of the developing countries with a high prevalence of micronutrient deficiencies and protein-energy malnutrition. Vitamin A is one of the most versatile vitamins with roles in various functions such as vision, immune defense, maintenance of body linings and skin. Fortifying cereals through processing and conventional breeding can tackle micronutrient deficiency. Orange Fleshed Sweet Potato (OFSP) is a source of food that contains useful β-carotene, starch, mineral, dietary fiber, and vitamins. The inclusion of OFSP enhances the beta-carotene content of bread. This research aims to develop Vitamin A rich cereals based bread enhanced with orange-fleshed sweet potato. The straight dough baking method was used to develop bread. Beta-carotene content and physical properties of bread were done based on standard methods. Blending of OFSP flour in cereals significantly influenced the physical properties of bread. The total carotenoid content of bread products with 10% of OFSP Flour was 3.998 mg/100 g while that of beta-carotene is 23.217 mg/100 g. Inclusion of OFSP in composite flour increased the total carotenoid and beta-carotene content of bread. Generally, formulated flour has huge advantageous as a means of enhancing beta-carotene content and helps to alleviate vitamin A deficiency.

Game-Based Intervention to Improve Knowledge on the Benefits of Fruits and Vegetables of In-School Adolescents Attending the International School, Ibadan, Nigeria

ObjectivesIn Southwestern Nigeria, studies have shown that only 6–12% of adolescents met the recommended minimum daily intake of fruits and vegetables. Poor knowledge of the nutritional and health benefits of fruits and vegetables is a major contributor to low consumption of fruits and vegetables. Insufficient intake of fruits and vegetables may be an underlying factor in the high prevalence of micronutrient deficiencies among adolescents. This study aimed to improve knowledge on the benefits of fruits and vegetables among in-school adolescents in Ibadan, Nigeria, through a game-based approach.MethodsThis quasi-experimental study was conducted among 40 students of the International School, Ibadan, Nigeria. Data on the knowledge of the benefits of fruits and vegetables of the students was collected pre-and post-intervention, via a semi-structured, self-administered questionnaire. The intervention group (n = 20) was exposed to a gamified nutrition intervention “Nutripoly” while the control group (n = 20) received no intervention. “Nutripoly” is a fruit- and vegetable-themed board game similar to Monopoly, in which players aim to win by becoming the wealthiest based on their knowledge of the benefits of fruits and vegetables to human health. Data were analyzed using descriptive statistics and McNemar's test.ResultsThe mean age of respondents was 14.9 ± 0.6 years. The study showed that most participants preferred fruits to vegetables. In the experimental group, the proportion of the students with adequate knowledge increased significantly from 30% at baseline, to 95% after the intervention (p = 0.000). In the control group, the change in the proportion of students with adequate knowledge (from 35% at baseline to 40% post-intervention) was not significant (p = 0.250). Preference and love of the participants for fruits and vegetables improved remarkably in the intervention group, as compared to the control group in which there was minimal improvement.ConclusionsA game-based nutrition education intervention is capable of improving the knowledge of in-school adolescents on the nutritional benefits of fruits and vegetables. Further investigations should be conducted to determine if the game-based intervention can increase the intake of fruits and vegetables among the adolescents.Funding SourcesThe research was self-funded.

Prevalence of Micronutrient Deficiencies in Patients Hospitalized with COVID-19: An Observational Cohort Study

Background: A higher risk for severe clinical courses of coronavirus disease 2019 (COVID-19) has been linked to deficiencies of several micronutrients. We therefore studied the prevalence of deficiencies of eight different micronutrients in a cohort of hospitalized COVID-19-patients. Methods: We measured admission serum/plasma levels of vitamins A, B12, D, and E, as well as folic acid, zinc, selenium, and copper in 57 consecutively admitted adult patients with confirmed COVID-19 and analyzed prevalence of micronutrient deficiencies and correlations among micronutrient levels. Further, we studied associations of micronutrient levels with severe disease progression, a composite endpoint consisting of in-hospital mortality and/or need for intensive care unit (ICU) treatment with logistic regression. Results: Median age was 67.0 years (IQR 60.0, 74.2) and 60% (n = 34) were male. Overall, 79% (n = 45) of patients had at least one deficient micronutrient level and 33% (n = 19) had ≥3 deficiencies. Most prevalent deficiencies were found for selenium, vitamin D, vitamin A, and zinc (51%, 40%, 39%, and 39%, respectively). We found several correlations among micronutrients with correlation coefficients ranging from r = 0.27 to r = 0.42. The strongest associations with lower risk for severe COVID-19 disease progression (adjusted odds ratios) were found for higher levels of vitamin A (0.18, 95% CI 0.05–0.69, p = 0.01), zinc (0.73, 95% CI 0.55–0.98, p = 0.03), and folic acid (0.88, 95% CI 0.78–0.98, p = 0.02). Conclusions: We found a high prevalence of micronutrient deficiencies in mostly older patients hospitalized for COVID-19, particularly regarding selenium, vitamin D, vitamin A, and zinc. Several deficiencies were associated with a higher risk for more severe COVID-19 courses. Whether supplementation of micronutrients is useful for prevention of severe clinical courses or treatment of COVID-19 warrants further research.

