补充维生素A和铁对孕妇铁营养状况的影响

目的　研究补充维生素 A、铁对孕妇铁营养状况的影响。方法　对 1 6 7名孕中期妇女进行铁和维生素 A营养状况的横断面调查并随机分成 4组 :对照组 (复合维生素 B片每日一片 ) ;补充维生素 A组 (1 1 0 0 μg/d) ;补充铁组 (6 0 mg/d元素铁 ) ;补充维生素 A和铁组 (VA1 1 0 0μg/d,Fe6 0 mg/d) ,共补充 1 0 w。结果　被调查孕妇孕中期维生素 A轻度缺乏率为 0 .6 % ,贫血患病率为 7.8% ,贮存铁缺乏率为 6 .2 %。血清 VA水平补充前各组正常 ,补充后对照组明显下降 ,但仍维持在正常范围。补 VA、补铁及补 VA+铁组血清 VA与补充前无明显差异 ,仍保持恒定。各组补充前后 Hb均在正常范围 ,差别不显著。血清铁蛋白、游离红细胞原卟啉及运铁蛋白饱和度补充后的改善效果均以补充 VA铁组优于单独补 VA或补铁组。结论　孕期同时补充 VA和铁对改善铁的营养状况优于单纯补铁。     

健康成人补充维生素A对铁营养状况影响

目的探讨补充维生素A(VA)对健康成人铁营养的影响。方法选择120名健康志愿者, 随机分为四组, 正常膳食, 进行6个月的不同VA剂量干预。抽取受试者干预前后空腹晨血并检测。结果干预后4组间血清VA浓度变化差异有统计学意义(P<0.05);干预前后各组受试者血液Hb浓度变化无统计学意义(P>0.05);干预后高剂量组血清铁营养指标变化差异有统计学意义(P<0.05), 其他3组差异无统计学意义(P>0.05)。结论铁营养状况正常的成人, 通过VA补充机体铁营养状况其他可得到提高。     

儿童维生素A与铁营养状况的相关性研究

目的了解中国儿童维生素A(VA)的营养状况、VA缺乏率、VA边缘缺乏率,研究血浆VA与铁营养状况的相关性。方法由2002年“中国居民营养与健康状况调查”的大样本中随机抽取380名3~12岁儿童,检测血浆VA含量,同时测定血红蛋白(Hb)、总铁结合力(TIBC)、铁蛋白(SF)及转铁蛋白受体(sTfR)。了解儿童VA营养状况,计算VA缺乏率、VA边缘缺乏率,研究VA与铁营养状况评价指标的相关性。结果受试儿童VA平均含量为(1·03±0·24)μmol/L,其中8·4%儿童VA缺乏,44·7%儿童VA边缘缺乏。血浆VA与Hb呈正相关(r=0·16986,P<0·01),与sTfR呈负相关(r=-0·12863,P<0·05),与TIBC、SF不相关。结论铁缺乏伴随VA边缘缺乏在中国儿童中普遍存在,VA与铁营养状况存在相关性。     

维生素A缺乏对大鼠铁营养状况的影响

目的 研究维生素A(VA)缺乏对大鼠铁营养状况的影响及其可能的机制。方法 雄性Wistar大鼠40只．按体重随机分为IVA和铁缺乏组，ⅡVA完全缺乏组，ⅢVA轻度缺乏组，Ⅳ VA正常对照组。实验动物喂饲8周后处死，测定血清VA、血清铁、铁蛋白、血红蛋白、肝内总铁含量，并用逆转录一聚合酶链反应(RT-PCR)法检测各组大鼠肝脏转铁蛋白mRNA的表达情况。结果 维生素A缺乏显地降低血清铁蛋白、血红蛋白和肝内总铁含量。抑制肝脏转铁蛋白mRNA的表达。结论 维生素A缺乏可能通过降低肝脏转铁蛋白mRNA的表达水平从而抑制了铁的吸收和转运。     

贫血孕妇铁与维生素A营养状况分析

目的 了解妊娠妇女铁、维生素A、核黄素等营养素的摄入及贫血的患病情况，为开展营养干预提供科学依据。方法随机抽取山东省莘县430名贫血孕妇和292名非贫血孕妇，采用24h回顾法比较2组孕妇主要营养素摄入情况，分析孕妇维生素A、核黄素及铁的营养水平。结果2组孕妇膳食均以粮谷类等植物性食物为主，铁的摄入量接近膳食推荐摄入量（RNIs）；血清检验结果显示，贫血组的铁营养水平明显低于非贫血组；85．2％贫血孕妇血浆铁蛋白〈14μg／L，转铁蛋白受体平均为31．42nmol／L；贫血组缺乏维生素A和核黄素的比例分别为62．9％和63．1％，明显高于相应的非贫血组（P〈0．01）。结论贫血不仅与铁的吸收利用率有关，而且与维生素A、核黄素摄入不足或缺乏有密切关系。     

