Micronutrient Deficiencies In Children Research Articles

High Prevalence of Multiple Micronutrient Deficiencies in Children with Intestinal Failure: A Longitudinal Study

To determine the prevalence of micronutrient deficiencies in children with intestinal failure as they transitioned from parenteral nutrition (PN) to enteral nutrition (EN). We reviewed medical records of all patients with severe intestinal failure treated from 1999 to 2008 at a multidisciplinary intestinal rehabilitation program who had undergone micronutrient biochemical monitoring. The cohort of 30 children (mean age, 5 years; range, 2 to 9 years; 18 boys) had median PN duration of 23 weeks (IQR, 13 to 34 weeks). Median transition from PN to full EN lasted 12 weeks (IQR, 8 to 20 weeks); during this transition, 33% of patients had at least one vitamin deficiency and 77% at least one mineral deficiency. After transition to 100% EN, 70% had at least one vitamin deficiency and 77% had at least one mineral deficiency, with the most common deficiencies being vitamin D (68%), zinc (67%), and iron deficiency (37%). After transition to 100% EN, multivariate analysis identified regular use of a multivitamin supplement (P=.004) and intact ileocecal valve (P=.02) as protective against the development of vitamin deficiencies, independent of bowel length, gestational age, and days on PN. Children with intestinal failure exhibit a high prevalence of micronutrient deficiencies during intestinal rehabilitation. Regular monitoring and aggressive supplementation in children with intestinal failure is warranted.

Micronutrient deficiency disorders among the rural children of West Bengal, India

Background: Multiple micronutrient deficiencies continue to be a major nutritional problem of public health significance in India.Aim: To assess the prevalence of micronutrient deficiencies among rural children of West Bengal, India.Subjects and methods: A community-based cross-sectional study was carried out on 9228 and 437 pre-school children, respectively, for assessment of vitamin A deficiency (VAD) and anaemia. Iodine deficiency disorders (IDD) were assessed in 3490 children of 6–12 years.Results: The prevalence of Bitot's spots, an objective sign of clinical VAD, was 0.6% and was significantly (p < 0.01) higher among children of 3–5 years. Prevalence of blood vitamin A deficiency ( < 20 μg/dL) was 61% and ∼81% of children were anaemic. About 25% children had both sub-clinical VAD and anaemia. The children of Scheduled Caste and Scheduled Tribe (OR = 2.3: 95% CI = 1.3–3.9) were at higher risk of anaemia, whereas children of Scheduled Tribe (OR = 4.5; 95% CI = 2.1–10.5) and 3–5 years (OR = 1.4; 95% CI = 1.0–2.0) were at risk for VAD. The prevalence of goitre was 9%.Conclusions: Micronutrient deficiencies were found to be of public health significance among rural children of West Bengal. Therefore, there is a need to initiate sustainable long-term interventions for prevention and control of micronutrient deficiencies in children.

Effects of iron and zinc fortified milk supplementation on working memory of underweight poor-urban school children: A randomized double blind controlled trial

Background Undernutrition associated micronutrientdeficiencies in children are still prevalent in most developingcountries. Iron and zinc deficiencies are the most commonmicronutrient deficiency globally, which significantly contributedeficits in cognitive function. Fortification with iron and zinc hasproven successfully in reducing certain cognitive impairmentslike memory.Objective To determine the effects of milk fortified with iron andzinc on memory of underweight poor-urban schoolchildren.Methods A double blind randomized controlled trial wasconducted on 218 underweight poor-urban schoolchildren aged7-9 years old; 113 children were supplemented twice daily with27 gram of milk fortified with iron pyrophosphate (12.15 mg) andzinc sulfate (4.4 mg) for three months, 105 children served ascontrols. Anthropometry measured including bodyweight, height,sitting height and middle upper arm circumference. Memory wasmeasured using digit span backward test in Wechsler IntelligenceScales III. Statistical analyses were performed with SPSS forWindows, version 11.0.Results Baseline data of digit span backward score in iron andzinc group was 2.4 (SD 1.2), and control group was 3.0 (SD 1.8).After intervention, mean digit span backward score in iron andzinc group was 3 .1 (SD 1.2) and in control group 3.0 (SD 1.3).There was no improvement digit span backward score in controlgroup after intervention, compared with 0.7 point improvementin iron and zinc group (P=0.009).Conclusion Milk fortified with iron and zinc improves workingmemory of underweight poor-urban schoolchildren.

CON: Secondary Surgical Debulking Is Not an Acceptable Option in Patients with Recurrent Platinum-Sensitive Ovarian Cancer

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 150 pmol/L, 6 ng/mL, International Zinc Nutrition Collaborative Group cut-off, 0.5 μmol/L, 10 μmol/L, and 50 μg/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.

Multiple micronutrient deficiencies persist during early childhood in Mongolia.