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients.

Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.

Achieving dietary micronutrient adequacy in a finite world

Achieving dietary micronutrient adequacy in a finite world

Nutritional Status of Adolescent Afghan Refugees Living in Peshawar, Pakistan.

Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk populations (refugees) have focused mainly on women and children (0–59 months). The current study aims to assess nutritional status of adolescent Afghan refugees; the population who are equally vulnerable to malnutrition and its consequences. In this cross sectional study, the nutritional status of 206 adolescent (10–19 years old) Afghans boys and girls living in a refugee camp in Peshawar, Pakistan was assessed using standard methods. The results indicate a prevalence of stunting, thinness, and overweight and obesity at 35.3%, 4.4% and 14.8%, respectively. Furthermore, there was a significantly high prevalence of micronutrient deficiencies (vitamin D, 80.5%; vitamin B12, 41.9%; and folate, 28.2%); and anemia (10.1%). Together, these findings indicate that this vulnerable population group suffers from the double burden of malnutrition and are thus at serious risk of impaired psychosocial cognitive development, general ill-health and diminished wellbeing. This study therefore highlights the urgent need to include adolescents in regular screening and intervention programs of such at-risk populations.

Content and Bioavailability of Minerals in Some Cameroonian Foods from Douala: Risks of Micronutrient Deficiencies

Malnutrition and micronutrient deficiencies rates among preschool children and women of childbearing age as the most groups affected, are still rising in Cameroon, despite large food production, which reflected food security over the past three decades. This work aimed at evaluating the nutrient composition of the main family and transitional foods of children in the Douala town of Cameroon for food based malnutrition approach. A food survey by interview using a structured questionnaire, including the recall of the last 24 hours food intakes, food frequency was carried out to over 500 women and caretakers in the city of Douala. Sixteen household dishes were selected from their high consumption frequencies and some traditional complementary foods were analyzed. Moisture and ash were determined by AOAC methods (1980). The following mineral contents: Fe, Zn, Ca, Mg, Mo, Mn, Cu, Cr, Al, Ni, Se, Sn, Cd, Pb, Hg, As were determined by HR-ICP-MS on the mineralized samples and Acid extracts determined to evaluate ‘in vitro’ bioavailability in all the samples. The results were analyzed statistically using the software “STATGRAPHICS” Centurion. For all the foods, the dry matter and ash content (g/100 g MF) ranged from 11.07±2.58 to 42.39±0.06 and from 3.56±0.21 to 8, 88±0.02 respectively. The contents of Ca, Mg, K, P Zn, Cu, Mn, Fe (mg / 100gMS) ranged from 32.01±0.1 to 878.33±128; from 48.67±3.5 to 616.3±150.00; from 22±3 to 142±5; 197±34 to 1346.33±137; 0.49±0.06 to 12.08±0.83; 0.12±0.001 and 0.33±0.02; 0.05±0.001 and 0.8±0.001; and from 1.42±0.55 to 6.61±2.25 respectively. The phytates / zinc ratio ranged from 0.00 to 51.62, thus suspecting a high inhibition of phytates on zinc and other divalent cations. All the foods samples had low mineral content and low bioavailability, which would explain the high prevalence of micronutrient deficiencies and the need to educate mothers and caregivers on dietary diversification in combination with micronutrient supplementation or fortification of infant foods with essential micronutrients where necessary.

Implicaciones clínicas e inmunológicas de los micronutrientes durante la infección por VIH

During HIV infection there is an alteration in the functions of the immune system and chronic inflammation that cannot be resolved with antiretroviral treatment (ART). Moreover, a high prevalence of micronutrient deficiencies has been reported in the HIV+ population due to an increase in their demand and excretion. Such chronic inflammation and micronutrient deficiency is associated with comorbidities not linked to the acquired immunodeficiency syndrome (AIDS) such as high blood pressure, cardiovascular disease, metabolic syndrome, cancer, and osteoporosis. The development of strategies aimed at regulating the inflammation and chronic activation present in HIV+ patients receiving ART to improve their quality of life and decrease the prevalence of comorbidities. A promising option is nutritional intervention through supplementaltion of micronutrients that have shown to have a regulatory effect on inflammation and immune response and which could represent a safe and cost-effective option.

