Multiple Micronutrient Deficiencies Research Articles

Micronutrient deficiencies and their co-occurrence among pregnant women in Mbeya region, Tanzania.

Micronutrient deficiencies, a global concern affecting vulnerable populations, including pregnant women, pose significant public health challenges. Specifically, micronutrient deficiencies in iron, vitamin A, iodine and folate have been of greatest public health concern among pregnant women. This study aimed to evaluate the co-occurrence of selected multiple micronutrient deficiencies among pregnant women attending Antenatal Care (ANC) in Mbeya, Tanzania. Employing a cross-sectional design, data were gathered from 420 pregnant women aged 15-49 years attending ANC in Mbeya Region. Semi-structured questionnaires captured socio-demographic data, and blood samples were collected for biomarkers assessment. The study used Stata 17.0 to analyze the data. Results revealed that six out of ten pregnant women exhibited at least one form of micronutrient deficiency, with 15.0% experiencing double deficiencies and 2.2% experiencing triple deficiencies. Iron Deficiency Anemia (IDA) was prevalent among 61.7% of anaemic pregnant women. Individual micronutrient deficiency rates were as follows: folate (21.7%), vitamin B12 (9.9%), iron (38.4%), vitamin A (9.8%), with a median Urinary Iodine Concentration (UIC) of 279.4μg/L. Pregnant women with anemia were more likely to have Multiple Micronutrient Deficiencies (MMD) compared to non-anemic counterparts (p-value <0.005). Additionally, those in the second trimester were at a higher risk of MMD than those in the first trimester (p-value <0.005). A higher wealth quantile appeared to protect against MMD (p-value <0.005). The study highlights the co-occurrence of MMD among pregnant women in Tanzania, indicates the necessity for an improved strategy to enhance multiple micronutrients intake through dietary diversity, MMS and fortified foods.

Comparative analysis of deep learning and machine learning-based models for simultaneous prediction of minerals in perilla (Perilla frutescens L.) seeds using near-infrared reflectance spectroscopy

Perilla seeds contain a rich array of essential minerals, thus having the potential to address multiple micronutrient deficiencies at a time. However, traditional methods of mineral estimation are complex, time-consuming, expensive, and require technical expertise. This study includes the development of Near-Infrared Reflectance Spectroscopy (NIRS)-based prediction models for predicting five important minerals (Calcium, Copper, Magnesium, Manganese, and Phosphorus) using machine learning and deep learning techniques. Four models, including 1D Convolutional Neural Networks (1D CNNs), Artificial Neural Networks (ANNs), Random Forests (RFs), and Support Vector Regression (SVR), were developed and evaluated. The developed 1D CNN model outperformed other considered models in predicting calcium, magnesium, and phosphorus content with RPD (Residual Prediction Deviation) values of 1.75, 1.83, and 2.96, respectively. Whereas, SVR performed best in predicting copper and manganese with an RPD of 1.82 and 2.2, respectively. The 1D CNN model demonstrated R2 (Coefficient of determination) values above 0.65 for all minerals, with a maximum of 0.88 for phosphorus. In addition, the developed models performed superior as compared to the Partial Least Square Regression method (R2= 0.32). The developed models provide efficient tools for rapidly screening perilla germplasm available in global repositories, thus aiding in the selection of mineral-rich genotypes to mitigate micronutrient deficiencies.

Productivity and Profitability of Diversified Legume-based Cropping Systems in the Indo-gangetic Plains of India as Influenced by Nutrient Management

Background: The continuing adoption of the rice-wheat cropping system (RWCS) and indiscriminate use of inorganic fertiliser has led to a decrease in soil fertility, an increase in multiple micronutrient deficiencies, a decrease in the water table and excessive greenhouse gas emissions, especially in the Indo Gangetic Plains. Adoption of crop diversification strategies, including legumes in cropping systems with integrated use of organic and inorganic nutrient sources, could be a viable option for achieving higher fodder tonnage and sustainable crop production in aforesaid ecologies. Methods: A field experiment was conducted during the kharif, rabi and summer seasons of 2018-19 and 2019-20 in a split-plot design comprising four cropping systems (CS) i.e., rice-wheat, rice-berseem, pearl millet-oats-moong bean and maize-cowpea-wheat in main plots; and four nutrient management (NM) practices i.e., 100% RDF (recommended dose of fertiliser), 100% RDF + cow urine (foliar spray), 100% RDF + PGPR (seed treatments) and 75% RDF + cow urine + PGPR were assigned in sub-plots with three replications of each treatment. Result: Investigations revealed that the significantly highest system productivity, net returns and higher nutrient availability were obtained under the rice-berseem cropping system with 100% RDF + PGPR treatment. The magnitude of increment in system productivity of the rice–berseem cropping system was 35.06, 57.87 and 87.29% over rice-wheat, maize-cowpea-wheat and pearl millet-oats-moong bean cropping system, respectively. The legume-based cropping system has strengthened and sustained crop productivity and profitability. The results of the present work confirmed that the adoption of legume-based crop diversification has significantly alleviated the crop yield of dairy-based farming systems.