Data on the prevalence of micronutrient deficiencies in children in Mongolia is limited. We therefore determined the prevalence of anaemia, iron deficiency anaemia (IDA), and deficiencies of iron, folate, vitamin A, zinc, selenium, and vitamin D among young Mongolian children. Anthropometry and non-fasting morning blood samples were collected from 243 children aged 6-36 months from 4 districts in Ulaanbaatar and 4 rural capitols for haemoglobin (Hb), serum ferritin, folate, retinol, zinc, selenium, and 25-hydroxyvitamin D (25-OHD) assays. Children with alpha-1-glycoprotein >1.2mg/L (n=27) indicative of chronic infection were excluded, except for folate, selenium, and 25-hydroxyvitamin D assays. Of the children 14.5% were stunted and none were wasted. Zn deficiency (serum Zn <9.9 micromol/L) had the highest prevalence (74%), followed by vitamin D deficiency 61% (serum 25-OHD<25 nmol/L). The prevalence of anaemia (24%) and iron deficiency anaemia (IDA) (16%) was lower, with the oldest children (24-36 mos) at lowest risk. Twenty one percent of the children had low iron stores, and 33% had vitamin A deficiencies (serum retinol < 0.70 micromol/L), even though two thirds had received vitamin A supplements. Serum selenium values were low, perhaps associated with low soil selenium concentrations. In contrast, no children in Ulaanbaatar and only 4% in the provincial capitols had low serum folate values (<6.8 nmol/L). Regional differences (p<0.05) existed for anaemia, deficiencies of vitamin A, folate, and selenium, but not for zinc or IDA. Of the children, 78% were at risk of > or = two coexisting micronutrient deficiencies emphasizing the need for multimicronutrient interventions in Mongolia.

Multiple micronutrient deficiencies persist during early childhood in Mongolia

The effectiveness of interventions in Mongolia to combat micronutrient deficiencies in children is uncertain. We determined the prevalence of anemia, iron deficiency anemia (IDA), and deficiencies of Fe, Zn, Se, and vitamin A among young Mongolian children. Anthropometry and non‐fasting morning blood samples were collected from 243 children (126 M, 117 F) aged 6–36 months from Ulaanbaatar and 4 rural capitals for hemoglobin (Hb), serum (s) ferritin, Zn, Se, and retinol assays. Children with α‐1‐glycoprotein&gt;1.2 mg/L (n = 27) indicative of infection were excluded. Of the children 14.5% were stunted and none were wasted. Zn deficiency (sZn&lt;9.9μmol/L) had the highest prevalence (74%). The prevalence of anemia (24%) and iron deficiency anemia (IDA) (16%) were lower, with the oldest children (24–36 mos) at lowest risk. 21% of the children had Fe deficiency, and 33% had vitamin A (sretinol &lt;0.70 μmol/L) deficiency. Serum Se values were low, as noted for South Island NZ children, where soil Se is low. Regional differences (p&lt;0.05) existed for anemia, deficiencies of Se and vitamin A, but not Zn or IDA. Age, location, log serum ferritin, infection, and serum zinc were major predictors of hemoglobin. Of the children, 64% were at risk of two or more coexisting micronutrient deficiencies emphasizing the need for multimicronutrient interventions in Mongolia. Funded by WHO, UNICEF, World Vision Mongolia, University of Otago.

Micronutrient deficiency in children.

Malnutrition increases morbidity and mortality and affects physical growth and development, some of these effects resulting from specific micronutrient deficiencies. While public health efforts must be targeted to improve dietary intakes in children through breast feeding and appropriate complementary feeding, there is a need for additional measures to increase the intake of certain micronutrients. Food-based approaches are regarded as the long-term strategy for improving nutrition, but for certain micronutrients, supplementation, be it to the general population or to high risk groups or as an adjunct to treatment must also be considered. Our understanding of the prevalence and consequences of iron, vitamin A and iodine deficiency in children and pregnant women has advanced considerably while there is still a need to generate more knowledge pertaining to many other micronutrients, including zinc, selenium and many of the B-vitamins. For iron and vitamin A, the challenge is to improve the delivery to target populations. For disease prevention and growth promotion, the need to deliver safe but effective amounts of micronutrients such as zinc to children and women of fertile age can be determined only after data on deficiency prevalence becomes available and the studies on mortality reduction following supplementation are completed. Individual or multiple micronutrients must be used as an adjunct to treatment of common infectious diseases and malnutrition only if the gains are substantial and the safety window sufficiently wide. The available data for zinc are promising with regard to the prevention of diarrhea and pneumonia. It should be emphasized that there must be no displacement of important treatment such as ORS in acute diarrhea by adjunct therapy such as zinc. Credible policy making requires description of not only the clinical effects but also the underlying biological mechanisms. As findings of experimental studies are not always feasible to extrapolate to humans, the biology of deficiency as well as excess of micronutrients in humans must continue to be investigated with vigour.

Micronutrient deficiencies in children--the problem and extent.

Micronutrient deficiencies in children--the problem and extent.