Nutrition Consultation Research Articles

Maternales Phenylketonurie-Syndrom trotz intensiver Patientenberatung

We report on a 21-year-old woman with classic phenylketonuria, who presented at our outpatient clinic at week 14 of pregnancy. Despite intensive preconceptional counselling about the risk of raised Phenylalanine (Phe) levels for the offspring and nutritional consultations about the necessity to be on a Phe-restricted diet she had elevated blood Phe concentrations. Phe level could be lowered to the recommended range during a stay as an inpatient, but the patient was not able to maintain the recommended levels due to non-compliance. The patient delivered a newborn with classic maternal PKU syndrome (microcephaly, brachygnathia, congenital heart defect and psychomotoric retardation), which is nowadays rarely seen under preconceptional Phe-restricted diet. With more PKU patients reaching the childbearing age, intensive preconception counselling about maternal PKU syndrome is of pivotal importance for the women. However, a major factor in preventing Phe embryopathy is patient compliance in keeping the diet, which was insufficient in the case presented.

Survey of nutrition instructors’ viewpoints

Background: Objective: Methods: Results: Conclusion: Keywords: N UTRITION EDUCATION , M EDICAL SCHOOL The results show that nutrition education is not enough in our country. It seems that horizontal and vertical integration of nutrition education in medical curriculum can be an effective way to increase physicians’ skills in nutrition. Almost all instructors believed that nutrition education is not satisfactory in medical schools. They also announced that the physicians’ ability in screening nutritional diseases, diagnosing patients’ nutritional problems, presenting nutritional guidelines to their patients, providing useful nutritional guidelines to the healthy population, and providing nutritional consultation to their patients is restricted. The graduates are also not familiar with specific nutritional cares for each disease. In this descriptive survey, a questionnaire was prepared and sent to all nutrition instructors and they were asked to fill the questionnaire and send it back. Statistical analysis was performed on received answers. To assess the opinions of nutrition instructors in medical schools and universities about nutrition education. Journal of Medical Education Summer 2003;3(2): 59-63 Although nutrition has a very important role in individual and society’s health and disease, it has not yet received proper attention in the curriculum of medical schools.

Recent Advances in Knowledge of Zinc Nutrition and Human Health

Zinc deficiency increases the risk and severity of a variety of infections, restricts physical growth, and affects specific outcomes of pregnancy. Global recognition of the importance of zinc nutrition in public health has expanded dramatically in recent years, and more experience has accumulated on the design and implementation of zinc intervention programs. Therefore, the Steering Committee of the International Zinc Nutrition Consultative Group (IZiNCG) completed a second IZiNCG technical document that reexamines the latest information on the intervention strategies that have been developed to enhance zinc nutrition and control zinc deficiency. In particular, the document reviews the current evidence regarding preventive zinc supplementation and the role of zinc as adjunctive therapy for selected infections, zinc fortification, and dietary diversification or modification strategies, including the promotion and protection of breastfeeding and biofortification. The purposes of this introductory paper are to summarize new guidelines on the assessment of population zinc status, as recommended by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the International Atomic Energy Agency (IAEA), and IZiNCG, and to provide an overview on several new advances in zinc metabolism. The following papers will then review the intervention strategies individually.

Analysis of Nutritional Support Status in the Intensive Care Unit

Background: Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status. Methods: Between January and December 2006, patients who were admitted to the intensive care unit (ICU) ≥ 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records. Results: Two hundred sixty-two patients stayed in the ICU a mean of 16.0 ± 9.8 days and received nutrition support for 11.0 ± 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 ± 253.8 kcal, the mean daily delivered caloric amount was 899.5 ± 338.7 kcal, and the total delivered/required caloric ratio was 66.4 ± 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 ± 25.8% and 55.9 ± 33.3%. Conclusions: In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.

Nutritional profile of pregnant women assisted in the first prenatal nutritional consultation in a philanthropic institution from São Paulo

Individualized nutritional evaluation in the beginning of the prenatal period is important to establish pregnant women nutritionalnecessities in this period and must be carried out continuously along pregnancy. The present study had as its aim to analyze the nutritional profileby surveying the registers contained in a database of 219 pregnant women attended in first prenatal consultation in the Outpatient Departmentof Amparo Maternal, a philanthropic institution. The studied pregnant women had an average 24.3 years, most single, with incomplete secondaryeducation and pertaining to E class. Regarding the first prenatal nutritional consultation, 73.9% began in the 3rd gestation term, and most wereprimigravid. As for nutritional condition, it was noticed that from pre- gestational to gestational state there was a fall in the classification oflow weight and eutrophy, and an increase of overweight. Food taken was on average below the recommended energetic values (2029 kcal and2146 kcal, for adolescent and adult pregnant women, respectively) and as for the distribution of macronutrients carbohydrates and lipids wereadequate and proteins above WHO recommendations. Regarding micronutrients, it was noticed that calcium and vitamin A were insufficient,and vitamin C above recommendations, an indication of the importance of assistance by a professional nutritionist in prenatal consultations forpromoting educative actions directed to correct eating habits.