The prevalence of anemia during pregnancy and its correlates vary by trimester and hemoglobin assessment method in Eastern Maharashtra, India.

Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low-resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger-prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation-adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron-folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation-adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community-based strategies targeting iron deficiency, as well as other causes of anemia.

Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) &lt; −2 SD), thinness (BMI-for-age z-score (BAZ) &lt; −2 SD) and overweight (BAZ &gt; 1). Iron deficiency was defined as serum ferritin&lt;15μg/L (&lt;70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol&lt;1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein &gt;5 mg/L or α1-acid glycoprotein &gt;1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.

Hidden hunger in patients with type 2 diabetes (T2D) and its effect on glycaemic control: a protocol for systematic review and meta-analysis

IntroductionHidden hunger or micronutrient deficiencies are quite common in many parts of the world, particularly in the countries of sub-Saharan Africa and South Asia. Micronutrient deficiencies may impact insulin signalling...

Multiple Micronutrient Deficiency Among Adolescent Girls with Normal Nutritional Status - Need for Fortified Nutritional Support in Rural Settings of South Tamil Nadu, India

Introduction: Adolescents contribute to one fifth of the world's population and is a high priority lifecycle stage for nutrition needs and intervention. Nutritional deficiency, including micronutrients, hinders their normal growth and development. Improving adolescent girls’ nutrition has reproduction-related benefits and serves as a unique opportunity to break the vicious cycle of intergenerational structural problems. The objective is to estimate the prevalence of anaemia, micronutrient deficiency and nutritional status among adolescent girls in rural India. Methods: A community-based cross-sectional study was conducted among 241 adolescent girls in rural Tirunelveli, India with 220 blood samples. Results: The mean age of 241 adolescent girls was 13.8±1.4 years and nutritional status was normal, overweight, obese, thin and stunted in 81.7%, 14.5%, 3.3%,0.4% and 4.6% respectively. The prevalence of anaemia, iron deficiency and iron-deficiency anaemia were 37.2%, 34.5% and 12.3%. Except for selenium, the estimated micronutrient deficiency levels were Vitamin B12 - 40.9%, Copper-30.9%, Zinc-13.6% and Iodine- 11%. Only 19.1% girls had adequate levels of all micronutrients. Vitamin B12 deficiency was more in girls who were overweight (p&lt;0.05). Conclusion: Multiple micronutrient deficiency with normal nutritional status is high among adolescent girls with Vitamin B12 deficiency higher than Iron. Multipronged strategies, including introducing micronutrient fortified healthy snacks in schools, might bring greater acceptance and improvement in nutritional health among these girls.

Effect of multiple micronutrient-fortified bouillon on micronutrient status among women and children in the Northern Region of Ghana: Protocol for the Condiment Micronutrient Innovation Trial (CoMIT), a community-based randomized controlled trial.