Potential of food-to-food fortification with cowpea leaves and orange-fleshed sweet potato, in combination with conventional fortification, to improve the cellular uptake of iron and zinc from ready-to-eat maize porridges.

An emerging tool in the fight against the high prevalence of micronutrient deficiencies in sub‐Saharan Africa is the production of nutritionally enhanced staple food products, through food‐to‐food fortification with micronutrient‐dense fruits and vegetables. This study investigated food‐to‐food fortification with cowpea leaves (CL) and orange‐fleshed sweet potato (OFSP) in combination with conventional micronutrient fortification and fermentation on the mineral and antinutrient contents and Caco‐2 cellular uptake of iron and zinc from ready‐to‐eat maize porridges. The amount of iron and zinc taken up from maize porridges (0.05 and 0.06 mg/100 g, db, respectively) was increased more after fortification with CL, compared to OFSP (0.32 and 0.23 mg/100 g, db versus. 0.11 and 0.04 mg/100 g, db, respectively). Despite the moderate cellular uptakes of iron and zinc from the CL fortified porridges (2.71% and 3.10%, respectively) compared to the OFSP fortified porridges (6.51% and 5.22%, respectively), the CL fortified porridges had much higher high iron and zinc contents (12.2–14.1 and 7.6–8.9 mg/100 g, db versus. 2.1–3.7 and 1.5–2.7 mg/100 g, db, respectively). This highlights the importance of increasing both the mineral content and bioavailability when fortifying a product. Even when a food product contains substantial antinutrients such as CL, if the mineral content and contents of bioavailability enhancers are high enough, the amounts of bioavailable iron and zinc can still be improved.

Association of Nutritional Status Measures with Self-efficacy and Experiencing Depressed Mood Among Pakistani Young Women (P10-090-19)

ObjectivesWe aimed to assess self-efficacy and the experience of depression-related emotions among non-pregnant adolescent and young women (15–23 years) living in rural Pakistan, and determine their association with measures of nutritional status. MethodsOutcomes were assessed from the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial baseline data (n = 25,279). Self-efficacy and depression-related emotions were determined and categorized using the general self-efficacy scale (low, moderate, and high) and DASS-21 tool (normal, mild, moderate, severe, and extremely severe), respectively. Nutritional status was evaluated using hemoglobin concentration (HemoCue Hb 301 System) and body mass index (BMI). Associations were assessed using ordinal logistic regression, and multivariate models were adjusted for education, parity, wealth index, and clustering. ResultsThe majority of participants were categorized as having moderate self-efficacy (50.6%) and experienced normal range depression-related emotions (76.3%). The mean hemoglobin concentration and BMI were 11.5 ± 1.9 g/dL and 20.2 ± 3.8 kg/m2, respectively. Each unit of increase in hemoglobin was associated with having higher self-efficacy (β = 0.018; 95% confidence interval (CI): 0.005 to 0.031) and lower severe depression-like emotions (β = -0.018; 95% CI: -0.033 to -0.002). Similarly, BMI was associated with higher self-efficacy (β = 0.010; 95% CI: 0.004 to 0.017) and lower severe depression-like emotions (β = -0.014; 95% CI: -0.022 to -0.007). For all models, however, wealth index had a stronger effect on the outcomes of interest. ConclusionsPoor nutritional status is suggested to be associated with behavioral organization and one’s emotional state. In this setting with a high prevalence of micronutrient deficiencies, we observed associations between lower hemoglobin and BMI with low self-efficacy and experiencing depressed mood, although the effect sizes were small. Findings may reflect potential confounding in the link between empowerment and mood, and poverty. Funding SourcesBill and Melinda Gates Foundation, World Food Programme.