Twelve weeks low glycemic load diet reduced body weight, fat mass and hunger in overweight/obese children

This is a preliminary report on the benefit of a weekly low glycemic load (GL) diet intervention designed to positively effect body weight (BW) and body composition by reducing satiety in overweight/obese (BMI=28.38±5.86 kg m −2 ) pre-pubertal children over a 12-week period. Thirteen otherwise healthy (11.46±1.94 years) children participated in the study. The low GL diet intervention included attending a weekly nutrition consultation, exchanging of at least 50% of the high glycemic index (GI) foods with low GI foods in the diet and portion control. Dietary changes were made based on weekly 4-day food-diaries over the 12-weeks. There were significant reductions in BW (68.08±22.03 vs. 65.64±22.12 kg), body mass index (BMI; 28.38±5.86 vs. 27.09±6.2 kg m −2 ), fat mass (26.02±12.8 vs. 23.64±12.8 kg) % body fat (36.82±6.1 vs. 33.81±7.4), and circumference measurements; waist (95.73±14.01 vs. 90.76±14.26 cm); hip circumference (97.23±13.37 vs. 93.34±18.80 cm); thigh circumference (59.08±7.9 vs. 56.80±8.1 cm). The significant reduction of self-reported hunger level (3.46±0.92 vs. 1.51±1.11) was also observed. The 12-week low GL diet seems to be a practical, effective approach to treat obesity in children.

Refeeding Syndrome: Recognition Is the Key to Prevention and Management

Refeeding syndrome is a life-threatening constellation of cardiovascular, pulmonary, hepatic, renal, neuromuscular, metabolic, and hematological abnormalities following inappropriate alimentary resuscitation in severely malnourished or starved individuals. Clinical observations of refeeding syndrome were originally described and reported around the time of World War II when prisoners of war and semi-starved war protestors experienced cardiac failure following nutrition repletion (1,2). Today, anorexia nervosa is one of the more frequent clinical presentations at risk of refeeding syndrome; however, malnourished elderly patients, oncology patients receiving chemotherapy, and postoperative patients may also be at risk. Recognizing individuals prone to refeeding syndrome and understanding the compensatory physiologic mechanisms and resulting nutritional implications are crucial to avoiding the morbidity and mortality associated with this phenomenon.

Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

BackgroundThere are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior.MethodsForty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval.DiscussionThe proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings.It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.

Bilateral Femoral Supracondylar Stress Fractures in a Cross Country Runner

Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

Memorial Sloan-Kettering Cancer Center program of cancer and aging. Experience of the 65+ Clinical Geriatric Program in the evaluation of older cancer patients

20728 The aging of the population and the increased incidence of cancer with age have resulted in a marked increase in older cancer patients. In addition to their cancer they have increased comorbidity making treatment decisions and their care more complicated. The older patients are at increased risk to suffer cancer treatment related toxicities. Therefore a coordinated approach is required to optimize care by giving the patients the opportunity to benefit from treatment and at the time minimize suffering from toxicities. The Memorial Sloan-Kettering Cancer Center as part of the Cancer and Aging program has organized the 65+ Clinical Geriatric Group to achieve this goal. The group consists of participants with expertise in geriatrics, finance, nutrition, occupational therapy, music therapy, pharmacy, physical therapy, psychiatry, social work, palliative care, medical and surgical oncology. The group meets on a monthly basis to plan on an ongoing basis the building of an infrastructure for multidisciplinary geriatric oncology care in the institution. A database has been organized to assess the group’s activity and evaluate outcomes. In the 3rd quarter of 2007 there were 1202 patient visits by team members with the majority visits in nutrition (22%), physical therapy (22%), occupational therapy (14%), psychiatry (16%) and social work (16%). In the period Oct-Dec 2007 69 geriatric pharmacy consultations were performed (mean 75.5; median age 76 years; male-55%; female-45%). A comprehensive medication review was conducted which included evaluation of drug compliance, and unnecessary prescription drug evaluation (using Beer’s Criteria). In the same period 305 geriatric nutritional consultations were provided (male-40%; female-60%; 71% over 70 years; 39.8% were overweight/obese based on BMI). The referral pattern for the nutrition consults was: physician referral-32%; referral administration-50%; patient self referral-17.6%. The activity of the group demonstrates that a geriatric evaluation and support program can be conducted in the setting of a Comprehensive Cancer Center. Future activities will include development of institutional guidelines for multidisciplinary geriatric care. No significant financial relationships to disclose.

