Vitamins and trace elements

Vitamins and trace elements are micronutrients which are essential for many key metabolic pathways. Each micronutrient represents part of a much larger and complex picture. Individual micronutrients interact with each other so that physiological adaptation to a deficiency may itself affect micronutrient metabolism leading to multiple deficiencies.     

Nutrient intakes and impact of fortified breakfast cereals in schoolchildren.

OBJECTIVE: To report micronutrient intakes in Northern Ireland schoolchildren, and to establish the contribution of fortified breakfast cereal to overall nutrient intakes and achievement of current dietary recommendations. DESIGN: Analysis of dietary intakes and physical characteristics of participants in a randomly selected 2% population sample of 1015 schoolchildren aged 12 and 15 years in Northern Ireland during the 1990/1 school year. MAIN OUTCOME MEASURES: Dietary intakes, physical characteristics, and their association with consumption of fortified breakfast cereal. RESULTS: Mean micronutrient intakes were generally adequate with the exception of low intakes of folate (boys and girls) and iron (girls). Fortified breakfast cereals, consumed by a high proportion (94% boys; 83% girls) of the sample, were associated with higher daily intakes of most micronutrients and fibre and with a macronutrient profile consistent with current nutritional recommendations. Appreciable proportions of subjects who did not consume fortified breakfast cereals had daily intakes that fell below the lower reference nutrient intake for riboflavin, niacin, folate, vitamin B-12, and iron (girls). CONCLUSIONS: The results demonstrate the potential of fortification in contributing to micronutrient intakes of schoolchildren, particularly where requirements are high, or for those on marginal diets of low nutritional quality.     

Nutrient intakes and impact of fortified breakfast cereals in schoolchildren

OBJECTIVE: To report micronutrient intakes in Northern Ireland schoolchildren, and to establish the contribution of fortified breakfast cereal to overall nutrient intakes and achievement of current dietary recommendations. DESIGN: Analysis of dietary intakes and physical characteristics of participants in a randomly selected 2% population sample of 1015 schoolchildren aged 12 and 15 years in Northern Ireland during the 1990/1 school year. MAIN OUTCOME MEASURES: Dietary intakes, physical characteristics, and their association with consumption of fortified breakfast cereal. RESULTS: Mean micronutrient intakes were generally adequate with the exception of low intakes of folate (boys and girls) and iron (girls). Fortified breakfast cereals, consumed by a high proportion (94% boys; 83% girls) of the sample, were associated with higher daily intakes of most micronutrients and fibre and with a macronutrient profile consistent with current nutritional recommendations. Appreciable proportions of subjects who did not consume fortified breakfast cereals had daily intakes that fell below the lower reference nutrient intake for riboflavin, niacin, folate, vitamin B-12, and iron (girls). CONCLUSIONS: The results demonstrate the potential of fortification in contributing to micronutrient intakes of schoolchildren, particularly where requirements are high, or for those on marginal diets of low nutritional quality.     

Impacts of an egg intervention on nutrient adequacy among young Malawian children

Eggs are a rich source of multiple nutrients that support child growth and development. Provision of eggs as a complementary food may improve dietary adequacy among young children at risk for undernutrition. Our objective was to test the impact of an egg intervention on the adequacy of total nutrient intakes and micronutrient density among 6‐ to 15‐month‐old Malawian children. Children 6 to 9 months old, living in Mangochi District, Malawi, were randomly assigned to the intervention group (n = 331) receiving an egg per day or a control group (n = 329) consuming their usual diet. Dietary intakes of macronutrients, vitamins and minerals were assessed using 24‐h recalls at baseline, 3‐month midline and 6‐month endline, with repeat recalls in a subsample. Usual nutrient intake and micronutrient density distributions were modelled to estimate group means and prevalence of inadequacy. Group differences at midline and endline were tested using unequal variance t tests with bootstrapped standard errors. The egg intervention resulted in higher intakes of fat and protein and lower intakes of carbohydrates. The egg group had lower prevalence of inadequacy for selenium, vitamin A, riboflavin, vitamin B₅, vitamin B₁₂ and choline. Micronutrient density inadequacy was lower in the egg group for vitamin A and choline at midline and endline, riboflavin at midline and vitamin B₅ at endline. Inadequacy of nutrient intakes or density remained highly prevalent in both groups for multiple micronutrients. Though the egg intervention increased intakes of protein and several micronutrients, total intakes and micronutrient density of multiple micronutrients remained far below recommendations.     