维生素A改善山区中学生血红蛋白及铁营养状况的作用

在人群调查中维生素Ａ缺乏常与缺铁性贫血共存，为阐明其中的关系，设计了三种含维生素和微量元素的胶囊给山区中学自带菜（一般为简单的干菜）的住校生各１００名服用。Ａ组为全量，Ｂ组去除维生素Ａ，Ｃ组为安慰剂葡萄糖。连续三个月，为单盲法试验／结果表明，在其他营养素供给充分的条件下，维生素Ａ使血清维生素Ａ、暗适应状况改善的同时，血红蛋白水平由试验前的１２１．１ｇ／Ｌ提高为三个月后的１３４．７ｇ／Ｌ，并使血清铁、运铁蛋白饱和度、血清铁蛋白、转铁蛋白有显著改善。血清视黄醇当量与血红蛋白、血清铁、运铁蛋白饱和度和转铁蛋白呈明显的正相关。提示维生素Ａ有助于改善血红蛋白及铁状况。     

补充维生素A对健康成人铁营养状况的影响

目的观察健康成人补充维生素A(VA)后铁营养状况的变化。方法选择115名健康成人志愿者,按血清视黄醇浓度用区组设计方法将男女志愿者随机分入4组(男、女各半),在日常膳食的基础上,分别补充不同剂量的VA,干预剂量(以视黄醇计)分别为600μg/d(A组)、400μg/d(B组)、200μg/d(C组)和0μg/d(D组),干预期4个月。补充剂为微胶囊化的视黄酰乙酸酯,将5日剂量装入1粒胶囊,每5日口服1粒。胶囊外包装只标注剂量类型,现场实验人员和受试者均不知道每一种胶囊的补充类型。干预期内,受试者接受常规膳食,每月进行1次24h回顾性膳食调查。干预试验前后,采集空腹上臂静脉血,取血清测定血液血红蛋白(Hb)浓度,血清视黄醇、血清铁(SI)、铁蛋白(SF)和转铁蛋白受体(TfR)浓度。结果共有108名受试者完成干预试验,A、B、C和D组各为27、28、27和26名。干预期内,4组受试者膳食能量营养素、视黄醇当量(RE)和铁摄入量无显著性差异(P>0.05)。干预结束后,A组受试者血清视黄醇浓度从干预前的(1.63±0.55)μmol/L升高到了(1.93±0.52)μmol/L(P<0.05);B和C组血清视黄醇浓度分别平均升高了0.29μmol/L和0.14μmol/L(均为P<0.05);而对照组D组变化不显著(P>0.05)。干预试验前后各组Hb差异没有显著性(P>0.05);高剂量VA组受试者干预后SI浓度比干预前显著升高,而SF和TfR浓度则显著降低(均为P<0.05);中剂量组和低剂量组在干预前后SF和TfR未见显著性变化。结论铁营养状况正常的成人,在没有专门给予膳食铁干预的情况下,通过较大剂量VA补充干预,铁营养状况仍然得到进一步提高。     

82例青年维生素A营养状况的调查及补充效果观察

用高效液相色谱法测定北京82例健康青年血清维生素A水平,并记录其膳食维生素A与胡萝卜素摄入情况。结果表明,受检者膳食维生素A与胡萝卜素平均每日摄入量为279.1±120.4µg视黄醇当量,与推荐的每日膳食供给量比较普遍摄入不足。血清维生素A平均含量为1.33±0.42µmol⁄L,其中14.6%受检者血清维生素A含量低于正常水平。对血清维生素A含量较低的志愿者口服补充维生素A胶九每人合计32.02万Iu后,血清维生素A显著提高。     

