Micronutrient Deficiencies In Children Research Articles

The return of the old masquerader—scurvy: a case report of pediatric limping and bone pain

BackgroundScurvy has been a rare condition in the developed world due to the increasing availability of adequate nutrition and easy access to fruits and vegetables. Scurvy is caused by severe vitamin C deficiency and has been historically associated with malnutrition in high-risk populations such as sailors. As it is an uncommon nutritional deficiency, scurvy is seldom suspected and usually under-diagnosed especially in the pediatric population.Case presentationWe report a case of a pediatric patient with a history of autism spectrum disorder presenting with atypical symptoms of scurvy with gait abnormalities, diffuse rash, musculoskeletal deconditioning, and bleeding manifestations. After multiple extensive investigations and a prolonged hospitalization, a detailed dietary analysis revealed a severely restricted diet devoid of fruits and vegetables. Physical examination revealed specific signs of corkscrew hair with peri-follicular hemorrhages, hypertrophic, and bleeding gums with a concurrent low vitamin C level. Treatment with vitamin C supplementation was initiated and he was ambulant within 1 month of discharge.ConclusionThis case highlights the importance of nutrition history for determining micronutrient deficiency in children with special needs. Enhanced physician education and higher index of suspicion regarding nutritional deficiencies will avoid over-investigations and delays for the institution of specific treatment.

Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis.

Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive. The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs). Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded. Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation. The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55). A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens. PROSPERO registration no. CRD42023409483.

Iron Deficiency in Young Children Beyond Anemia: Clinical Features, Maternal Factors, and the Predictor for Neuropsychomotor Development Delay

Introduction: Iron deficiency (ID) is the most common micronutrient deficiency in children and is prevalent in young children, especially in those with long-term exclusive breastfeeding (BF). Iron deficiency anemia (IDA), the most common type of pediatric anemia, while it is not the only clinical manifestation of ID. In Taiwan, prevalence of IDA was up to 23% in child-bearing women. It was reported that the iron levels in the breast milk of IDA mothers were markedly lower than that of non-IDA mothers. ID alone in young children can cause neurocognitive development symptoms, including inattention, psychomotor delay, cognition impairment, pica, etc, in children. However, clinical reports on ID, not IDA, are relatively few. We aimed to investigate the clinical features and influencing factors of ID in young children. Methods and Materials: There were 33 young children diagnosed as ID at outpatient department at Taipei Medical University Hospital from 2017 to 2019. The charts were retrospectively reviewed and clinical data were collected, including diagnostic age, initial symptoms, periods of breast-feeding (BF), hemoglobin (Hb), mean corpuscular volume (MCV), serum ferritin (SF), serum iron, total iron binding capacity (TIBC), zinc levels, thalassemia survey, duration of iron supplement, and laboratory improvement after iron supplement. Whether there were neuropsychomotor (NPMD) delay depended on the chart record of doctors of pediatric rehabilitation. Results: The median age of ID diagnosis was 2.5 years (range: 5 month－7.17 years). There were 31 (94%) of ID children initially presented with either koilonychias, picky eating, or poor appetite. 24 (72.7%) were found to have koilonychias, and among them, 18 (54.5%) had flat nails and 6 (18.2%) had spoon nails. 17 (51.5%) were picky eaters, 16 (48.5%) had poor appetite, 7 (21.2%) had pale nails, and 3 (9.1%) had pica. 11 (33.3%) had NPMD delay. The median duration of BF was 10.8 months (range: 0 to 36). There were 12 (36.4%) children whose mother had IDA. The median Hb was 11.2 g/dL (IQR: 10－12.65), median MCV was 76.45 fL, median SF level was 25 ng/mL (IQR: 13.25－45.5), and median transferrin saturation was 9.25% (IQR: 7－12.88). The median serum zinc level at diagnosis of ID was 66.4 μg/dL. In addition, 21 (63.6%) has concurrent zinc deficiency, 10 (30.3%) had pediatric IDA, and 2 (6.3%) had combined thalassemia trait. The median (IQR) duration of iron supplement is 3 (3-6) months. After treatment, patients' data revealed a significant increase in median Hb of 12.6 mg/dL, median MCV of 78.7 fL, median SF of 47 ng/mL, and median transferrin saturation of 15.35%. By correlation analysis, breastfeeding duration was also moderately correlated to SF level (Pearson rank=-0.5224). Maternal IDA history also had a negative correlation to SF level in ID children (Pearson rank=-0.4053). By multivariate linear regression (MVLR) analysis, breastfeeding duration and maternal IDA history were identified as significantly inverse predictors for SF levels in ID children. ID children with NPMD delay had significantly higher rate of concurrent zinc deficiency. By MVLR analysis, serum zinc level was identified as a significant inverse predictor for NPMD delay among ID children (Odd's ratio: 0.89, 95%CI: 0.799-0.991, p-value=0.0336*). Conclusion: Our results highlighted the clinical features of ID in infants and children. A high proportion of ID children had maternal IDA history (36.4%) and NPMD delay (33.3%). Iron supplementary was effective to improve ID. Breastfeeding duration and maternal IDA history can negatively impact SF level in ID children. Good levels of serum zinc in ID children can predict lower risk of NPMD delay. Disclosures : No relevant conflicts of interest to declare.