COMPREHENSIVE MANAGEMENT OF MUCOUS MEMBRANE PEMPHIGOID IN A MEDICALLY COMPROMISED PATIENT (DIABETES MELLITUS AND HYPERTENSION) (A CASE REPORT)

Mucous membrane pemphigoid (MMP) is an autoimmune mucocutaneous blistering disease characterized by autoantibodies to components within the basement membrane zone. The lesions may produce risk of scarring of the cants (symblepharon), inversion of the eyelashes (entropion) and trauma to the cornea (trichiasis). We reported a case of MMP in a 56-year old female with controlled diabetes mellitus and hypertension whose ocular involvement has lead to blindness of the right eye. The diagnosis of MMP was based on the history and clinical findings in oral medicine department. Management of this patient included the administration of anti-fungal, corticosteroid, diaminodiphenylsulfone, nutritional supplementation oral hygiene promotion and consultation to internal medicine specialist and ophtalmologist. The improvement of oral lesions progressed well within five months. We conclude that optimal improvement can be reached by comprehensive management with controlling systemic factor and good cooperation between medical team and patient.

Effect of Nutrition Intervention on Non-Communicable Disease Risk Factors among Tehranian Adults: Tehran Lipid and Glucose Study

Background/Aim: Several epidemiologic studies have shown that many nutritional and non-nutritional risk factors for non-communicable diseases are modifiable. This study was conducted to determine the effectiveness of nutrition intervention on non-communicable disease risk factors among Tehranian urban adults. Methods: In the Tehran Lipid and Glucose Study (TLGS), 1,474 subjects, aged 3 years and over, were selected for dietary assessment; nutrition intervention was implemented for one third through pamphlets, posters, nutritional consultations, educational courses, and demonstration of films in the community health medical centers, schools, and other public places. After a 3.8-year follow-up period, data were collected for 578 subjects, aged 18–74 years, who participated in the second phase of the study; there were 356 subjects in the control group and 222 in the intervention group. Mean body mass index, energy intake, macronutrients, fibre, micronutrients, serum lipids, fasting blood sugar, and systolic and diastolic blood pressures were determined in both groups. Results: The mean fasting blood sugar concentrations increased significantly in the control group and decreased significantly in the intervention group. Mean diastolic blood pressure and total cholesterol and low-density lipoprotein cholesterol levels decreased in both groups. However, the body mass index showed a significant increase in both groups. Adjusted for age, sex, and baseline variables, the cholesterol intake (214 vs. 232 mg/day, p < 0.05) was significantly lower in the intervention as compared with the control group. Conclusions: The present study shows decreases in fasting blood sugar, total serum cholesterol, and daily cholesterol intake after nutrition interventions. Specific intervention measures, keeping in mind cultural and socio-economic factors, could modify dietary patterns and are effective in the primary pre- vention of non-communicable diseases.

Impact of a Basic Nutrition Course for Residents at a Faculty Hospital

Background/Aims: To assess whether a basic nutrition course for residents at a faculty hospital improves their knowledge of nutrition and increases the number of consultation requests for nutrition by alerting participants to the high prevalence of undernutrition in hospitals. Methods: The residents from 34 departments of basic, internal and surgical sciences were recruited to take a 1-day course. Questionnaires, designed to assess knowledge of nutrition, were completed at the beginning and at the end of the course. The results of the questionnaires and the number of consultation demands for nutrition before and after the course were compared. Results: The results of 161 participants were evaluated. The mean (±SE) numbers of correct answers given to the first and second questionnaires were 14.9 ± 0.22 and 18.7 ± 0.21, respectively (p < 0.01). When the number of requests for nutrition consultation during 7-month periods (just before and after the course) were compared, the mean number of requests in each month during these periods were found to be 1.81 ± 0.58 and 4.06 ± 1.20, respectively (p < 0.01). Conclusions: A short course of basic nutrition for residents improves their basic knowledge and leads to an increase in the number of consultation requests for nutritional support.