贫血孕妇维生素A、维生素B_2和铁营养状况及抗氧化水平的调查分析

目的分析孕期贫血妇女的血浆维生素A(VA)、维生素B2(VB2)和铁营养状况及抗氧化水平。方法将孕中期妇女分成非贫血组(Hb≥110g/L,36人)和贫血组(HB80~105g/L,426人),经知情后同意参加。采用24小时膳食回忆法了解受试者每日主要营养素摄入情况,采集空腹静脉血5ml,分析血浆VA、VB2和铁蛋白(SF)水平,超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)活性,丙二醛(MDA)和红细胞膜流动性的变化。结果贫血孕妇VA、VB2摄入不足,分别为推荐摄入量(RNIs)的58·7%和57·2%,铁的来源仍为吸收率低的植物性食物。贫血孕妇的血浆VA(1·25μmol/L)和铁蛋白(20·57μg/L)水平明显低于非贫血孕妇(VA1·57μmol/L,SF33·16μg/L,P<0·05),全血谷胱苷肽还原酶活性系数(BGRAC)(1·79)水平高于非贫血组(1·52);SOD(77·1U/ml)和GSH-Px(61·9U)活性低于非贫血组(SOD92·2U/ml,GSH-Px71·6U,P<0·05);MDA(4·58nmol/ml)和红细胞膜的P和η值(P=0·2622,η=2·7465)明显高于非贫血组(MDA3·78nmol/ml,P=0·2360,η=2·3658,P<0·05)。且随贫血程度的加重,VA、铁蛋白水平、SOD和GSH-Px活性进一步下降,BGRAC、MDA、P和η值明显升高。结论妊娠中期贫血妇女血浆VA、VB2、铁蛋白及抗氧化能力均明显低于非贫血孕妇。且随贫血程度的加重而降低。     

缺铁性贫血对妊娠及其结局的影响

目的　了解孕妇缺铁性贫血 (IDA)的程度和主要相关因素 ,探讨其对妊娠结局的不良影响和补铁后的效果。方法　膳食调查、血液铁水平测定及补铁效果、妊娠结局观察的临床对照研究。结果　育龄妇女在妊娠前、后血红素铁摄入量较低 ;孕中、晚期IDA发生率分别为 14 3%,2 8 3%,其中Hb >10 0 g/L者占 94 3%;IDA孕妇组子痫前期发生率及分娩时宫缩乏力率、宫内发育迟缓和低出生体重发生率均显著高于正常孕妇组 ,IDA孕妇经补铁后 ,其血液铁水平和妊娠结局均有所改善。结论　孕期轻度IDA对母儿均有影响 ,妇女孕前应进行营养教育和指导 ,对孕期IDA应及时防治。     

The Influence of Vitamin A Supplementation on Iron Status

Vitamin A (VA) and iron deficiencies are important nutritional problems, affecting particularly preschool children, as well as pregnant and lactating women. A PubMed (National Library of Medicine, National Institutes of Health, Bethesda, MD, USA) literature review was carried out to search for clinical trials published from 1992 to 2013 that assessed the influence of vitamin A supplementation on iron status. Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone. Some studies did not include a placebo group and only a few of them assessed vitamin A status of the individuals at baseline. Moreover, the studies did not consider any inflammatory marker and a reasonable number of iron parameters. Another important limitation was the lack of assessment of hemoglobin variants, especially in regions with a high prevalence of anemia. Assessment of hemoglobin variants, inflammatory markers and anemia of chronic inflammation would be important to the studies investigated. Studies involving different populations are necessary to elucidate the interaction between the two micronutrients, especially regarding iron absorption and modulation of erythropoiesis.     

Importance of Pre-Pregnancy and Pregnancy Iron Status: Can Long-Term Weekly Preventive Iron and Folic Acid Supplementation Achieve Desirable and Safe Status?

Most women worldwide enter pregnancy without adequate iron reserves or are already iron deficient. Estimates of iron needs during pregnancy are markedly reduced when iron reserves are available. The needs of absorbed iron to correct mild to moderate anemia in the last two trimesters are estimated. Pre-pregnancy and prenatal weekly supplementation can improve iron reserves effectively and safely, preventing excess iron and favoring better pregnancy outcomes. We explain how the weekly supplementation idea was developed, why current hemoglobin norms may be inadequately high (especially in pregnancy), and why excess iron as recommended by many agencies for developing populations can be undesirable.     