Parenteral support and micronutrient deficiencies in children with short bowel syndrome: A comprehensive retrospective study

Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure. The duration of parenteral support (PS) and the long-term micronutrient needs in children with SBS vary, based on their clinical and anatomical characteristics. Our study aimed to review the clinical course and identify high risk patient groups for prolonged PS and long-term micronutrient supplementation. A retrospective review was conducted on electronic medical records of children with SBS and chronic intestinal failure who were enrolled in the multidisciplinary intestinal rehabilitation program at Manchester Children's Hospital, UK. Children were included in the review if they required PN for more than 60 days out of 74 consecutive days and had at least 3 years of follow-up. Statistical analysis was performed using IBM SPSS Statistics 24.0. 40 children with SBS achieved enteral autonomy (EA) and 14 remained dependent on PS after 36 months of follow up. Necrotizing enterocolitis was the most common cause for intestinal resection (38.9%) followed by gastroschisis (22.2%), malrotation with volvulus (20.4%), segmental volvulus (9.3%) and long segment Hirschsprung disease (1.9%). Those who achieved EA had significantly longer intestinal length 27.5% (15.0-39.3) than those who remained on PS 6.0% (1.5-12.5) (p<0.001). Type I SBS was only found in the PS cohort. Median PN dependence was 10.82 months [IQR 5.73-20.78]. Congenital diagnosis was associated with longer PN dependence (21.0±20.0) than acquired (8.7±7.8 months), (p=0.02). The need for micronutrient supplementation was assessed after the transition to EA; 87.5% children had at least one micronutrient depletion, most commonly Vitamin D (64.1%), followed by iron (48.7%), Vitamin B12 (34.2%), and vitamin E (28.6%). Iron deficiency and vitamin A depletion were correlated with longer PS after multivariate analysis (OR: 1.103, 1.006-1.210, p=0.037 and OR: 1.048, 0.998-1.102, p=0.062 respectively). In our cohort, small bowel length was the main predictor for EA. Children on longer PS, had more often a congenital cause of resection and were at risk for micronutrient deficiencies in EA.

