Mineral status of non-anemic Peruvian infants taking an iron and copper syrup with or without zinc from 6 to 18 months of age: A randomized controlled trial

ObjectivesWe evaluated changes in the status of iron, zinc, and copper in non-anemic Peruvian infants who were receiving daily supplements of 10 mg of iron and 0.5 mg of copper with or without 10 mg of zinc from 6 to 18 mo of age.MethodsOverall, 251 infants were randomized to receive one of two daily supplements. Venous blood draws at 6, 12, and 18 mo of age were taken to characterize hemoglobin, plasma ferritin, zinc, and copper concentrations. The urinary excretion of zinc was also measured at each time point. Repeated measures analysis of variance was used to evaluate changes over time and by supplement type.ResultsBoth hemoglobin and copper concentrations increased significantly and plasma ferritin decreased from 6 to 12 mo of age (P < 0.05). Mean plasma zinc concentrations in the zinc treatment group were maintained over time, whereas zinc concentrations in the control group declined; differences by treatment were found at 12 and 18 mo of age (P < 0.05). Urinary zinc concentration was increased in the zinc group at 12 mo only. There was evidence that zinc treatment improved the hemoglobin level at 18 mo of age (P = 0.09). Compliance with supplementation was high, with 81% of the intended dose consumed over the 12-mo period.ConclusionsDaily mineral supplementation over the course of 1 y appears to be feasible and acceptable in this population. A combined supplement can improve the status of iron, zinc, and copper in infants at the same time.     

Safety and tolerance of the human milk probiotic strain Lactobacillus salivarius CECT5713 in 6-month-old children

ObjectiveIntestinal microbiota plays an important role in the prevention of certain diseases during the pediatric years. Thus, there is an increasing interest in the addition of probiotics to infant formulas. The aim of this study was to evaluate the safety of a follow-on formula with Lactobacillus salivarius CECT5713 in 6-mo-old children.MethodsThe antibiotic susceptibility of L. salivarius CECT5713 was analyzed by a dilution method. A double-blinded, randomized, placebo controlled study was performed. Children (n = 80) were distributed in two groups and consumed the formula supplemented or not with probiotics (2 × 10⁶ colony-forming units [cfu]/g) during 6 mo. Fecal samples were collected at enrollment, at 3 mo, and at the end of trial. Clinical and anthropometric evaluations were performed. Depending on the variable, one-way or two-way repeated measures analysis of variance were used for the statistical analysis.ResultsThe antibiotic susceptibility profile of the strain resulted as safe. No adverse effects associated with the consumption of the probiotic formula were reported. In addition, clinical parameters did not differ between groups. Consumption of the probiotic supplemented formula led to an increase in the fecal lactobacilli content (7.6 ± 0.2 versus 7.9 ± 0.1 log cfu/g, P < 0.05). Lactobacillus salivarius CECT5713 was detected in the feces of volunteers from the probiotic group. Probiotic consumption induced a significant increase in the fecal concentration of butyric acid at 6 mo.ConclusionThus, a follow-on formula with L. salivarius CECT5713 is safe and well tolerated in 6-mo-old infants.     

Combined iron and zinc supplementation in infants improved iron and zinc status, but interactions reduced efficacy in a multicountry trial in southeast Asia

Deficiencies of iron and zinc are prevalent worldwide. Interactions between these micronutrients therefore have important consequences, also for supplementation. To investigate effects on hemoglobin and zinc concentrations and interactions of iron and zinc supplementation in infants, data from 4 parallel, randomized, placebo-controlled, double-blind trials in Indonesia, Thailand, and Vietnam were pooled. Infants (n=2468), aged 4-6 mo, were supplemented daily with iron (10 mg) and/or zinc (10 mg) for 6 mo. At 3 sites, infants were given vitamin A capsules (VAC) at recruitment. Combined supplementation reduced prevalences of anemia by 21% (P<0.01) and zinc deficiency by 10% (P<0.05) but was less effective (P<0.05) than supplementation with either iron (28% reduction in anemia) or zinc alone (18% reduction in zinc deficiency). Iron reduced the effect of zinc supplementation (interaction P<0.01), but had no separate effect on zinc status, whereas zinc supplementation had a negative effect on hemoglobin concentrations (-2.5 g/L, P<0.001), independent of iron supplementation (Pinteraction=0.25). The effect of iron supplementation on hemoglobin concentrations was almost twice as large in boys than in girls (effect size 12.0 vs. 6.8 g/L, respectively). In infants not receiving iron, VAC administration tended to be associated with lower (3.2%, P=0.07) hemoglobin concentrations. Combined supplementation of iron and zinc was safe and effective in reducing the high prevalences of anemia and iron and zinc deficiencies. Zinc supplementation may negatively affect iron status but iron supplementation does not seem to affect zinc status. Furthermore, VAC administration in the absence of iron supplementation may increase the incidence of anemia.     