Habitual micronutrient intake during and after pregnancy in Caucasian Londoners

Micronutrient status is of fundamental importance both upon conception and throughout pregnancy. There is an abundance of literature investigating nutrient intakes during individual trimesters of pregnancy but few studies have investigated baseline intakes of nutrients throughout gestation as a continuum. The current investigation set out to measure habitual micronutrient intakes at weeks 13, 25, 35 of pregnancy and 6 weeks postpartum using a prospective background information questionnaire, 4–7-day weighed food diary and postnatal questionnaire. Seventy-two primiparous, Caucasian Londoners were recruited at the study start with 42 completing the first, second, third trimester and postpartum study stages respectively. Study findings indicated that sodium intakes were significantly higher than UK guidelines throughout and after pregnancy ( P  < 0.001). Intakes of folate, iron, vitamin D, potassium, iodine and selenium were lower than UK recommendations during and after pregnancy, but to varying levels of statistical significance ( P  < 0.05). Only 23–38% of women met UK recommendations for folate (300 µg day⁻¹) through dietary sources. Similarly, only a small percentage of women met dietary guidelines for iron (19–28%). The findings from the current study indicate that public health interventions may be required to help expectant mothers achieve an optimal diet, particularly after birth when dietary recommendations increase for some micronutrients.     

Causes of nutrition-related public health problems of preschool children: available diet

The primary goal of this review is to examine the timing and nature of dietary inadequacy during the first 5 years of life. An important issue is that many children in developing countries are already nutritionally depleted by the end of the first year of life, because maternal undernutrition can cause low fetal accumulation of nutrient stores and secretion of inadequate amounts of some micronutrients in breast milk. Improvement of maternal diet and micronutrient status is required to remedy this situation. During the period of complementary feeding, most households may be able to provide their young children with sufficient energy and protein from home-produced complementary foods, but many do not feed foods with an adequate energy density or a sufficient number of meals per day. Inadequate micronutrient intakes and resulting deficiencies are common in preschoolers because of a lack of sufficient animal source foods, and have been associated with delayed child development. Dietary diversity is an especially important determinant of micronutrient intakes when animal source food intake is low. Interventions with animal source foods have produced improvements in growth, micronutrient status, cognitive performance and activity of children. Although much is now known about the role of inadequate diets in preschooler malnutrition, on a global scale the ability of households to apply this knowledge to improve the diets of their children is still limited.     

Role of micronutrients for physical growth and mental development

Due to control of florid and severe cases of protein-energy malnutrition, deficiencies of micronutrients in children have assumed public health importance. According to National Nutrition Monitoring Bureau of India, over 50% of apparently healthy looking children have subclinical or biochemical deficiencies of vitamin A, vitamins B₂, B₆, folate and vitamin C. Over two-third of children have clinical evidences of iron deficiency while deficiency of trace minerals like iodine and zinc is quite common in certain populations. Children have food preferences and they are quite fussy to take green leafy vegetables and fruits thus compromising their intake of micronutrients from dietary sources. The full genetic potential of the child for physical growth and mental development may be compromised due to subclinical deficiencies of micronutrients which are commonly referred to as “hidden hunger”. Micronutrients are required for the integrity and optimal functioning of immune system. Children with subclinical deficiency of micronutrients are more vulnerable to develop frequent and more severe common day-to-day infections thus triggering a vicious cycle of undernutrition and recurrent infections. A number of micronutrients are required for optimal physical growth and neuromotor development. Isolated deficiencies of micronutrients are rare in clinical practice and usually deficiencies of multiple micronutrients co-exist. The first 3 years of life are most crucial and vulnerable to the hazards of undernutrition. All efforts should be made so that preschool children are given a balanced and nutritious home-based diet. However, it has been shown that it is not possible to meet 100% requirements of recommended dietary allowances (RDA’s) of micronutrients from dietary sources alone and most preschool children need administration of nutritional supplements to optimize their genetic potential for physical growth and mental development.     

