Supplementation In Young Children Research Articles

Parallelism between hypovitaminosis D3 and recently detected myopia in children with amplified screen use in the COVID-19 era-A preliminary study.

This introductory study aims to analyze the association of serum vitamin D3 levels with recently detected myopia in Indian children following home confinement post-COVID-19 pandemic. Children aged 5-15 years who had not attended physical school in the past 1 year and visited the ophthalmology department with various ocular symptoms were divided into two groups: the myopic group with recently detected myopia and the non-myopic group with ocular ailments other than myopia. All children underwent basic ophthalmic evaluation and a general physical examination. Blood samples were collected for serum vitamin D3 levels. A pretested questionnaire inquiring about the duration of exposure to a digital screen, outdoor activities, and socioeconomic status was filled out for all children. The mean serum vitamin D3 level in the myopic group was 28.17 ± 15.02 ng/dl in comparison to 45.36 ± 17.56 ng/dl in the non-myopic group (P value < 0.05). Linear regression of the data establishes that myopia is associated with hypovitaminosis D3 (OR- 13.12, 95% CI 2.90-50.32, a P value of 0.001). The correlation between spherical equivalent and vitamin D3 levels was significant (Pearson correlation value: 0.661). In the myopic group, 63.3% of children had screen use >6 hours against 43.3% of children in the non-myopic group. In the myopic group, 33.3% of the children had an outdoor activity duration of <2 hours against 6.6% of children in the non-myopic group. This study proposes hypovitaminosis D3 as a strong factor associated with the development of myopia in children. Although it is a preliminary study, it suggests that the trial for vitamin D3 supplementation in young children to delay or cease the development of myopia is warranted.

Exchangeable Zinc Pool Size Reflects Form of Zinc Supplementation in Young Children and Is Not Associated with Markers of Inflammation.

A sensitive and reliable biomarker of zinc status has yet to be identified, but observational research suggests that the exchangeable zinc pool (EZP) size may be a possible biomarker. This randomized, placebo-controlled trial aimed to compare the change in EZP size from baseline to endline in 174 children who were preventatively supplemented with 10 mg of zinc as part of a multiple micronutrient power (MNP) or as a standalone dispersible tablet for 24 weeks versus a placebo powder. The effects of systemic inflammation on EZP size were also evaluated. Zinc stable isotopes were administered intravenously to children at baseline and endline, and the EZP was measured by the urine extrapolation method. A total of 156 children completed the study with the zinc dispersible tablet group having the greatest increase in EZP (14.1 mg) over 24 weeks when compared with the MNP group (6.8 mg) (p < 0.01) or placebo group (2.0 mg) (p < 0.001). Median EZP size was not different between children with normal or elevated serum inflammatory markers. EZP size was responsive to longitudinal zinc supplementation and reflected the expected difference in bioavailability for two forms of supplementation. The apparent absence of an effect of inflammation on EZP size may offer an advantage for use as a biomarker for group comparisons between different interventions.

Vitamins A, D, E status as related to supplementation and lung disease markers in young children with cystic fibrosis.

The variable response to fat-soluble vitamin supplementation in young children with cystic fibrosis (CF), and factors contributing to this variability, remain under-investigated. To determine if recommended supplement doses normalize serum vitamins A (retinol), D (25-hydroxy-vitamin D, 25OHD), and E (α-tocopherol), and identify factors predictive of achieving sufficiency, in children with CF in the first 3 years of life. We studied 144 infants born during 2012-2017 and diagnosed with CF through newborn screening. Serum retinol, 25OHD, α-tocopherol and plasma cytokines interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were measured in early infancy and yearly thereafter. Vitamin supplement intakes and respiratory microbiology were assessed every 1-2 months in infancy and quarterly thereafter. The prevalence of vitamin D insufficiency (<30 ng/ml) at all ages combined was significantly higher (22%) compared to vitamin A (<200 ng/ml, 3%) and vitamin E (<5 µg/ml, 5%). All children were vitamin A sufficient by age 2 years. Vitamin E insufficiency was rare. Only 42% were early responders of vitamin D and 17% remain insufficient despite high supplement intakes. IL-6 was positively correlated, while IL-8, IL-10, and TNF-α were negatively correlated, with retinol and 25OHD. Multiple regression analysis revealed that supplement dose, season, α-tocopherol, pancreatic insufficiency, respiratory infections and IL-10 were significant predictors of 25OHD. Diagnosis through newborn screening coupled with supplementation normalized serum retinol and α-tocopherol in almost all infants with CF by age 3 years. However, response to vitamin D supplements in young children with CF occurred later and variably despite early and sustained supplementation.

