Multiple Micronutrient Deficiencies Research Articles

Feasibility and effect of life skills building education and multiple micronutrient supplements versus the standard of care on anemia among non-pregnant adolescent and young Pakistani women (15\u201324\xa0years): a prospective, population-based cluster-randomized trial

BackgroundAdolescence is a critical period for physical and psychological growth and development, and vitamin and mineral requirements are correspondingly increased. Health and health behaviours correspond strongly from adolescence to adulthood. Developing a preconception care package for adolescent and young women in resource-limited settings could serve to empower them to make informed decisions about their nutrition, health, and well-being, as well as function as a platform for the delivery of basic nutrition-related interventions to address undernutrition.MethodsIn this population-based two-arm, cluster-randomized, controlled trial of life skills building education (provided bi-monthly) and multiple micronutrient supplementation (provided twice-weekly; UNIMMAP composition), we aim to evaluate the effectiveness of the intervention on the prevention of anemia (hemoglobin concentration < 12 g/dL) among adolescent and young women (15–24 years) in Matiari district, Pakistan compared to the standard of care. Several secondary objectives related to nutrition (anthropometry [height, weight, middle upper arm circumference (MUAC)], nutritional status [iron, vitamin A, vitamin D]); general health (morbidity, mortality); and empowerment (age at marriage, completion of the 10th grade, use of personal hygienic materials during menstruation) will also be assessed. Participants will be enrolled in the study for a maximum of 2 years.DiscussionEmpowering adolescent and young women with the appropriate knowledge to make informed and healthy decisions will be key to sustained behavioural change throughout the life-course. Although multiple micronutrient deficiencies are known to exist among adolescent and young women in low-resource settings, recommendations on preconception multiple micronutrient supplementation do not exist at this time. This study is expected to offer insight into providing an intervention that includes both education and supplements to non-pregnant adolescent and young women for a prolonged duration of time within the existing public health programmatic context.Trial registrationThis study is part of the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The MaPPS Trial was registered retrospectively on clinicaltrials.gov (Identifier: NCT03287882) on September 19, 2017.

Maternal Nutrition during Early Pregnancy and Cardiometabolic Status of Neonates at Birth.

Objective To explore the impact of maternal body weight on maternal nutrition and micronutrient status in early pregnancy and potential impact on metabolic status in newborns. Methodology The EU FP7 project GIFTS was conducted from Jan 2012 to May 2014. Demographic details and anthropometric measurements of women in the first trimester of pregnancy were obtained. Blood samples were collected for OGTT, insulin, lipid profile, serum folate, ferritin, vitamin D, vitamin B12, and red cell folate. Newborn anthropometric characteristics were observed. Cord blood samples were collected after delivery for glucose, insulin, and lipid profile of newborns. Results A total of 301 pregnant mothers, 108 overweight, 63 underweight, and 130 normal weight were included. Prevalence of vitamin D deficiency (<30 ng/mL) and low vitamin B12 (<190 ng/l) were high, 44% and 42%, respectively, in the first trimester. Anemic women (due to B12 or iron deficiency) were 79%, while 72% had low ferritin levels. Gestational diabetes was 16%. Differences were observed between underweight and overweight mothers (P < 0.05) for fasting blood glucose, insulin levels, and serum ferritin were observed. No significant difference was observed between vitamin D, serum B12, and red cell folate levels. Conclusion Prevalence of multiple micronutrient deficiencies was common among Pakistani women during early pregnancy despite the nonvegetarian diet that has important implications for pregnancy care in Pakistan and potentially in expatriate communities living abroad. This trial is registered with ISRCTN number 83599025.