Chemical and functional properties of nutrient-dense beverages developed from underutilised crops

Beverages are typically seen as wholesome snacks that can be included in a daily diet. Despite being part of the regular diet, the majority of these beverages are low in nutrients and high in calories. Worldwide, a variety of industrial processes, raw ingredients and microorganisms are used to manufacture fermented food. Many indigenous or traditional fermented foods and beverages are still prepared today as a form of domestic art. They are created in small businesses, communities and homes. Among the fermented foods that are important to people's diets worldwide are beverages that might have a non-dairy origin. In this study, Moringa oleifera Leaf Powder (MoLP) was used to fortify two beverages, including Amasi (Bambara groundnut) and Mageu (sorghum), at 0% (control), 1% and 5%. After fortifying the fermented and unfermented variations, the beverages' biochemical, chemical and functional properties were analysed. The effects of MoLP (1% and 5%) on the stress, viscosity and torque characteristics of Amasi were significant (p ?0.05). For all of the samples, Amasi and Mageu's values for protein, ash and moisture increased significantly (p ?0.05) due to the inclusion of MoLP. These findings indicate that MoLP-fortified beverages can act as a source of nutrients to address micronutrient deficiencies in children and adults.

The effect of zinc supplementation on anthropometric measurements in healthy children over two years: a systematic review and meta-analysis

BackgroundZinc deficiency is one of the most important micronutrient deficiencies in children that can affect the children’s growth pattern. In this regard, different studies were conducted to assess the effect of zinc supplementation on growth patterns in healthy children. To the best of our knowledge, no systematic review has summarized the results of these studies. So, in the present study, we systematically reviewed the result of the studies that assessed the effect of zinc supplementation on anthropometric parameters in healthy, over 2-year-old children.MethodsA systematic search was carried out in PubMed, Scopus, and Web of Science from inception to November 2021. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI).ResultsThe pooled results of eight studies, including 1586 participants, showed that zinc supplementation significantly increases height [(WMD): 0.9, 95% CI: (0.27, 1.52), p < 0.001], weight [(WMD): 0.51, 95% CI: (0.06, 0.97), p < 0.001], height for age (HAZ) [(WMD): 0.07, 95% CI: (0.03, 0.10), p < 0.001]. Also, meta-regression analysis did not reveal any significant association between dose and duration of intervention and anthropometric parameters.ConclusionThe present study demonstrates the beneficial effects of zinc supplementation on weight, height, and HAZ.

Nutritional Support in the Prevention of Micronutrient Deficiency with Fruit and Fruit Products in Children

The aim is to study the macro- and microelement composition of food products of fruit and fruit origin, often consumed by the local population of the Zarafshan Valley for the purpose of nutritional and micronutrient support in the prevention of micronutrient deficiency in children. Fruit and vegetable food products grown in the Samarkand region are characterized by a high content of essential, low content of brain, an abiogenic, aggressive and toxic element, which indicates high biological activity and safety for the child. Nutritional and micronutrient support using fruit and fruit foods containing high concentrations of pharmaco micronutrients should be recommended in order to optimize the growth and development of children and the micronutrient status of the body and its functions, accelerate the recovery processes and improve the quality of life.

Micronutrient Deficiency in Children and Adolescents with Obesity—A Narrative Review

Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.

Prevalence of micronutrient deficiency and its impact on the outcome of childhood cancer: A prospective cohort study

Impact of micronutrient deficiency on childhood malignancy is unexplored. We estimated the prevalence of baseline micronutrient deficiency in children with cancer and its impact on event-free survival (EFS) and overall survival (OS). A longitudinal cohort study was conducted at a tertiary cancer centre in India. Children (≤18 years) with de novo malignancy were enrolled between October 2012 and May 2014. Baseline levels of vitamin B12, folate, zinc, selenium, copper, and iron were measured and values below 150pmol/L, 6ng/mL, International Zinc Nutrition Collaborative Group cut-off, 0.5μmol/L, 10μmol/L, and 50μg/dL, respectively, indicated deficiency. Total 535 children [326 (60.9%) haematological and 209 (39.1%) solid malignancies] were enrolled with median follow-up of 66 months. Vitamin B12, folate, zinc, selenium, copper and iron deficiencies were found in 209 (39.1%), 89 (16.6%), 173 (32.3%), 39 (7.3%), 12 (2.2%), and 231 (43.2%) children, respectively. Selenium deficiency independently predicted poor EFS (hazard ratio [HR]=1.56; p=0.038) and OS (HR=1.65; p=0.027) in the cohort. In haematological malignancies, selenium deficiency predicted poor EFS (HR=1.81; p=0.023) and OS (HR=2.12; p=0.004). In solid malignancies, vitamin B12 (HR=1.55; p=0.028) and zinc (HR=1.74; p=0.009) deficiencies predicted poor EFS, and zinc deficiency predicted poor OS (HR=1.77; p=0.009). Multiple micronutrient (≥3) deficiencies also predicted poor EFS (HR=1.69; p=0.001) and OS (HR=1.83; p<0.001) in the whole cohort. Selenium deficiency was independently predictive of adverse outcomes in childhood cancer, particularly in haematological malignancies. Zinc deficiency adversely affected solid tumours. The adjunct use of micronutrient supplementation in paediatric malignancies should be explored.

