Iron, folic acid and zinc intakes and status of low socio-economic pregnant and lactating Amazonian women

Dietary intakes were obtained by 24-h recall from 25 women in the first and third trimesters of pregnancy and 25 women in the first 3 months of lactation from eight towns in the Amazon valley. No consistent differences were found between the towns, so the results have been analysed together. Intakes of iron, free and total folate and zinc were nearly all very low compared with current recommendations. Despite their low intakes, the majority of the women had acceptable values of haemoglobin, haematocrit and MCHC. Serum folate concentrations were almost all extremely low (less than 2.5 ng/ml). The levels of RBC folate were also low, but in general not as severely so as those for serum folate. Serum zinc concentrations ranged from 0.2 to 0.7 microgram/ml, whereas the lower limit of acceptability has been put by various authors as 0.59-0.69 microgram/ml according to the stage of pregnancy. In breast milk, total folate in the majority of women ranged from 25 to 50 ng/ml, the greater part of it being in the free form. Zinc levels in breast milk were within the range 0-2 microgram/ml.     

A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight-for-age Z-scores in South African children

Micronutrient powders (MNP) are often added to complementary foods high in inhibitors of iron and zinc absorption. Most MNP therefore include high amounts of iron and zinc, but it is no longer recommended in malarial areas to use untargeted MNP that contain the Reference Nutrient Intake for iron in a single serving. The aim was to test the efficacy of a low-iron and -zinc (each 2.5 mg) MNP containing iron as NaFeEDTA, ascorbic acid (AA), and an exogenous phytase active at gut pH. In a double-blind controlled trial, South African school children with low iron status (n = 200) were randomized to receive either the MNP or the unfortified carrier added just before consumption to a high-phytate maize porridge 5 d/wk for 23 wk; primary outcomes were iron and zinc status and a secondary outcome was somatic growth. Compared with the control, the MNP increased serum ferritin (P < 0.05), body iron stores (P < 0.01) and weight-for-age Z-scores (P < 0.05) and decreased transferrin receptor (P < 0.05). The prevalence of iron deficiency fell by 30.6% (P < 0.01) and the prevalence of zinc deficiency decreased by 11.8% (P < 0.05). Absorption of iron from the MNP was estimated to be 7-8%. Inclusion of an exogenous phytase combined with NaFeEDTA and AA may allow a substantial reduction in the iron dose from existing MNP while still delivering adequate iron and zinc. In addition, the MNP is likely to enhance absorption of the high native iron content of complementary foods based on cereals and/or legumes.     

Changes in iron status during pregnancy in peruvian women receiving prenatal iron and folic acid supplements with or without zinc

BACKGROUND: Iron deficiency anemia is the most prevalent nutrient deficiency during pregnancy, yet there are few data on the effect of prenatal iron supplementation in women in developing countries. OBJECTIVE: Our objective was to describe the effect of iron supplementation on hematologic changes during pregnancy, and the effect on those changes of adding zinc to the supplements. DESIGN: Pregnant women were enrolled in a randomized, double-masked study conducted at a hospital in a shantytown in Lima, Peru. Women were supplemented daily from 10-24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 microg folic acid with or without 15 mg Zn. Hemoglobin and ferritin concentrations were measured in 645 and 613 women, respectively, at enrollment, at 28-30 and 37-38 wk gestation, and in the cord blood of 545 neonates. RESULTS: No differences in iron status were detected by supplement type, but hematologic changes were related to initial hemoglobin status. Women with anemia (hemoglobin <110 g/L) showed steady increases in hemoglobin concentration throughout pregnancy whereas women with relatively higher initial hemoglobin concentrations had declining values during mid pregnancy, then rising values by 37-38 wk gestation. Women with an initial hemoglobin concentration >95 g/L showed increases in serum ferritin by the end of the pregnancy. Despite supplementation, women with poorer hematologic status; who were younger, single, and multiparous; and who consumed fewer supplements were more likely to have anemia at the end of pregnancy. CONCLUSIONS: These hematologic changes are congruent with the effects of iron supplementation reported in placebo-controlled trials and the addition of zinc did not significantly affect them.     