Effects of vitamin B12 supplementation on neurodevelopment and growth in Nepalese Infants: A randomized controlled trial.

Vitamin B12 deficiency is common and affects cell division and differentiation, erythropoiesis, and the central nervous system. Several observational studies have demonstrated associations between biomarkers of vitamin B12 status with growth, neurodevelopment, and anemia. The objective of this study was to measure the effects of daily supplementation of vitamin B12 for 1 year on neurodevelopment, growth, and hemoglobin concentration in infants at risk of deficiency. This is a community-based, individually randomized, double-blind placebo-controlled trial conducted in low- to middle-income neighborhoods in Bhaktapur, Nepal. We enrolled 600 marginally stunted, 6- to 11-month-old infants between April 2015 and February 2017. Children were randomized in a 1:1 ratio to 2 μg of vitamin B12, corresponding to approximately 2 to 3 recommended daily allowances (RDAs) or a placebo daily for 12 months. Both groups were also given 15 other vitamins and minerals at around 1 RDA. The primary outcomes were neurodevelopment measured by the Bayley Scales of Infant and Toddler Development 3rd ed. (Bayley-III), attained growth, and hemoglobin concentration. Secondary outcomes included the metabolic response measured by plasma total homocysteine (tHcy) and methylmalonic acid (MMA). A total of 16 children (2.7%) in the vitamin B12 group and 10 children (1.7%) in the placebo group were lost to follow-up. Of note, 94% of the scheduled daily doses of vitamin B12 or placebo were reported to have been consumed (in part or completely). In this study, we observed that there were no effects of the intervention on the Bayley-III scores, growth, or hemoglobin concentration. Children in both groups grew on an average 12.5 cm (SD: 1.8), and the mean difference was 0.20 cm (95% confidence interval (CI): -0.23 to 0.63, P = 0.354). Furthermore, at the end of the study, the mean difference in hemoglobin concentration was 0.02 g/dL (95% CI: -1.33 to 1.37, P = 0.978), and the difference in the cognitive scaled scores was 0.16 (95% CI: -0.54 to 0.87, P = 0.648). The tHcy and MMA concentrations were 23% (95% CI: 17 to 30, P < 0.001) and 30% (95% CI: 15 to 46, P < 0.001) higher in the placebo group than in the vitamin B12 group, respectively. We observed 43 adverse events in 36 children, and these events were not associated with the intervention. In addition, 20 in the vitamin B12 group and 16 in the placebo group were hospitalized during the supplementation period. Important limitations of the study are that the strict inclusion criteria could limit the external validity and that the period of vitamin B12 supplementation might not have covered a critical window for infant growth or brain development. In this study, we observed that vitamin B12 supplementation in young children at risk of vitamin B12 deficiency resulted in an improved metabolic response but did not affect neurodevelopment, growth, or hemoglobin concentration. Our results do not support widespread vitamin B12 supplementation in marginalized infants from low-income countries. ClinicalTrials.gov NCT02272842 Universal Trial Number: U1111-1161-5187 (September 8, 2014) Trial Protocol: Original trial protocol: PMID: 28431557 (reference [18]; study protocols and plan of analysis included as Supporting information).

