Suboptimal Micronutrient Intake Research Articles

Suboptimal micronutrient intake among children aged 6 to 23 months in Ethiopia: Further analysis of the demographic and health survey.

The recommended essential micronutrient such as food rich in vitamin-A or iron, multiple micronutrient powder or iron supplement, routine daily consumption of iodine, and vitamin-A supplement are deficient among children in Ethiopia. This has been a significant public health problem despite the government efforts. Although few studies have examined the micronutrient intake among children, they are limited in scope and methodological measurements. Analyzing the micronutrient intake among children across all regions and leveraging all essential micronutrient elements are crucial for generating improved evidence to better inform policy. Thus, we examined the micronutrient intake among children aged 6 to 23 months in Ethiopia. We used data from the Ethiopian Demographic and Health Survey. A two-stage stratified sampling technique was employed, and 1392 children aged 6 to 23 months were included in our analysis. We conducted a multilevel mixed-effect binary logistic regression analysis to identify determinants of micronutrient intake. In the final model, we used a p-value of less than 0.05 and Adjusted Odds Ratio (AOR) with their 95% confidence interval (CI). We found that only 27.6% (95% CI: 26.8-31.6) of children aged 6 to 23 months were received the recommended micronutrients in Ethiopia. We identified that maternal educational status (Educated mothers (AOR = 2.09, 95%CI:1.23-3.58)), health facility delivery (AOR = 2.14, 95%CI:1.42-2.98), household wealth status (middle quantile (AOR = 1.80, 95%CI:1.01-3.21)), children's age (12 to 23 months age (AOR = 2.36, 95% CI: 1.33-4.21)), and mother's exposure to media (AOR = 1.70, 95%CI: 1.42-2.04) were increased micronutrient intake, whereas residing in the rural communities (AOR = 0.27, 95%CI: 0.21-0.34) decreased micronutrient intake. Nearly three-fourths of children aged 6 to 23 months did not receive the recommended essential micronutrients in Ethiopia. Therefore, there is a need to broaden strategies aimed at enhancing the intake by improving information and knowledge dissemination among mothers during facility visits and through media channels.

Association between the Carbohydrate Quality Index (CQI) and Nutritional Adequacy in a Pediatric Cohort: The SENDO Project.

Suboptimal micronutrient intake in children remains a public health concern around the world. This study examined the relationship between a previously defined dietary carbohydrate quality index (CQI) and the risk of micronutrient intake inadequacy in a pediatric cohort of Spanish preschoolers. Children aged 4-5 years old were recruited at their medical center or at school, and information on sociodemographic, dietary, and lifestyle variables were collected through a self-administered online questionnaire. Dietary information was obtained from a validated 147-item semi-quantitative food frequency questionnaire. We calculated the CQI and categorized participants into quartiles according to their scores. We assessed the intakes of 20 micronutrients and evaluated the probability of intake inadequacy by using the estimated average requirement cut-off point. Generalized estimating equations were used to adjust for potential confounders and account for the intra-cluster correlations between siblings. The adjusted proportions of children with an inadequate intake of ≥three micronutrients were 23%, 12%, 11%, and 9% in the first, second, third, and fourth quartiles of the CQI, respectively. Children in the highest quartile of the CQI had 0.22-fold lower odds (95% CI 0.10-0.48) of having ≥three inadequate micronutrient intakes than their peers in the lowest quartile. These findings reinforce the relevance of carbohydrate quality in children's diets.

Differences in Micronutrient Intakes of Exclusive and Partially Breastfed Indonesian Infants from Resource-Poor Households are Not Accompanied by Differences in Micronutrient Status, Morbidity, or Growth

