Iron deficiency risk in children: discrepancy between dietary and biochemical assessments

A random sample group of 300 children and adolescents (aged 0.5 to 16 years) from a Mediterranean town of Spain, were investigated as part of a health education program. Analysis of dietary iron intake and the biochemical parameters of iron status (red cell volume, erythrocyte protoporphyrin concentration, transferrin saturation percentage and serum ferritin) were measured. Based on dietary assessment, the percentage of children with iron intake levels below the Catalonia Recommended Daily Amounts varied from 24% to 77% and showed age and sex differences. The percentage of children with iron intakes below their own individual requirements varied between 7% and 41%. The age groups with the highest risk of iron deficiency were girls aged between 6 and 24 months, and boys aged between 13 and 16 years. However, based on the biochemically assessed iron status, the results revealed an overall prevalence of iron deficiency varying from 0 to 23.3%. The highest prevalence was encountered in boys and girls between 6 and 24 months (23.3%), compared with only 3.3% between 13 and 16 years. Despite conducting the investigation with the recommended controlled methodology, the results from dietary assessed risk of iron deficiency were significantly different from those assessed biochemically. Hence, caution is required when designing health programme strategies based exclusively on nutritional intake assessments.     

Nutritional status of adolescent girls in regard to zinc, copper, and iron

Adolescent girls in the sixth through eight grades were surveyed for dietary intake and nutritional status in regard to zinc, copper, and iron in both the fall of 1975 and the spring of 1976. The adolescents (183 girls in the fall and 184 girls in the spring) consumed on the average 60 and 75% of the Recommended Dietary Allowances for iron and zinc, respectively. The mean concentration of zinc in hair samples was 216 +/- 64 microgram/g in the fall and 191 +/- 36 microgram/g in the spring. The mean concentration of copper in hair samples was 31 +/- 23 microgram/g. None of the girls had a concentration of zinc in their hair samples of less than 100 microgram/g. Hair concentrations of zinc anc copper were significantly correlated, but serum and hair concentrations of zinc were inversely correlated. However, in subsample of 102 girls, 3% has serum zinc levels below 70 microgram/100 ml and 4% had serum copper levels below 70 microgram/100 ml. Only 1% of the subjects had a hematocrit below 36%. No significant difference in any of these parameters was noted between girls who had experienced menarche and those who had not.     

儿童锌缺乏敏感指标的评价

为评价反映儿童锌缺乏的敏感指标.方法 我们对300名3～6岁儿童进行膳食调查与体格检查,同时测定了锌缺乏组和对照组儿童的尿锌与尿肌酐比值,血清ALP活性,血清胆固醇水平及锌缺乏儿童补锌治疗前后上述指标的变化.结果 锌缺乏组与对照组尿锌与尿肌酐比值,血清ALP活性有显著性差异.锌缺乏组儿童血浆锌,尿锌与尿肌酐比值,血清ALP活性,血清胆固醇水平在补锌治疗前后有显著性差异.结论 血浆锌和血清ALP同时降低可以预示儿童体内锌缺乏,需要补锌治疗;尿锌与尿肌酐比值能较敏感地反映儿童的锌营养状况;胆固醇与锌营养之间的关系值得进一步研究.     

Nutrient Intake Adequacy from Food and Beverage Intake of US Children Aged 1–6 Years from NHANES 2001–2016

The early years, between the ages of one and six, are a period of rapid physical, social and cognitive growth and a nutritionally adequate diet is an important factor for optimum development. We investigated the micronutrient adequacy and status of young US children aged 1–6 years (n = 9848) using 24-h dietary recall interviews completed by parents and caregivers participating in the National Health and Nutrition Examination Survey (NHANES) 2001–2016. data. The proportion of the sample not meeting the Dietary Reference Intakes (DRI) increased with increasing age and was most pronounced for calcium. Despite adequate iron intake, 7.4% and 2.5% had signs of iron deficiency and anemia based on serum ferritin and hemoglobin levels, with younger children and WIC participants at most risk and Non-Hispanic Black children the least. Vitamin B6 intake was adequate, but 6.4% had serum pyridoxal-5-phosphate deficiency. For vitamin E, 69% had intakes below the estimated average requirement (EAR), yet serum deficiency was only detected in 0.9%. Vitamin D intake was inadequate for 87%, but true deficiency may be overestimated. Mean DHA intake was 24 mg/d, well below expert recommendations of 70–100 mg/day. Iron and vitamin B6 deficiency and inadequate calcium, fiber, choline, potassium and DHA intakes are a concern for a significant percentage of young children. The discrepancy between nutrient intakes and serum deficiency levels needs to be further investigated.     