Pengaruh advokasi pelayanan gizi dan penyuluhan terhadap jumlah kunjungan pasien di Poliklinik Gizi Rumah Sakit Umum Raden Mattaher Jambi

Background: The number of patients’ visits at nutrition polyclinic is relatively low whereas the need of nutrition consultation at hospital polyclinic is high. Visits at nutrition polyclinic generally come from referrals of doctors at hospital polyclinics. The number of visits greatly depends on doctors referring patients to nutrition polyclinic. Low visit at nutrition polyclinic is due to the absence of socialization of nutrition service. It is necessary to conduct socialization of nutrition service by dissemination of information to outpatients and advocacy to stakeholders, especially doctors, who are expected to refer patients to nutrition polyclinic to increase visit.Objectives: To find out the effect of nutrition service advocacy and socialization to the number of visits at nutrition polyclinic of Raden Mattaher Hospital, Jambi.Methods: The study was a quasi-experimental using one group with pre-test and post-test design. Respondents of the study were doctors working in polyclinics and outpatients. There were 32 respondents of advocacy group and 180 respondents of socialization group. Data obtained were the number of patients’ visits analyzed statistically using Wilcoxon range test. Data of diagnostic types of patients having nutrition consultation were analyzed descriptively.Results: Advocacy of nutrition service to doctors and socialization to patients could increase visits of patients at nutrition polyclinic. There were significant increase of patients’ visits at nutrition polyclinic and visits based on diagnosis (p&lt;0.05). A new type of diagnosis referred to nutrition polyclinic after intervention was found.Conclusion: Advocacy given to respondents who had made referral to nutrition polyclinic and socialization given to patients could increase the number of patients visiting nutrition polyclinic.

Job Analysis and Satisfaction of Dietitian of School Foodservice for Job Efficiency

This study conducted task analysis of dietitian working in school foodservice through the job importance and performance and job satisfaction survey in Gwangju and Jeonnam areas. Of 646 questionnaires, 244 cases were analyzed by SPSS 12.0 and frequency, t‐test, ANOVA were performed. In the job performance, there are significant differences in food supplier selection (p=0.013), assessment of number of meals/day (p=0.033) in the food selection and purchase management. In terms of job importance, there are significant differences in assessment of nutritional requirement (p=0.002), analysis of nutrition intake (p=0.037), in the nutrition management and consultation with faculty, students and parents (p=0.001) in the general operation. Elementary school dietitians were the most satisfied with their salary and compensation, work environment and Middle school dietitians were the least satisfied in the analysis of job satisfaction. These results suggest that it is necessary to differentiate the main task of dietitian by the school classification (elementary, middle, high school) in Korea for improving work efficiency.

The Effects of 6-Week Low Glycemic Load Diet Based on Low Glycemic Index Foods in Overweight/Obese Children - Pilot Study

Objective: To evaluate the effectiveness of a 6-week low Glycemic Load (GL) diet intervention based on low Glycemic Index (GI) foods on body weight, body composition, metabolic risk factors and satiety in overweight/obese pre-pubertal children.Methods: Following a pediatric examination 8 healthy, average age 11 year old, Caucasian, pre-pubertal overweight/obese (BMI = 24, 7 ± 3.8 kg/m2) children participated in the study. The Low GL diet intervention was based on the replacement of at least 50% of the high GI foods with Low-GI foods. The children with one of their parents participated in weekly nutrition consultations. Body composition, fasting glucose, insulin, cholesterol and triglyceride were measured before and after the study. Dietary changes were made based on weekly 4-day food-diaries.Results: Despite no change in body weight, there was a significant (p < 0.05) reduction in % body fat (29.4 ± 4.2 vs. 25.4 ± 5.3), Waist-to-Hip Ratio (WHR 0.87 ± 0.053 vs. 0.86 ± 0.05), decrease in self-reported hunger level (4.37 ± 0.74 vs. 1.75 ± 0.75) and the total number of risk factors (28 vs. 15). There was a strong negative correlation between fasting glucose and insulin levels at baseline and in the magnitude of change after the study (r = −0.93 and r = −0.85 respectively; p < 0.01).Conclusions: A 6 week study demonstrated the practicality and effectiveness of this Low GL dietary approach. Despite of the unchanged body weight, Low GL diet consultations positively modified body fat content and cardiovascular risk factors in overweight or obese children.

