Nutritional Deficiency Disorders Research Articles

A cross sectional study on menstrual hygiene of adolescent girls in rural field practice area of Kalaburagi, Karnataka, India

Background: Adolescents make nearly one tenth of Indian population and form a crucial segment of the society. A large variety of morbidities such as nutritional deficiency disorders (stunting, wasting), menstrual disorders, etc. prevail among them. Menstruation is generally considered as unclean in the Indian society. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. There is a substantial lacuna in the knowledge about menstruation among adolescent girls. Adolescent girls have incomplete and inaccurate information about the menstrual physiology and hygiene. Good hygienic practices such as the use of sanitary pads and adequate washing of the genital area are essential during menstruation. Methods: A cross-sectional study was carried out from January to December 2012. House to house survey was conducted; a pre-structured and pre-tested questionnaire was administered to all the adolescent girls of 10-19 years in the study area. Results: Majority of girls 121 (38.05%) were in high school; Out of 318 adolescent girls, 200 (62.89%) had attained menarche when they were 13-14 years old; Among 200 girls, majority 138(69%) use piece of cloth and 62 (31%) use sanitary pad as sanitary protection during menstruation. There was a significant association between usage of sanitary protection (cloth/pad) and education of adolescent girls (p<0.05). Conclusions: Health education programs regarding menstrual hygiene are necessary in rural areas and social marketing of sanitary napkin should be promoted to avoid use of unhygienic sanitary napkins.

Prevalence of anemia among adolescent girls residing in rural field practice area of M. R. Medical College, Kalaburagi, Karnataka, India: a cross-sectional study

Background: A large variety of morbidities such as nutritional deficiency disorders (stunting, wasting), menstrual disorders, etc. prevail among adolescents. They make nearly one tenth of Indian population and form a crucial segment of the society. Their current nutritional status will decide the wellbeing of the present as well as the future generations. Under-nutrition among these girls was associated with reduced lean body mass, lack of muscular strength and decreased work capacity and obstetric complications. Anemia is common during adolescence due to demands of increased growth and menstrual blood loss. Studies have shown that iron deficiency exists in both clinical as well as subclinical forms in adolescent girls. In adolescent girls, the onset of menstruation can alter the iron status of an individual not only by creating a demand for more iron due to blood loss but also due to the pro-inflammatory nature of menstrual cycle itself.Methods: A cross-sectional study was carried out from January to December 2012. House to house survey was conducted; a pre-structured and pre-tested questionnaire was administered to all the adolescent girls of 10-19 years in the study area.Results: Majority of girls 121 (38.05%) were in high school; Majority of adolescent girls 132 (41.51%) belong to class IV; Out of 318 adolescent girls, 200 (62.89%) had attained menarche at the time of study; Majority of adolescent girls 176 (55.35%) were moderately anaemic, followed by 15 (4.72%) were having severe anemia, 13 (4.09%) were having mild anemia.Conclusions: Anemia is one of the health problems adolescent girls are facing in rural area.

Phyrnoderma: Associated nutritional co-morbodities among children attending at Nutrition Clinic, Osmania General Hospital, Hyderabad, India

Introduction: Phrynoderma, meaning toad skin, is a form of follicular hyperkeratosis. Multiple nutritional deficiency disorders have been implicated in the etiology of phrynoderma. It is commonly seen in the children belonging to low socio-economic strata, clinically characterized by discrete, follicular, skin colored papules with keratotic plugs distributed over elbows, knees, extensor extremities and buttocks. The present study aims to determine the clinical presentation and associated nutritional co morbidities in diagnosed phrynoderma cases. Materials and Methods: A series of 339 clinically diagnosed phyronderma cases attending the Nutrition Unit of tertiary care hospital during a period from September 1995 to March 2014 were retrospectively reviewed. All cases were reviewed for clinical history, cutaneous examination findings including associated signs of nutritional deficiencies. Results: In a total of 339 patients of Phrynoderma studied, there were 195 males and 144 females. Majority of patients were in 6-10years age group. The lesions were distributed bilaterally and symmetrically in 196 (57.8%) patients. The lesions were localized predominantly to elbow followed by extremities in upper body and knees in lower body followed by buttocks. A total of 16.2% patients had associated ocular and skin findings and 13.3% of patients had the signs of Vitamin A deficiency. Conclusion: Phyrnoderma is a disorder of young children and adolescents and can be considered as multifactorial disease involving deficiencies of various nutrients along with local factors such as pressure and friction responsible for pathogenesis of the disease.