云南大红山铜矿区成年居民铜、铁、锌血清水平和膳食摄入量

目的 了解云南大红山铜矿成年居民铜、铁、锌的血清水平和膳食摄入量.方法 在大红山矿区随机抽取180名成年居民,采用原子吸收分光光度法检测血清铜、铁、锌水平.从180人中随机抽取60人,采刚化学分析法调查膳食铜、铁、锌摄入量.结果 171人的血清铜、铁、锌水平分别为（0.90±0.18）、（1.25±0.93）、（0.75±0.28）mg/L,血清铜和铁呈显著负相关（r=-0.26,P＜0.001）.血清铜与年龄呈显著正相关（r=0.25,P＜0.001）,女性血清铜水平明显高于男性（P=0.011）.60人的膳食铜、铁、锌摄入量分别为（1.74±1.09）、（16.29±10.73）、（7.56±3.38）mg/d,女性均明显低于男性（P＜0.05）.血清铜、铁、锌水平和膳食摄入量均存在地区差异.结论 云南大红山矿区成年居民血清铜、铁水平均正常,血清锌水平偏低.铜、铁、锌的膳食摄入量均未超过可耐受最高摄人量,且部分人摄入量偏低.     

Changes in vitamin and mineral intakes and serum concentrations among free-living men on cholesterol-lowering diets: the Dietary Alternatives Study

Nutritional adequacy of diets with 18-30% of calories from fat was investigated in men with elevated serum cholesterol (n = 396) at the end of diet classes and 1 and 2 y later. On 4-d food records, intakes of vitamin A, beta-carotene, folate, vitamin C, magnesium, vitamin B-6, iron, thiamin, and riboflavin increased from baseline whereas niacin, selenium, vitamin E, and zinc decreased. Median zinc intake, 80% of the recommended dietary allowance (RDA) at baseline, decreased to approximately 75% of the RDA, most markedly when intakes of meat, fish, and poultry were limited to 85 g/d. Nutrient densities generally increased. Of the serum nutrients measured, median beta-carotene and vitamin C increased, whereas vitamin B-6, iron, and zinc were unchanged. Below-normal values were fewer for vitamin C and magnesium. Diets similar to the National Cholesterol Education Program Step-Two Diet [less than 7% saturated fatty acids, less than 200 mg cholesterol/d] appeared to provide increased levels of most micronutrients both short and long term to men receiving comprehensive dietary counseling.     

学龄儿童维生素A营养状况及其与铁的相关性研究

为观察学龄儿童维生素A(VA)营养状况、亚临床VA缺乏患病率及VA与铁的相关性 ,对北京房山山区 1 0 1 2名 7～ 1 3岁学龄儿童进行膳食调查 ,随机抽取 30 5名儿童 ,静脉采血于避光下分离血清 ,用高效液相色谱法检测血清VA含量 ,同时测定其血清铁蛋白 (SF)、红细胞游离原卟啉 (FEP)和血红蛋白 (Hb) ,并依现行标准将其分为正常、铁缺乏 (ID)、红细胞生成缺铁期 (IDE)与缺铁性贫血 (IDA)四组 ,观察VA与铁的相关性。结果显示受检儿童膳食总能量、蛋白质和铁平均每日摄入量均达到膳食营养素的推荐摄入量 (RNI)及适宜摄入量 (AI) ,但平均每日VA摄入量为 (51 3 7± 2 86 1 ) μgRE ,仅占RNI的 59 7% ;血清VA平均含量为(1 0 1± 0 2 9) μmol L ,血清VA低于 1 0 5μmol L者占受检儿童的 59 0 % ,其中 1 2 8%的儿童血清VA低于0 70 μmol L ,正常及以上者仅占 41 0 %。并观察到血清VA含量与机体铁状况有相互随对方下降而减低的趋势。结果表明 ,该地区儿童存在明显的VA缺乏 ,应加强营养教育、改善不合理的膳食结构并通过适当的VA防治予以纠正     

Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey, 1988-1994

Approximately 10.2 million persons in the United States sometimes or often do not have enough food to eat, a condition known as food insufficiency. Using cross-sectional data from the Third National Health and Nutrition Examination Survey (NHANES III), we examined whether dietary intakes and serum nutrients differed between adults from food-insufficient families (FIF) and adults from food-sufficient families (FSF). Results from analyses, stratified by age group and adjusted for family income and other important covariates, revealed several significant findings (P < 0.05). Compared with their food-sufficient counterparts, younger adults (aged 20-59 y) from FIF had lower intakes of calcium and were more likely to have calcium and vitamin E intakes below 50% of the recommended amounts on a given day. Younger adults from FIF also reported lower 1-mo frequency of consumption of milk/milk products, fruits/fruit juices and vegetables. In addition, younger adults from FIF had lower serum concentrations of total cholesterol, vitamin A and three carotenoids (alpha-carotene, beta-cryptoxanthin and lutein/zeaxanthin). Older adults (aged > or =60 y) from FIF had lower intakes of energy, vitamin B-6, magnesium, iron and zinc and were more likely to have iron and zinc intakes below 50% of the recommended amount on a given day. Older adults from FIF also had lower serum concentrations of high-density lipoprotein cholesterol, albumin, vitamin A, beta-cryptoxanthin and vitamin E. Both younger and older adults from FIF were more likely to have very low serum albumin (<35 g/L) than were adults from FSF. Our findings show that adults from FIF have diets that may compromise their health.     