Maximizing the benefits and minimizing the risks of intervention programs to address micronutrient malnutrition: symposium report

Interventions to address micronutrient deficiencies have large potential to reduce the related disease and economic burden. However, the potential risks of excessive micronutrient intakes are often not well determined. During the Global Summit on Food Fortification, 9–11 September 2015, in Arusha, a symposium was organized on micronutrient risk–benefit assessments. Using case studies on folic acid, iodine and vitamin A, the presenters discussed how to maximize the benefits and minimize the risks of intervention programs to address micronutrient malnutrition. Pre‐implementation assessment of dietary intake, and/or biomarkers of micronutrient exposure, status and morbidity/mortality is critical in identifying the population segments at risk of inadequate and excessive intake. Dietary intake models allow to predict the effect of micronutrient interventions and their combinations, e.g. fortified food and supplements, on the proportion of the population with intakes below adequate and above safe thresholds. Continuous monitoring of micronutrient intake and biomarkers is critical to identify whether the target population is actually reached, whether subgroups receive excessive amounts, and inform program adjustments. However, the relation between regular high intake and adverse health consequences is neither well understood for many micronutrients, nor do biomarkers exist that can detect them. More accurate and reliable biomarkers predictive of micronutrient exposure, status and function are needed to ensure effective and safe intake ranges for vulnerable population groups such as young children and pregnant women. Modelling tools that integrate information on program coverage, dietary intake distribution and biomarkers will further enable program makers to design effective, efficient and safe programs.     

Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs

We estimated how micronutrient needs of young children, aged 6–24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in three age groups (6–8, 9–12, and 13–24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin D and iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin.     

Effects of dietary counselling on micronutrient intakes in pregnant women in Finland

The intake of some micronutrients is still a public health challenge for pregnant women in Finland. This study examined the effects of dietary counselling on micronutrient intakes among pregnant women at increased risk of gestational diabetes mellitus in Finland. This study utilised data from was a cluster‐randomised controlled trial (n = 399), which aimed to prevent gestational diabetes. In the intervention group, the dietary counselling was carried out at four routine visits to maternity care and focused on dietary fat, fibre and saccharose intake. A validated 181‐item food frequency questionnaire was used for evaluating the participants'' food consumption and nutrient intakes. The differences in changes in micronutrient intakes from baseline (pre‐pregnancy) to 36–37 weeks'' gestation were compared between the intervention and the usual care groups using multilevel mixed‐effects linear regression models, adjusted for confounders. Based on the multiple‐adjusted model, the counselling increased the intake of niacin equivalent (coefficient 0.50, 95% confidence interval [CI] 0.03–0.97), vitamin D (0.24, CI 0.05–0.43), vitamin E (0.46, CI 0.26–0.66) and magnesium (5.05, CI 0.39–9.70) and maintained the intake of folate (6.50, CI 1.44–11.56), from early pregnancy to 36 to 37 weeks'' gestation. Except for folate and vitamin D, the mean intake of the micronutrients from food was adequate in both groups at baseline and the follow‐up. In conclusion, the dietary counselling improved the intake of several vitamins and minerals from food during pregnancy. Supplementation on folate and vitamin D is still needed during pregnancy.     

Micronutrient fortification of foods — rationale,application and impact

Deficiencies in intake of essential vitamins and minerals (commonly referred to as micronutrients) that are essential for efficient energy metabolism and other functions of the human body (commonly termed as micronutrients) are severe and widespread in many parts of the world. They cause an immeasurable burden on individuals, on health services, education systems and families caring for children who are disabled or mentally impaired. Studies by World Bank have shown that countries whose populations suffer from micronutrient deficiencies encounter economic losses as high as 5% of gross domestic product (GDP). The solution to control and prevent micronutrient deficiencies is available and affordable. At a national level, micronutrient malnutrition can be addressed by implementing programmes designed to educate people to diversify their diets (where appropriate foods are available), or by fortifying commonly eaten foods with the missing micronutrients or providing nutrient supplements through targeted distribution programmes. Food fortification is increasingly recognized as an effective means of delivering micronutrients. Fortification of foods can provide meaningful amounts of the nutrient at normal consumption of the food vehicle. Proper choice of fortificant and processing methods could ensure the stability and bioavailability of the nutrient. The level of fortification should take into account variations in food consumption to ensure safety for those at the higher end of the scale and impact for those at the lower end. Fortification needs to be supported by adequate food regulations and labeling, quality assurance and monitoring to ensure compliance and desired impact. In industrialized countries food fortification has played a major role in the substantial reduction and elimination of a number of micronutrient deficiencies. Although a growing number of large scale fortification programmes in different parts of the world are beginning to demonstrate impact at the biochemical level and are leading to the elimination of several nutrient deficiencies, food fortification remains an underutilized opportunity in many developing countries where micronutrient malnutrition remains a public health problem.     