Vitamin B12 Eksikliği Olan Çocuklarda Klinik ve Laboratuvar Bulguların ve Tanısal Zorlukların Değerlendirilmesi

Aim: In this study, we evaluated the clinical and laboratory data of healthy children with vitamin B12 deficiency. The benefits of methylmalonic acid (MMA) and homocysteine levels and the difficulties encountered in diagnosing vitamin B12 deficiency were pointed out. &#x0D; Materials and Methods: A total of 70 healthy children whose serum cobalamin levels were below 126.5 pg/ml were included in the study. The age, gender, serum vitamin B12, urine MMA, plasma homocysteine, white blood cell, hemoglobin, thrombocyte, main corpuscular volume (MCV), main platelet volume (MPV), folic acid, and ferritin levels were obtained retrospectively from the hospital’s medical records. The correlation analysis test compared vitamin B12 with MMA and homocysteine.&#x0D; Results: The mean age was 8.21±6.15 years, and vitamin B12 deficiency was found in 6.29% of healthy children. Cobalamin levels ranged from 50-126 pg/ml, with a mean of 102.57±18.97 pg/ml. Urine MMA and serum homocysteine levels were 0.59±0.67 ng/ml and 13.50±0.67 g/dl, respectively. The correlation coefficient value (r) was found to be -0.342 and -0.437, moderately negative for MMA and homocysteine, respectively. MMA levels were normal in 36 patients, and homocysteine levels were normal in 48 patients. &#x0D; Conclusions: Vitamin B12 deficiency is a common micronutrient deficiency in children. The diagnosis of vitamin B12 deficiency can be complex in healthy children who do not display typical laboratory findings, particularly elevated MMA and homocysteine.

Anthropometric and Micronutrient Assessment in Pediatric Patients with Cleft Lip and Palate in a Tertiary Care Hospital of Haryana, India

Introduction: Cleft lip (CL) and/or cleft palate (CP) are the most common visible craniofacial anomalies throughout the world. CL and CP occur due to a failure of the skeletal components of the mid-face to fuse. The affected individual may have an isolated defect or a combination of both. These children can be undernourished due to feeding difficulties after birth. The growth problems of children with clefts have largely been attributed to inadequate nutrition. The aim of the study is to assess the anthropometric status and micronutrient deficiencies in children with cleft lip and palate. Methods: This is a cross-sectional study of 18 months duration conducted at SGT medical college, Gurugram, a tertiary care center in Haryana, India between June 2020 to December 2021 involving the assessment of patients with cleft lip and palate between the age of 3 months to 5 years of either gender who visited pediatric unit for complete evaluation before surgery. A total of 100 patients were enrolled in the study and the following information was recorded: age, gender, hemoglobin, serum vitamin D3 level, serum ferritin, and serum vitamin B12 level. Results: A total of 100 patients were included in the study, of which, 53 (53%) were males and 47 (47%) were females. Anthropometrically, in our study, 83% of patients had moderate to severe wasting, according to WHO classification. Anemia was prevalent in 71.1% of cases in the current study. Vitamin D3 deficiency was seen in 88% of the study population, while 37% of cases had Vitamin B12 deficiency. The correlation between anthropometric assessment and nutritional deficiency suggested that children of cleft lip and palate with severe wasting had significant iron deficiency anemia as well as vitamin B12 deficiency. However, vitamin D deficiency was not statistically significant in severe wasting group. Conclusion: A large number of children with cleft lip and/or palate are not exclusively breastfed due to anatomical deficits. They need supplemental Iron and vitamin D to meet the demands. Macro and micronutrient deficiencies along with recurrent infections, lead to moderate to severe wasting and stunting in these children causing severe malnutrition with complications and failure to thrive.