Association of nutritional status and anemia with multi-micronutrient supplementation in young children in Peru

Introduction:Although several social interventions have been developed by the Peruvian State, anemia is present in one out of every two children in Peru. Thus, it is important to evaluate whether such interventions are achieving their objectives.Objective:This study aimed to determine the association of nutritional status and anemia with multi-micronutrient supplementation in children younger than three years in Huancayo, Peru.Materials and Methods:This retrospective, longitudinal, analytical, and observational study included secondary data of children younger than 3 years from the Sicaya District, in the Huancayo province. Data were collected from health center medical records. Nutritional and anemia status, and socio-demographic characteristics of children receiving multi-micronutrient supplementation were recorded. Statistical analyses were based on generalized linear models.Results:Data of 76 children with available medical records were analyzed, and their pre- and post-intervention median ages were 6 and 11 months (range: 7–35 months), respectively. Significant positive linear correlations were observed between the number of multi-micronutrient doses and weight, height, and hemoglobin concentration. In bivariate and multivariate analyses, no significant associations were observed between anthropometric measurements and anemia (after multi-micronutrient intervention) (p>0.05), nor between the number of received doses of multi-micronutrients, sex, and age.Conclusion:Multi-micronutrient supplementation may be correlated with both physiological and anthropometric variables, but not with indicators of child development. These associations require further evaluations to determine whether social programs promoting multi-micronutrient supplementation improve the development of children with anemia.

EPS4.02 Whole-genome sequencing reveals that genetic variations predict effectiveness of vitamin D supplementation in young children with cystic fibrosis

ePS4.02 Whole-genome sequencing reveals that genetic variations predict effectiveness of vitamin D supplementation in young children with cystic fibrosis

Practical tips for paediatricians: Assessment and management of young children with iron deficiency.

Funding sources: The Pediatric Outcomes Research Team (PORT) is supported by a grant from the Hospital for Sick Children Foundation. Disclosures: PCP received a grant from Canadian Institutes of Health Research (CIHR) for an ongoing trial of iron supplementation in young children with iron deficiency (FRN # 115059). Mead Johnson Nutrition (MJN) supplies Fer-In-Sol® drops in-kind for this investigator-initiated trial. CIHR and MJN had no role in the preparation of this manuscript.

Comparison of Preventive and Therapeutic Zinc Supplementation in Young Children in Burkina Faso: A Cluster-Randomized, Community-Based Trial

The WHO and UNICEF recommend therapeutic zinc supplementation (TZS) for the treatment of diarrhea. In zinc-deficient populations, preventive zinc supplementation might provide greater benefits for reducing diarrhea and malaria incidence and increasing growth and plasma zinc (pZn) concentration. If effective, intermittent preventive zinc supplementation (IPZS) would cost less than daily preventive zinc supplementation (DPZS). We assessed the effects of IPZS, DPZS, and TZS in children on the primary outcomes of diarrhea incidence, malaria incidence, growth, and pZn concentration compared with nonsupplemented control groups. Rural Burkinabe children (n = 7641; 6-30 mo old) in 36 clusters were randomly assigned to 1 of 5 treatment groups for 16, 32, or 48 wk: 1) IPZS (10 mg Zn/d for 10 d every 16 wk); 2) DPZS (7 mg Zn/d); 3) TZS (20 mg Zn/d for 10 d for diarrhea); 4) morbidity surveillance control (MSC); or 5) nonintervention control (NIC). Supplemented groups remained masked until completion of primary analyses with mixed models. At baseline, stunting (28.6%) and low pZn concentration (<65 μg/dL; 43.5%) were common. After 48 wk, mean ± SE pZn increased more (P = 0.008) in the DPZS group (3.9 ± 1.3 μg/dL) than in the TZS (-0.5 ± 1.2 μg/dL) and NIC (-1.2 ± 0.9 μg/dL) groups. All supplemented groups had a moderately lower incidence of reported diarrhea (0.48-0.49 compared with 0.57 episodes/100 d, P = 0.001) and reported fever (1.1-1.2 compared with 1.5 episodes/100d, P < 0.001) and gained slightly less length (3.15-3.20 compared with 3.36 cm/16 wk, P < 0.001) than the MSC group, but did not differ from each other. Prevalence of diarrhea and incidences of confirmed fever and malaria were not different across study groups. The preventive and TZS groups had reduced diarrhea incidence, but it is uncertain whether this resulted from a functional response to zinc or reporting bias. The comparison should be re-examined in populations known to respond to zinc supplementation. This trial was registered at www.clinicaltrials.gov as NCT00944359.