Prevalence of micronutrient deficiencies clinically in rural school going children

Background: Micronutrients are those vitamins and minerals required in very small quantities in our bodies which are essential for a number of different functions including growth and development. Micronutrient deficiencies (MD) are the conditions which are prevalent in the society and parents are unaware of the same due to their asymptomatic nature. The aim of this study was to study the prevalence of MD in school children in rural area of Kolhapur district.Methods: This prospective study was carried out among 960 school children of, 8 randomly selected Government schools (120 from each school and from each class 30 children) between the age group of 5-10 years in rural Kolhapur, between July-September 2017. Clinical Features of MD for vitamin A (corneal dryness, Bitot’s spot, skin lesions), for vitamin B (angular chelosis, glossitis, knuckle pigmentation), for vitamin C (bleeding gums, scorbutic rosary), for vitamin D (bow legs, rachitic rosary, pot belly, frontal bossing) and pallor, goitre, dental caries for iron, iodine and fluoride deficiency respectively were examined. The data was analysed statistically.Results: The overall prevalence of MD was 35% with 37.45% in girls with highest (40.8%) in the age group of 8-9 years. The features of vitamin deficiency for vitamin B in 30%, for vitamin A in 15%, for vitamin D in 12%, for vitamin C in 2%. The features of mineral deficiency for iron and fluoride in 38.8% and 36.6% respectively were present. Commonest clinical features of vitamin deficiency were glossitis (15.6%), corneal dryness (9.6%), angular chelosis (7.5%) and knuckle pigmentation (6.9%). Multiple MD were seen in 12.7% of children. Conclusions: Rural school children do suffer from MD significantly. These conditions should be timely evaluated as these are preventable and treatable.

Phytosiderophore release in relation to multiple micronutrient metal deficiency in wheat

ABSTRACTPhytosiderophore (PS) release, which occurs mainly under iron deficiencies in the representative Poaceae, has been speculated to be a general adaptive response to enhance the acquisition of micronutrient metals. However, it is very common to encounter deficiency of micronutrients other than iron (Fe) in soils and interactions with respect of multi-micronutrient deficiency to effect on PS release are not known. Further, the diurnal rhythm for the release of PS may also be affected under multiple micronutrient deficiency. PS release capacity and PS content of roots and the diurnal rhythm of PS release was measured in selected efficient and inefficient wheat genotypes varied on individual and combined deficiency of Fe, zinc (Zn), copper (Cu) and manganese (Mn) in nutrient solution culture. A nutrient sufficient treatment was also taken as experimental control. Lack of Fe in the nutrient medium caused a significantly higher release of PSs followed by Zn, Mn and Cu in the same order. The diurnal rhythm of PS release was similar in the absence of either of the micronutrients or under their combined deficiency. Micronutrient sufficient control did not release any PS. Fe-use-efficient cultivars produced and released a larger amount of PS and differed from the inefficient cultivars in terms of the PS release but not in the PS biosynthesis in the roots. Thus, indicating that the limitation at the level of release of the PS is responsible for low Fe use efficiency of the Fe deficiency susceptible cultivars. Further, the diurnal variation in the PS release was similar for all the investigated wheat cultivars and did not influence the variation in the Fe use efficiency.

Combining food-based dietary recommendations using Optifood with zinc-fortified water potentially improves nutrient adequacy among 4- to 6-year-old children in Kisumu West district, Kenya.

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.

Multiple Micronutrient Deficiencies Exist in Aged‐care Residents, with Serum Zinc, not Iron, Being a Major Predictor of Anemia