Heme Iron Concentrate and Iron Sulfate Added to Chocolate Biscuits: Effects on Hematological Indices of Mexican Schoolchildren

Objective: Food fortification is one of the most effective strategies for increasing iron intake in the population. A simple blind trial was conducted to compare the effect of 2 forms of iron fortification and assess the changes in hemoglobin and iron status indices among preschool children from rural communities.

Methods: Hemoglobin was evaluated in 47 children aged 3–6 years old. For 72 days (10-week period), children ate Nito biscuits. Thirteen pupils with elevated hemoglobin levels were assigned to the biscuit control group, and pupils with hemoglobin equal to 13.5 mg/dL or less were randomly allocated to consume fortified biscuits with a heme iron concentrate (n = 15) or iron sulfate (n = 19). Changes in hemoglobin, plasma ferritin, and other hematological indices were evaluated with analysis of variance (ANOVA) for repeated measurements.

Results: Except mean corpuscular hemoglobin concentrations (+1.27 ± 2.25 g/dL), hematological indices increased significantly across the study: Mean corpuscular volume (+2.2 ± 1.0 f/dL), red blood cells (+0.30 ± 0.37 M/μL), mean corpuscular hemoglobin (+1.8 ± 1.74 pg), hemoglobin (+1.68 ± 0.91 g/dL), hematocrit (+3.43% ± 3.03%), and plasma ferritin (+18.38 ± 22.1 μg/L) were all p < 0.05. After 10 weeks, the adjusted effect of the iron-fortified chocolate biscuits in the hemoglobin levels was higher than the control group (+1.1 ± 0.2 g/dL) but no difference was found between consumers of fortified biscuits with heme iron concentrate or iron sulfate (+1.9 ± 0.2 g/dL and +2.0 ± 0.2 g/dL, respectively).

Conclusion: Heme iron concentrate and iron sulfate were equally effective in increasing Hb levels and hematological indices. Processed foods were shown to be an effective, valuable, and admissible intervention to prevent anemia in preschool children.     

Lycopene supplementation (passata sauce) reduces apoptosis but does not affect oxidant-responsive heme oxygenase-1 in human lymphocytes

ObjectiveWe tested the hypothesis that lycopene supplementation reduces the expression of oxidant-responsive heme oxygenase-1 (HO-1) in basal conditions and in response to an oxidant challenge and determined whether this is temporally associated with increased cell viability.MethodsWe determined basal and stimulated ex vivo expression of HO-1 and cell viability in lymphocytes from volunteers after lycopene supplementation. Twenty-four healthy young men on a low lycopene diet consumed 1) 170 g of passata sauce with butter or 2) butter alone for 3 wk in a randomized crossover design.ResultsPlasma lycopene concentrations at the end of the tomato and control trials were 0.54 ± 0.20 versus 0.20 ± 0.15 μmol/L, respectively (P < 0.05). There was a significant increase in the proportion of live cells (91 ± 5% versus 87 ± 9%) and a corresponding reduction in apoptosis (6 ± 4% versus 11 ± 9%) in untreated lymphocytes after supplementation (P < 0.05), with no effect on cell viability in response to hydrogen peroxide treatment. HO-1 protein expression in basal conditions and induction of HO-1 after hydrogen peroxide treatment was not different between trials.ConclusionLycopene supplementation did not affect basal oxidative stress or susceptibility to oxidant-induced stress as indicated by the expression of the oxidant-responsive protein HO-1 and cell viability in response to hydrogen peroxide treatment. However, lycopene supplementation significantly reduced apoptosis in freshly harvested untreated lymphocytes. We conclude that this was not through an oxidant-mediated mechanism because of the lack of an effect on oxidant-responsive HO-1.     