Macro e micronutrientes na orientação nutricional para obesidade

A obesidade é uma doença crônica e tem se tornado uma epidemia em todo o mundo. Sua etiologia é multifatorial e o tratamento complexo, envolvendo dieta, exercícios físicos, fármacos e, em casos mais graves, cirurgia. De acordo com os guias e consensos, nacionais e internacionais, a distribuição dos macronutrientes fica em torno de 35% a 65% do valor energético total (VET) de carboidratos, 15 a 25% do VET de proteínas e 20 a 40% do VET de lipídios. Por meio de uma revisão de literatura, foram encontradas recomendações controversas. Conforme análise crítica dos pesquisadores envolvidos e de acordo com resultados de pesquisas recentes, concluiu-se que dieta hipocalórica (restrição de 500 a 750 kcal/dia), hiperproteica (>25% do VET), hipoglicídica e normolipídica foi eficaz na perda e manutenção do peso a longo prazo. Em relação aos lipídios, verificou-se que a dieta deve ser mais qualitativa, com a redução na ingestão de colesterol, gorduras saturadas e trans. O consumo de fibras deve ser estimulado. Dietas restritivas não se mostraram sustentáveis por um longo período, mas podem ser usadas em um período determinado. Além disso, a alta prevalência de deficiência de micronutrientes em indivíduos com obesidade foi consensual entre os autores, inclusive antes da cirurgia bariátrica. Concluiu-se que a adesão dietética e, consequentemente, o balanço negativo são fatores decisivos para a promoção da perda de peso. O planejamento alimentar deve ser flexível e individualizado e o contato entre o nutricionista e o paciente deve ser constante, visando a reeducação alimentar. O presente artigo realizou uma análise crítica das recomendações de macro e micronutrientes na obesidade visando contribuir para o tratamento dietético dessa população.

Folate and Vitamin B12 in Morbid Obesity: The Influence of Folate on Anti-Atherogenic Lipid Profile.

Previous studies showed a high prevalence of micronutrient deficiencies in obese subjects, with low folate and vitamin B12 serum levels and intakes. Correlations between vitamins and lipids have been investigated both in animal and human studies. The aim of our study is to evaluate the influence of dietetic and serum levels of folate and vitamin B12 on lipid pattern in morbidly obese subjects. We also analysed the relationship between serum concentrations and dietary intake of these micronutrients, and compared the intakes to the Recommended Levels of Nutrients and Energy Intakes (LARN). In 122 morbidly obese patients, mean BMI 45±7kg/m2, we evaluated anthropometric parameters, hepatic, glyco/lipid profile, total folate and vitamin B12, blood pressure, and finally nutritional intakes in a subgroup of 68 patients using a food frequency questionnaire about the frequency of food consumption and daily water intake. These values were determined in obese patients before and one year after sleeve gastrectomy. Both before and after surgery, levels of vitamins and minerals remained in normal range compared to LARN. According to univariate analysis, at baseline folate showed a significantly positive correlation with high-density lipoprotein cholesterol (p=0.028, ρ=0.204), apolipoprotein A-I (p=0.006, ρ=0.268) and vitamin B12 (p=0.040, ρ=0.192), and a significantly negative correlation with triglycerides (p=0.049, ρ=-0.184). Folate and vitamin B12 levels do not correlate with their nutritional intakes, which remain within recommended range after surgery. In conclusion the correlation between folate and anti-atherogenic lipid profile is confirmed also in a large group of morbid obese patients.

Nutritional Status and Psychological Impairment in Rural Adolescent Girls: Pilot Data From "KOKAN" Region of Western India.

Background: Adolescence is a period during which psychological foundations are laid down as well as consolidated. Not much information is available on rural Indian adolescent girls and their psychological health.Methods: We did a pilot survey of psychological health of 80 adolescent girls residing at KOKAN region of western India. Psychological health was evaluated using Youth Paediatric Symptom Checklist (Y-PSC) consisting of 35 items with maximum score of 70. Girls with a score >30 were classified as psychologically impaired. In addition we also collected random blood sample and measured the micronutrients. Macronutrient intake was estimated by 24 h recall.Results: The mean age of the girls was 14 years with a standard deviation of 1.5. In all 35/76 (46.1%) could be classified as psychologically impaired. There was a high prevalence of micronutrient deficiencies with varying degrees. More than 65% were deficient in calcium, zinc and folic acid. About 22% were anemic and 36% were vitamin B1 deficient. More than 75% had a low recommended dietary allowance (RDA) of macronutrients. Those with poor serum calcium concentration had higher psychological score (p < 0.05). Fat and calcium intakes were inversely associated with psychological score (p < 0.05 and p < 0.001 respectively). Odds ratios for psychological impairment were significant for those with low calcium levels [1.47 (95% CI 1.21, 4.31)], and for those with low calcium intake 1.43 (1.08, 3.19) and low iron intake 3.04 (1.02, 9.26).Conclusion: Our pilot data has shown the urgent need to improve the nutrition of adolescent girls, which could improve their psychological health.

