Multiple Micronutrient Deficiencies Research Articles

Micronutrient Deficiency in Pregnancy: Time to Think Beyond Iron and Folic Acid Supplementation.

Micronutrients play an important role in influencing pregnancy outcomes. Anemia is common among pregnant women against which iron and folic acid supplementation programs are already in action. The study aimed to estimate the prevalence of anemic and selected micronutrient status among pregnant women. It is a community-based cross-sectional study. The study was carried out among pregnant women registered in Primary Health Center, Kallur, Tirunelveli district, Tamil Nadu, India, using a semi-structured data capture tool. The blood samples were collected following standard procedure. The micronutrient status among 139 pregnant women were selenium <1%, copper <1%, zinc 11.5%, iodine 14.4%, Vitamin B12 41.7%, and ferritin 42.4%. Vitamin B12, zinc, and selenium levels showed a significant difference with reference values among the three trimesters. Iron and folic acid supplementation was followed by 58.7% of pregnant women. Multiple micronutrient deficiency with anemia was found among 54.6%. Anemia and micronutrient deficiency are high among pregnant women in this region. Since iron and folic acid supplementation strategies are already being implemented by the government, it is high time that we extend our health policy beyond that and plan for micronutrient supplementation as well.

Прием витаминно-минеральных комплексов во время беременности необходим: сравнительный анализ действующих рекомендаций

Currently, the Russian Federation has several methodological and clinical recommendations, programs and guidelines developed by the communities of nutritionists, pediatricians and obstetricians-gynecologists. All of them are of informational and methodological nature and are designed for practical use. The aim of the study is to compare the current recommendations on the use of vitamins and minerals in the nutrition of pregnant women to maintain the optimal micronutrient status, as well as to assess their compliance with global trends. Nutritionists' recommendations are aimed at prophylactic intake of vitamin and mineral supplements (VMS) to improve the micronutrient status of a pregnant woman and meeting the needs of the fetus. The 2020 recommendations of domestic obstetricians and gynecologists on the use of micronutrients in the nutrition of pregnant women are based on fundamentally different criteria and proceed from the extent to which additional intake of a particular micronutrient may reduce the risk of obstetric and perinatal complications. Given the high prevalence of multiple micronutrient deficiencies among pregnant women, the absence of programs for mandatory enrichment of products of mass consumption with B vitamins and iron, iodization of table salt, in Russia it is advisable to prescribe VMS by women in order to replenish the insufficient intake of vitamins and minerals with the diet. In 2019, new guidelines from the Federation of Gynecology and Obstetrics (FIGO) were published that recommend a routine daily intake of VMS specifically designed for pregnant women. It seems expedient and logical to create unified national clinical guidelines harmonized with modern international recommendations based on consensus between nutritionists, obstetricians-gynecologists and pediatricians. The presence of such a regulatory document will facilitate the work of practitioners. A lot of educational work is also needed to explain the benefits of prophylactic intake of VMS during preparation and during pregnancy to maintain the health of the mother and child. Key words: multiple vitamin-mineral supplements, pregnancy, current recommendations, micronutrient sufficiency

Optimization of the micronutrients sufficiency of feeding women and children on exclusively breastfeeding by enriching of the woman diet

A significant part of pregnant and lactating women have a lack of several micronutrients at once (vitamin D, group B, iodine, iron, etc.). The secretion of vitamins A, E, D, C, B1, B2, B6, B12, iodine and selenium into breast milk decreases with their insufficient consumption and insufficient provision of the nursing mother. The content of folates, calcium, magnesium, phosphorus in breast milk is maintained even if they are insufficient in the mother, however, enriching the diet with them during breastfeeding, improving the status of the mother, prevents the depletion of reserves in her body. The iron and zinc content in breast milk is determined by the mothers status during pregnancy. The intake of vitamin-mineral supplements or food products enriched with micronutrients during the pregravid period, during pregnancy and lactation leads to an improvement in the provision of a woman and her child by increasing the content of vitamins, iodine and selenium in breast milk. The use of vitamin-mineral supplements is an effective way not only to eliminate multiple micronutrient deficiencies in the diet and improve the status of a lactating woman, but also to optimize the vitamin composition of breast milk and the provision of an exclusively breastfed baby.