Micronutrient deficiencies are prevalent in West Africa, particularly among women of reproductive age (WRA) and young children. Bouillon is a promising food fortification vehicle due to its widespread consumption. This study aims to evaluate the impact of multiple micronutrient-fortified bouillon cubes, compared to control bouillon cubes (fortified with iodine only), on micronutrient status and hemoglobin concentrations among lactating and non-lactating WRA and young children in northern Ghana. This randomized, controlled doubly-masked trial will be conducted in the Kumbungu and Tolon districts in the Northern Region of Ghana, where prior data indicate multiple micronutrient deficiencies are common. Participants will be: 1) non-pregnant non-lactating WRA (15-49 y), 2) children 2-5 y, and 3) non-pregnant lactating women 4-18 months postpartum. Eligible participants will be randomly assigned to receive household rations of one of two types of bouillon cubes: 1) a multiple micronutrient-fortified bouillon cube containing vitamin A, folic acid, vitamin B12, iron, zinc, and iodine, or 2) a control cube containing iodine only. Each participant's household will receive a ration of bouillon cubes every 2 weeks, and households will be advised to prepare meals as usual, using the study-provided cubes. The trial duration will be 9 months for non-pregnant non-lactating WRA and children, and 3 months for lactating women. The primary outcomes will be changes in biomarkers of micronutrient status and hemoglobin among WRA and children and milk micronutrient concentrations among lactating women. Secondary outcomes will include change in prevalence of micronutrient deficiency and anemia; dietary intake of bouillon and micronutrients; inflammation, malaria, and morbidity symptoms; and child growth and development. Evidence from this study will inform discussions about bouillon fortification in Ghana and West Africa. The trial was registered on ClinicalTrials.gov (NCT05178407) and the Pan-African Clinical Trial Registry (PACTR202206868437931). This manuscript reflects protocol version 4 (August 29, 2022).

Multiple micronutrient deficiencies in early life cause multi-kingdom alterations in the gut microbiome and intrinsic antibiotic resistance genes in mice.

Globally, ~340 million children suffer from multiple micronutrient deficiencies, accompanied by high pathogenic burden and death due to multidrug-resistant bacteria. The microbiome is a reservoir of antimicrobial resistance (AMR), but the implications of undernutrition on the resistome is unclear. Here we used a postnatal mouse model that is deficient in multiple micronutrients (that is, zinc, folate, iron, vitamin A and vitamin B12 deficient) and shotgun metagenomic sequencing of faecal samples to characterize gut microbiome structure and functional potential, and the resistome. Enterobacteriaceae were enriched in micronutrient-deficient mice compared with mice fed an isocaloric experimental control diet. The mycobiome and virome were also altered with multiple micronutrient deficiencies including increased fungal pathogens such as Candida dubliniensis and bacteriophages. Despite being antibiotic naïve, micronutrient deficiency was associated with increased enrichment of genes and gene networks encoded by pathogenic bacteria that are directly or indirectly associated with intrinsic antibiotic resistance. Bacterial oxidative stress was associated with intrinsic antibiotic resistance in these mice. This analysis reveals multi-kingdom alterations in the gut microbiome as a result of co-occurring multiple micronutrient deficiencies and the implications for antibiotic resistance.

Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity.

Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.

Обогащение молочной продукции недостающими в рационе россиян пищевыми веществами

The aim of the study is to analyze modern approaches to the enrichment of dairy products with missing nutrients in the diet — a complex of micronutrients and dietary fiber. Based on the presence of multiple micronutrient deficiencies in the population and taking into account the relationship of micronutrients in the organism, the most popular and effective is the enrichment of dairy products with a complex of vitamins and minerals in the form of multicomponent premixes. In recent years, β-glucans from various origins and apple pomace have been increasingly used as a source of dietary fiber. Cereal β-glucans have technological and biological properties. The dose of β-glucans for fermented milk products is in the range of 0,1–0,5 %, for cheeses and cheese-like products — 0,2–1,4 %, for ice cream and frozen desserts — 0,5–2,0 %. The advantage of apple pomace is the simultaneous high content of dietary fiber and antioxidant compounds. The introduction of dry pomace powder into the formulation of yogurt and fermented milk products at a dose of up to 3 % provides an improvement in technological parameters, an increase in syneresis and antioxidant properties of the product.

Multiple micronutrient deficiencies alter energy metabolism in host and gut microbiome in an early-life murine model.