2014—2015年新疆喀什维吾尔族孕妇膳食、叶酸和铁营养状况

目的了解喀什维吾尔族孕妇膳食营养摄入状况,探讨其体内叶酸水平及其影响因素。方法于2014—2015年,以喀什地区358例维吾尔族孕妇为研究对象,采取3天24小时膳食回顾法进行膳食营养调查并采集血液标本;采用氰化高铁血红蛋白法测定血红蛋白(Hb),使用生物素双抗体夹心酶联免疫吸附法(ELISA)检测体内叶酸。将资料用V2.7.13营养计算器软件处理,与2013版《中国居民膳食营养素参考摄入量(DRIs)》进行比较。结果粮谷类、畜禽类和油脂摄入量基本达标,蔬菜水果类、蛋类、奶及奶制品和大豆及坚果类摄入偏低,鱼虾类摄入为(0.18±3.95)g,盐摄入偏高(9.03±3.97)。孕早期能量(101.19%)、蛋白质(107.87%)、钙(32.48%)、铁(195.30%)、锌(106.63%)、硒(55.77%)、碘(15.54%),维生素B1(87.50%)、维生素B2(60.00%)、维生素C(65.69%)、叶酸(13.21%);孕晚期能量(84.29%)、蛋白质(72.44%)、钙(27.77%)、铁(180.38%)、锌(121.16%)、硒(53.11%)、碘(11.26%),维生素B1(75.33%)、维生素B2(49.33%)、维生素C(57.37%)、叶酸(13.15%)。孕妇贫血总检出率为18.89%,血红蛋白平均值为(119.42±13.90)g/L。孕妇在早期与晚期的Hb水平和贫血检出率差异均有统计学意义(P<0.05);叶酸总缺乏检出率为75.42%,平均叶酸水平为(9.15±4.22)nmol/L,孕妇在早期和晚期的叶酸水平和叶酸缺乏检出率比较差异均有统计学意义(P<0.05)。结论喀什维吾尔族孕妇的膳食构成欠合理,蔬菜水果摄入不足,鱼虾类摄入严重缺乏,盐类摄入偏高。三大营养素供能比在适宜比例范围内;孕晚期的能量和蛋白质摄入低于DRIs,孕妇铁、锌摄入偏高,硒、维生素B2和C摄入不足,钙、碘和叶酸严重缺乏;孕妇贫血晚期较早期严重,孕期叶酸水平低、孕晚期低于早期。     

sTfR与孕妇、新生儿、婴儿亚临床缺铁及缺铁性贫血前瞻性纵向研究

【目的】 通过前瞻性纵向监测贫血孕妇及其新生儿、婴儿的Hb,sTfR,分析孕妇贫血对婴儿6月龄时铁代谢的影响。 【方法】 随机抽取Hb<100 g/L的56例临产孕妇作为研究组,选取56例Hb>110 g/L的同孕周临产孕妇作为对照组,两组孕妇所生各56例新生儿、婴儿为子代研究组、子代对照组,婴儿于出生时、42 d、4个月、6个月进行定期体检,孕妇、新生儿、6月龄婴儿抽血检测Hb、sTfR。 【结果】 与对照组比较,贫血孕妇及其所生婴儿6月龄时的Hb、sTfR值差异有统计学意义(P<0.01),新生儿Hb、sTfR值差异无统计学意义(P>0.05)。贫血孕妇所生婴儿6月龄时IDA检出率为60.8%%,正常孕妇所生婴儿为21.6%,差异有统计学意义(P<0.01)。 【结论】 孕妇贫血是导致6月龄婴儿SID及IDA的主要危险因素。     

The diets of pregnant and post-pregnant women in different social groups in London and Edinburgh: calcium, iron, retinol, ascorbic acid and folic acid

Dietary records were obtained twice in pregnancy and once post-partum, from 265 women in all social classes in London and Edinburgh. Some Edinburgh women, and lactating women, showed the higher levels of calcium intake. For iron, retinol, ascorbic acid and folic acid, there was a consistent and significant regional and social class gradient in intakes. This favoured English women in 'non-manual' social groups, leaving the Scottish 'manual' class, after pregnancy, with the lowest intakes. Mean intakes of Ca and Fe were consistently below the current UK recommended daily amount (RDA). Intakes of retinol were all above it, and ascorbic acid intakes ranged above and below the RDA.     