Food consumption patterns of Canadian preschool children in relation to zinc and growth status

Hair and serum zinc and copper, growth percentiles, and dietary intakes, based on 3-day weighed food records, were determined for 106 Canadian preschool children (62 M, 44 F) aged 4-5 yr. Mean (+/- SD) hair zinc levels were (M) 103 +/- 35 micrograms/g vs (F) 129 +/- 34 micrograms/g, p less than 0.001, and median hair copper level was 12.4 micrograms/g (M + F). Mean serum zinc and copper were 111 +/- 13 micrograms/dL (M + F) and 122 +/- 21 micrograms/dL (M + F), respectively. Males with low hair zinc (less than 70 micrograms/g) had a lower mean height-for-age percentile (42 +/- 29 vs 58 +/- 25%, p less than 0.05), even when adjusted for midparent height. Males with hair zinc less than 70 micrograms/g and/or height-for-age less than 15% consumed less meat, poultry, and fish and received similar average zinc intakes but higher calcium intakes than males with hair zinc greater than or equal to 70 micrograms/g and/or height-for-age greater than or equal to 15%. Suboptimal zinc nutriture was associated with lower intakes of readily available zinc from flesh foods and higher intakes of calcium.     

Physical training and copper, iron, and zinc status of swimmers

The influence of physical training on copper, iron, and zinc nutriture was studied before and at the end of a competitive season in 16 female and 13 male swimmers and in 13 female and 15 nontraining control subjects. Mean daily energy, protein, and carbohydrate intakes increased (p less than 0.05) in the swimmers. Estimated copper, iron, and zinc intakes increased (p less than 0.05) in the male swimmers. Hematocrit and hemoglobin did not change but ferritin increased (p less than 0.05) in male swimmers. Plasma copper, iron and zinc were within the ranges of normal values and did not change. Erythrocyte superoxide dismutase (SOD) activity increased (p less than 0.01) after training. The findings indicate that copper, iron, and zinc nutriture is not adversely affected by physical training when dietary intakes are adequate, and that increases in red blood cell SOD activity without an increase in dietary copper are a functional adaptation of copper metabolism to aerobic training.     

Nutrient intake of Korean-American, Korean, and American adolescents

This study compared dietary intakes of Korean, Korean-American, and American adolescents. Data were collected by 24-hour recall method from 471 Korean and 134 Korean-American adolescents. Data for American adolescents were obtained from NHANES III. Korean Americans had the lowest energy and cholesterol intakes but a higher percentage of energy from fat compared with Koreans. Korean and Korean Americans had lower intakes of calcium, iron, and zinc but higher sodium intake than Americans. Intakes of energy, folate, calcium, and iron in all three groups were below the recommended intakes for American adolescents. Korean Americans consumed cooked rice and Kimchi less often, but cookies, sweets, and soda were consumed more frequently than Koreans. These results indicate that Korean-American adolescents' dietary profiles are midway between those typical in Korea vs the United States. Nutrition education must focus on the benefits and weaknesses of Korean and western diets and how to blend the two cultures for optimal nutrition.     

Production of stable-isotope-labeled bovine heme and its use to measure heme-iron absorption in children

BACKGROUND: The use of stable isotopes has provided valuable insights into iron absorption in humans, but the data have been limited to nonheme iron. OBJECTIVE: Our objectives were to produce heme iron enriched in (58)Fe and to use it to study the absorption of heme iron and the effect of iron and zinc intakes on heme-iron absorption in children. DESIGN: Labeled bovine heme was produced in a bovine model. Forty-eight children were randomly assigned to consume identical meals containing 1 of 3 doses of labeled heme iron (2, 4, or 8 mg as hemoglobin) and 1 of 2 doses of inorganic zinc (1 or 9 mg); successful measurements of iron absorption, zinc absorption, or both were made in 40 of these subjects. We hypothesized that fractional heme-iron absorption would decrease as heme-iron intake increased and that higher zinc intakes would decrease heme-iron absorption. RESULTS: (58)Fe heme was produced with an enrichment (mass/mass) of 9.5%. Fractional iron absorption in children was significantly affected by the intake of heme iron (P = 0.0013) and of zinc (P = 0.0375), but, contrary to expectations, heme-iron absorption was higher at higher zinc intakes. Absolute heme-iron absorption was higher in the group with higher zinc intakes, but only for those with the lowest heme-iron intake (2 mg; P = 0.0147). Although fractional zinc absorption decreased as zinc intake increased (P = 0.031), absolute zinc absorption continued to increase across the intake range studied (P = 0.018). CONCLUSIONS: Heme iron intrinsically labeled with (58)Fe can be produced at sufficient enrichments for use in human studies. In children, heme iron and zinc absorption decrease as the dose of each mineral increases. Heme iron did not inhibit zinc absorption. At lower heme intakes, zinc intakes may increase heme-iron absorption.     