Efficacy and safety of hepcidin-based screen-and-treat approaches using two different doses versus a standard universal approach of iron supplementation in young children in rural Gambia: a double-blind randomised controlled trial

Efficacy and safety of hepcidin-based screen-and-treat approaches using two different doses versus a standard universal approach of iron supplementation in young children in rural Gambia: a double-blind randomised controlled trial

Current Information Gaps in Micronutrient Research, Programs and Policy: How Can We Fill Them?

Micronutrient (MN) interventions have a very positive effect on public health and have been a major focus of nutrition research and policy for over 3 decades. Most MN policies are established by the World Health Organization based on available evidence from well-designed trials. These include recommendations on iron + folic acid supplements for pregnancy, high-dose vitamin A supplementation for children <5 years, multiple MN supplementation in young children, food fortification, and universal salt iodization. However, important gaps remain in the evidence base, some periods of the life span have been paid insufficient attention, and some MN policies are incomplete or inconsistent. Examples include the pending decision about whether to recommend multiple MN supplementation in pregnancy or preconception, a lack of information about whether supplementation of lactating women improves breast milk quality and infant development, uncertainty about when and where fortification of complementary foods or supplements is beneficial to preschoolers, and whether folic acid fortification can be harmful in population groups with a high prevalence of vitamin B12 deficiency. The most effective dose of MNs has rarely been tested systematically. MN interventions alone are not very effective for improving the growth and development of young children. Newer methods for the analysis of MNs in breast milk are revealing low concentrations in many populations, so more information is needed on the effects of different interventions on milk nutrient content. We need to improve biomarkers of MN status and should measure multiple biological responses to MN interventions using modern nutritional science methods, including metabolomics, proteomics and epigenetics; these will reveal effects of MNs that are not yet fully appreciated.

Zinc Deficiency in Childhood and Pregnancy: Evidence for Intervention Effects and Program Responses.

Zinc is a key micronutrient of particular importance during childhood and pregnancy. Zinc deficiency has been linked to increased infection and stunting among children and is a risk factor for adverse pregnancy outcomes and preterm delivery. Targeted interventions have the potential to alleviate the adverse effects of zinc deficiency via therapeutic and preventive supplementation, fortification and biofortification, but implementation is challenging. A growing number of low- and middle- income countries have introduced national policies for zinc treatment of diarrhea among children under 5 years in response to mounting evidence of reduced episode duration and severity as well as reduced incidence in the ensuing months, but coverage remains low in the absence of effective scale-up efforts. Implementation of preventive zinc supplementation in young children has also been slow, despite evidence linking routine daily supplementation and treatment regimens with reductions in stunting and the incidence of diarrhea and pneumonia. Acceptance of other zinc interventions, including traditional fortification, fortification with micronutrient powders and biofortification, is hindered by unclear evidence on efficacy. Additional research is therefore warranted to ascertain the efficacy of delivering zinc through fortified and biofortified foods and in combination with other micronutrients in supplements or powders. Operations research is also necessary to establish best practices for scale-up of therapeutic zinc supplementation for diarrhea.

Screening and routine supplementation for iron deficiency anemia: a systematic review.

Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force. We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed. No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results. Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.

The use of implementation intentions to promote vitamin D supplementation in young children.

Only 50% of Dutch children aged 0–4 years receive sufficient daily vitamin D supplementation. This study aims to investigate the effectiveness of implementation intentions in promoting vitamin D supplementation among young children. An electronic survey was conducted among parents of children aged 0–4 (n = 171). These parents were randomly assigned to two groups: one that received implementation intention instructions and one that did not. At follow-up, there were no significant between group differences in any outcome measures. These results suggest that merely asking parents to formulate an implementation intention with respect to giving their child daily vitamin D supplementation is insufficient to improve vitamin D intake among young children. However, testing the intervention via the Internet may not have allowed us to exploit the full potential of the strategy. Investigation of the use of implementation intentions in the setting of toddler consultation clinics is therefore recommended.