Long-term effects of moderate protein diet on renal function and low-grade inflammation in older adults with type 2 diabetes and chronic kidney disease

ObjectivesThe aim of this study was to determine the long-term effects of a moderate protein diet (MPD) on renal function, low-grade inflammation, and oxidative stress in older adults with type 2 diabetes, which to date are unclear.MethodsSeventy-four older adults with type 2 diabetes and chronic kidney disease (stage G3b–G4) were enrolled in the study. During the 4-wk baseline period (T0), all patients were asked to follow a normal protein diet regimen, providing 1.1 g/kg daily. Successively, all patients were asked to follow an MPD, for 36 mo, providing 0.7 g/kg daily, for only 6 d/wk. Patients who refused to follow an MPD treatment were included in the control (NPD [normal protein diet] group). During the 36 mo of the study, creatinine clearance, blood urea nitrogen, proteinuria, blood pressure, glycated hemoglobin (Hb)A_1c, fat-free mass, low-grade inflammation (interleukin-6 and C-reactive protein) were evaluated monthly and oxidative stress (urinary 8-epiprostaglandin [Epi-PG]F2α) was evaluated every 3 mo.ResultsDuring T0, mean creatinine clearance, proteinuria, blood urea nitrogen, blood pressure, HbA_1c, fat free mass, low-grade inflammation, and oxidative stress were similar in both groups. After 36 mo, a significant reduction in decline of renal function was observed in the MPD group but not in controls (2.4 ± 0.2 versus 5.7 ± 0.5 mL·min·y, respectively; P < 0.05 versus control). Similarly, a significant reduction in proteinuria, serum interleukin-6, serum C-reactive protein, and urinary 8-Epi-PGF2α excretion, was observed in the MPD group (P < 0.05 versus NPD).ConclusionIn older adults with type 2 diabetes, long-term effects of an MPD regimen are associated with a significant decline of renal function, proteinuria, low-grade inflammation, and oxidative stress without a change in fat-free mass.     

Protein Supplementation Improves Physical Performance in Frail Elderly People: A Randomized,Double-Blind,Placebo-Controlled Trial

ObjectivesProtein supplementation has been proposed as an effective dietary strategy to increase skeletal muscle mass and improve physical performance in frail elderly people. Our objective was to assess the impact of 24 weeks of dietary protein supplementation on muscle mass, strength, and physical performance in frail elderly people.Design/setting/participantsA total of 65 frail elderly subjects were included and randomly allocated to either daily protein or placebo supplementation (15 g protein at breakfast and lunch).MeasurementsSkeletal muscle mass (DXA), muscle fiber size (muscle biopsy), strength (1-RM), and physical performance (SPPB) were assessed at baseline, and after 12 and 24 weeks of dietary intervention.ResultsSkeletal muscle mass did not change in the protein- (from 45.8 ± 1.7 to 45.8 ± 1.7 kg) or placebo-supplemented group (from 46.7 ± 1.7 to 46.6 ± 1.7 kg) following 24 weeks of intervention (P > .05). In accordance, type I and II muscle fiber size did not change over time (P > .05). Muscle strength increased significantly in both groups (P < .01), with leg extension strength tending to increase to a greater extent in the protein (57 ± 5 to 68 ± 5 kg) compared with the placebo group (57 ± 5 to 63 ± 5 kg) (treatment × time interaction effect: P = .059). Physical performance improved significantly from 8.9 ± 0.6 to 10.0 ± 0.6 points in the protein group and did not change in the placebo group (from 7.8 ± 0.6 to 7.9 ± 0.6 points) (treatment × time interaction effect: P = .02).ConclusionDietary protein supplementation improves physical performance, but does not increase skeletal muscle mass in frail elderly people.     

Effect of Brazil nut supplementation on the blood levels of selenium and glutathione peroxidase in hemodialysis patients