English

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first &amp; second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron

Complementary Foods and Milk-Based Formulas Provide Excess Protein but Suboptimal Key Micronutrients and Essential Fatty Acids in the Intakes of Infants and Toddlers from Urban Settings in Malaysia.

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6–23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.

High Prevalence of Stunting and Anaemia Is Associated with Multiple Micronutrient Deficiencies in School Children of Small-Scale Farmers from Chamwino and Kilosa Districts, Tanzania.

Inadequate macro- and micronutrient nutrition and its consequences, such as anaemia, iron and vitamin deficiency, and growth retardation, could particularly affect children of small-scale farmers. In the present cross-sectional study, 666 school children aged 5–10 years from villages of Chamwino and Kilosa districts were studied for associations between nutritional and micronutrient status and dietary intake. The overall prevalence of stunting, underweight, and overweight was 28.1, 14.4, and 5%, while that of anaemia and deficiency of iron (ID), vitamin A (VAD), and zinc (ZnD) was 42.9, 29.3, 24.9, and 26.4%, respectively. Dietary recalls (24h) revealed that, except of iron (74%), only small proportions of children reached the recommended daily micronutrient intakes: 4% for zinc, 19% for vitamin A, and 14–46% for B vitamins. Stunting was highly associated with wasting in both districts and with VAD in Chamwino. Anaemia was predicted by ID, VAD, and ZnD in Chamwino and by elevated infection markers, C-reactive protein (CRP) and α-1 glycoprotein (AGP), in Kilosa. Overall, elevated CRP and/or AGP increased the risk while higher serum carotenoids indicating a diet of more fruit and vegetables reduced the risk of VAD. The significantly lower prevalence of anaemia and ID in Chamwino was related to higher iron and vitamin A intake and the consumption of mainly bulrush millet with dark green leafy vegetables compared to maize or rice with legumes in Kilosa. Nutrition and hygiene education integrated with home and school garden programmes could reduce the multiple burdens of anaemia; micronutrient deficiencies and infections; and, in the long term, the prevalence of stunting.

The Rates of and Relationship between Anemia and Deficiency of Iron, Zinc, Vitamin B12 and Folic Acid in Hospitalized Children

Aim: Increased frequency of deficiency due to the insufficient intake of iron, zinc, vitamin B12-D and folic acid has been reported in the society. We aimed to investigate the rates of deficiency of these vitamins and minerals, as well as anemia frequency in children admitted to pediatric outpatient clinics of our tertiary hospital in a retrospective three-year period.&#x0D; Materials and Methods: The frequency of micronutrient deficiency and the relationship between them was determined using statistical methods by evaluating the levels of hematocrit and other micronutritional elements in patients admitted to the general pediatrics outpatient clinics of our hospital between 01.06.2015 and 31.05.2018. The only patient inclusion criteria were being tested for zinc, iron, iron binding, hemogram, vitamin B12, folic acid, ferritin and vitamin D for any reason.&#x0D; Results: After the evaluation of 64487 patients, we discovered the rates of anemia and iron, zinc, folate, vitamin D, vitamin B12 and ferritin deficiency as 30.8%, 52.1%, 41.1%, 18.2%, 32.4%, 20.1% and%26.7 respectively. Additionally, our results indicate that the frequency of folic acid deficiency decreased over the past years, whereas the rates of zinc and vitamin D deficiency increased over time. The final results show a negative correlation between anemia and folic acid, vitamin D, vitamin B12 and iron binding capacity, and a positive correlation between anemia and iron, ferritin and zinc.&#x0D; Conclusion: Although it does not reflect the frequency of deficiency in the general population since the data are collected from hospitalized children, it could be argued that multiple micronutrient deficiencies are significantly common in Turkey and zinc and vitamin D deficiency has been increasing over the years, when compared with the results of previous studies.

The global challenge of hidden hunger: perspectives from the field.