BackgroundAnemia is a significant comorbidity in older adults with a complex etiology that is not fully attributable to iron deficiency. Other micronutrient and non‐nutritional health‐related associations have also been implicated as possible causal factors.ObjectiveTo examine the relations of serum iron, zinc, selenium and vitamin D status with hemoglobin concentrations and anemia in residents of New Zealand aged‐care facilities.MethodsA cross‐sectional survey of 309 rest‐home level care residents from 16 aged‐care facilities across New Zealand. Blood samples were analyzed for biomarkers of micronutrient status and inflammation. Multivariate regression was performed to examine the relations of micronutrient and inflammation biomarkers, and socio‐demographic and health factors (BMI, medication use, malnutrition and frailty status), with hemoglobin and anemia. Direct and indirect (through zinc) associations between selenium and hemoglobin were investigated using mediation analysis.ResultsData were available for 284 residents with complete hemoglobin and micronutrient results. Mean participant age was 85.1 (± 7.7) years old and approximately two‐thirds were female (67.6%). Anemia was present in 89 participants (31.3%) however, less than 2% of participants had either depleted iron stores or iron deficiency (with or without the presence of anemia). In contrast, 81.7% and 50.7% of participants had low serum zinc (&lt; 10.7 μmol/L) and low serum selenium concentrations (&lt; 0.82 μmol/L), respectively. Vitamin D deficiency (25OHD &lt; 50 nmol/L) was low, as 75% of all residents were taking monthly high‐dose vitamin D supplements. Proton pump inhibitor (PPI) or H2 antagonist medications were prescribed for 47.4% of participants. Being female, taking PPI or H2 antagonist medications and having a BMI ≥ 30kg/m2 were negatively associated with hemoglobin, while there was a positive association with serum zinc (P &lt; 0.05). Selenium had an indirect effect on hemoglobin which was mediated by zinc, with a significant effect of selenium on zinc and zinc on hemoglobin (P &lt; 0.05). The effect of zinc explained 30.1% of the relationship between serum selenium and hemoglobin. Low serum zinc, PPI or H2 antagonist medications and risk of malnutrition were associated with greater odds of being anemic (P &lt; 0.05).ConclusionHigh prevalence of low serum zinc is associated with a greater risk of anemia in elderly aged care residents, and mediates the effect of selenium on hemoglobin. Medications which alter iron absorption are also associated with lower hemoglobin concentrations. These findings emphasize the importance of monitoring the effect of medication on nutritional status in this vulnerable population and consideration of multiple micronutrient deficiencies when interpreting anemia.Support or Funding InformationDepartment of Human Nutrition, University of Otago; The Maurice and Phyllis Paykel Trust, New Zealand; Lottery Health New Zealand

Energy and nutrient intake of infants and young children in pastoralist communities of Ethiopia.

Nutrient intake from complementary foods often is suboptimal in subsistent farming households of developing countries, but little is known about this in pastoralist communities. The aim of this study was to estimate the energy and nutrient intake of children ages 6 to 23mo living in pastoralist communities of Ethiopia. As part of the Ethiopian National Food Consumption Survey, 24-h dietary recall data were collected through in-home interviews from a nationally representative sample. In the present study, we report on the feeding characteristics, energy and nutrient intake of infants and young children (ages 6-23mo) living in pastoralist communities (N=896) of Ethiopia. Energy and nutrient intakes were estimated and compared with estimated needs from complementary foods. The nutrient density of the complementary diets was compared with desired densities. About one-third of the children were stunted. Diets were predominantly dairy and cereal-based. The dietary diversity score was low (2±1.2). Consumption of nutrient-dense foods such as animal source foods (other than milk), vitamin A-rich fruits and vegetables was very low. Energy intake from complementary foods were inadequate. Multiple micronutrient deficiencies including thiamin, niacin, iron, zinc, and calcium and in some instances vitamins A and C were observed in young children. The number of micronutrients for which intake was found deficient increased with child's age. Energy and nutrient intakes from complementary foods are inadequate in pastoralist communities of Ethiopia. Interventions that improve knowledge and practice of complementary feeding are needed in this setting.

Nutrition, infection and stunting: the roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children.