ObjectiveIn patients who have undergone hemodialysis, large amounts of reactive oxygen species (ROS) are produced and, at higher concentrations, ROS are thought to be involved in the pathogenesis of cardiovascular disease. It has been proposed that selenium (Se) may exert an antiatherogenic influence by reducing oxidative stress. The richest known food source of selenium is the Brazil nut (Bertholletia excelsa, family Lecythidaceae), found in the Amazon region. We evaluated the effect of Brazil nut supplementation on blood levels of Se and glutathione peroxidase (GSH-Px) activity in patients on hemodialysis.MethodsA total of 81 patients on hemodialysis (52.0 ± 15.2 y old, average time on dialysis 82.3 ± 91.4 mo, body mass index 24.9 ± 4.4 kg/m²) from the RenalCor and RenalVida Clinics in Rio de Janeiro, Brazil, were studied. All patients received one nut (around 5 g, averaging 58.1 μg Se/g) a day for 3 mo. The Se concentrations in the nuts and in plasma and erythrocytes were determined by atomic absorption spectrophotometry with hydride generation (Hitachi, Z-500). GSH-Px levels were measured using Randox commercial kits.ResultsPlasma Se (18.8 ± 17.4 μg/L) and erythrocyte (72.4 ± 37.9 μg/L) levels were below the normal range before nut supplementation. After supplementation, the plasma level increased to 104.0 ± 65.0 μg/L and erythrocytes to 244.1 ± 119.5 μg/L (P < 0.0001). The activity of GSH-Px also increased after supplementation, from 46.6 ± 14.9 to 55.9 ± 23.6 U/g of hemoglobin (P < 0.0001). Before supplementation, 11% of patients had GSH-Px activity below the normal range (27.5–73.6 U/g of hemoglobin). After supplementation, all patients showed GSH-Px activity within the normal range.ConclusionThe data revealed that the investigated patients presented Se deficiency and that the consumption of only one Brazil nut a day (5 g) during 3 mo was effective to increase the Se concentration and GSH-Px activity in these patients, thus improving their antioxidant status.     

Evidence of zinc deficiency in competitive swimmers

ObjectiveThe aim of this study was to assess the nutritional zinc (Zn) status of elite swimmers during different training periods.MethodsA longitudinal paired study was performed at the University of Sao Paulo in eight male swimmers 18 to 25 y old who had been swimming competitively at the state and national levels for at least 5 y. The swimmers were evaluated over a total period of 14 wk: before the basic and specific preparatory period (BSPP-baseline), at the end of the basic and specific preparatory period (post-BSPP), and at the end of the polishing period (PP). Levels of Zn were determined in the plasma, erythrocyte, urine, and saliva by atomic absorption spectrophotometry. Anthropometric measurements and a 3-d food record were also evaluated.ResultsThe median plasma Zn concentration was below the reference value in all training periods (BSPP-baseline 59 μg/dL, post-BSPP 55.9 μg/dL, after PP 58.8 μg/dL, P > 0.05), as were threshold values for erythrocytes (BSPP-baseline 36.5 μg of Zn/g of hemoglobin, post-BSPP 42 μg of Zn/g of hemoglobin, after PP 40.7 μg of Zn/g of hemoglobin, P > 0.05), urinary Zn (BSPP-baseline 280 μg/24 h, post-BSPP 337 μg/24 h, after PP 284 μg/24 h, P > 0.05), and salivary Zn (BSPP-baseline 66.1 μg/L, post-BSPP 54.1 μg/L, after PP 79.7 μg/L, P > 0.05). Salivary Zn did not correlate with plasma and erythrocyte Zn levels.ConclusionThe results suggest that the elite swimmers studied presented a possible Zn deficiency and that salivary Zn was not adequate to evaluate the Zn nutritional status.     

Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran

ObjectivesShort sleep duration and low diet quality are associated with weight gain. However, little is known about the relationship between sleep duration and the quality of diets. Therefore, we aimed to compare the diet quality indices and anthropometric measures between short and longer sleepers.MethodsThis cross-sectional study consisted of 410 female youths who were chosen among students of Isfahan University of Medical Sciences based on stratified random sampling method. Dietary intake assessment was done using a semiquantitative validated food frequency questionnaire. Sleep duration was estimated using self-reported nocturnal sleep duration by each person. Anthropometric measures were done using standard protocols. Diet quality indices (including dietary energy density, dietary diversity scores, healthy eating index, nutrient adequacy ratio, and mean adequacy ratio) were calculated using the standard definition.ResultsSubjects who slept less than 6 h/d were more likely to be overweight and obese (P = 0.0001) and also abdominally obese (P = 0.03). They also consumed more dietary energy (2406 ± 825 versus 2092 ± 700 kcal/d; P = 0.01, respectively) and carbohydrates (58.1 ± 16.2% versus 51.6 ± 10.3%; P = 0.03) but a lower amount of fiber (12 ± 7 versus 18 ± 7 g/d; P = 0.04), fruits (2.4 ± 0.6 versus 3.1 ± 0.7 servings/d; P = 0.04), whole grains (0.9 ± 0.1 versus 1.3 ± 0.1 servings/d; P = 0.04), and beans (0.3 ± 0.1 versus 0.8 ± 0.1 servings/d; P = 0.04). All diet quality indices were significantly lower among short sleepers (P < 0.05), apart from dietary energy density, which did not differ significantly (P = 0.8).ConclusionOur findings confirm the association of short sleep duration and obesity in young female youths. It might be derived from lower diet quality among short sleepers more than longer sleepers.     