Effects of malnutrition during the reproductive cycle on nutritional status and lactational performance of rat dams

To assess the effects of malnutrition imposed at various stages of the reproductive cycle on maternal nutritional status and lactational performance, rats were fed 50% of the intake of control animals fed adlibitum (C) either before pregnancy (R-B), before and during pregnancy (R-BP), during lactation (R-L) or throughout the experimental period (R-BPL). At day 14 of lactation, maternal plasma albumin and vitamin A, liver iron stores and carcass fat were reduced in the restricted animals (R-L, R-BPL). Vitamin A stores were lowest in the chronically malnourished rats and were not replenished by refeeding during lactation. Milk yield was compromised in the restricted rats; the acutely malnourished rats (R-L) were much more severely affected than those chronically underfed (R-BPL). The restricted animals (R-L, R-BPL) only partially compensated by producing a more nutrient-dense milk. As a result, only total daily output of milk lactose and iron were reduced in the restricted rats. Thus, nutritional insults occurring both before and during lactation influenced lactational performance. The negative effects of chronic malnutrition were largely overcome by refeeding during lactation.     

四种方法补充富马酸亚铁改善大鼠铁营养状况比较

目的通过动物实验,比较4种不同方式补充富马酸铁对大鼠铁营养状况的影响。方法刚断乳的雌性Wistar大鼠,用铁缺乏饲料(<10mg铁/kg饲料)喂养至血红蛋白低于100g/L。选择50只大鼠,按血红蛋白含量和体重随机分为铁缺乏对照组(ID)、每日小剂量补铁组(LDs)、每周1次小剂量补铁组(LWs)、每日大剂量补铁组(HDs)、每周1次大剂量补铁组(HWs),每组10只大鼠。补充期为12周。实验结束时,取大鼠的腹主动脉血,测定血红蛋白(Hb)、红细胞游离原卟啉(FEP)、血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)、运铁蛋白饱和度(TS)等。结果补充4周后,HDs或HWs补充组Hb含量升高速度显著高于LDs、LWs补充组。补充8周后,4种补充方式之间Hb、FEP含量差异无统计学意义(P>0.05)。但补充12周后,HDs补充组大鼠的SI、TS、SF含量显著高于HWs、LDs、LWs补充组,HDs补充组的TS接近60%。结论间歇性补铁,短期效果不如每日补铁,但延长补充时间,其改善机体铁营养状况的效果与每日补铁基本相同。     

顺义县农村儿童铁状况及隐性缺铁的干预效果

【目的】　通过调查顺义县农村儿童铁状况 ,隐性缺铁患病现状及对补铁效果观察 ,为改善我国儿童铁营养状况 ,降低缺铁性贫血患病率提供依据。　【方法】　对顺义县农村 3～ 7岁儿童 2 79名进行膳食调查与铁生化指标检测 ,分析比较各期铁缺乏患病状况 ,筛选隐性缺铁儿童 30名口服硫酸亚铁每日 0 .15g(相当元素铁 30mg) ,连续 8周 ,重复测定血液生化指标 ,并与干预前及对照组 (隐性缺铁未实施铁干预 )儿童比较。　【结果】　各年龄组儿童能量、蛋白质和铁平均每日摄入量均达到推荐的膳食营养素供给量标准 ,维生素C每日摄入量明显不足 ,低于供给量标准的 80 % ;血液铁生化指标SF(5 3 .2 1± 2 5 .95 ) μg/L ,SI(16 .49± 5 .33) μmol/L ,TS(2 4.9± 8.6 ) % ,Hb(12 6 .6± 11.6 )g/L ;铁缺乏检出率为 2 8.1% ,其中ID占 14 .8% ,IDE占 10 .3 % ,IDA占 3 .0 % ,隐性缺铁检出率占缺铁总人数的 89.5 % ,接近IDA检出率的 9倍 ;补铁后各项铁指标显著提高 ,未实施铁干预的隐性缺铁儿童中有 6 .7%发展为IDA。　【结论】　该人群铁缺乏检出率为 2 8.1% ,其中隐性缺铁占 89.5 % ,为IDA的 9倍 ,实施隐性缺铁的营养干预对预防IDA ,降低其患病率有重要作用     