The aim of this review paper is to explore the strategies employed to tackle micronutrient deficiencies with illustrations from field-based experience. Hidden hunger is the presence of multiple micronutrient deficiencies (particularly iron, zinc, iodine and vitamin A), which can occur without a deficit in energy intake as a result of consuming an energy-dense, but nutrient-poor diet. It is estimated that it affects more than two billion people worldwide, particularly in low- and middle-income countries where there is a reliance on low-cost food staples and where the diversity of the diet is limited. Finding a way to improve the nutritional quality of diets for the poorest people is central to meeting the UN sustainable development goals particularly sustainable development goal 2: end hunger, achieve food security and improved nutrition and promote sustainable agriculture. As we pass the midpoint of the UN's Decade for Action on Nutrition, it is timely to reflect on progress towards achieving sustainable development goal 2 and the strategies to reduce hidden hunger. Many low- and middle-income countries are falling behind national nutrition targets, and this has been exacerbated by the COVID-19 pandemic as well as other recent shocks to the global food system which have disproportionately impacted the world's most vulnerable communities. Addressing inequalities within the food system must be central to developing a sustainable, cost-effective strategy for improving food quality that delivers benefit to the seldom heard and marginalised communities.

Multiple Micronutrients, Including Zinc, Selenium and Iron, Are Positively Associated with Anemia in New Zealand Aged Care Residents

Anemia is a significant comorbidity for older adults not fully attributable to iron deficiency. Low-grade inflammation and other micronutrient deficiencies also contribute. This cross-sectional study examined the relationships between nutrient and non-nutrient factors with hemoglobin and anemia in 285 residents (>65 years) of 16 New Zealand aged-care facilities. Blood samples were analyzed for hemoglobin, ferritin, sTfR, hepcidin, zinc, selenium, and interleukin-6 (IL-6), (with ferritin, sTfR, zinc and selenium adjusted for inflammation). Linear regression models examined the relationships between micronutrient biomarkers (iron, zinc, selenium, vitamin B-12 and D), age, sex, and health factors with hemoglobin. Thirty-two percent of participants exhibited anemia, although <2% had either depleted iron stores or iron deficiency. Plasma zinc and selenium deficiencies were present in 72% and 38% of participants, respectively. Plasma zinc and total body iron (TBI) were positively associated (p < 0.05) with hemoglobin, while gastric acid suppressing medications, hepcidin, and interleukin-6 were inversely associated. These relationships were maintained after the application of anemia cut-offs. These findings emphasize the importance of considering multiple micronutrient deficiencies as risk factors for anemia.

Clinical assessment of micronutrient deficiencies in 2-6 years old children: a survey with pediatricians

Background: Worldwide, at least fifty percent of children, younger than 5 years of age, suffer from micronutrient, protein and calorie deficiencies causing negative impact on health. Our study aims to understand the pediatricians’ perspectives on diagnosis and management of these micronutrient deficiencies (MND).Methods: A cross sectional questionnaire-based survey of 490 pediatricians, wherein the questionnaire focused on prevalence, causes, diagnosis, management and long-term impact of micronutrient deficiencies in children aged 2 to 6 years.Results: Majority of pediatricians (94%) commonly see MNDs in their clinical practice; with 94% pediatricians seeing MNDs in stunted children, 93% in wasted and 89.0% in obese children. About 50–90% pediatricians reported calorie, protein, vitamins and mineral deficiencies. Not eating a balanced diet was the cause of nutrient deficiency as per 97% pediatricians, while about 93-97% opined MNDs also cause frequent illness, lack of energy/weakness, loss of weight or causes thinness. All pediatricians believe that minerals, vitamins and proteins are important for immunity and bone development. Also, 88% pediatricians believe multiple MNDs can be evaluated by physical examination and clinical history; and about 40% pediatricians suggest intervention to 25-50% children. Also, they believe that MNDs impact long-term health outcomes like growth, cognitive development, metabolic development and social development.Conclusions: Micronutrient deficiencies contribute to lack of energy, frequent illness, and compromised immune system which in turn have short-term and long-term impact on overall growth and development. Hence there is a need to assess and address the MNDs at the earliest.