BackgroundWhen maternal micronutrient intakes and statuses are compromised, reductions in micronutrient concentrations in neonatal stores and human milk may result in suboptimal micronutrient intakes, statuses, and functional outcomes of breastfed infants during the critical first 6-month period. ObjectivesWe compared the adequacy of micronutrient intakes and statuses at 2 and/or 5 months and morbidity and growth faltering at 2, 5, and 12 months in a cohort of exclusively breastfed (EBF) and partially breastfed (PBF) infants from low-resource Indonesian households. MethodsAt 2 and 5 months, the breastfeeding status and human milk intake of 212 infants were determined using the deuterium oxide dose-to-mother technique, and intakes were calculated from milk micronutrient concentrations and 3-d weighed food intakes. At 5 months, five infant micronutrient biomarkers, hemoglobin, C-reactive protein, and α-1-acid-glycoprotein were measured. Infant morbidity, weight, and length were measured at 2, 5, and 12 months. Means, medians, or proportions were reported for each group and differences between groups were statistically determined. ResultsMedian intakes of iron, thiamin, niacin, and vitamin B-12 were higher in PBF than EBF infants at 5 months (all P values < 0.05), but intakes in all infants were below adequate intakes. At 5 months, anemia was <20% in both groups, although fewer PBF versus EBF infants had vitamin B-12 deficiency (11.5% vs. 28.6%, respectively; P = 0.011). The mean ± SD length-for-age z-scores for EBF versus PBF infants at 2 months were 0.7 ± 0.9 versus −0.5 ± 1.1, respectively (P = 0.158), declining to −1.4 ± 0.9 versus −1.1 ± 1.2, respectively, at 12 months (P = 0.059). Reported morbidity rates were generally low, with no evidence of a difference between infant groups (all P values > 0.126). ConclusionsIrrespective of exclusive or partial breastfeeding status, micronutrient intakes of infants were low, statuses were compromised, and growth faltering during the critical 6 months period of early infancy was present. The findings highlight the importance of improving maternal nutritional statuses and evaluating their impacts on infant outcomes.

Changes in micronutrient intake and factors associated with this change among older Australian men: the Concord Health and Ageing in Men Project.

To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men. Prospective study. Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable 'not meeting' (meeting ≤ 6) or 'meeting' (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake. Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up). The mean age was 81 years (range 75-99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services. Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.

62 Nutritional assessment of children in Hartley Bay (Gitga’at), BC

Abstract Background Hartley Bay is a small, remote Gitga’at community. As part of “Brighter Smiles”, a multidisciplinary child health partnership between the Gitga’at Nation and BC Children’s Hospital, the community requested a quality assurance project to describe the nutritional status of its children and assess the impact of the existing school based nutrition program. Objectives The community wished to explore ways in which the existing nutrition program could be optimized to further meet the nutritional needs of its children in terms of macronutrient, micronutrient and meal content and to explore food beliefs and values. Design/Methods Gitga’at health leadership guided the design of the study and community approval was sought at an early stage. All Hartley Bay families with children aged 5-18 were invited to participate. With the support of the teachers, a 24-hour dietary recall survey was completed online during school time using the WEB-Q software program. Nutritional information was then analyzed and compared. Anthropometric data (heights, weights, BMI and blood pressures) were collected during routine clinic visits in September 2018, compared with population based norms and analyzed. Results Anthropometric data was collected for 23/30 school aged children. In terms of anthropometrics, 45.5% of girls and 16.7% of boys had a body mass index (BMI) in the healthy range (3rd-85th percentile). Results showed 18.2% girls and 25% of boys had a BMI in the overweight range (85th – 97th percentile), while 36.4% of girls and 58.3% of boys respectively were in the obese or severely obese range. Blood pressures demonstrated that 75% of females and 62.5% of males were normotensive (systolic BC &amp;lt;87%ile). There are many accomplishments of the community highlighted in this study including attitudes towards traditional foods and harvesting, openness to try new foods and spending meal time with family. Four in 18 students were meeting the recommended 5 servings of vegetables/fruits per day. The average intake of sodium for 9-13 year olds was 3g/day (recommended upper limit is 2.2g/day). For 14-18 year olds the average sodium intake was 4.6g/day (recommended upper limit is 2.3g/day). One in 18 students met adequate intake for calcium, 2/18 for fibre and 13/18 for vitamin D. The majority of children in this community are obtaining the recommended percentage energy from fats, carbohydrates and protein. Conclusion A significant proportion of Hartley Bay children had anthropometric measurements suggesting they were at risk for long term negative health outcomes. The study also indicated areas to improve, with suboptimal micronutrient intake. Successes of the community were also highlighted. The data was presented to Hartley Bay health staff, Elders and community members so that it can be used collaboratively by the health staff and community leadership to work on community-designed programs for health promotion.

Improvement in Cognition Following Double-Blind Randomized Micronutrient Interventions in the General Population.