A Study of Anemia among Pregnant Women in District Hapur, U.P., India

Anemia is the most common nutritional deficiency disorder in the world. The aim of study was to determine the prevalence and the various sociodemographic factors associated with anemia among pregnant women at Rama Medical College, Hospital, Pilkhwa, Hapur, U.P., India. This study was carried out from Jan 2015 to Feb 2016. A total of 482 pregnant women were selected using a systematic random sampling technique. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration of the women were determined and the results were analysed. Pregnant women who had hemoglobin (Hb) value of < 11gm were selected in study. Overall prevalence of anemia among the pregnant women was found to be 65.15%. Factors such as level of education of women and socioeconomic status were found to be significantly associated with the prevalence of anemia in pregnancy in this area. There is a need to monitor hemoglobin during pregnancy and there by improve the outcome of pregnancy. This research work presents the magnitude of anemia and its determinant factors among pregnant women. As far as this research is done in the western part of U. P. India, where there is a different cultural issue related to pregnancy and dietary habit, it will help the researchers to know the problem in different parts of the country.

Evaluation of Weekly Iron and Folic Acid Supplementation Programme for adolescents in rural schools of Kannur, North Kerala, India: A cross-sectional study

Background: Iron deficiency is the major cause for anemia and widespread nutritional deficiency disorder in India. In 2013, Ministry of Health and Family Welfare has launched the Weekly Iron and Folic Acid Supplementation (WIFS) Programme to reduce the prevalence and severity of nutritional anemia in adolescent population. Since it is a relatively new program, we conducted this survey to evaluate current status of the program implementation in the schools, Kannur, India. Objective: To evaluate the current status of WIFS Programme implementation in the schools of Kannur, north Kerala, India. Materials and Methods: It was a cross-sectional study carried out in schools under the rural field practice area of Community Medicine Department, Kannur Medical College, Kannur. Two schools were selected randomly for the data collection and a sample of 524 students and 39 teachers were studied for a period of 1 month. A pretested, semi-structured, self-administered questionnaire was administered and descriptive statistics and associations were analyzed. Results: Out of the 524 students, 50.4% were males and 49.6% females, 77.3% of them had not consumed iron and folic acid (IFA) tablets regularly—main reasons were feeling healthy and parent’s resistance. Awareness about anemia and its symptoms was good but significant difference existed between the schools. Twenty-three percent had side effects after IFA tablets intake and common side effect was stomach pain. All 39 teachers opined WIFS Programme was useful and 90% teachers counseled the students. Fifty percent teachers told they faced resistance from parents. Conclusion: Awareness about anemia was good but WIFS implementation in schools was not regular. There is a need to strengthen the program by giving proper training to the teachers and by giving health education to the parents and students about the benefits of WIFS.

Effect of Ayurveda Medications (Kasīsa Bhasma and Dhātrī Avaleha) on Iron Deficiency Anaemia: A Randomized Controlled Study.