Prevalence of Micronutrient Deficiencies in Geriatric Bariatric Patients

Obese individuals have high prevalence of thiamine deficiency and hypovitaminosis D. Our hypothesis is that geriatric, bariatric surgery patients are at risk for micronutrient deficiencies. In this retrospective study, 3 males and 30 females (gastric bypass: n = 27; vertical sleeve gastrectomy: n = 6) individuals were evaluated. Eight micronutrients are measured using commercial blood testing. Mean age is 70 yr, mean body mass index is 35 kg/m2, with a mean of 11 years after bariatric surgery. Hypovitaminosis D is identified in 32 of 33 patients. Low vitamin B12 is identified in 32%, low vitamin A in 16%, low vitamin E in 31%, low zinc in 22%, and low iron in 35%. Twenty patients (61%) have clinical thiamine deficiency. Geriatric patients have multiple micronutrient deficiencies after bariatric surgery. Focusing on deficiencies of thiamine, vitamin B12, vitamin D, and iron in geriatric, bariatric patients could enforce treatments designed to prevent development of disabling deficiency syndromes.

High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation.

Multiple micronutrient deficiencies (MNDs) co‐exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6–17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B12 and C‐reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes.

Multiple micronutrient deficiencies in pregnancy

Rationale: Many studies have focussed on maternal anaemia and iron deficiency and limited studies are available on multiple micronutrient deficiencies and the factors associated with them.

A Cross-sectional Study of Plasma Trace Elements and Vitamins Content in Androgenetic Alopecia in Men.

Androgenetic alopecia (AGA) is the most common variant of male pattern baldness in which occurrence and development of multiple genetic, hormonal, and metabolic factors are involved. We aimed to estimate plasma element content (Mg, Ca, Zn, Cu, Se, Fe), vitamin status (B12, D, E, and folic acid) in patients with AGA using direct colorimetric tests or atomic absorption spectrometry, and the influence of these parameters in the formation of various hair loss patterns. The study included 50 patients with I-IV stages of AGA divided into two groups with normal and high levels of dihydrotestosterone compared with 25 healthy individuals. The presence of two patterns of pathological hair loss in the androgen-dependent (parietal) and androgen-independent (occipital) areas of the scalp was confirmed. It was shown that all patients with AGA have a deficiency of elements (Zn, Cu, Mg, Se) and vitamins (B12, E, D, folic acid). However, the hair loss rate was not due to their content. А positive interrelation between quantitative trichogram parameters in the occipital region and iron metabolism in pairs "hair density vs Fe" and "hair diameter vs ferritin" was shown. In turn, in the parietal region, an inverse correlation of hair diameter with plasma Cu level was found, the most pronouncing in patients with high levels of dihydrotestosterone. The obtained results indicate the importance of multiple micronutrient deficiencies in the AGA occurrence accompanied by the existence of two different hair loss patterns, differently related to the content of certain trace elements and androgens in the blood.

Dietary Inadequacy, Micronutrient Deficiencies, and Approaches to Preventing Poor Nutrition in the Gaza Strip.

Palestine refugees comprise the largest refugee population in the world, most of whom are encamped in Middle Eastern countries. In the Gaza Strip, where ∼1.4 million Palestinians reside, there are high prevalences of anemia and multiple micronutrient deficiencies (MNDs), including those of iron, zinc, vitamins A, B12, D, and E, ranging from 11.4% to 84.7% among pregnant women and 2.9% to 70.9% among preschool children. Dietary diversification and adequate food fortification are framed in policies but remain aspirational goals. Alternative, effective, targeted preventive approaches include, for women, replacement of antenatal iron-folic acid with multiple micronutrient supplementation, and for young children, point-of-use multiple micronutrient powder fortification to prevent anemia, both of which can reduce other MNDs and may bring additional health benefits. These interventions coupled with monitoring of dietary intakes, periodic assessment of MNDs, and implementation research to improve existing nutrition interventions are warranted to protect the health of the Middle East Palestinian diaspora.

Pre-operative micronutrient deficiencies in patients with severe obesity candidates for bariatric surgery