The impact of poor nutrition on physiological health is well understood (Costarelli et al., 2013). Less is known about the effects of diet on brain function and cognition in the general population (Ames, 2010; Parletta et al., 2013; White et al., 2017) and we are still in the early stages of understanding the role of specific nutrients to normal and pathological neuronal functioning. In the present study, the putative effect of a multivitamin/mineral or vitamin D supplement on cognitive function over an 8-week period was compared with volunteers taking vitamin C. Healthy adults (N = 60) were recruited, age range 21–59 years ( = 39.07 years, SD = 11.46), with participants randomly allocated to conditions in a double-blind protocol. Participants also completed a 14-day food diary to gather information on micronutrient intake. The cognitive test battery included measures from the Wechsler Adult Intelligence Scale-III (WAIS-III; Wechsler et al., 2008), Wechsler Memory Scale-IV (WMS-IV; Wechsler, 2009) and Delis-Kaplan Executive Function System (D-KEFS; Delis et al., 2001), along with the Doors and People (Baddeley et al., 1994) and a serial reaction time task. Analyses showed better performance on some tasks in all groups following the intervention period, notably on measures of verbal and visual memory and visuomotor processing speed. The Multivitamin group showed significant improvements on tasks of visual strategy generation (along with the Vitamin C group), motor planning, explicit and implicit learning, and working memory. This evidence suggests that sub-optimal micronutrient intake may have a negative effect on cognition across the lifespan.

Metabolic engineering of micronutrients in crop plants.

Micronutrient deficiency is a widespread phenomenon, most prevalent in developing countries. Being causally linked to the occurrence of a range of diseases, it affects billions of people worldwide. Enhancing the content of micronutrients in crop products through biotechnology is a promising technique to fight micronutrient malnutrition worldwide. Micronutrient fortification of food products has been implemented in a number of Western countries, but remains inaccessible for poor rural populations in a major part of the developing world. Moreover, evidence of the negative impacts of this practice on human health, at least for some vitamins, is accumulating. Biofortification of crop plants-the enhancement of vitamins and minerals through plant biotechnology-is a promising alternative or complement in the battle against micronutrient deficiencies. Owing to a growing knowledge about vitamin metabolism, as well as mineral uptake and reallocation in plants, it is today possible to enhance micronutrient levels in crop plants, offering a sustainable solution to populations with a suboptimal micronutrient intake.

Moderate ‘multivitamin’ supplementation improved folate and vitamin B12 status in the elderly

The dependent elderly are widely considered to be at higher risk of nutritional problems. Suboptimal micronutrient intake might put the elderly, especially those living in nursing homes, at high risk of morbidity. So far, no public authority, except for the Israel Ministry of Health, has issued particular recommendations for micronutrient supplementation for the elderly. We hypothesized that moderate ‘multivitamin’ supplementation could improve the vitamin status of the dependent elderly. The study took place in two nursing homes and included 144 dependent elderly (males/females, 35/109). Demographic and clinical data as well as routine blood tests were retrieved from the patient electronic medical records. After a two-year daily ‘multivitamin’ supplementation, containing 120μg of folic acid, there was a small and non-significant increase of 12% in serum folate; the same ‘multivitamin’ preparatory, containing 2.4μg of vitamin B12, significantly increased serum vitamin B12 by 8%. Three models of evaluation clearly showed the effect of a two- year vitamin supplementation: 1. The number of subjects with the lowest baseline concentration range, decreased, with moderate concentration, increased, with no difference at the higher concentrations; 2. Above each vitamin concentration, the number of subjects was higher than at baseline; 3. The two vitamins at the two lower concentration tertiles increased, and at the highest tertile, folate was not affected, whereas vitamin B12 decreased. Therefore, very moderate ‘multivitamin’ supplementation, as practiced in our study, has a high probability of improving vulnerable old population health status without causing any adverse effects to others.

Utility of a brief index to measure diet quality of Australian preschoolers in the Feeding Healthy Food to Kids Randomised Controlled Trial.