The efficacy of zinc supplementation in young children with acute lower respiratory infections: A randomized double-blind controlled trial

Acute lower respiratory infections are the most frequent illnesses globally in children less than 5 years old. The aim of this randomized double blind controlled trial is to assess the effectiveness of zinc gluconate supplementation for 2 months period compared to placebo in reducing respiratory morbidity in acute lower respiratory infected children up to 5 years of age living in zinc poor population. Children were randomly assigned to receive either 10mg zinc gluconate or placebo for 60 days. Demographic and clinical data were collected at baseline and every two weeks for 180 days. The final analysis included 96 children allocated equally to the two groups. The number of episodes of acute lower respiratory infections and severe acute lower respiratory infections were significantly lower in zinc group compared to placebo group (20.8% vs. 45.8% (P=0.009) and 21.7% vs. 58.3% (P<0.001), respectively). The acute lower respiratory infections free days were higher in the zinc supplemented group (P<0.001). The median recovery time of morbidity was significantly shorter in zinc group (P<0.001). Zinc supplement may result in significant reduction in respiratory morbidity among children with acute lower respiratory infections in zinc poor population. This study was registered under ClinicalTrials.gov Identifier no. NCT00536133.

Vitamin D supplementation in young children: associations with Theory of Planned Behaviour variables, descriptive norms, moral norms and habits

In the Netherlands, a supplementation of 10 microg vitamin D is recommended for children (aged 0-4 years), given that vitamin D contributes to the development of healthy bones and deficiency during childhood is a risk factor for osteoporosis at a later age. However, only 60 % of the Dutch children receive sufficient vitamin D supplementation a day. In order to develop interventions to improve supplementation intake, it is necessary to gain insight into the behaviour of parents in giving their children vitamin D supplementation and its association with variables of the Theory of Planned Behaviour, moral and descriptive norms and habits. A cross-sectional survey to assess present supplementation-related behaviour, knowledge, received information, intention, attitude, subjective norm, perceived behavioural control, moral norm, descriptive norm and habit. Data obtained from a representative Internet Panel by means of electronic questionnaires. Parents (n 270) of children aged 0-4 years. Half of the parents (48.9 %) gave their child sufficient vitamin D supplementation. Giving the supplement at a fixed time, a positive intention and habit were significantly associated with actual behaviour. The higher age of the child, first-born status, a fixed time for taking vitamin supplementation, descriptive norm and moral obligation were significantly associated with intention. These results indicate that because many parents do not give their children adequate vitamin D supplementation, the promotion of supplementation during the first years of life is a necessity. Effective yet simple strategies should be developed, focused on improving moral obligation, descriptive norms and habit formation.

Zinc supplementation for the prevention of acute lower respiratory infection in children in developing countries: meta-analysis and meta-regression of randomized trials

Routine zinc supplementation is a potential intervention for the prevention of acute lower respiratory infection (ALRI) in developing countries. However, discrepant findings from recent randomized trials remain unexplained. Randomized trials of zinc supplementation in young children in developing countries were identified by a systematic literature review. Trials included in the meta-analysis met specific criteria, including participants <5 years of age, daily/weekly zinc and control supplementation for greater than 3 months, active household surveillance for respiratory morbidity and use of a case definition that included at least one sign of lower respiratory tract illness. ALRI case definitions were classified on the basis of specificity/severity. Incidence rate ratios (IRRs) were pooled by random-effects models. Meta-regression and sub-group analysis were performed to assess potential sources of between-study heterogeneity. Ten trials were eligible for inclusion (n = 49 450 children randomized). Zinc reduced the incidence of ALRI defined by specific clinical criteria [IRR 0.65, 95% confidence interval (CI) 0.52-0.82], but had no effect on lower-specificity ALRI case definitions based on caregiver report (IRR 1.01, 95% CI 0.91-1.12) or World Health Organization 'non-severe pneumonia' (0.96, 95% CI 0.86-1.08). By meta-regression, the effect of zinc was associated with ALRI case definition, but not with mean baseline age, geographic location, nutritional status or zinc dose. Routine zinc supplementation reduced the incidence of childhood ALRI defined by relatively specific clinical criteria, but the effect was null if lower specificity case definitions were applied. The choice of ALRI case definition may substantially influence inferences from community trials regarding the efficacy of preventive interventions.