Prevalence of Micronutrient Deficiency in Patients with Morbid Obesity Before Bariatric Surgery.

Postoperative micronutrient deficiency is a known side effect of bariatric surgery. In this study, we examined the prevalence of micronutrient deficiency in patients with morbid obesity (MO) preoperatively. A total of 1732 patients with MO wishing to undergo bariatric surgery (age: 40±12years, mean BMI: 44±9kg/m2, means±SD, 77.3% female) were analyzed in this cross-sectional examination. Iron state, vitamin B12, folic acid, 25hydroxy(OH)-vitamin D, PTH, vitamin A, and vitamin E levels were determined. Subsequently, patients underwent nutritional counseling and were substituted accordingly. A total of 63.2% (n=1094) of the patients had a deficit in folic acid (<5.3ng/ml), 97.5% (n=1689) in 25OHvitamin D (<75nmol/l), and 30.2% (n=523) had a PTH elevation (>56.9pg/ml). A total of 5.1% (n=88) of the patients presented with a deficit in vitamin B12 (<188pg/ml) and 6.2% (n=107) in vitamin A (<1.05μmol/l). A total of 9.6% (n=166) exhibited iron deficiency (ferritin<15μg/l). None of the patients had a deficit in vitamin E. There were no gender differences except for ferritin deficiency (women 11.8% vs. men 1.5%, p<0.001). Patients in the highest BMI tertile had significantly more often a deficit in vitamin D (p=0.033) and folic acid (p<0.001). Patients in the lowest age tertile had significantly more often a deficit in folic acid (p<0.001). Our data show a high prevalence of micronutrient deficiency in patients with morbid obesity preoperatively and emphasize the importance of exact preoperative evaluation and adequate substitution as well as postoperative surveillance.

Nutrient deficiencies prior to bariatric surgery.

The purpose of this review is to provide an update of recent additions to our understanding of the prevalence of nutrient deficiencies and the potential role of preoperative weight loss in contributing to these deficiencies in obese individuals planning to undergo bariatric surgery. Recent reports that have included bariatric surgery candidates from sites around the world have shown consistent deficiencies in a variety of nutrients. Although protein-energy malnutrition is uncommon preoperatively, micronutrient deficiencies occur commonly with multiple deficiencies often present in the same individual. No difference in the prevalence of deficiency between men and women is apparent, and a standard profile of susceptibility to deficiency has not been identified. In the only studies that have evaluated dietary intake of total energy, macronutrients and micronutrients preoperatively, despite an excess of calories ingested, micronutrient intake tends to be lower than recommended. A high prevalence of micronutrient deficiencies, especially vitamin D, folate, B12 and iron, is present in obese individuals being considered for bariatric surgery. Despite high-caloric intake, the deficiencies present appear to be related to the poor quality of the diet and low micronutrient intake. These findings strengthen prior recommendations of routine preoperative nutritional screening. Because a standard profile of susceptibility to deficiency has not been identified, extensive nutritional screening, including micronutrient testing, should be considered in all patients in the preoperative setting. Finally, we recommend early supplementation of vitamins and minerals based on laboratory assessment and incorporation of a program to optimize eating behaviors prior to surgery.

Addressing Micronutrient Deficiencies: Sustaining the Initiative

Objective: The objective of this paper is to inform about the implementation and success of an innovative pilot project for addressing the high prevalence of micronutrient deficiency in Rajasthan, India.Design: The paper is based on the secondary information collected during the implementation phase of the project. The project was implemented in two blocks of Udaipur district in Rajasthan, India to provide facility of flour fortification at the level of small chakkis (local grinding mills) where anyone could get their wheat grinded and fortified with Iron, Folic Acid and Vitamin B-12 at no additional cost.Setting: A census of available small chakkis in the blocks was done. In total, 397 chakkis were identified in both blocks. The identified chakkis were categorized according to their daily grinding and those which were grinding wheat up to 100 kg and above daily, were made partners in this initiative. In total, 200 chakkis were engaged in both blocks.Subject: The subject for the study included both grinding mill owners and the rural population residing in the study area. Results: From February 2013 till January 2015, the average production by 200 chakkis was 340 MT per month which means approximately 38,000 individuals have consumed micronutrient added wheat flour. Conclusion: The acceptance for flour fortification has increased exponentially within a short period of 15 months, it can be assumed that the acceptance will grow further if dedicated efforts are made which is possible only if the awareness generation activities started during the intervention is sustained.