Micronutrients perform a wide range of physiological functions essential for growth and development. However, most people still need to meet the estimated average requirement worldwide. Globally, 2 billion people suffer from micronutrient deficiency, most of which are co-occurring deficiencies in children under age five. Despite decades of research, animal models studying multiple micronutrient deficiencies within the early-life period are lacking, which hinders our complete understanding of the long-term health implications and may contribute to the inefficacy of some nutritional interventions. Evidence supporting the Developmental Origins of Health and Disease (DOHaD) theory demonstrates that early-life nutritional deficiencies carry life-long consequences mediated through various mechanisms such as abnormal metabolic programming, stunting, altered body composition, and the gut microbiome. However, this is largely unexplored in the multiple micronutrient deficient host. we developed a preclinical model to examine undernutrition's metabolic and functional impact on the host and gut microbiome early in life. Three-week-old weanling C57BL/6N male mice were fed a low-micronutrient diet deficient in zinc, folate, iron, vitamin A, and vitamin B12 or a control diet for 4-weeks. Our results showed that early-life multiple micronutrient deficiencies induced stunting, altered body composition, impaired glucose and insulin tolerance, and altered the levels of other micronutrients not depleted in the diet within the host. In addition, functional metagenomics profiling and a carbohydrate fermentation assay showed an increased microbial preference for simple sugars rather than complex ones, suggestive of a less developed microbiome in the low-micronutrient-fed mice. Moreover, we found that a zinc-only deficient diet was not sufficient to induce these phenotypes, further supporting the importance of studying co-occurring deficiencies. Together, these findings highlight a previously unappreciated role of early-life multiple micronutrient deficiencies in shaping the metabolic phenome of the host and gut microbiome through altered glucose energy metabolism, which may have implications for metabolic disease later in life in micronutrient-deficient survivors.

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.

A systematic review and meta-analysis of adolescent nutrition in Ethiopia: Transforming adolescent lives through nutrition (TALENT) initiative.

Ethiopia has undergone rapid economic growth over the last two decades that could influence the diets and nutrition of young people. This work systematically reviewed primary studies on adolescent nutrition from Ethiopia, to inform future interventions to guide policies and programs for this age group. A systematic search of electronic databases for published studies on the prevalence of and interventions for adolescent malnutrition in Ethiopia in the English language since the year 2000 was performed using a three-step search strategy. The results were checked for quality using the Joanna Bridge Institute (JBI) checklist, and synthesized and presented as a narrative description. Seventy six articles and two national surveys were reviewed. These documented nutritional status in terms of anthropometry, micronutrient status, dietary diversity, food-insecurity, and eating habits. In the meta-analysis the pooled prevalence of stunting, thinness and overweight/obesity was 22.4% (95% CI: 18.9, 25.9), 17.7% (95% CI: 14.6, 20.8) and 10.6% (7.9, 13.3), respectively. The prevalence of undernutrition ranged from 4% to 54% for stunting and from 5% to 29% for thinness. Overweight/obesity ranged from 1% to 17%. Prevalence of stunting and thinness were higher in boys and rural adolescents, whereas overweight/obesity was higher in girls and urban adolescents. The prevalence of anemia ranged from 9% to 33%. Approximately 40%-52% of adolescents have iodine deficiency and associated risk of goiter. Frequent micronutrient deficiencies are vitamin D (42%), zinc (38%), folate (15%), and vitamin A (6.3%). The adolescent population in Ethiopia is facing multiple micronutrient deficiencies and a double-burden of malnutrition, although undernutrition is predominant. The magnitude of nutritional problems varies by gender and setting. Context-relevant interventions are required to effectively improve the nutrition and health of adolescents in Ethiopia.

The Prevalence of Iron and Vitamin D Deficiencies in Pediatric Patients With Inflammatory Bowel Disease in Bahrain.