"Are We Feeding Them Enough?" Micronutrient Deficiency in Children Aged Six Months to Fourteen Years in India.

In this study, we conducted a systematic literature review of the various micronutrient deficiencies (MNDs) that affect children in India and an examination of whether there is a geographic basis for MNDs.MNDs are a common problem in the developing world, in particular, among children in South Asia. According to the United Nations Children’s Fund, millions of children suffer from stunted growth, cognitive delays, weakened immunity, and diseases because of MNDs. These physical ailments have several economic, social, and public health implications, and they can severely hamper a country’s growth. This study aims to clarify existing data on this topic and highlight the disparities between children living in urban and rural areas in India.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic literature review of a total of five studies. Study quality was assessed using appropriate checklists, and the studies strengthened the hypothesis that MNDs are common among children in India. Because the selected studies were heterogeneous, no statistical conclusions are drawn here. However, a central premise is that MNDs in children are prevalent in India and are related to poverty. No link between geographic location and MNDs is established; rather, recommendations are made for further research on the topic.

Production of Beta-Carotene Rich Biscuits from Composite Wheat-Orange- Fleshed Sweet Potato Flour, Palm Oil and Eggs

One of the main micronutrient deficiencies in children under five years is vitamin A deficiency (VAD). This study aimed to produce biscuit from composite wheat-orange- eshed sweet potato flour (OFSP), palm oil and eggs and to determine its contribution to the diet of children on the age group of 1-3 years. For the biscuit formulations codified ‘’AE, BE and CE’’ were prepared by partial replacement of wheat with OFSP flour in proportion at 0%, 30% and 50% respectively, and margarine by crude palm oil 1/3 (33%), this combination was supplemented by 20g of egg. While the control biscuit codified A0, was prepared using 100g of wheat flour and 30g of margarine. The carotenoid contents of the prepared biscuit were determined by using the method describe by Rodriguez Amaya and Kimura (2004). The analysis of variance was used to determine the significant difference in the samples with a significant level of 0.05. Results of the study revealed that the carotenoid content in the biscuits ranged from 96.03 μg/100g to 15251 μg/100g (86.82μg/100g to 12200.8μg/100g of beta-carotene) and the Retinol Activity Equivalent (RAE) was reported from 6.4 to 1016.7μg RAE/100g in the control and the formulation CE respectively. The protein content ranged from 5.48 to 7.91%, and the energy level was reported from the 468.46 to 484.6 Kcal/100g in the biscuits. All biscuits were in the acceptable range (6.36 to 7.63) related to the sensory score. From the results of study, biscuits formulation appears to be efficient, since it produced biscuits of high nutritional values within the RAE range which could prevent the VAD in young children since 2 to 5 portions of biscuits could cover the retinol equivalent for children aged 1-3 years- old.