Background:This paper explores the role that Ayurveda can play in the management of Iron Deficiency Anaemia, a major nutritional deficiency disorder affecting people across the globe.Methodology:Forty (40) patients suffering from Iron deficiency anaemia as per WHO guidelines, between the age group of 20 to 60 yrs of either sex participated in the study. Study was a randomized, controlled, open label clinical study. Patients were randomly divided into two groups: Group D (n = 20) received Dhārī avaleha 10 g twice a day after food. Group K (n = 20) received capsules Kasīsa bhasma 125 mg thrice a day. Both interventions were administered for 30 days and the subjects were followed up for next 30 days with placebo capsules to assess the sustainability of the effects. Assessments were done at baseline, 30th and 60th days. Primary outcome measure was hemoglobin estimation (Hb) and secondary outcome measures were the other hematological parameters such as Red blood cell (RBC) indices, total RBC count, Packed Cell volume (PCV) and Peripheral Blood smear study.Results:Both interventions produced significant improvements (P < 0.001). Kasīsa bhasma was better compared to dhātrī avaleha in terms of primary (P < 0.0001) and secondary outcomes. Comparison of outcomes from base line – 30th day, base line – 60th day and 30th – 60th day showed significant (P < 0.0001) improvement in both the groups in parameters such as haemoglobin, MCV and MCH. Hence improvements sustained during placebo intervened sustainability period also.Conclusions:Study effectively shows that Kasīsa bhasma is better then Dhātrī avaleha. Improvements by both interventions were sustained even during the sustainability period.

Transdermal iron replenishment therapy.

Iron deficiency anemia is one of the major nutritional deficiency disorders. Iron deficiency anemia occurs due to decreased absorption of iron from diet, chronic blood loss and other associated diseases. The importance of iron and deleterious effects of iron deficiency anemia are discussed briefly in this review followed by the transdermal approaches to deliver iron. Transdermal delivery of iron would be able to overcome the side effects associated with conventional oral and parenteral iron therapy and improves the patient compliance. During preliminary investigations, ferric pyrophosphate and iron dextran were selected as iron sources for transdermal delivery. Different biophysical techniques were explored to assess their efficiency in delivering iron across the skin, and in vivo studies were carried out using anemic rat model. Transdermal iron delivery is a promising approach that could make a huge positive impact on patients suffering with iron deficiency.

A Nanoparticulate Ferritin-Core Mimetic Is Well Taken Up by HuTu 80 Duodenal Cells and Its Absorption in Mice Is Regulated by Body Iron

Background: Iron (Fe) deficiency anemia remains the largest nutritional deficiency disorder worldwide. How the gut acquires iron from nano Fe(III), especially at the apical surface, is incompletely understood.Objective: We developed a novel Fe supplement consisting of nanoparticulate tartrate-modified Fe(III) poly oxo-hydroxide [here termed nano Fe(III)], which mimics the Fe oxide core of ferritin and effectively treats iron deficiency anemia in rats.Methods: We determined transfer to the systemic circulation of nano Fe(III) in iron-deficient and iron-sufficient outbread Swiss mouse strain (CD1) mice with use of 59Fe-labeled material. Iron deficiency was induced before starting the Fe-supplementation period through reduction of Fe concentrations in the rodent diet. A control group of iron-sufficient mice were fed a diet with adequate Fe concentrations throughout the study. Furthermore, we conducted a hemoglobin repletion study in which iron-deficient CD1 mice were fed for 7 d a diet supplemented with ferrous sulfate (FeSO4) or nano Fe(III). Finally, we further probed the mechanism of cellular acquisition of nano Fe(III) by assessing ferritin formation, as a measure of Fe uptake and utilization, in HuTu 80 duodenal cancer cells with targeted inhibition of divalent metal transporter 1 (DMT1) and duodenal cytochrome b (DCYTB) before exposure to the supplemented iron sources. Differences in gene expression were assessed by quantitative polymerase chain reaction.Results: Absorption (means ± SEMs) of nano Fe(III) was significantly increased in iron-deficient mice (58 ± 19%) compared to iron-sufficient mice (18 ± 17%) (P = 0.0001). Supplementation of the diet with nano Fe(III) or FeSO4 significantly increased hemoglobin concentrations in iron-deficient mice (170 ± 20 g/L, P = 0.01 and 180 ± 20 g/L, P = 0.002, respectively). Hepatic hepcidin mRNA expression reflected the nonheme-iron concentrations of the liver and was also comparable for both nano Fe(III)– and FeSO4-supplemented groups, as were iron concentrations in the spleen and duodenum. Silencing of the solute carrier family 11 (proton-coupled divalent metal ion transporter), member 2 (Slc11a2) gene (DMT1) significantly inhibited ferritin formation from FeSO4 (P = 0.005) but had no effect on uptake and utilization of nano Fe(III). Inhibiting DCYTB with an antibody also had no effect on uptake and utilization of nano Fe(III) but significantly inhibited ferritin formation from ferric nitrilotriacetate chelate (Fe-NTA) (P = 0.04). Similarly, cellular ferritin formation from nano Fe(III) was unaffected by the Fe(II) chelator ferrozine, which significantly inhibited uptake and utilization from FeSO4 (P = 0.009) and Fe-NTA (P = 0.005).Conclusions: Our data strongly support direct nano Fe(III) uptake by enterocytes as an efficient mechanism of dietary iron acquisition, which may complement the known Fe(II)/DMT1 uptake pathway.