Polyunsaturated Fatty Acid Supplementation in Young Children with Autism

Recent reports suggest that 52–95% of children with an autism spectrum disorder in the United States are using some form of alternative treatment (Hanson et al. 2007; Harrington et al. 2006; Wong and Smith 2006). One alternative treatment that has been shown to have some potential promise is polyunsaturated fatty acid supplementation (PUFA). PUFAs are naturally occurring lipids that must be taken in through the diet and are critical to the rapidly developing brains of young children (Fernstrom 2000; Horrocks and Farooqui 2004). This pilot study involved a 3-month, prospective, open label, but randomized, parallel groups design of PUFA supplement compared to a healthy, low sugar diet (attention control) for young children with an autism spectrum disorder (ASD). The PUFA for this study was Docoahexanoic Acid (DHA). The PUFA group had ten participants while the control group had 13 participants. Participants in the PUFA took two capsules per day for a daily dose of 400 mg of DHA for 3 months. No clinical gains were realized on any of the behavioral or developmental outcome measures. The statistically significant differences can be accounted for by differences in the two groups at baseline. While no clinical improvements were observed, the omega-3 supplements were well-tolerated. While our results do not support DHA supplementation at 400 mg / day, further inquiry is warranted given the equivocal results among individuals with autism and other developmental disorders. Our study was limited by a small sample size and limited outcome measures.

Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind trial

BackgroundVitamin A and zinc are crucial for normal immune function, and may play a synergistic role for reducing the risk of infection including malaria caused by Plasmodium falciparum.MethodsA randomized, double-blind, placebo-controlled trial of a single dose of 200 000 IU of vitamin A with daily zinc supplementation was done in children of Sourkoudougou village, Burkina Faso. Children aged from 6 to 72 months were randomized to receive a single dose of 200 000 IU of vitamin A plus 10 mg elemental zinc, six days a week (n = 74) or placebo (n = 74) for a period of six months. Cross-sectional surveys were conducted at the beginning and the end of the study, and children were evaluated daily for fever. Microscopic examination of blood smear was done in the case of fever (temperature ≥37.5°C) for malaria parasite detection.ResultsAt the end of the study we observed a significant decrease in the prevalence malaria in the supplemented group (34%) compared to the placebo group (3.5%) (p < 0.001). Malaria episodes were lower in the supplemented group (p = 0.029), with a 30.2% reduction of malaria cases (p = 0.025). Time to first malaria episode was longer in the supplemented group (p = 0.015). The supplemented group also had 22% fewer fever episodes than the placebo group (p = 0.030).ConclusionThese results suggest that combined vitamin A plus zinc supplementation reduces the risk of fever and clinical malaria episodes among children, and thus may play a key role in malaria control strategies for children in Africa.

Anthropometric, environmental, and dietary predictors of elevated blood cadmium levels in Ukrainian children: Ukraine ELSPAC group

No comprehensive data on sources or risk factors of cadmium exposure in Ukrainian children are available. In this we measured the blood levels of cadmium among 80 Ukrainian children and evaluated sources of exposure. A nested case–control study from a prospective cohort of Ukrainian 3-year-old children was conducted. We evaluated predictors of elevated blood cadmium using a multivariable logistic regression model. The model included socioeconomic data, parent occupation, environmental tobacco smoke, hygiene, body-mass index, and diet. Dietary habits were evaluated using the 1992 Block-NCI-HHHQ Dietary Food Frequency survey. Elevated cadmium was defined as blood levels in the upper quartile (⩾0.25 μg/L). The mean age for all 80 children was 36.6 months. Geometric mean cadmium level was 0.21 μg/L (range=0.11–0.42 μg/L; SD=0.05). Blood cadmium levels were higher among children taking zinc supplements (0.25 vs 0.21 μg/L; P = 0.032 ), children who ate sausage more than once per week (0.23 vs 0.20; P = 0.007 ) and children whose fathers worked in a by-product coking industry (0.25 vs 0.21; P = 0.056 ). In the multivariable model, predictors of elevated blood cadmium levels included zinc supplementation (adjusted OR=14.16; P < 0.01 ), father working in a by-product coking industry (adjusted OR=8.50; P = 0.03 ), and low body mass index (<14.5; adjusted OR=5.67; P = 0.03 ). This is the first study to indicate a strong association between elevated blood cadmium levels and zinc supplementation in young children. Whole-blood cadmium levels observed in this group of Ukrainian children appear to be similar to those reported in other Eastern European countries.

HIV and Leprosy in the Eastern United States

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