The aim was to evaluate the utility of a brief dietary intake assessment tool in measuring nutritional adequacy of preschoolers and differences in food and nutrient intake between quartiles stratified by overall diet quality. Dietary intakes of preschoolers (n = 146) from the Feeding Healthy Food to Kids trial were reported by parents/caregivers using a 120-item food frequency questionnaire (FFQ). Diet quality was assessed using the Australian Recommended Food Score for Preschoolers. Analyses were performed using Kruskal-Wallis one-way analysis of variance, adjusted for Type 1 error. Participants were grouped into quartiles by total food score for comparison of subscale scores, food groups and nutrient intakes from the FFQ. Participants who scored less than the median total food score of 36 were more likely to have suboptimal micronutrient intakes. Median fruit (9 vs 5, P < 0.0001) and vegetable (14 vs 7, P < 0.0001) subscale scores for preschoolers in the highest quartile were significantly higher than the lowest quartile, indicating much greater fruit and vegetable variety. Statistically significant differences in diet quality score by quartiles (P < 0.05) were found for total energy and percentage energy from core foods, protein, fibre and 11 micronutrients. The Australian Recommended Food Score for Preschoolers is a practical brief diet quality assessment tool to measure food variety and nutritional adequacy in Australian preschoolers. Stratifying children by baseline diet quality in future nutrition interventions is recommended in order to identify those who are likely to benefit or require more targeted approaches to address specific nutritional needs in order to optimise food and nutrient intakes.

The Influence of Pre-natal Supplement Initiation on Preterm Birth Among Majority Hispanic Women in Los Angeles County: The Role of Nativity.

Objectives Despite being encouraged to take pre-natal supplements, suboptimal micronutrient intake is common in pregnancy, especially among Hispanic women. In this study, we assessed whether initiation and timing of pre-natal vitamin use influences the risk of preterm birth. Methods Women who gave birth to singletons in 2003 in Los Angeles County, California, were enrolled into a population-based case-control study. Focusing on non-Hispanic white and Hispanic women, associations between timing of pre-natal supplement use and preterm birth were assessed using logistic regression. Results Among Hispanic mothers, the odds of preterm birth increased the later a woman initiated pre-natal supplement use in pregnancy. The magnitude of this association was larger in US-born compared to foreign-born Hispanic women. Conclusions These findings suggest that nativity may modify the relationship between pre-natal supplement use and preterm birth possibly due to underlying differences in diet composition of Hispanic women by place of birth.

Essentiality of Trace Element Micronutrition in Human Pregnancy: A Systematic Review

The physiological challenges and metabolic demands of pregnancy increase maternal nutritional requirements for macro and micronutrients, critical for the establishment and maintenance of a healthy pregnancy. Trace elements are essential for a variety of cellular processes, and their deficiency has been linked to complications of pregnancy such as preeclampsia, preterm delivery and small for gestational age babies. Growing evidence suggests that populations of both developing and developed nations may be at risk of sub-optimal micronutrient intakes and that micronutrient supplementation may provide a cost-effective and safe strategy to improve pregnancy outcomes. This review evaluates the importance of essential trace element micronutrition in pregnancy and discusses the benefits of supplementation on maternal outcomes and fetal development. The potential importance of key essential trace elements; magnesium, copper, zinc, calcium, iodine, manganese, selenium and iron are discussed and their importance in pregnancy considered.

Food and nutrient intake of Irish community-dwelling elderly subjects: who is at nutritional risk?

To assess the dietary intakes of Irish community-dwelling elderly individuals, participating in the ELDERMET project. Cross-sectional study. Cork city and county region of southern Ireland. Two hundred and eight (94 males, 114 females) community-dwelling subjects aged 64-93 yrs. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Anthropometric data were recorded. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). A high rate of overweight/obesity was observed in this population group. Consumption of energy-dense, low-nutrient foods was excessive among this population group. Older elderly subjects (≥75 yrs) consumed significantly (P<0.01) more desserts/sweets than younger elderly (64-74 yrs). Intakes of dietary fat and saturated fat were high while dairy food consumption was inadequate in both males and females. Elderly females typically had a more nutrient-dense diet than males. A considerable proportion of subjects, particularly males, had inadequate intakes of calcium, magnesium, vitamin D, folate, zinc and vitamin C. The data indicate that the diet of Irish community-dwelling elderly individuals is sub-optimal with respect to nutrient intake, and excessive in terms of fat intake, with implications for the health status of this population group. Reductions in dietary fat and increased low fat dairy food intakes are recommended for the prevention of diet-related disease in older persons. In addition, strategies to improve a number of sub-optimal micronutrient intakes need to be developed and implemented, particularly among elderly males.