The regulation of linear growth by nutritional and inflammatory influences is examined in terms of growth-plate endochondral ossification, in order to better understand stunted growth in children. Linear growth is controlled by complex genetic, physiological, and nutrient-sensitive endocrine/paracrine/autocrine mediated molecular signalling mechanisms, possibly including sleep adequacy through its influence on growth hormone secretion. Inflammation, which accompanies most infections and environmental enteric dysfunction, inhibits endochondral ossification through the action of mediators including proinflammatory cytokines, the activin A-follistatin system, glucocorticoids and fibroblast growth factor 21 (FGF21). In animal models linear growth is particularly sensitive to dietary protein as well as Zn intake, which act through insulin, insulin-like growth factor-1 (IGF-1) and its binding proteins, triiodothyronine, amino acids and Zn2+ to stimulate growth-plate protein and proteoglycan synthesis and cell cycle progression, actions which are blocked by corticosteroids and inflammatory cytokines. Observational human studies indicate stunting to be associated with nutritionally poor, mainly plant-based diets. Intervention studies provide some support for deficiencies of energy, protein, Zn and iodine and for multiple micronutrient deficiencies, at least during pregnancy. Of the animal-source foods, only milk has been specifically and repeatedly shown to exert an important influence on linear growth in both undernourished and well-nourished children. However, inflammation, caused by infections, environmental enteric dysfunction, which may be widespread in the absence of clean water, adequate sanitation and hygiene (WASH), and endogenous inflammation associated with excess adiposity, in each case contributes to stunting, and may explain why nutritional interventions are often unsuccessful. Current interventions to reduce stunting are targeting WASH as well as nutrition.

Serum Zinc Is a Major Predictor of Anemia and Mediates the Effect of Selenium on Hemoglobin in School-Aged Children in a Nationally Representative Survey in New Zealand

Background: Zinc, selenium, and vitamin D status of New Zealand (NZ) school-aged children was examined in a national survey in 2002. To our knowledge, however, the role of these micronutrients as predictors of hemoglobin has not been explored despite plausible mechanisms for such relations.Objective: We examined the relations of iron, zinc, selenium, and vitamin D status with hemoglobin and anemia in children of New Zealand European and other (NZEO) ethnicity enrolled in the 2002 Children’s Nutrition Survey and explored whether zinc mediated the relation between selenium and hemoglobin.Methods: Multivariate regression was performed to examine the relations of serum micronutrient biomarkers, acute inflammation, socioeconomic status, and body mass index (BMI) with hemoglobin and anemia of NZEO children aged 5–15 y (n = 503). A mediation analysis also investigated direct and indirect (through zinc) relations between selenium and hemoglobin.Results: In total, 4.6% of the children were anemic, 3.2% had depleted iron stores, and none had iron deficiency anemia. The prevalence of low serum zinc (<8.7–10.1 μmol/L depending on age and sex), selenium (<0.82 μmol/L), and 25-hydroxyvitamin D (<50 nmol/L) was 14.1%, 22.9%, and 48.5%, respectively. Major predictors of hemoglobin were serum zinc, age, and BMI-for-age z score (P < 0.001); log ferritin and being female were also statistically significant (P < 0.05). Selenium had an indirect effect that was mediated by zinc, with a significant effect of selenium on zinc (P = 0.002) and zinc on hemoglobin (P < 0.001). Zinc was the only variable associated with anemia risk (OR: 5.49; 95% CI: 1.95, 15.46).Conclusions: Low serum zinc was an independent risk factor for anemia in NZEO school-aged children and mediated the effect of low selenium on hemoglobin. These findings emphasize the importance of considering multiple micronutrient deficiencies in addition to iron when interpreting anemia and of appreciating the mechanistic interactions that underlie these associations.

Association between food insecurity and anemia among women of reproductive age.