PurposeIn patients with obesity, micronutrient deficiencies have been reported both before and after bariatric surgery (BS). Obesity is a chronic pro-inflammatory status, and inflammation increases the risk of micronutrient malnutrition. Our objective was to assess in pre-BS patients the prevalence of micronutrient deficiencies and their correlation with blood values of C-reactive protein (CRP).MethodsAnthropometric data, instrumental examinations, and blood variables were centrally measured in the first 200 patients undergoing a pre-BS evaluation at the “Città della Salute e della Scienza” Hospital of Torino, starting from January 2018.ResultsAt least one micronutrient deficiency was present in 85.5% of pre-BS patients. Vitamin D deficiency was the most prevalent (74.5%), followed by folate (33.5%), iron (32%), calcium (13%), vitamin B12 (10%), and albumin (5.5%) deficiency. CRP values were high (> 5 mg/L) in 65% of the patients. These individuals showed increased rate of iron, folate, vitamin B12 deficiency, and a higher number of micronutrient deficiencies. In a multiple logistic regression model, increased CRP levels were significantly associated with deficiencies of vitamin B12 (OR = 5.84; 95% CI 1.25–27.2; p = 0.024), folate (OR = 4.02; 1.87–8.66; p < 0.001), and with the presence of ≥ 2 micronutrient deficiencies (OR = 2.31; 1.21–4.42; p = 0.01).ConclusionsMicronutrient deficiencies are common in patients with severe obesity undergoing BS, especially when inflammation is present. In the presence of increased CRP values before surgery, it might be advisable to search for possible multiple micronutrient deficiencies.

What is food-to-food fortification? A working definition and framework for evaluation of efficiency and implementation of best practices.

Food-to-food fortification (FtFF) is an emerging food-based strategy that can complement current strategies in the ongoing fight against micronutrient deficiencies, but it has not been defined or characterized. This review has proposed a working definition of FtFF. Comparison with other main food-based strategies clearly differentiates FtFF as an emerging strategy with the potential to address multiple micronutrient deficiencies simultaneously, with little dietary change required by consumers. A review of literature revealed that despite the limited number of studies (in vitro and in vivo), the diversity of food-based fortificants investigated and some contradictory data, there are promising fortificants, which have the potential to improve the amount of bioavailable iron, zinc, and provitamin A from starchy staple foods. These fortificants are typically fruits and vegetables, with high mineral as well as ascorbic acid and β-carotene contents. However, as the observed improvements in micronutrient bioavailability and status are relatively small, measuring the positive outcomes is more likely to be impactful only if the FtFF products are consumed as regular staples. Considering best practices in implementation of FtFF, raw material authentication and ingredient documentation are critical, especially as the contents of target micronutrients and bioavailability modulators as well as the microbiological quality of the plant-based fortificants can vary substantially. Also, as there are only few developed supply chains for plant-based fortificants, procurement of consistent materials may be problematic. This, however, provides the opportunity for value chain development, which can contribute towards the economic growth of communities, or hybrid approaches that leverage traditional premixes to standardize product micronutrient content.

Vitamin-mineral supplements for correction of multiple micronutrient deficiency

Multiple micronutrient deficiency (simultaneous insufficient supply of the organism with several vitamins at once (vitamin D, B group), as well as calcium, magnesium, zinc and iodine, and not an isolated deficiency of any one micronutrient is characteristic of a significant part of the Russian population throughout the year, regardless of places of residence. The growing need of the organism at different periods of life (puberty, pregnancy, breastfeeding, aging), various diseases, drug therapy, the period of convalescence, stress, the use of various diets, enrichment of the diet with polyunsaturated fatty acids and dietary fiber, religious observance, adverse environmental factors further increase the risk of multiple micronutrient deficiencies. Micronutrients (vitamins and essential minerals) are closely interconnected into complex metabolic networks, which provide maintaining homeostasis and health. Deficiency of each of the essential micronutrients is a risk factor for the development of a particular disease, and simultaneous multiple micronutrient deficiency creates a “causality network” of not just one, but several diseases at once. Conversely, an adequate or optimal sufficiency of the body with all micronutrients, respectively, creates a “network of conditions ensuring the prevention of the disease”, due to the full implementation of all processes dependent on them in the body. This means that replenishing inadequate food intake of scarce micronutrients is an important way to maintain health and longevity. Given the variety of vitamin-mineral supplements, it is important to choose the right supplement. The maximum effectiveness to maintain the body’s vitamin and mineral status at the optimum level will be ensured by the intake of not individual micronutrients, but vitamin and mineral supplements containing a complete set of vitamins in doses close to the physiological needs of the body and basic minerals (calcium, magnesium, zinc and iodine), the deficit of which is characteristic for the Russian population.