Breakfast eating pattern and its association with dietary quality indices and anthropometric measurements in young women in Isfahan

ObjectiveTo assess the association between consuming or skipping breakfast and dietary quality indices such as the Healthy Eating Index (HEI), the Dietary Diversity Score (DDS), diversity scores of different food groups, and anthropometric measurements in young Isfahanian women.MethodsWomen 18 to 28 y old were selected randomly from among university students (n = 411) in Isfahan, Iran. A validated semiquantitative questionnaire was used to assess dietary intake. Five food groups of the Food Guide Pyramid were considered for calculating the DDS and diversity score of the food groups. Subjects were categorized based on consuming or skipping breakfast. The HEI was calculated based on 10 components including the five food groups, different fat and sodium intakes, and the DDS.ResultsBreakfast consumers versus skippers had higher scores for the HEI (66 ± 13 versus 47 ± 13, P = 0.001), the DDS (6.8 ± 1.2 versus 4.9 ± 0.7, P = 0.001), and the DDSs for fruits (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001), vegetables (1.6 ± 0.2 versus 1.2 ± 0.1, P = 0.001), and whole grains (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001). Also, eating breakfast was associated with lower values for dietary energy density (0.96 ± 0.25 versus 1.04 ± 0.40, P = 0.01), the body mass index (20.0 ± 1.8 versus 23.3 ± 2.7, P = 0.001), and waist circumference (69.2 ± 7.6 versus 72.5 ± 8.7, P = 0.001). There was a higher prevalence of breakfast consumers in the third tertiles of the HEI and DDS. However, there was a smaller percentage of breakfast consumers in the third tertiles of the body mass index and waist circumference.ConclusionsBreakfast consumption was associated with higher scores of the dietary quality indices and lower values for the body mass index and waist circumference in young Isfahanian women. Further studies should be performed to determine the relation between the kind of breakfast consumed and the dietary quality indices.     

Early endothelial nitrosylation and increased abdominal adiposity in Wistar rats after long-term consumption of food fried in canola oil

ObjectiveThe aim of this study was to establish whether the long-term consumption of reused canola oil contributes to the development of dyslipidemia, obesity, and endothelial function.MethodsCanola oil was used for one frying cycle (1 FC) of corn flour dough or reused 10 times (10 FC). Rats received chow diet (control) or supplemented with 7% raw oil (RO), 1 FC or 10 FC oil (n = 10 per group). Food consumption, blood pressure (BP), and body weight plasma glucose, plasma lipids were monitored. Vascular reactivity was analyzed using aorta rings stimulated with phenylephrine and acetylcholine. Nitrotyrosine presence in aorta rings was analyzed by immunohistochemistry.ResultsAfter 10 wk of follow-up, visceral adipose tissue was significantly more abundant in 1 FC (7.4 ± 0.6 g) and 10 FC (8.8 ± 0.7 g) than the RO (5.0 ± 0.2 g; P = 0.05 versus 10 FC group) or control group (2.6 ± 0.3 g; P = 0.05 versus all groups). Despite similar plasma cholesterol, triglycerides, and BP among groups, a significantly reduced acetylcholine-induced vascular relaxation was observed in the three groups receiving the oil-supplemented diet (47.2% ± 3.6%, 27.2% ± 7.7%, and 25.9% ± 7.6% of relaxation, for the RO, 1 FC, and 10 FC, respectively; P < 0.05 for all versus 62.4% ± 9.7% of the control group). Endothelial dysfunction was concomitant with the presence of nitrotyrosine residues at a higher extent in the groups that received heated oils compared with the RO group.ConclusionHigh canola oil intake over 10 wk was associated with increased adipose tissue and early endothelial dysfunction probably induced by peroxinitrite formation. Such deleterious effects were significantly potentiated when the consumed oil had been used repeatedly for frying.     