Introduction Inflammatory bowel diseases (IBD) are chronic diseases that can affect nutrient absorption leading to micronutrient deficiencies and biochemical abnormalities.This study aimed to assess certain serum micronutrients and nutritionally related biochemical markers levels in patients with pediatric IBD and to compare the actual levels and the prevalence of micronutrients deficiencies and biochemical abnormalities between patients with Crohn's disease (CD) and those with ulcerative colitis (UC). Methods A retrospective cross-sectional study reviewing medical records of patients with IBD was conducted in the pediatric department,Salmaniya medical complex, Bahrain, from 1January 1984 to 31December 2021. Demographic data and laboratory resultsrelated to micronutrients and biochemical markers including full blood count, totalprotein,albumin,globulin,iron, ferritin, folic acid, vitamin B12, calcium, phosphorous, magnesium, and vitamin D levelswere collected upon presentation before starting the treatment. Nutritional deficiencies were compared based on sex, nationality, type of IBD, age at presentation, disease duration, weight at diagnosis, and inflammatory markers levels including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results Of 157 patients with pediatric IBD, 117 (74.5%) were included. Sixty-six (56.4%) patients were males. Sixty-six (56.4%) had CD and 51 (43.6%) had UC. No patient had indeterminant colitis. The mean age at presentation was 10.8±3.8 years. Most patients had one or more micronutrient deficiencies (n=110, 94%). Anemia was a common finding (n=79/116, 68.1%), with iron deficiency anemia (IDA) being predominant. Low iron levels were noted in64/77 (83.1%) patients with a medianof 5.0 (2.0-9.3) µmol/L (normal range, 11.6-31.3);isolated iron deficiency (ID) in 11/18 (61.1%)and IDAin 53/59 (89.8%) patients. Vitamin D deficiency was the second most common (n=45/61, 73.8%). Serum albumin, ferritin, calcium, phosphorous, and magnesium were deficient in 29.2%, 27.8%, 31.7%, 12.5%, and 10%, respectively. One patient had vitamin B12 deficiency while nonehad folate deficiency. Patients with CD had significantly lower serum iron (5.4±5.6 versus 8.1±6.09 µmol//L, p=0.02) and lower serum protein (71.7±8.7 versus 75.4±9.9 g/L, p=0.043)but higher serum ferritin (45 (19-110.2) versus 21.3 (10.3-51.2) µg/L, p=0.046) compared to those with UC. Elevated ESR was noted in 62/105 (59.1%) patientswhile high CRP was found in 67/104 (64.4%).Patients with low ironhadhigher ESR (28 (17-47) versus 14 (10-33) mm/h, p=0.028) and higher CRP (13.3 (1.6-42) versus 1.8 (0.9-4.6) mg/L, p=0.019) levelscompared to those with normal levels. Conclusion Patients with pediatric IBD are at risk of multiple micronutrient deficiencies and biochemical abnormalities. Iron and vitamin D deficiencies are the most frequent. Patients with CD are more prone to have lower serum iron and protein levels than those with UC.ID was associated with elevated inflammatory markers.

Serum concentration of zinc, copper, iron, and its associated factors among pregnant women of small-scale farming in western Ethiopia

Micro-nutrients are required in small amounts to maintain growth and cell functioning to complete the life cycle through reproductions. However, pregnant women in developing countries like Ethiopia are vulnerable to multiple micro-nutrient deficiencies. Therefore, this study aimed at assessing the serum level of metals and associated factors like dietary diversity, and health-related problems in pregnant women among small-scale farming in Kellem Wellega, western Ethiopia. A cross-sectional laboratory-based study was conducted from June to August 2021 on 417 pregnant women attending antenatal care at rural healthcare facilities. Data was collected by using per-tested structured questionnaires via face-to-face interviews. The data analysis was conducted using SPSS version 24.0, and multivariate logistic regression analysis was performed to determine the association between predictor and outcome variables. A statistically significant was considered at p value < 0.05 for all the analyses. Our study findings showed that 62.1, 80.9, and 71.9% of the participants were deficient in iron, zinc, and copper micro-nutrient levels, respectively. Pregnant women who could not have formal education were 3.24 (AOR = 3.24, 95% CI 1.33–7.91) and 3.98 (AOR = 3.98, 95% CI 1.2–13.15) times more likely to show zinc and copper deficiency than those who attended secondary school and above, respectively. Furthermore, pregnant women involved only in farming activities were 0.57 (AOR = 0.57, 95% CI 0.36–0.91) and 4.33 (AOR = 5.72, 95% CI 2.34–13.97) times more likely to be exposed to iron and zinc deficiency than those who were engaged in other activities. This study revealed that pregnant women with low income were 6.36 times more likely to be exposed to zinc micro-nutrient deficiencies than those with high-income participants (AOR = 6.36, 95% CI 1.47–27.61). Additionally, those participants who ate a varied diet between 1 and 4 items per day were 2.26 (AOR = 2.26, 95% CI 1.43–3.59) and 2.77 (AOR = 2.77, 95% CI 1.6–4.61) times more likely to suffer zinc and copper micro-nutrient insufficiency than those who consumed 5–10 items per day. Finally, pregnant women who developed diarrhea in the past three months were 1.82 (AOR = 2.77, 95% CI 1.14–2.92) and 2.52 (AOR = 2.52, 95% CI 1.3–4.91) times more likely to be exposed to iron and copper deficiency than those who never show the symptoms, respectively. This study identified low concentrations of zinc, iron, and copper in the blood serum of pregnant women of small-scale farmers.