Scope of nutritional assessment in community and clinical settings

The nutritional status of an individual is usually the result of multiple factors which interact with each other in different proportions. Acknowledging the role of diet in the onset of many diseases, assessment of the nutritional status of an individual/family/community is of extreme public health importance. The nutritional assessment is done with an aim to obtain specific information about the prevalence and geographic distribution of nutritional disorders in a given community/a specified population group, to identify nutritionally vulnerable high risk groups and to assess the role of different epidemiological factors in the natural history of the nutritional deficiency disorders. To conclude, the comprehensive nutritional assessment is an effective tool to assess the prevalence of nutritional disorders, to plan corrective measures and simultaneously evaluate the effectiveness of the implemented strategies.

Formulation and Shelflife Evaluation of Kodo Millet Incorporated Ready to Cook Mixes

Minor millets are recognized as important substitute for major cereal crops to cope up with worldwide food shortage and to meet the demand of increasing population of both developing and developed countries [1]. Kodo millet is highly nutritious but has received little attention in terms of product utilization. Supplementation of millets in cereal based products have become increasingly popular due to nutritional and economic advantages. They are considered as a shield against nutritional deficiency disorder and provide nutritional security [2]. Hence the present study was done to formulate and standardize ready to cook mixes with incorporation of kodo millet at 10%, 20% and 30% respectively and to assess the shelf life of formulated ready to cook mixes. Results showed that recipes prepared out of ready to cook mixes with incorporation of kodo millet was highly acceptable. Shelf life evaluation showed that microbial load was within safe limit in the kodo millet incorporated ready to cook mixes upto 45 days.

Diffuse Hair Loss in a Young Female

We present the case of a 21 year-old woman who came to our attention complaining an acute and diffuse hair loss, lasting from about 5 months. She also observed an important hair thinning. The patient was healthy and denied events like psychological stress, significant fever or fast weight loss in the previous months. She had no nutritional deficiency or thyroid disorders. The personal history revealed polycystic ovary syndrome, with normal hormones levels. Her familiar history was positive for male androgenetic alopecia. Clinical examination of the scalp revealed moderate hair density (Figure 1). Eyebrows, eyelashes and body hair were normal, as well as nails.