Prenatal iron supplements impair zinc absorption in pregnant Peruvian women

Prenatal iron supplements may adversely influence zinc absorption during pregnancy. To examine the impact of prenatal iron supplements on supplemental zinc absorption, fractional zinc absorption was measured in 47 pregnant Peruvian women during the third trimester of pregnancy (33 +/- 1 wk gestation). Of these 47 women, 30 received daily prenatal supplements from wk 10-24 of pregnancy until delivery. Supplements contained 60 mg of Fe and 250 microg of folate without [iron group (Fe), n = 16] or with [iron and zinc supplemented group (Fe + Zn), n = 14] 15 mg of Zn. The remaining 17 women [unsupplemented control group (C)] received no prenatal supplementation. Zinc concentrations were measured in plasma, urine and cord blood and percentage zinc absorption was determined following dosing with oral ((67)Zn) and intravenous ((70)Zn) stable zinc isotopes. Percentage zinc absorption was significantly lower than controls in fasting women receiving iron- containing prenatal supplements (20.5 +/- 6.4 vs. 20.2 +/- 4.6 vs. 47.0 +/- 12.6%, Fe, Fe + Zn and C groups, respectively, P: < 0.0001, n = 40). Plasma zinc concentrations were also significantly lower in the Fe group compared to the C group (8.2 +/- 2.2 vs. 9.2 +/- 2.2 vs. 10.9 +/- 1. 8 micromol/L, Fe, Fe + Zn and C groups, respectively, P: = 0.002), and cord zinc concentrations were significantly related to maternal plasma Zn levels (y = 6.383 + 0.555x, r = 0.486, P: = 0.002). The inclusion of zinc in prenatal supplements may reduce the potential for iron supplements to adversely influence zinc status in populations at risk for deficiency of both these nutrients.     

孕产妇叶酸认知状况及知识需求调查

目的 探讨孕产妇叶酸认知的影响因素,为有效实施叶酸干预提供科学依据。方法 根据甘肃省经济状况和地理分布选择临洮、靖远2个县,以孕后3个月至产后1年的2 094名妇女为研究对象,进行面对面访谈及匿名问卷调查。结果 低龄及高龄、低文化程度、低经济收入的孕产妇对神经管畸形和叶酸认知较低,仅4.90%的≤20岁孕产妇知晓叶酸正确服用时间;15.94%小学及以下文化程度孕产妇听说过神经管畸形,6.55%知晓叶酸最佳服用时间;年经济收入≤8 000元孕产妇听说过神经管畸形的占20.72%,认为叶酸是维生素类保健品的占19.82%;在叶酸知识来源途径方面,从医生处获得叶酸相关知识的占38.29%,期待从医生处获得的占42.19%。结论 低龄及高龄、低文化程度、低收入孕产妇是健康教育的重点人群;叶酸服用最佳时间是健康教育的重点内容;以医生为主体、利用电视等多种媒体手段是健康教育的重要途径。     

124例孕妇妊娠期血清叶酸水平动态观察

[目的 ]　观察孕期血清叶酸水平变化 ,为孕妇补充叶酸提供依据。　 [方法 ]　用放射免疫法检测 12 4例孕妇孕早、中、晚期血清叶酸水平动态变化 ,检测非孕健康妇女 40例作为对照组 ,同时问卷调查孕期饮食及补充叶酸制剂情况。　 [结果 ]　①随着妊娠周数增加 ,血清叶酸水平逐渐下降 ,至孕晚期叶酸明显下降 ,与孕早期、孕中期相比差异有显著性 (P<0 .0 0 1)。②孕期补充叶酸与未补充叶酸孕妇比较孕晚期血清叶酸水平差异显著 (P <0 .0 0 1)。　 [结论 ]　孕期只通过膳食补充叶酸是不够的 ,还需要摄取含叶酸的维生素类补给品。     