Nutritional management of children and adolescents on insulin pump therapy – a survey of Australian Practice

The aims of the survey were to review nutritional care provided to children on insulin pump therapy (IPT) and to identify areas of consensus in medical nutrition therapy. Interventions were compared with existing evidence for best practice. A questionnaire was sent to Dieticians in tertiary pediatric diabetes centers in Australia. Data were gathered on clinic demographics, reasons for commencement of pump therapy, and time spent in medical nutrition therapy. Details of nutrition education strategies were identified. Outcomes from nutrition interventions were reported. A 100% response rate was achieved (n = 12). A number of nutrition therapy interventions were provided to children on IPT. These included carbohydrate counting, glycemic index (GI), and carbohydrate exchanges. At most centers, nutrition education involved teaching dose adjustment for meals based on the carbohydrate content of the meal with estimations to within 5 g. All centers taught GI. The format of nutrition education, including number and length of consults, varied greatly between centers. Only one center had developed nutrition guidelines for managing insulin pump patients. Most pediatric diabetes centers in Australia did not follow nutrition guidelines for the management of children on IPT. There were inconsistencies in the number and length of nutrition consultations provided. Some strategies employed in nutrition education were not supported by existing guidelines for best practice. Differences between centers highlighted gaps in the evidence for nutrition therapy interventions in children on pumps.

Conclusions of the Joint WHO/UNICEF/IAEA/IZiNCG Interagency Meeting on Zinc Status Indicators

Zinc deficiency is an important cause of morbidity in developing countries, particularly among young children, yet little information is available on the global prevalence of zinc deficiency. A working group meeting was convened by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the International Atomic Energy Agency (IAEA), and the International Zinc Nutrition Consultative Group (IZiNCG) to review methods of assessing population zinc status and provide standard recommendations for the use of specific biochemical, dietary, and functional indicators of zinc status in populations. The recommended biochemical indicator is the prevalence of serum zinc concentration less than the age/sex/time of day-specific cutoffs; when the prevalence is greater than 20%, intervention to improve zinc status is recommended. For dietary indicators, the prevalence (or probability) of zinc intakes below the appropriate estimated average requirement (EAR) should be used, as determined from quantitative dietary intake assessments. Where the prevalence of inadequate intakes of zinc is greater than 25%, the risk of zinc deficiency is considered to be elevated. Previous studies indicate that stunted children respond to zinc supplementation with increased growth. When the prevalence of low height-for-age is 20% or more, the prevalence of zinc deficiency may also be elevated. Ideally, all three types of indicators would be used together to obtain the best estimate of the risk of zinc deficiency in a population and to identify specific subgroups with elevated risk. These recommended indicators should be applied for national assessment of zinc status and to indicate the need for zinc interventions. The prevalence of low serum zinc and inadequate zinc intakes may be used to evaluate their impact on the target population's zinc status.

Dietary Indicators for Assessing the Adequacy of Population Zinc Intakes

The assessment of dietary zinc intakes is an important component of evaluating the risk of zinc deficiency in populations, and for designing appropriate food-based interventions, including fortification, to improve zinc intakes. The prevalence of inadequate zinc intakes can describe the relative magnitude of the risk of zinc deficiency in the population and identify subpopulations at elevated risk. As a cornerstone to evaluating the adequacy of population zinc intakes globally, a set of internationally appropriate dietary reference intakes must be defined. The World Health Organization/Food and Agriculture Organization/International Atomic Energy Agency (WHO/FAO/IAEA) and the Food and Nutrition Board/US Institute of Medicine (FNB/IOM) have presented estimated average requirements (EAR) for dietary zinc intake, and, more recently, the International Zinc Nutrition Consultative Group (IZiNCG) presented a revised set of recommendations for international use. A prevalence of inadequate zinc intakes greater than 25% is considered to represent an elevated risk of population zinc deficiency. As the requirement estimates are derived from smaller, clinical studies and, for children, most components of the estimates are extrapolated from data for adults, it was desirable to evaluate their internal validity. The estimated physiological requirements for adult men and women appear to adequately predict zinc status as determined by biochemical indicators of status and/or zinc balance. With the use of data from available studies, the reported prevalence of low serum zinc concentration and the estimated prevalence of inadequate zinc intakes predict similar levels of risk of zinc deficiency, particularly among pregnant and nonpregnant women. Conformity between these two indicators is less consistent for children, suggesting that further data and/or direct studies of zinc requirements among children are needed.

Zinc

Zinc