Nutritional Status of Baiga Tribe of Baihar, District Balaghat, Madhya Pradesh

A community based cross-sectional study was carried out to assess the nutritional status of Baiga tribal population of Baihar, Balaghat district of Madhya Pradesh. A total of 1197 individuals from 436 households were studied for anthropometric measurements and clinical examination. The consumption of all the food stuff except cereals and millets were lower than recommended dietary allowances. The intake of micronutrients was lower than recommended dietary allowances. Vitamin ‘A’ deficiency was a major nutritional deficiency disorder in this tribe. The magnitude of wasting (weight for height

Biophysical techniques for transdermal delivery of iron

Iron deficiency anemia is the one of the major nutritional deficiency disorder. Current conventional treatment options with oral and parenteral iron formulations are associated with limitations and numerous side effects. Transdermal delivery of iron was explored systematically as an alternative treatment option as it is non-invasive and patient compliant. Ferric pyrophosphate was used as the source of iron for transdermal delivery. Biophysical techniques like iontophoresis, electroporation and microporation were explored for the delivery of FPP and in vivo studies were carried out in anemic rat model. Therapeutically required quantities of iron can be delivered using combination of these active techniques.

Clinical Profile of Mid Day Meal Beneficiaries of Primary Schools in Kurukshetra District

The various aspects of clinical profile in mid day meal beneficiaries, between the age group of 6-11 years from Kurukshetra district have been studied. One time observational study of five hundred government primary school children was conducted. A qualified medical practitioner was associated for clinical examination of children having mid-day-meal. Clinical symptoms observed were noted in the structured schedule. Observation of clinical signs reveal the anatomical changes due to malnutrition like deficiency disorders for iron, Vitamin A, B-complex, C and D. Symptoms of anemia were observed at a higher rate in girls than boys. Spongy (9.2%) and bleeding (5.3%) gums indicating Vitamin C deficiency was recorded in few subjects. Bones were found normal except few children who were diagnosed with distal wrist/ bowed legs/ pigeon chest. However, the prevalence of these nutritional deficiency disorders may be attributed to their poor nutritional status. Nutrition intervention in the form of supplementation and education in primary schools along with families, teachers and communities has to be strengthened to effectively address malnutrition.

Prevalence of Nutritional Deficiency Disorders among Rural School-Age Children in Jawan Block of Aligarh District

Background Children in the age group of 5-15 years are often considered as school age. It is recorded that in India, one fifth population consists of children between 5-14 years, which includes the primary and secondary school-age (1). Adequate micronutrient status is critical for good health and development during childhood. Access to high quality data on nutrition and health indicators in this age group would aid in prioritizing and setting up deliberate, evidence based nutrition intervention programs, targeting the nutritional problems that are of real concern (7). Objectives: 1. to examine the prevalence of clinical signs of nutritional deficiency disorders among school-age children. 2. to find out the difference in prevalence of deficiency disorders among boys and girls.

NUTRITIONAL DEFICIENCY DISORDERS IN PAEDIATRICS: AN AYURVEDIC PERSPECTIVE

Nutrition i s major concern f or the mankind. Food determines body condition right from the womb to tomb; it is main source of energy. Abnormal nutrition may cause both over and under nutrition hazards. It causes more than half of the nearly 11 million deaths each year among c hildren under age five. Nutritional deficiency disorders are viewed under Apatarpanajanya vyadhis. Ancient Acharyas explained diseases related to nutritional deficiency such as Phakka, Parigarbhika, Bala shosha etc in different samhitas . This paper highlig hts Ayurvedic perspective of nutritional deficiency related disorders.

Weekly iron folate supplementation in adolescent girls--an effective nutritional measure for the management of iron deficiency anaemia.