Maternal zinc, iron, folic acid, and protein nutriture and outcome of human pregnancy

Four hundred fifty women were observed during pregnancy and postpartum. Forty-three variables including 12 laboratory indices of maternal nutrient status were assessed. Of the variance in fetal weight and head circumference 9.9 and 8.1%, respectively, were predictable by polynomial stepwise regression of laboratory indices of maternal nutriture. Maternal plasma zinc levels were inversely correlated with fetal weight. The occurrence of pregnancy complications in the highest and lowest quartiles of maternal plasma zinc, albumin, iron, and folic acid were compared. Using data only from the initial blood samples for which the trimester was identified precisely (n = 394), a significant association was found between the total occurrence of fetomaternal complications and zinc and albumin levels in the lowest quartile (zinc, p less than 0.02; albumin, p less than 0.02). Low zinc or low albumin were also associated with the specific complications of fetal distress (zinc, p less than 0.002; albumin p less than 0.002). High plasma folate was also associated with the total occurrence of complications (p less than 0.008) and with fetal distress (p less than 0.002). When all data (n = 713) including repeat blood samples and data from 56 mothers in whom the trimester could not be verified precisely were evaluated, associations between other complications and lowest quartile zinc and albumin and highest quartile folate were identified. Discriminant analysis of data from the initial blood samples revealed that plasma zinc was a discriminator for fetomaternal complications only in women in the lowest quartile for plasma zinc.     

The effect of combined dietary iron, calcium and folic acid supplementation on apparent 65Zn absorption and zinc status in pregnant rats

In the present study the effect of combined iron, calcium and folic acid supplementation of the diet on 65Zn retention and zinc status was studied in the pregnant rat. Female Wistar rats were fed on a low- (8 micrograms/g) or high- (60 micrograms/g) Zn diet for 14 d and then mated overnight. After mating, half the rats were fed on the low- or high-Zn diet as before, whilst the other half were fed on similar diets supplemented with Fe, Ca and folic acid. The level of supplementation was chosen to reflect proportionately the possible increase in daily intakes of these nutrients by pregnant women. Rats which did not mate successfully were used as non-pregnant controls. On day 18 of pregnancy, each animal was given a meal of the appropriate diet labelled extrinsically with 65Zn, and on day 20 rats were killed. Carcass 65Zn retention was lower in pregnant and non-pregnant rats fed on the supplemented diets compared with those fed on the unsupplemented diets. Rats which consumed the supplemented diets throughout pregnancy had reduced plasma Zn concentrations but femur and fetal Zn concentrations were unaffected. Maternal femur Ca and fetal Fe concentrations were lower in the high-Zn groups compared with rats fed on low-Zn diets. It was concluded that the risk of inducing fetal Zn depletion as a consequence of Fe, Ca and folic acid supplementation during pregnancy appeared to be slight.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies

In sub-Saharan Africa, anaemia in pregnancy results from multiple causes including malaria, iron deficiency and haemoglobinopathies. In a cross-sectional study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrations of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha-globin genotypes. Anaemia (haemoglobin [Hb] < 11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. Ferritin levels were considerably influenced by malaria and inflammatory processes (CRP > 0.6 mg/dL). Depending on the definition applied, the prevalence of iron deficiency ranged between 5% and 46%. The HbAS trait was observed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta-thalassaemia was present in 1% of the women and alpha(+)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS had higher malaria parasite densities than those with HbAA. In individuals with highly elevated HbF (> 10%), parasitaemia occurred in 27% only. Low gravidity, second trimester of pregnancy, malaria, raised CRP levels, and homozygous alpha(+)-thalassaemia were independent risk factors for anaemia in multivariate analysis. alpha(+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women. Iron deficiency appears not to be a major health problem in this population. Haemoglobinopathies are common but, except for homozygous alpha(+)-thalassaemia, do not substantially contribute to anaemia in pregnancy. alpha(+)-Thalassaemia ameliorates malarial anaemia in pregnant women.     