Background: Food insecurity and hidden hunger (micronutrient deficiency) affect about two billion people globally. Household food insecurity (HFI) has been shown to be associated with one or multiple micronutrient (MMN) deficiencies among women and children. Chronic food insecurity leads to various deficiency disorders, among which anemia stands out as the most prevalent one. As a high malnutrition prevalent country, Bangladesh has one of the highest rates of anemia among all Asian countries. In this study, we wanted to investigate for any association exists between HFI and anemia among women of reproductive age in Bangladesh.Methodology: Information about demographics, socioeconomic and anemia status on 5,666 married women ageing between 13 and 40 years were collected from a nationally representative cross-sectional survey Bangladesh Demographic and Health Survey (BDHS 2011). Food security was measured by the Household Food Insecurity Access Scale (HFIAS). Capillary hemoglobin concentration (Hb) measured by HemoCue® was used as the biomarker of anemia. Data were analysed using cross-tabulation, chi-square tests and multiple logistic regression methods.Results: Anemia prevalence was 41.7%. Logistic regression showed statistically significant association with anemia and type of residency (p = 0.459; OR = 0.953, 95%CI = 0.840–1.082), wealth status (Poorest: p < 0.001; OR = 1.369, 95%CI = 1.176–1.594; and average: p = 0.030; 95%CI = 1.017–1.398), educational attainment (p < 0.001; OR = 1.276, 95%CI = 1.132–1.439) and household food insecurity (p < 0.001; 95%CI = 1.348–1.830). Women who reported food insecurity were about 1.6 times more likely to suffer from anemia compared to their food secure counterparts.Conclusion: HFI is a significant predictor of anemia among women of reproductive age in Bangladesh. Programs targeting HFI could prove beneficial for anemia reduction strategies. Gender aspects of food and nutrition insecurity should be taken into consideration in designing national anemia prevention frameworks.

Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency.

Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies.

Common Mistakes which Women commit during Pregnancy

Pregnancy is the time when mothers start worrying about their physical health. This overview of multiple micronutrients during pregnancy and lactation emphasizes 2 relatively neglected issues. The first is that maternal micronutrient status in the periconceptional period, and throughout pregnancy and lactation, should be viewed as a continuum; too often these 3 stages are treated and discussed separately from both a scientific and a public health perspective. Iron and vitamin B-12 are included as examples to stress how status at conception affects maternal, fetal, and infant status and health until the child is weaned. The second issue is that while most attention has been focused on a few micronutrients, for example iron and folate as discussed elsewhere in this Supplement, multiple micronutrient deficiencies occur simultaneously when diets are poor. Some of these deserve more attention as causes of poor pregnancy outcome, including other B vitamin deficiencies that result in homocysteinemia, antioxidants, vitamin D, and iodine. In lactation, maternal status or intake of the B vitamins (except folate), vitamin A, selenium and iodine strongly affect the amount of these nutrients secreted in breast milk. This can result in the infant consuming substantially less than the recommended amounts and further depleting stores that were low at birth. While the optimal mode of meeting recommended micronutrient intakes is an adequate diet, in some situations supplementation is also important. Unfortunately, information is lacking on the optimal formulation of micronutrient supplements for pregnant women, and the need to continue these supplements during lactation is not recognized in many situations where maternal and infant health could benefit.

Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery

Over 78 million American adults have obesity. Bariatric surgery is the leading means of durable weight loss. Nutritional deficiencies are commonly treated post-operatively but are often undiagnosed pre-operatively. Malnutrition is correlated with adverse surgical outcomes. The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study. We recruited 58 bariatric candidates approved to undergo the Roux-en Y gastric bypass. Nutritional status was determined for vitamins A, B12, D, E-α, and E-β/γ as well as thiamine, folate, and iron. We used clinical as well as frank deficiency cut-offs based on the Institute of Medicine and the World Health Organization guidelines. This cohort was largely female (77.6%) and white (63.8%). Median age was 42.2 years. Median body mass index (BMI) was 46.3 kg/m(2). Multiple comorbidities (MCM) were present in 41.4%, 54.0% hypertension, 42.0% diabetic, 34.0% sleep apnea. Men had more comorbidities, 69.2 % with MCM. Folate and iron saturation varied significantly by sex. Vitamins A, D, E-α, and thiamine significantly varied by race. Vitamin D negatively correlated with BMI (p = 0.003) and age (p = 0.030). Vitamin A negatively correlated with age (p = 0.001) and number of comorbidities (p = 0.003). These pre-operative bariatric candidates had significant malnutrition, particularly in vitamin D (92.9%) and iron (36.2 to 56.9 %). Multiple micronutrient deficiency (MMND) was more common in blacks (50.0 versus 39.7% overall). Number of comorbidities did not correlate with MMND. Malnutrition in one or multiple micronutrients is pervasive in this pre-operative bariatric cohort. The effect of pre-operative supplementation, especially vitamin D and iron, should be explored.