Agroforestry diversity,indigenous food consumption and nutritional outcomes in Sauria Paharia tribal women of Jharkhand,India

Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross‐sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty‐four‐hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty‐nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD‐W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD‐W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD‐W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women.     

Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh

Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women''s dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women''s dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.     

Effect of infections and environmental factors on growth and nutritional status in developing countries

Despite numerous advances and improvements in child health globally, malnutrition remains a major problem and underlies a significant proportion of child deaths. A large proportion of the hidden burden of malnutrition is represented by widespread single and multiple micronutrient deficiencies. A number of factors may influence micronutrient deficiencies in developing countries, including poor body stores at birth, dietary deficiencies and high intake of inhibitors of absorption such as phytates and increased losses from the body. Although the effects of poor intake and increased micronutrient demands are well described, the potential effects of acute and chronic infections on the body's micronutrient status are less well appreciated. Even more obscure is the potential effect of immunostimulation and intercurrent infections on the micronutrient distribution and homeostasis. The association therefore of relatively higher rates of micronutrient deficiencies with infectious diseases may be reflective of both increased predisposition to infections in deficient populations as well as a direct effect of the infection itself on micronutrient status indicators. Recently the association of increased micronutrient losses such as those of zinc and copper with acute diarrhea has been recognized and a net negative balance of zinc has been shown in zinc metabolic studies in children with persistent diarrhea. It is also recognized that children with shigellosis can lose a significant amount of vitamin A in the urine, thus further aggravating preexisting subclinical vitamin A deficiency. Given the epidemiological association between micronutrient deficiencies and diarrhea, supplementation strategies in endemic areas are logical. The growing body of evidence on the key role of zinc supplementation in accelerating recovery from diarrheal illnesses in developing countries supports its use in public health strategies.     

Growth failure. A complication of dietary treatment of hypercholesterolemia

We describe 8 children among a group of 40 in whom growth failure was associated with unsupervised dietary treatment of hypercholesterolemia. In 3 children, nutritional dwarfing ensued, and in 5, weight loss or insufficient weight gain occurred. Children with growth failure consumed significantly less energy and zinc than those children growing well. The dietary intakes of the 3 children with nutritional dwarfing were the most markedly deficient in total energy, fat, and micronutrients. These data suggest that the diagnosis and dietary treatment of hypercholesterolemia have potentially adverse consequences. Overzealous application of a low-fat, low-cholesterol diet may lead to growth failure due to inadequate intake of energy, vitamins, and minerals. Careful monitoring of children receiving modified fat and cholesterol intakes for hypercholesterolemia treatment is mandatory to ensure adequate nutrition for normal growth and development.     

An observational study to evaluate micronutrient status during enteral feeding.

BACKGROUND: There are few data on the optimal micronutrient composition of paediatric enteral feeds. The recent European Directive on Foods for Special Medical Purposes (1999/21/EC) did not distinguish between the composition of adult and paediatric feeds. AIMS: To evaluate, in an open, observational study, the long term nutritional biochemistry of 12 children aged 1-6 years and/or 8-20 kg. METHODS: The children were receiving at least 50% of their estimated average requirement (EAR) for energy from paediatric enteral formulae: 1.0 kcal/ml (Nutrison Paediatric Standard) or 1.5 kcal/ml (Nutrison Paediatric Energy Plus). Venous blood samples for trace elements, vitamins, and minerals were taken at study entry and six months later. Parents kept three day food and feed records every month. RESULTS: Despite a median energy intake of only 75% EAR (range 52-158%), 67% (n = 8) achieved their reference nutrient intake (RNI) for all micronutrients. No significant micronutrient deficiencies were seen on blood analysis after six months. Eighty three per cent (n = 10) had vitamin B(12) and 92% (n = 11) had copper intake >150% RNI. Fifty eight per cent (n = 7) had high plasma B(12) (>733 micromol/l) and 75% (n = 9) had high serum copper (>22 micromol/l) concentrations. CONCLUSIONS: Children without excess losses maintain adequate micronutrient status on long term enteral feeding. Subjects had high blood concentrations of vitamin B(12) and copper, and had high dietary intakes of these micronutrients. We suggest that the maximum nutrient guidelines for paediatric enteral feeds should be more clearly defined.     