Iron absorption from brown rice/brown rice-based meal and milled rice/milled rice-based meal

Background Milled rice is the staple food among Filipinos and is mostly consumed three times a day. Rice as a source of iron could therefore have an important role in the existing 37% prevalence of iron-deficiency anemia in the country. Previous iron absorption studies in Filipinos from rice and rice-based meals were carried out on milled rice but no research was done on brown rice of the same variety. This leads to the hypothesis that brown rice may be better than milled rice in terms of iron content.

Objective To determine iron absorption from brown rice and brown rice-based meal, and from milled rice and milled rice-based meal of the same variety.

Methods The rice variety used in the study was F₂ seeds of PSB Rc72H. Iron absorption from brown/milled rice and brown/milled rice-based meals was determined in 12 healthy human subjects from the incorporation of radioisotopes of iron into erythrocytes 14 days after administration of the labeled rice/rice-based meals. The above samples were also analyzed for nutrient content, including dietary fiber, and iron.

Results The iron content of brown rice was significantly higher (1.1 ± 0.1 mg/100 g) than that of milled rice (0.6 ± 0.1 mg/100 g). Brown rice has significantly greater amounts of total dietary fiber (5.4 ± 0.4%) than milled rice (1.7 ± 0.2%; P < 0.05). Both tannic acid and phytic acid contents in brown rice (56.9 ± 3.2 mg/100 g and 290.1 ± 18.0 mg/100 g, respectively) were significantly higher than those of milled rice (21.3 ± 2.3 mg/100 g and 84.0 ± 12.4 mg/100 g, respectively; P<0.05). The amount of iron absorbed from brown rice (0.13 ± 0.02 mg) did not differ significantly from that from milled rice (0.14 ± 0.02 mg). However, the amount from brown rice-based meal (0.36 ± 0.04 mg) differed significantly from that from brown rice (P<0.05) as well as that from milled rice-based meal (0.35 ± 0.03 mg) from that from milled rice (P<0.05). Moreover, brown rice-based meal did not differ significantly from milled rice-based meal (P<0.05).

Conclusion Iron absorbed from milled rice and brown rice did not differ significantly, as well as that from brown rice-based meal and milled rice-based meal. Differences in iron absorbed from brown/milled rice and brown/milled rice-based meals may be due to the iron content of the test foods and the presence of iron enhancers in the meal (e.g. fish, vegetables and citrus fruit).     

Iron Supplementation Is Associated with Improvement of Motor Development,Hemoglobin Level,and Weight in Preterm Infants during the First Year of Life in China

Iron supplementation is recommended for preterm infants due to impaired iron endowment. However, the health outcomes of this recommendation remain controversial. Thus, this study aimed to determine the association of iron supplementation with neurobehavioral development, hemoglobin (Hb), and anthropometric characteristics in preterm infants. A retrospective cohort design was applied to collect data from 1568 preterm infants at 0–3 months of corrected age (mo CA) from a hospital in South China. Infants were categorized into a 3-month iron supplementation group (IG, n = 697) or a control group (CG, n = 871) according to medical records, and then followed through to 12 mo CA. Data on neurobehavioral development, anthropometry, Hb level, history of diseases, and nutrition were collected at 3, 6, and 12 mo CA. The results showed that, compared with the CG, iron supplementation was positively related to improved gross motor skills and weight at 6 mo CA (β = 1.894, β = 5.322) and 12 mo CA (β = 4.019, β = 6.830) and fine motor skills at 12 mo CA (β = 1.980), after adjustment for confounding factors including illness, nutritional supplements, and diet. Iron supplementation was also related to elevated Hb levels and its increase at 3 mo CA (β = 2.196, β = 3.920) and 6 mo CA (β = 3.011, β = 7.259). In conclusion, iron supplementation for 3 months in Chinese preterm infants is positively associated with improved motor development, elevated Hb levels, and higher body weight during the first year of life.     