Micronutrients in pregnancy in low- and middle-income countries.

Pregnancy is one of the more important periods in life when increased micronutrients, and macronutrients are most needed by the body; both for the health and well-being of the mother and for the growing foetus and newborn child. This brief review aims to identify the micronutrients (vitamins and minerals) likely to be deficient in women of reproductive age in Low- and Middle-Income Countries (LMIC), especially during pregnancy, and the impact of such deficiencies. A global prevalence of some two billion people at risk of micronutrient deficiencies, and multiple micronutrient deficiencies of many pregnant women in LMIC underline the urgency to establishing the optimal recommendations, including for delivery. It has long been recognized that adequate iron is important for best reproductive outcomes, including gestational cognitive development. Similarly, iodine and calcium have been recognized for their roles in development of the foetus/neonate. Less clear effects of deficiencies of zinc, copper, magnesium and selenium have been reported. Folate sufficiency periconceptionally is recognized both by the practice of providing folic acid in antenatal iron/folic acid supplementation and by increasing numbers of countries fortifying flours with folic acid. Other vitamins likely to be important include vitamins B12, D and A with the water-soluble vitamins generally less likely to be a problem. Epigenetic influences and the likely influence of micronutrient deficiencies on foetal origins of adult chronic diseases are currently being clarified. Micronutrients may have other more subtle, unrecognized effects. The necessity for improved diets and health and sanitation are consistently recommended, although these are not always available to many of the world’s pregnant women. Consequently, supplementation programmes, fortification of staples and condiments, and nutrition and health support need to be scaled-up, supported by social and cultural measures. Because of the life-long influences on reproductive outcomes, including inter-generational ones, both clinical and public health measures need to ensure adequate micronutrient intakes during pregnancy, but also during adolescence, the first few years of life, and during lactation. Many antenatal programmes are not currently achieving this. We aim to address the need for micronutrients during pregnancy, the importance of micronutrient deficiencies during gestation and before, and propose the scaling-up of clinical and public health approaches that achieve healthier pregnancies and improved pregnancy outcomes.

The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance

Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies. This study aimed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status, cognition, physical performance and nutritional deficiencies of 7-10 years old south Indian children. A randomized, double blind placebo controlled study design was used with normal healthy children from low to middle income families, aged 7-10 years randomly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink. The drinks were provided 6 days/week for 5 months. Assessments included anthropometry, blood biochemistry, physical performance and cognition at baseline and endline. The baseline characteristics of the study groups were similar. The changes in body weight and height were similar between the groups at the end of the study. Levels of vitamin B12, red cell folate and vitamin B2 significantly improved in the intervention group, while vitamin D, selenium and body iron showed no difference. The Hemoglobin (Hb) and serum ferritin levels of the control group decreased at endline, while those in the intervention group maintained their levels. The serum transferrin receptor levels increased in both the groups. The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline. Overall improvement in cognitive and physical performance was seen in both the groups at endline, with no significant differences between the groups. The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2, Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink. It also reduced anemia and the risk of deficiencies of iron, and B12, in apparently healthy children. ClinicalTrials.gov IdentifierNCT01415557. Clinical Trial RegistryIndia - REF/2012/12/004332.