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

In coeliac disease (CD) micronutrient deficiencies may occur due to malabsorption in active disease and diminished intake during treatment with a gluten-free diet (GFD). This study assessed the micronutrient status in children with CD at diagnosis and follow-up. Fifteen micronutrients were analysed in 106 blood samples from newly diagnosed CD and from patients on a GFD for <6 months, 6-12 months and with longstanding disease (>12 months). Predictors of micronutrient status included: demographics, disease duration, anthropometry, gastrointestinal symptoms, raised tissue transglutaminase antibodies (TGA), multivitamin use and faecal gluten immunogenic peptide (GIP). Micronutrient levels were compared against laboratory reference values. At CD diagnosis (n=25), low levels in ≥10% of patients were observed for: vitamins E (88%), B1 (71%), D (24%), K (21%), A (20%) and B6 (12%), ferritin (79%), and zinc (33%). One year post-diagnosis, repletion of vitamins E, K, B6 and B1 was observed (<10% patients). In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis. Copper, selenium and magnesium did not differ significantly between diagnosis and follow-up. All samples for B2, folate, vitamin C (except for one sample) and B12 were normal. A raised TGA at follow-up was associated with low vitamins A and B1 (raised vs normal TGA; vitamin A: 40% vs 17%, p=0.044, vitamin B1: 37% vs 13%, p=0.028). Low vitamin A (p=0.009) and vitamin D (p=0.001) were more common in samples collected during winter. There were no associations between micronutrient status with GIP, body mass index, height, socioeconomic status, or gastrointestinal symptom. Multivitamin use was less common in patients with low vitamin D. Several micronutrient deficiencies in CD respond to a GFD but others need to be monitored long-term and supplemented where indicated.

Development and Implementation of Liposomal Encapsulated Micronutrient Fortified Body Oil Intervention for Infant Massage: An Innovative Concept to Prevent Micronutrient Deficiencies in Children.

Indian communities have the ancient cultural practice of gentle oil massage for infants which has been shown to play a beneficial role in neuro-motor development. The concept of incorporating nanosized liposomes of micronutrients (i.e., iron, folate, vitamin B12, and vitamin D) in the body oil leverages this practice for transdermal supplementation of essential micro-nutrients. This paper describes the experience of developing an intervention in the form of body oil containing nanosized liposomes of iron and micro-nutrients built on the social context of infant oil massage using a theory of change approach. The process of development of the intervention has been covered into stages such as design, decide and implement. The design phase describes how the idea of nanosized liposomal encapsulated micronutrient fortified (LMF) body oil was conceptualized and how its feasibility was assessed through initial formative work in the community. The decide phase describes steps involved while scaling up technology from laboratory to community level. The implementation phase describes processes while implementing the intervention of LMF oil in a community-based randomized controlled study. Overall, the theory of change approach helps to outline the various intermediate steps and challenges while translating novel technologies for transdermal nutrient fortification to community level. In our experience, adaptation in the technology for large scale up, formative work and pilot testing of innovation at community level were important processes that helped in shaping the innovation. Meticulous mapping of these processes and experiences can be a useful guide for translating similar innovations.

Principles of monitoring and intervention for micronutrient deficiency in children with autism spectrum disorder

Principles of monitoring and intervention for micronutrient deficiency in children with autism spectrum disorder

The relationship between anthropometric measures, vitamin consumption and biochemical values as cardiovascular disease predictors in a school population in bogotá

Rationale: Malnutrition and micronutrient deficiency in children, remains a public health problem in Colombia. In long term basis, this may translate in augmented cardiovascular problems, therefore, we seek to understand in a school population how their nutritional and lifestyle habits may relate to this possible outcome.

Lessons learned from implementing the pilot Micronutrient Powder Initiative in four districts in Ghana

BackgroundMicronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients. Home-fortification (HF) could improve children’s diet quality in these settings. The Ghana Health Service, supported by UNICEF, integrated the pilot Micronutrient Powder Initiative (MPI) into Child Welfare Clinic (CWC) services in four districts (Tain, Tolon, Talensi, and Ho West), whereby micronutrient powder (MNP) is supplied for HF for children aged 6–23 months attending CWCs. This study’s main aim was to identify the facilitators, barriers and “lessons learned” after 2 years of program implementation.MethodsThis was a qualitative cross-sectional study. MNP distributed and children enrolled were obtained from program records. Primary data were collected from November to December 2019 and included, by district: interviews with senior program staff; key informant interviews and focus group discussion with caregivers in each of 6 sub-districts; and discussions workshop with frontline staff from at least 10 health facilities. Besides field notes, all interactions were audio-recorded and transcribed verbatim. Qualitative data were analyzed using NVivo10.ResultsThe MPI remains on-going, with about 2.5 million MNP sachets distributed to nearly 30,000 children within 90 district-months. Caregivers generally accept the MNP; reported positive responses in children include: “increased appetite”, “less frequent illnesses, “increased energy/strength”, “increased weight”, and “walking independently relatively early”. Main facilitators are: generally regular MNP availability; increased patronage of CWC services; various contact points for supplying MNPs; fairly strong social mobilization strategy; good integration of MPI with CWC services; “one-on-one” counselling for caregivers reporting side effects; and tracing caregivers to address concerns and monitor adherence. Main barriers are: lack of counselling materials; caregivers’ suspicions towards the program; absence of refresher training for frontline workers; and perceived MNP side-effects. Key lessons learned are: incorporating MNPs into CWC services is feasible, acceptable, and could reduce child micronutrient deficiencies in program districts; and MPI’s success requires stronger community sensitization, equipping frontline workers to advise caregivers and manage side-effects, and consciously identifying and managing logistical challenges.ConclusionFurther research is needed to evaluate the effectiveness of the MPI in reducing micronutrient deficiencies among 6–23-months-olds in Ghana.

Anemia and Iron and Vitamin B12 Deficiencies in Children Under 5 in Mexico: Results from the National Health and Nutrition Survey (ENSANUT)

Abstract Objectives To examine the burden of anemia, iron deficiency, and vitamin B12 deficiency in children under 5 in Mexico. Methods Data from the recently completed National Health and Nutrition Survey (ENSANUT 2018) were analyzed to examine the burden of anemia and micronutrient deficiencies in children under 5 (1 to &amp;lt;5 years). Hemoglobin (Hb) concentrations werequantified in capillary blood samples (n = 3144) via HemoCue.Venous blood samples (n = 1019) were collected, centrifuged, processed, and stored &amp;lt;−80°C until analysis of micronutrient biomarkers. Serum ferritin (SF), C-reactive protein (CRP), and vitamin B12 concentrations were measured via immunoassays. Hemoglobin was adjusted for altitude; anemia was defined as hemoglobin &amp;lt;11.0 g/dL. Iron deficiency was defined as serum ferritin &amp;lt;12.0 µg/L and iron insufficiency was defined as serum ferritin &amp;lt;20.0 µg/L; inflammation was defined as CRP concentrations &amp;gt; 5.0 mg/L (and CRP &amp;gt; 1.0 mg/L). Iron deficiency anemia was defined as hemoglobin &amp;lt;11.0 g/dL and serum ferritin &amp;lt;12.0 μg/L. Vitamin B12 deficiency and vitamin B12 insufficiency were defined as &amp;lt;148.0 and &amp;lt;221.0 pmol/L, respectively. Survey frequency procedures were used to examine the prevalence of anemia and micronutrient deficiencies; survey linear and logistic regression were used to examine associations of micronutrient biomarkers with hemoglobin concentrations and odds of anemia. Results A total of 22.9% of children were anemic in this population. In the biomarker sub-sample, 10.0% of children were iron deficient (SF &amp;lt; 12.0 µg/L), and 29.9% had serum ferritin concentrations &amp;lt;20.0 µg/L. A total of 9.5% of children had CRP concentrations &amp;gt;5.0 mg/L, and 34.7% had CRP &amp;gt; 1.0 mg/L. The prevalence of vitamin B12 deficiency (vitamin B12 &amp;lt; 148.0 pmol/L) was 5.4% and 21.5% of children had vitamin B12 insufficiency (vitamin B12 &amp;lt; 221.0 pmol/L). Conclusions Findings suggest that the burden of anemia and iron and vitamin B12 insufficiency is high in young children in Mexico. Funding Sources ENSANUT was funded by The Ministry of Health of Mexico.