Iron status of pregnant Indian women from an area of active iron supplementation

ObjectiveThe aim of this study was to investigate the iron status of pregnant tribal women from Ramtek, Nagpur, Maharashtra, India using a combination of indices.MethodsA community-based observational study was conducted to assess iron status using a convenience sample of pregnant Indian tribal women from Ramtek. Pregnant women were recruited at 13 to 22 wk gestation (first visit; n = 211) and followed to 29 to 42 wk gestation (second visit; n = 177) of pregnancy. Sociodemographic and anthropometric data; iron supplement intake; and blood samples for estimating hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), and C-reactive protein (CRP) were obtained.ResultsThe mean (SD) Hb concentration at recruitment was 106 (15) g/L and 106 (14) g/L at the second visit; 41% of the women at recruitment and 55% at second visit were anemic (14% higher, P < 0.001). No women at recruitment and 3.7% at second visit had SF concentration < 15 ng/mL; and 3.3% at recruitment and 3.9% at the second visit had sTfR > 4.4 ng/mL (0.6% higher, P = 0.179). Almost 62% and 71% of pregnant women used iron supplements at both visits, respectively. Iron supplement intake > 7 d in the preceding month improved the Hb concentration by 3.23 g/L and reduced sTfR concentration by 13%; women who were breastfeeding at the time of recruitment had 11% higher SF concentration.ConclusionsThe iron indices suggest that pregnant tribal women of central India, although anemic, had good iron status. Use of iron supplements > 7 d in the preceding month improved iron status; however, non–iron-deficiency anemia persisted in this group.     

Factors Influencing Zinc Status of Apparently Healthy Indians

Objectives: To identify dietary, environmental and socio-economic factors associated with mild zinc deficiency, three zinc status indices; erythrocyte membrane zinc (RBCMZn), plasma zinc and super oxide dismutase (SOD) were assessed in free living and apparently healthy Indian population.

Methods: Dietary patterns of 232 men and 223 women (20–65 yr) from rural, industrial and urban regions of Western India were evaluated by food frequency questionnaire. RBCMZn was estimated using atomic absorption spectrometry, hemoglobin and serum ceruloplasmin by spectrophotometer. On a sub sample (48 men and 51 women) plasma zinc and SOD were also assessed.

Results: Mean RBCMZn was 0.5 ± 0.1 μmols/g protein with 46% individuals showing zinc deficiency. Mean plasma zinc was 0.98 ± 0.12 μg/mL with 25% men and 2.5% women having values below normal range. Mean SOD was 0.97 ± 0.1 (u/mL cells). A significant positive correlation was observed between intakes of green leafy vegetables, other vegetables and milk products with RBCMZn status (p < 0.05). But these were not correlated with plasma zinc (p > 0.2). Cereal and legume intakes were negatively correlated with RBCMZn (p < 0.05) but positively correlated with plasma zinc (p < 0.05) and not correlated with SOD (p > 0.2). Fruit and other vegetable intake were positively correlated with SOD (p < 0.05) alone. Logistic regression analyses revealed that RBCMZn was positively associated with intakes of β-carotene, zinc and environmental conditions and negatively associated with family size (p < 0.05). Plasma zinc indicated positive association with zinc, thiamin and riboflavin intakes (p < 0.05) and SOD showed negative association with iron and family size.

Conclusion: RBCMZn was a more sensitive indicator of long-term zinc status than plasma zinc and SOD. Prominent determinants of zinc status were intakes of beta-carotene and zinc along with environmental conditions and family size.     

Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras

Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented. We examined whether iron supplements affect growth or morbidity of breast-fed infants. Full-term infants in Sweden (n = 101) and Honduras (n = 131) were randomly assigned to three groups at 4 mo of age: 1) placebo from 4 to 9 mo; 2) placebo from 4 to 6 mo and iron supplements [1 mg/(kg. d)] from 6 to 9 mo; or 3) iron supplements from 4 to 9 mo. All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo. Growth was measured monthly and morbidity data were collected every 2 wk. Among the Swedish infants, gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo. The same effect on length was seen in Honduras, but only at 4-6 mo among those with initial hemoglobin (Hb) > or =110 g/L. There was no significant main effect of iron supplementation on morbidity, nor any significant interaction between iron supplementation and site, but for diarrhea (with both sites combined), there was an interaction between iron supplementation and initial Hb. Among infants with Hb < 110 g/L at 4 mo, diarrhea was less common among those given iron than in those given placebo from 4-9 mo, whereas the opposite was true among those with Hb > or = 110 g/L (P < 0.05). We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb.     

Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term

Purpose

An iron intake of >2 mg/kg/d is recommended for preterm infants. We hypothesized that human milk (HM)-fed preterm infants require iron supplementation after discharge, whereas iron-fortified formulae (IFF; 0.8–1.0 mg iron/100 ml) may provide sufficient dietary iron until 6 months post-term.

Methods

At term age, 3 and 6 months post-term, ferritin (μg/l) was measured in 92 IFF-fed infants (gestational age (median (interquartile range)) 30.7 (1.4) weeks, birth weight 1,375 (338) gram) and 46 HM-fed infants (gestational age 30.0 (1.7) weeks, birth weight 1,400 (571) gram). Iron intake (mg/kg/d) between term age and 6 months post-term was calculated.

Results

Iron was supplemented to 71.7 % of HM-fed and 83.7 % of IFF-fed infants between term age and 3 months post-term and to 13 % of HM-fed and 0 % of IFF-fed infants between 3 and 6 months post-term. IFF-fed infants had an iron intake from supplements and formula of 2.66 (1.22) mg/kg/d between term age and 3 months post-term and 1.19 (0.32) mg/kg/d between 3 and 6 months post-term. At 3 and 6 months post-term, the incidence of ferritin <12 μg/l was higher in HM-fed compared to IFF-fed infants (23.8 vs. 7.8 % and 26.3 vs. 9.5 %, P < 0.02).

Conclusion

This observational study demonstrates that ferritin <12 μg/l is more prevalent in HM-fed infants until 6 months post-term. This may be due to early cessation of additional iron supplementation. We speculate that additional iron supplementation is not necessary in preterm infants fed IFF (0.8–1.0 mg iron/100 ml), as they achieve ferritin ≥12 μg/l without additional iron supplements between 3 and 6 months post-term.     

Probiotics,feeding tolerance,and growth: A comparison between HIV-exposed and unexposed very low birth weight infants

ObjectiveThe aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed (but uninfected) versus HIV non-exposed preterm infants. The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants.MethodsA randomized, double-blind, placebo-controlled trial was conducted during the period from July 2011 to August 2012. HIV-exposed and non-exposed premature (<34 wk gestation) infants with a birth weight of ≥500 g and ≤1250 g were randomized to receive either a probiotic mixture or placebo. The multispecies probiotic mixture consisted of 1 × 10⁹ CFU, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day and was administered for 28 d. Anthropometrical parameters, daily intakes, and feeding tolerance were monitored.ResultsSeventy-four HIV-exposed and 110 unexposed infants were enrolled and randomized (mean birth weight 987 g ± 160 g, range, 560–1244 g; mean gestational age 28.7 wk). In all 4227 probiotic doses were administered (mean 22.9/infant). There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z scores for length and head circumference at day 28 than the unexposed group (P < 0.01 and P = 0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups.ConclusionProbiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV exposure.     

Prevalence and predictors of anemia in a population of North Indian children

ObjectiveAnemia is an important health concern worldwide, particularly in poor populations such as in India. The objective of this study was to determine the prevalence and predictors of anemia and iron status.MethodsOne thousand children ages 6 to 30 mo were included in a study undertaken in low- to middle-income neighborhoods in New Delhi, India. Children of Tigri and Dakshinpuri were identified through a community survey. Plasma concentrations of hemoglobin (Hb), soluble transferrin receptor (sTfR), folate, vitamin B₁₂, and total homocysteine (tHcy) were measured. Predictors for plasma Hb concentration were identified in multiple linear regression models and considered significant if P-value <0.05.ResultsThe prevalence of anemia (Hb concentration <11 g/dL) was 69.6% (n = 696) whereas the prevalence of iron deficiency (elevated sTfR i.e., >4.7 nmol/L) was 31% (n = 309). The main predictors for Hb concentration were plasma concentrations of sTfR (standardized beta coefficient [β], −0.49; P < 0.001), folate (β, 0.15; P < 0.001), vitamin B₁₂ (β, 0.10; P < 0.001), tHcy (β, −0.11; P < 0.001) among the biomarkers. Length-for-age Z score (β, 0.08; P = 0.002) and family income (β, 0.06; P = 0.027) also predicted Hb concentration.ConclusionAnemia was common in this population. Iron, folate, and vitamin B₁₂ status were important predictors for plasma Hb concentration. Improving the status of these nutrients might reduce the burden of childhood anemia in India.