A Cross-Sectional Study Assessing Dietary Intake and Physical Activity in Canadian Patients with Nonalcoholic Fatty Liver Disease vs Healthy Controls

BackgroundPoor diet and a sedentary lifestyle can contribute to nonalcoholic fatty liver disease (NAFLD). ObjectiveOur aim was to compare diet and physical activity of patients with NAFLD and healthy controls with current recommendations. DesignThis was a cross-sectional study. Participants/settingsSeventy-four patients with biopsy-proven NAFLD (33 simple steatosis and 41 steatohepatitis [NASH]) and 27 healthy controls participated between 2003 and 2011. Main outcome measuresFood records and activity logs were completed for 7 days. Results were compared with Dietary Reference Intakes and Canadian Physical Activity Guidelines. Plasma vitamin C was measured to assess food record accuracy. Statistical analyses performedIntake/activity for each participant was compared with the recommendations and proportion of subjects not meeting the requirements was calculated. Groups were compared by Kruskal-Wallis and Mann-Whitney U test or z-test with Bonferroni adjustment. ResultsMore patients with NASH (58.5%) were obese compared with patients with simple steatosis (24.2%) and healthy controls (7.4%; P<0.01). Patients with NAFLD showed more insulin resistance than healthy controls. The reported energy intake was below estimated requirements in all groups (P≤0.001). The proportion of subjects from each group exceeding acceptable energy intake from fat was as follows: simple steatosis: 27.3%; NASH: 46.3%; healthy controls: 63.0% (simple steatosis vs health controls; P<0.05) and from saturated fat: simple steatosis: 42.4%; NASH: 70.7%; healthy controls: 63.0% (simple steatosis vs. NASH; P<0.05). In each group, >80% of subjects did not consume enough linoleic or linolenic acid, vitamin D, and vitamin E, and >60% exceeded the upper intake level for sodium. Only 53.1% of patients with simple steatosis and 53.8% of patients with NASH, but 84.6% of healthy controls, met recommendations for physical activity (P=0.020). Plasma vitamin C was normal, similar among groups, and correlated with vitamin C intakes. ConclusionsAll participants followed a similar Western diet with high fat and sodium intakes and suboptimal micronutrient intakes. However, physical activity was lower in NAFLD compared with healthy controls and was associated with higher body mass index and insulin resistance.

Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls

In the era of modern multidisciplinary clinical management, very little is known about the prevalence and presentation of malnutrition in children with gastrointestinal disorders (GastroD) particularly employing composite, global measures of nutritional status. Anthropometry, body composition, dietary intake, eating habits and grip strength were assessed with bedside methods in 168 patients from outpatient gastroenterology clinics (n, median (IQR) years; Crohn's disease (CD): n=53, 14.2 (11.6:15.4); ulcerative colitis (UC): n=27, 12.2 (10.7:14.2); coeliac disease: n=31, 9.3 (7.5:13.6); other GastroD: n=57, 9.8 (7.2:13.8)) and compared with 62 contemporary healthy controls (n, median (IQR): 9.8 (6.9:13.8)) and the results of the recent UK, National Diet and Nutritional Survey (NDNS). Children with CD had lower BMI z-scores than controls (median (IQR): -0.3 (-0.9:0.4) vs 0.3 (-0.6:1.4); P=0.02) but only 2% were classified as thin (BMI z-score <-2 s.d.). The prevalence of obesity in children with UC was 19%, 6% in CD, 11% in children with other GastroD and 15% in controls. No difference was found in grip strength measurement between groups. Except for CD children, the proportion of patients with suboptimal micronutrient intake was similar to that of controls and the cohort of children from the latest NDNS. A higher proportion of children with CD had suboptimal intake for riboflavin, vitamin B6 and calcium and consumed significantly more meat products, juices (including carbonated drinks), spreads/jams and crisps and savoury snacks and significantly fewer portions of dairy, fish, fruits and vegetables compared with healthy controls. GastroD affect children's body composition, growth, strength, dietary intake and eating habits, particularly CD, but to a lesser extent than expected.