Prevalence and risk factors of micronutrient deficiencies pre- and post-antiretroviral therapy (ART) among a diverse multicountry cohort of HIV-infected adults

HIV-infected adults have increased risk of several individual micronutrient deficiencies. However, the prevalence and risk factors of concurrent and multiple micronutrient deficiencies and whether micronutrient concentrations change after antiretroviral therapy (ART) initiation have not been well described. The objective of this study was to determine the prevalence and risk factors of individual, concurrent and multiple micronutrient deficiencies among ART-naïve HIV-infected adults from nine countries and assess change in micronutrient status 48 weeks post-ART initiation. A random sub-cohort (n=270) stratified by country was selected from the multinational PEARLS clinical trial (n=1571 ART-naïve, HIV-infected adults). We measured serum concentrations of vitamins A, D (25-hydroxyvitamin), E, carotenoids and selenium pre-ART and 48 weeks post-ART initiation, and measured vitamins B6, B12, ferritin and soluble transferrin receptor at baseline only. Prevalence of single micronutrient deficiencies, concurrent (2 coexisting) or conditional (a deficiency in one micronutrient given a deficiency in another) and multiple (≥3) were determined using defined serum concentration cutoffs. We assessed mean changes in micronutrient concentrations from pre-ART to week 48 post-ART initiation using multivariable random effects models. Of 270 participants, 13.9%, 29.2%, 24.5% and 32.4% had 0, 1, 2 and multiple deficiencies, respectively. Pre-ART prevalence was the highest for single deficiencies of selenium (53.2%), vitamin D (42.4%), and B6 (37.3%) with 12.1% having concurrent deficiencies of all three micronutrients. Deficiency prevalence varied widely by country. 48 weeks post-ART initiation, mean vitamin A concentration increased (p<0.001) corresponding to a 9% decrease in deficiency. Mean concentrations also increased for other micronutrients assessed 48 weeks post-ART (p<0.001) but with minimal change in deficiency status. Single and multiple micronutrient deficiencies are common among HIV-infected adults pre-ART initiation but vary between countries. Importantly, despite increases in micronutrient concentrations, prevalence of individual deficiencies remains largely unchanged after 48 weeks on ART. Our results suggest that ART alone is not sufficient to improve micronutrient deficiency.

Development of Food Based Dietary Guidelines for Kenyan Women Using Linear Programming

Objectives: Women in Kenya are at high risk of multiple micronutrient deficiencies due to low intake through monotonous diets. Country-specific food based dietary recommendations (FBRs) facilitate dietary improvement. Main objective was to develop and evaluate FBRs based on the existing diet using linear programming for women of reproductive age from Mbooni division, Eastern Kenyan. Methods: A consumption study was conducted among 205 woman (19-50 yrs.) using three nonconsecutive 24-hour recalls. Excel, Access and SPSS were used to prepare required model parameters (foods consumed by >10% of women, including median portion size, weekly frequency consumption, food composition values, food group patterns (median and range), staple/snacks. Linear programming (‘Optifood') was used to develop and evaluate FBRs. Results: Out of 62 foods, 30 foods were consumed by more than 10% of the surveyed women. Fat, iron, folate and vitamin-B12 requirements could not be met both in worst (≥70%RNI) and best case (≥100% RNI) scenario diets, covering 43.6%, 48.4%, 30.0% & 18.8% of RNI. Calcium, vitamin A, riboflavin, niacin, B6 and zinc intake was inadequate, but requirements could be met by inclusion of kale, pumpkin leaves, red beans, cow's milk and cooking fat. Conclusions: Realistic food based dietary guidelines based on locally available foods for Kenyan women were successfully developed using linear programming. These guidelines will ensure at least 70% RNI of energy, protein, calcium, vitamin A, C, B1, B2, B5, B6, and zinc. To obtain adequate amounts of fat, folate, iron and vitamin-B12 in the women's diet, alternative strategies are required. © 2015 Ngala et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conference Abstract

Quadruple burden of HIV/AIDS, tuberculosis, chronic intestinal parasitoses, and multiple micronutrient deficiency in ethiopia: a summary of available findings.