Introduction:Nutritional anaemia in India is common morbidity seen in late adolescent and young female population. There are many conflicting opinions regarding dosage of iron folic acid supplementation for managing this simple nutritional deficiency disorder. Hence, this ‘Randomized Controlled Trial’ was undertaken in adolescent girls suffering from Iron Deficiency Anaemia visiting ‘Urban Health and Training Centre’ situated in urban slum area. The aim of this study was to assess the (a) Impact of weekly iron folic acid supplementation in comparison with daily iron supplementation for the management of Iron Deficiency Anaemia in adolescent girls visiting ‘Urban Health and Training Centre’; (b) Adverse drug reaction profile in ‘Weekly Iron Folic Acid Supplementation’ and ‘Daily Iron Folic Acid Supplementation’ regimes; (c) Compliance profile for ‘Weekly Iron Folic Acid Supplementation’ and ‘Daily Iron Folic Acid Supplementation’ regimes in adolescent girls.Methods and Material:Randomized controlled trial was conducted in adolescent girls visiting ‘Urban Health and Training Centre’ during the study period June, 2011 to October, 2012. The 120 anaemic (Haemoglobin < 12 gm%) adolescent girls (10-19 years) were distributed randomly by block randomization in two groups; one receiving daily Iron and Folic Acid supplementation and in other group receiving weekly Iron and Folic Acid supplementation for 3 months. All the study subjects were given de-worming (Albendazole 400 mg) and required health education separately. Both the groups were monitored for Haemoglobin estimation, compliance and adverse drug reactions, if any. Open-Epi Statistical Software was used for data analysis.Results:The mean age of study subjects in ‘Daily Iron and Folic Acid Supplementation’ and ‘Weekly Iron and Folic Acid Supplementation’ group was 13.48 and 13.55 years respectively. Their mean pre intervention Haemoglobin was 10.1±1.1 gm/dl and 10.4±1.1 gm/dl respectively. The mean rise in Haemoglobin after lean period of 1 month in respective groups was almost equal i.e. 1.0±0.7 gm/dl and 1.0±0.8 gm/dl. Adverse Drug Reactions were 8.3% in weekly regime as compared to 13.35% in daily regime, abdominal pain being the commonest adverse drug reaction seen. The compliance calculated as mean of unconsumed ‘Iron and Folic Acid’ tablets was 6.1±10.98 in ‘Daily Iron Folic Acid Supplementation’ group, while it was 1.3±3.15 in ‘Weekly Iron Folic Acid Supplementation’ group (p=0.0012), making weekly regime more promising than daily regime with better treatment compliance.Conclusions:Weekly supplementation of ‘Iron and Folic Acid’ in ‘Iron Deficiency Anaemia’ patients is as good as daily supplementation with added benefits of less adverse reactions and better compliance.

Effects of iron deficiency on cognitive function in school going adolescent females in rural area of central India.

Iron deficiency anemia is most common nutritional deficiency disorder in India and remains a formidable health challenge. Girls in the period of later school age and early adolescence are prone to develop iron deficiency. Iron deficiency leads to many non-hematological disturbances which include growth and development, depressed immune function in infants; reduces physical work capacity; decreases the cognitive function in both infants and adolescents. Present study was done to know the prevalence of iron deficiency in both the anemic and non anemic school going adolescent girls, to assess the effect of iron deficiency on cognitive functions in anemic iron deficient and non-anemic iron deficient school girls in a village school situated in central India. Methods. A secondary school having girl students in the age group of 12–15 years studying in sixth to ninth standard was selected. Serum ferritin concentration was estimated by ELISA. For assessing the cognitive function mathematics score, one multi-component test for memory, attention and verbal learning and Intelligent Quotient scores of the students were used. Results. Scholastic Performance, IQ and Scores of Mental balance, Attention & Concentration, Verbal Memory and Recognition were decreased in iron deficient girls, both anemic and non anemic as compared to the non iron deficient girls.

Strategies to improve iron status in women at risk of developing anaemia

Iron deficiency is one of the most prevalent nutritional deficiency disorders worldwide, with teenage girls and women of childbearing age, especially pregnant and postpartum mothers, being most affected. Although supplements may be required in some instances, simple dietary and lifestyle changes may also help individuals to establish a healthy iron status. This article presents useful information that nurses and midwives can provide to women during particular life phases such as pregnancy, adolescence and old age to improve their iron status.

Epidemiologic study on nutritional biotin deficiency and congenital disorders of biotin metabolism

Epidemiologic study on nutritional biotin deficiency and congenital disorders of biotin metabolism