Dietary intakes in children born small for gestational age and appropriate for gestational age: A longitudinal study

Children born small for gestational age (SGA) have an increased risk of cardiovascular disease (CVD) and associated risk factors in later life; however, little is known about their dietary intakes. The objective of this study was to assess dietary intakes in SGA and appropriate for gestational age (AGA) at 3.5, 7, and 11 years. The Auckland Birthweight Collaborative Study is a longitudinal case–control study of children born at term (n = 871). Children were assessed at 3.5 (n = 550), 7 (n = 591), and 11 (n = 620) years of age. Diet was assessed using a 24‐hr record‐assisted recall. Reported dietary intakes were analyzed and compared with the Australian and New Zealand Nutrient Reference Values. Compared with AGA, median energy intakes were significantly lower in SGA at 3.5 years (4.2 MJ [IQR, 3.0 to 5.8] vs. 5.4 MJ [IQR, 3.9 to 6.5]; p < .0001) but not at 7 and 11 years. Inadequate dietary intakes of micronutrients were more prevalent among SGA at 3.5 years and 11 years of age. A large proportion of SGA and AGA children consumed more than the recommended amounts of saturated fats, sugars, and sodium. There was no association of dietary intake and socio‐demographic factors. This study reveals that dietary intake in 3.5‐year‐old children born SGA is lower in energy and a variety of micronutrients compared with dietary intake in AGA. These intakes may however be appropriate given their BMI z‐scores. High intakes of sodium, saturated fat, and sugars are a concern for all children in this cohort.     

Traditional prenatal and postpartum food restrictions among women in northern Lao PDR

Culturally determined food restrictions are common among pregnant and postpartum women in Asia. This study aimed to describe perinatal dietary restrictions, factors associated with food avoidances and attainment of minimum dietary diversity (MDD-W) among women in Lao PDR. Mother–child (aged 21 days to <18 months) dyads (n = 682) were enrolled into a cohort study in northern Lao PDR and interviewed at one time point postpartum. During pregnancy and postpartum, 1.6% and 97% of women reported following dietary restrictions, respectively. Cluster analysis identified four distinct postpartum dietary patterns: most restrictive (throughout first 2 months postpartum); least restrictive; 2 weeks highly restrictive and 1 month highly restrictive, followed by 19%, 15%, 5% and 62% of women, respectively. Greater maternal age, gravidity and higher household socioeconomic status were associated with allowing more diverse foods, while women from food insecure households followed more restrictive diets for longer. Women belonging to the Hmong ethnic group followed a highly restrictive diet of white rice and chicken for the first month postpartum. MDD-W was achieved by 10% of women restricting their diet at the time of the interview compared with 17% of women who were consuming their normal diet (p = 0.04). Postpartum dietary restrictions are widespread among women in northern Lao PDR. These highly restrictive diets, low dietary diversity and food insecurity likely contribute to micronutrient deficiencies in women that may have important consequences for their breastfed infants through reduced breastmilk micronutrient content, which requires further exploration. Culturally appropriate strategies to increase micronutrient intakes among women should be considered.     

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana

Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW.Objective: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area.Methods: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-lmmuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 μg/dl, 80.0 μg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology.Results: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies.Conclusion: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.     

Growth and nutritional status of children with homozygous sickle cell disease

BACKGROUND: Poor growth and under-nutrition are common in children with sickle cell disease (SCD). This review summarises evidence of nutritional status in children with SCD in relation to anthropometric status, disease severity, body composition, energy metabolism, micronutrient deficiency and endocrine dysfunction. METHODS: A literature search was conducted on the Medline/PUBMED, SCOPUS, SciELO and LILACS databases to July 2007 using the keywords sickle cell combined with nutrition, anthropometry, growth, height and weight, body mass index, and specific named micronutrients. RESULTS: Forty-six studies (26 cross-sectional and 20 longitudinal) were included in the final anthropometric analysis. Fourteen of the longitudinal studies were conducted in North America, the Caribbean or Europe, representing 78.8% (2086/2645) of patients. Most studies were observational with wide variations in sample size and selection of reference growth data, which limited comparability. There was a paucity of studies from Africa and the Arabian Peninsula, highlighting a large knowledge gap for low-resource settings. There was a consistent pattern of growth failure among affected children from all geographic areas, with good evidence linking growth failure to endocrine dysfunction, metabolic derangement and specific nutrient deficiencies. CONCLUSIONS: The monitoring of growth and nutritional status in children with SCD is an essential requirement for comprehensive care, facilitating early diagnosis of growth failure and nutritional intervention. Randomised controlled trials are necessary to assess the potential benefits of nutritional interventions in relation to growth, nutritional status and the pathophysiology of the disease.