A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries

Micronutrient status during pregnancy influences maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. Research reporting dietary intake during pregnancy in nationally representative population samples, however, is limited. This review summarizes the micronutrient intakes of pregnant women from developed countries and compares them with relevant national recommendations. A systematic search without date limits was conducted. All studies reporting the micronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified studies for inclusion and assessed methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Pregnant women in developed countries are at risk of suboptimal micronutrient intakes. Folate, iron, and vitamin D intakes were consistently below nutrient recommendations in each geographical region, and calcium intakes in Japan were below the Japanese recommendations and the average intake levels in other developed countries. Research examining the implications of potential nutrient insufficiency on maternal and offspring health outcomes is needed along with improvements in the quality of dietary intake reporting.

Following Up Folate and Its Function in Colorectal Carcinogenesis

given to women with suboptimal micronutrient intake. Because the trial was carried out during the folic acid fortification era and the women volunteering were likely to be health-conscious, with a history of vitamin supplement use, the median intake of folate, B6, and B12 at study entry was relatively high, at 108%, 167%, and 292% of the respective recommended dietary allowances (1). The lack of effect of high-dose folate/B6/B12 supplementation on adenoma risk in a well-nourished population agrees with a recent combined analysis of the three large randomized, placebocontrolled trials of folic acid supplementation, which were carried out in the United States, Canada, the United Kingdom, and Denmark among patients with an adenoma history (2632 men and women) (8). After up to 3.5 years of folic acid use, at 0.5 or 1.0 mg/day, risk of adenoma, or advanced adenoma, was not statistically significantly increased or decreased. Interestingly, folic acid was associated with non-statistically significant reductions in risk among subjects in the two lowest quartiles of circulating folate at study entry. This combined analysis is encouraging, even though more follow-up is needed. The largest of the three trials included had previously reported potentially adverse effects: a statistically nonsignificant increased risk of adenoma, especially advanced adenoma, after 3 and 6–8 years of follow-up (9). Although these randomized trials do suggest that high-dose folic acid is not a promising chemopreventive agent for colorectal cancer, they do not completely resolve the role of folate and other B vitamins in colorectal carcinogenesis. In 2010, in a pooled analysis of 13 prospective studies of folate intake and colon cancer, including 5720 incident cases and up to 7–20 years of follow-up, both dietary folate intake and total folate intake (from diet and supplements) were inversely, although modestly, associated with risk (comparing extreme quintiles, RRs = 0.92, 95% CI = 0.84 to 1.00 and 0.85, 95% CI = 0.77 to 0.95, respectively) (10). The stronger association with total folate intake might be due to an expanded range of intake, enhanced bioavailability of the synthetic folic acid in supplements, or the presence of other B vitamins in the multivitamins that provided most of the supplemental folate. More recently, in analyses of incident colorectal cancer diagnosed in the folic acid fortification era, the American Association of Retired Persons cohort reported a statistically significant 30% reduction in colorectal cancer risk comparing extremes of total folate intake (6484 incident cases) (11); and the Cancer Prevention Study II reported a statistically significant 19% reduction comparing extreme quintiles of total intake (1023 incident cases) (12). Although the strength of these associations with total folate intake

Micronutrients and Older Adults

The aging population worldwide is increasing. Although many older adults are living longer, healthier lives, aging is also associated with a variety of physiologic and psychological changes that influence nutrition status and the need for medical care. Many factors increase the risk for poor nutrient intake among older adults. Suboptimal micronutrient intake for particular vitamins and minerals is reported to be common.

Nutrition and hemostasis: A focus on urbanization in South Africa

South Africa is experiencing a rapid urbanization of its African population characterized by a demographic, nutrition, lifestyle, and health transition. The resultant high prevalence of high cardiovascular disease, in particular of stroke, is of concern. In this narrative review it is suggested that, together with hypertension, changes in the hemostatic system may be one of the major contributors to stroke in this population. It is further suggested that these changes are related to increased fat and animal protein intakes, decreased intakes of total carbohydrate and dietary fiber, as well as persistent suboptimal micronutrient intakes of Africans in transition. The effects of this nutrition transition on plasma fibrinogen, fibrin network structures, plasminogen activator inhibitor 1 activity levels and some other clotting and fibrinolytic factors are discussed. It is concluded that despite indications of present protective mechanisms against the development of coronary heart disease (CHD) in this population the observed changes in diet and hemostatic profiles may eventually lead to a high prevalence of both stroke and CHD in urban black South Africans. It is further suggested that timely nutritional interventions and research of effects thereof on the hemostatic system are urgently needed.