每周补充维生素A及每周补铁对学龄前儿童贫血的干预试验

【目的】　了解每周补充维生素A及每周补铁对改善学龄前儿童铁和维生素A营养状况的效果。　【方法】　将筛选出的铁和 /或维生素A缺乏儿童随机分成三组 ,每周分别给予 5万IU维生素A胶丸、60mg元素铁、10mg维生素B1,补充 4周后观察Hb、血清VA、铁蛋白、运铁蛋白受体的变化情况。　【结果】　干预前后 ,补铁组、补维生素A组以及补维生素B1组Hb值分别上升 8.8g/L ,10 .8g/L ,7.2 g/L(P <0 .0 0 1) ;补维生素A组和补维生素B1组血清VA分别上升 0 .13 7μmol/L ,0 .10 3 μmol/L(P <0 .0 0 1) ,而补铁组血清VA补充前后差异无显著性。各组铁蛋白在补充后显著性降低 ,而运铁蛋白受体显著升高。　【结论】　①由幼儿园教师监督实施每周补铁是行之有效的。②维生素A缺乏会影响铁向组织的转运和造血过程。③维生素A和铁缺乏同时存在地区 ,每周补维生素A与每周补铁在改善贫血上效果一致。     

Associations between Dietary Iron and Zinc Intakes,and between Biochemical Iron and Zinc Status in Women

Iron and zinc are found in similar foods and absorption of both may be affected by food compounds, thus biochemical iron and zinc status may be related. This cross-sectional study aimed to: (1) describe dietary intakes and biochemical status of iron and zinc; (2) investigate associations between dietary iron and zinc intakes; and (3) investigate associations between biochemical iron and zinc status in a sample of premenopausal women aged 18–50 years who were recruited in Melbourne and Sydney, Australia. Usual dietary intakes were assessed using a 154-item food frequency questionnaire (n = 379). Iron status was assessed using serum ferritin and hemoglobin, zinc status using serum zinc (standardized to 08:00 collection), and presence of infection/inflammation using C-reactive protein (n = 326). Associations were explored using multiple regression and logistic regression. Mean (SD) iron and zinc intakes were 10.5 (3.5) mg/day and 9.3 (3.8) mg/day, respectively. Median (interquartile range) serum ferritin was 22 (12–38) μg/L and mean serum zinc concentrations (SD) were 12.6 (1.7) μmol/L in fasting samples and 11.8 (2.0) μmol/L in nonfasting samples. For each 1 mg/day increase in dietary iron intake, zinc intake increased by 0.4 mg/day. Each 1 μmol/L increase in serum zinc corresponded to a 6% increase in serum ferritin, however women with low serum zinc concentration (AM fasting < 10.7 μmol/L; AM nonfasting < 10.1 μmol/L) were not at increased risk of depleted iron stores (serum ferritin <15 μg/L; p = 0.340). Positive associations were observed between dietary iron and zinc intakes, and between iron and zinc status, however interpreting serum ferritin concentrations was not a useful proxy for estimating the likelihood of low serum zinc concentrations and women with depleted iron stores were not at increased risk of impaired zinc status in this cohort.     

孕妇铁营养状况评价指标的选择

本文利用计算机及SYSTAT软件对追踪观察的100名孕妇妊娠中期和妊娠晚期的八项血液学指标进行了主成分分析,发现仅用红细胞游离原卟啉、血浆运铁蛋白饱和度、血红蛋白、血浆铁蛋白四项指标即可满意地反映孕妇机体的铁营养状况。     

Iron Sucrose Versus Oral Iron Therapy in Pregnancy Anemia

Background:

Iron deficiency anemia (IDA) is the most common medical problem in pregnancy. Parenteral iron is a useful treatment, although iron dextran use decreased due to anaphylaxis. Iron sucrose is a newer agent that has overcome the shortcomings of iron dextran.

Objective:

The aim of this study was to compare the efficacy and tolerance of intravenous iron sucrose (IVIS) therapy with oral iron (OI) therapy in pregnant women with IDA and to study the factors influencing treatment.

Materials and Methods:

This prospective, randomized clinical trial included pregnant women between 14 and 36 weeks with established IDA who were treated with IVIS or OI (ferrous fumarate). All patients were monitored for laboratory response and adverse effects. Independent sample-t test, Chi square test and ANOVA were used for statistical analysis. P < 0.05 was considered significant.

Results:

Although hemoglobin increased in both the groups, increase in the reticulocyte count and percentage increase in hemoglobin was significantly higher in the IVIS group than in the OI group (23.62% vs. 14.11%). Serum ferritin was significantly higher in the IVIS group than in the OI group (P = 0.000). The IVIS group had no major side-effects. Compliance was good with OI, although 23% had gastrointestinal side-effects. Patient weight, gestation at diagnosis, initial hemoglobin and ferritin levels did not influence the response to treatment.

Conclusion:

IVIS is safe and effective in the treatment of IDA during pregnancy. Iron stores increased better with IVIS compared with OI.