妊娠神经管畸形孕妇血清叶酸与同型半胱氨酸水平分析

目的:比较妊娠早期神经管畸形(neural tube defects,NTDs)孕妇及正常孕妇血清叶酸和同型半胱氨酸(ho-mocysteine,Hcy)水平,分析两种物质的代谢水平与妊娠NTDs的关系。方法:采用病例对照研究方法,以NTDs高发的山西省5个县作为研究现场,选择9所医院收集研究对象,对所有研究对象采集肘静脉血5ml,检测其血清叶酸和Hcy水平,比较病例组和对照组血清叶酸和Hcy的差异。分别以对照组血清叶酸和Hcy浓度的第10和第90百分位数作为界值,划分为2个水平组,比较不同水平组NTDs的发病风险。结果:妊娠NTDs孕妇血清平均叶酸水平显著低于对照组(10.4nmol/Lvs14.7nmol/L,P0.05),同时血清Hcy高于对照组,差异无统计学意义。低叶酸水平孕妇妊娠NTDs的危险性显著增加(AOR=3.0,95%CI为1.2～7.7)。结论:孕期血清叶酸低水平是研究人群NTDs发生的危险因素。     

育龄妇女在围孕期服用叶酸依从性递进指标界定

出生缺陷中神经管畸形发病率高且危害大.育龄妇女在孕前3个月至孕早期3个月内每日服用0.4 mg叶酸可有效预防50％ ～ 80％神经管畸形的发生[1,2].为了解农村孕妇围孕期叶酸服用依从性现状及探讨其判断标准,进行了相关研究。     

围孕期妇女叶酸水平及其季节变化特征

摘要:目的　描述新婚育龄妇女叶酸水平的人口分布及季节分布特征,为进一步指导增补叶酸提供科学依据。方法　利用婚前医学检查项目,收集合肥地区3个县城（肥东、肥西、长丰）2 040名新婚育龄妇女血标本,其中孕妇731人,非孕妇1 309人;调查研究基本人口统计特征资料。结果　孕妇组叶酸水平（555.84±218.885）nmol/L高于非孕妇组（502.54±187.22）nmol/L,差异有统计学意义（t＝-8.460,P＜0.001）。在孕妇人群中不同季节、不同年龄段叶酸水平差异有统计学意义（P值均＜0.05）。在非孕妇人群中不同地区、受教育程度、年龄段、季节的叶酸水平差异均有统计学意义（P值均＜0.05）。结论　妇与非孕妇红细胞内叶酸水平存在差异;应根据季节给与孕妇补充不同水平叶酸;加强不同人口特征孕妇和非孕妇叶酸相关知识的健康教育。     

Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute

Background

Latin America, China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia. The 10/66 Dementia Research Group's title refers to the 66% of people with dementia that live in developing countries and the less than one tenth of population-based research carried out in those settings. This paper describes the protocols for the 10/66 population-based and intervention studies that aim to redress this imbalance.

Methods/design

Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries (India, China, Nigeria, Cuba, Dominican Republic, Brazil, Venezuela, Mexico, Peru and Argentina), with a sample size of between 1000 and 3000 (generally 2000). Each of the studies uses the same core minimum data set with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non communicable disease risk factor questionnaires, disability/functioning, health service utilisation, care arrangements and caregiver strain). Nested within the population based studies is a randomised controlled trial of a caregiver intervention for people with dementia and their families (ISRCTN41039907; ISRCTN41062011; ISRCTN95135433; ISRCTN66355402; ISRCTN93378627; ISRCTN94921815). A follow up of 2.5 to 3.5 years will be conducted in 7 countries (China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Argentina) to assess risk factors for incident dementia, stroke and all cause and cause-specific mortality; verbal autopsy will be used to identify causes of death.

Discussion

The 10/66 DRG baseline population-based studies are nearly complete. The incidence phase will be completed in 2009. All investigators are committed to establish an anonymised file sharing archive with monitored public access. Our aim is to create an evidence base to empower advocacy, raise awareness about dementia, and ensure that the health and social care needs of older people are anticipated and met.