Association between irritable bowel syndrome and micronutrients: A systematic review.

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms. Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends. Twenty-six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non-IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients. Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.

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.

Sanitation and Multiple Micronutrient Supplementation in Pregnancy Outcomes: Literature Review

BACKGROUND: Around 2.6 billion people lack proper sanitation. In addition, nutritional problems such as multiple micronutrient (MMN) deficiency can increase morbidity, mortality, and impaired neurocognitive growth at later stages of life. In addition to the need for a sanitary approach, a globally applicable strategy to prevent micronutrient deficiencies in pregnant women, UNICEF recommends the use of MMN for prenatal supplementation as an initial program in developing countries, to reduce the risk of poor birth outcomes. AIM: The aim of this literature study was to analyze the relationship between sanitation and the multimicronutrient (MMN) approach in pregnancy and birth outcomes. METHODS: This research was conducted using literature review method. Various references were collected from online database including reports, journals, and books. The journals were mostly from the scholarly journals. The articles were screened according to the research objectives. The keywords used are sanitation, pregnancy, and multiple micronutrient approach. RESULTS: Several studies have shown that sanitation and the multi micronutrient (MMN) approach play a role in determining pregnancy outcomes. We conclude that the importance of sanitation on pregnancy outcome is to reduce the chance of infection. The importance of MMN in pregnancy outcomes is that mothers who consume MMN during pregnancy can reduce the risk of poor birth output. The role of stakeholders is needed in the future. CONCLUSIONS: Several studies have shown that sanitation and multi micronutrient (MMN) play a role in determining pregnancy outcome.

The Magnitude of Hidden Hunger and Cognitive Deficits of Children Living in Some Selected Orphanages in Kumasi, Ghana During the COVID Pandemic

Many studies have assessed the magnitude of mixed micronutrient deficiencies or individual micronutrient deficiencies among children under 5 years, women of reproductive age (15‐ 49 years old) and pregnant women. This has led to various interventions for these population groups including supplementations, fortifications etc. However, the same attention has not been given to vulnerable children living in various orphanages, especially in Children’s Homes in Ghana where much is not known about their nutritional status. Socio‐ economic downturns like that induced by the current coronavirus pandemic affects food security and nutrition, thus the nutritional status of this vulnerable population could potentially be worsened.ObjectiveThis study assessed the magnitude of hidden hunger and cognitive deficits of 130 children (6‐ 13 years old) living in three selected orphanages in Kumasi, Ghana.MethodologySociodemographic data, anthropometric assessment (BMI‐for‐age and height‐for‐age), dietary assessment (3‐day repeated 24‐ hour dietary recall), urinary iodine levels and cognitive performance (Raven’s Coloured Progressive Matrices) were assessed.FindingsBoys formed 50.8% of the study population while girls formed 49.2%. The median age of participants was 10.50 years. About 12.3%, 7% and 10.0% of participants were stunted, thin and overweight/ obese respectively. Prevalence of mild iodine deficiency (i.e. 50‐ 99 μg/L) was 16.2%. Iodine deficiency was significantly higher (16.2%) in participants who had lived for at least 7 years in the orphanage compared to those who had lived less than 7 years (23.6%) (p = 0.047). About 17% of participants performed poorly (< 50%) in the cognition test. Mean cognitive test scores were significantly different among the orphanages (p = 0.027). Majority of participants, 89.2%, 54.6%, 76.9% and 77.7% had adequate intakes for iron, zinc, vitamin C and folate respectively whereas intake of vitamins A and B12 were inadequate for majority of participants (90.8% and 50.8% respectively). There was no significant correlation between micronutrient intake and cognitive performance. However, mean cognition test scores were significantly different between participants who had adequate and inadequate intake of iron and vitamin A (p = 0.007 and p < 0.001 respectively).The significance of the research is to provide data for relevant policy makers and stakeholders involved in the care of orphans and vulnerable children in Ghana like the Social Welfare Department. It is also expected that this research will stimulate further studies in the occurrence of multiple micronutrient deficiencies in vulnerable children since nutrition is not only necessary for physical development, but also for cognitive development and life‐long health (WHO, 2016).ConclusionFindings of this study warrant a closer look at nutritional intakes in orphanages to improve on hidden hunger.