Human immunodeficiency virus (HIV), tuberculosis (TB), and helminthic infections are among the commonest public health problems in the sub-Saharan African countries like Ethiopia. Multiple micronutrient deficiencies also known as the “hidden hunger” are common in people living in these countries either playing a role in their pathogenesis or as consequences. This results in a vicious cycle of multiple micronutrient deficiencies and infection/disease progression. As infection is profoundly associated with nutritional status resulting from decreased nutrient intake, decreased nutrient absorption, and nutrient losses, micronutrient deficiencies affect immune system and impact infection and diseases progression. As a result, micronutrients, immunity, and infection are interrelated. The goal of this review is therefore to provide a summary of available findings regarding the “quadruple burden trouble” of HIV, TB, intestinal parasitic infections, and multiple micronutrient deficiencies to describe immune-modulating effects related to disorders.

Dietary modifications to improve micronutrient status of Indian children and adolescents with type 1 diabetes.

Diet plays a crucial role for maintaining normal growth and development while optimizing glycemic control in children with diabetes. Dietary restrictions, in a diabetic child's diet may lead to micronutrient deficiencies. To examine dietary nutritional deficiencies of Asian Indian children with Type 1 diabetes mellitus and develop micronutrient-rich recipes suitable for them. Anthropometry, diet (3-day recall) of 70 children with diabetes (24 boys) was recorded. Daily nutrient intakes and nutrient content of recipes were estimated using CDIET version 2.0. Mean intake amongst children for energy was 79% of Indian Recommended Dietary Allowance (RDA), protein was 105% RDA, but fat intakes were high (143% RDA). Mean intakes of riboflavin, β carotene, zinc, iron were less than 50%, and thiamin and calcium were around 60% RDA suggesting a possible multiple micronutrient deficiency. Based on popularly consumed snacks, 20 healthy recipes were devised that can be incorporated in children's diet. Mean energy content of new recipes was similar to routine snacks (281±28 kcal/100 g vs 306±27 kcal/100 g cooked weight). However, the mean vitamin and mineral content of new recipes was significantly higher (p<0.01). There was a five-fold increase in total mineral content (zinc, calcium and iron) and twofold increase in total vitamin content (β carotene, vitamin C, vitamin B-1, B-2, and B-3) in new recipes compared with the routine snacks. Multiple dietary micronutrient deficiencies are observed in diabetic children. Addition of newly developed recipes in their everyday diet may help to enhance micronutrient intakes without increasing their energy load.

Context for Food-Based Approaches for Improved Feeding of Infants and Children in Ethiopia

Regardless of efforts by the health sector and partner organizations, maternal and child malnutrition is still a challenge in Ethiopia. To describe the context of current infant and child feeding patterns in Ethiopia. Feeding patterns, diet content and quality, and nutritional outcomes and feeding practices of mothers of young children are described from literature review of a number of field studies. Protein and energy deficiencies and multiple micronutrient deficiencies are common. Breastfeeding is often prolonged until 2 years of age, with introduction of small amounts of poor-quality complementary foods. Vitamin A and iodine deficiencies have also been problems. Focus group discussions showed that mothers did not believe that animal-source foods are needed.by young children or schoolchildren. However, the Health Extension Program led by the Federal Ministry of Health promotes optimal child feeding as one of the health extension packages. Continued use of germination and fermentation of cereals should be encouraged to increase bioavailability of trace elements. Use of fat in the diet would increase energy density. To improve the situation, extension education, including nutrition and agricultural expertise delivered in aformat understandable to mothers about appropriate complementary feeding, including animal-source foods, is urgently needed, with expansion of governmental and nongovernmental resources.