Vitaminology: from molecular aspects to improving technology of vitamin status children and adults

A statistical analysis of the data on the sufficiency with vitamins of certain groups of the Russian adults and children from 1987 to 2017 revealed certain patterns. At first, the presence of multiple micronutrient deficiency (vitamins D, B group, as well as a number of minerals) is still a characteristic feature. At second, vitamin D deficit is the most common. At third, the decrease in the frequency of detection of B vitamin deficiency was inhibited and it still persists in a significant number of examined individuals (median detection frequency is 41%). Vitamin C, A and E deficiency is rarely found among healthy adults. The literature analysis and rat model studies show that the performance of each vitamin depends on the saturation of the organism with other vitamins. Sufficient provision of the body with all vitamins is a necessary condition for the implementation of many functions of vitamin D, the functions of B vitamins are inextricably linked. A diet composed of traditional products does not allow reaching the optimal supply of the body with vitamins and minerals. Everyday using of fortified foods or vitamin-mineral supplements (VMS) is an effective way to eliminate the micronutrient deficiency in the nutrition of the population. The theoretical basis for the development of VMS, intended for different groups of the population, includes the study of the initial vitamin-mineral status, features of work and physical activity, taking into account the role of the lack of individual vitamins in the development of the pathological process and the drug therapy used, individual characteristics of metabolism, in particular due to gene polymorphism. VMS with optimal composition should include vitamin D and all vitamins of B group. The doses of vitamins should be significant, comparable with the recommended daily intake. Additional biomedical requirements for the composition of VMS are formed taking into account the characteristics of the diet. The dose of the antioxidant vitamins and mineral substances should be increased in order to mitigate the effect of dietary fiber with adsorbing properties or polyunsaturated fatty acids that are susceptible to peroxidation and reduce antioxidant status of the organism. VMS with increased doses of all vitamins are intended for the quick and effective elimination of micronutrient deficiency. The total daily intake of micronutrients should not be excessive.

Interrelations Between School-Based Services, Dietary Intake and Micronutrient Deficiencies Among School-Going Children and Adolescents Aged 5–19 Years in India

Abstract Objectives India is home to 119 million children (CH; 5–9 y) and 253 million adolescents (AD; 10–19 y), a majority of whom suffer from multiple micronutrient deficiencies (MND). Given high school enrolment levels in India (90% of CH and 75% of AD) schools are a good platform for services and behavior change interventions targeted toward this age group. We sought to analyze the prevalence and predictors of MND in school going CH and AD in India. Methods Data from India's Comprehensive National Nutrition Survey 2016–18 were analyzed separately for CH aged 5–9 y (n = 10,640), AD aged 10–14 y (n = 5390) and AD aged 15–19 y (n = 3693). Serum/plasma concentrations of ferritin, retinol, B12, erythrocyte folate, 25-hydroxyvitamin D, zinc and C-reactive protein were measured. We assessed the weighted prevalence of each MND using established WHO cutoffs, after adjusting ferritin and retinol for inflammation. Primary predictors of MND were dietary intake and access to school services. Multivariable logistic regression models were used to examine associations between these factors and each MND, controlling for socio-demography (sex, residence, wealth quintile, ethnicity, parental education, siblings) and hygiene-sanitation services. Results The top three micronutrient deficiencies were folate (29%), vitamin A (22%), vitamin D (19%) among CH and folate (38%), zinc and B12 (31% each) in AD. One or more MND affected 69% of CH and 83% of AD. In CH, deworming was associated with reduced odds of folate deficiency (AOR and 95% CI: 0.80, 0.68–0.94) and health camps were associated with vitamin A deficiency (0.68, 0.51–0.91). In AD 10–14y, receipt of free school meals had lower odds of B12 deficiency (0.66, 0.49–0.88). In AD 15–19y, health camps were inversely associated with vitamin D deficiency (0.69, 0.51–0.95). CH and AD who consumed green leafy vegetables, pulses and fruits daily had reduced odds of iron, folate or vitamin D deficiencies (AORs: 0.58–0.81). Consumption of fish, chicken or meat (≥2 times/week) was associated with lower odds of almost all MND in CH (AORs: 0.39–0.75), and of iron and B12 deficiencies in AD (AORs: 0.42–0.66). Conclusions Most CH and AD in India suffer from multiple MND. Improving diet quality through school meals and strengthening school-based health services may contribute to MND reductions in this population. Funding Sources UNICEF, POSHAN.