Nutritional and physiological status of U.S. national figure skaters

This study assessed the nutrient intake, body composition and biochemical indices of National Figure Skating Championship competitors. Four-day diet records, fasting blood samples, and anthropometric measurements were obtained 2 months after the National Championships from 41 figure skaters 11-18 years of age. Energy, carbohydrate, fat, dietary fiber and cholesterol intake were significantly lower compared to the NHANES III averages for adolescents in the U.S. In general, the mean intakes for most vitamins except vitamin D and E were above the recommended intake. But the athletes had lower intakes of vitamin E and B12, and higher intakes of vitamin C, and thiamin (females only) compared with NHANES III. The mean intakes of magnesium, zinc, and iodine by the male skaters were below the recommended levels, as were the mean intakes of calcium, iron, phosphorus, magnesium, and zinc by the female skaters. Also, the number of servings from vegetable, fruit, dairy, and meat groups were below the recommended levels. Biochemical indices of nutritional status were within normal limits for all skaters. But plasma electrolyte concentrations were indicative of potential dehydration status. The results suggest there is a need to develop dietary intervention and educational programs targeted at promoting optimal nutrient and fluid intakes by these athletes to maintain performance and improve long-term health status.     

Weight-for-height measurement and saturated fatty acid intake are predictors of serum cholesterol level in children.

To assess the relationship of serum cholesterol level to anthropometric measurements and dietary intake, we measured serum cholesterol, height, weight, triceps skinfold, and 24-hour dietary intake in 80 children (mean age = 9.8 years) during April 1989. The mean serum cholesterol level was 3.95 mmol/l. In comparison with national data, weight-for-height and triceps skinfold measurements exceeded the 90th percentile in 18 (23%) and 26 (33%) of the children, respectively. Mean cholesterol and fat intakes were 114 mg/1,000 kcal and 36% of energy, respectively. In multiple stepwise regression analyses, weight-for-height measurement and saturated fatty acid intake were most predictive of serum cholesterol levels. Diets of children who consumed 30% of energy or less from fat (low-fat group) met or exceeded the Recommended Dietary Allowances except for energy and vitamin E and were higher in percentage of energy from carbohydrate, dietary fiber, magnesium, iron, and copper than were diets of children who consumed 31% of energy or more from fat (high-fat group). Children in the high-fat group ate more red/processed meats, baked desserts, and fats/oils than children in the low-fat group. Our data indicate that programs to reduce risk of cardiovascular disease in children may need to focus on maintaining ideal body weight and reducing saturated fatty acid intake.     

Zinc status and sexual development in adolescent girls

Forty-eight black adolescent girls, aged 8 to 16, from the inner city of Baltimore were divided into five groups according to breast and pubic hair development. Blood and hair zinc concentrations as analyzed by atomic absorption spectrophotometry were within ranges reported by other investigators. Hair zinc levels significantly increased (p less than .05) from the second to the last stage of puberty and were significantly correlated (p less than .05) with erythrocyte zinc levels, height, and weight. Mean dietary intakes of calories and protein, as measured from a 24-hour recall, were adequate and increased with stage of breast and pubic hair development. Mean zinc intakes reported in the 24-hour recall averaged 66% of the RDA in the latter half of puberty. It appeared that zinc nutriture was generally adequate in this population, even though the dietary intake of zinc was below the recommended level.     

Cross-sectional study of blood lead effects on iron status in Korean lead workers

OBJECTIVE: This study assessed the iron status of Korean male lead workers by measuring the dietary iron intake and biochemical indices, and tested the hypothesis that a high blood lead level is associated with impaired iron function, which results in higher prevalence of iron deficiency when the route of exposure is not the gastrointestinal tract. METHODS: One hundred eighteen lead workers and 42 non-lead workers were recruited from mandatory annual health surveillance sites for industrial workers. Blood lead, hemoglobin, and hematocrit levels were evaluated as hematologic parameters, and serum iron concentrations, total iron-binding capacity, and percentage of transferrin saturation were evaluated as iron-status parameters. Dietary iron intake was assessed by a 24-h recall method. RESULTS: Lead workers had significantly lower hemoglobin, hematocrit, serum iron levels, percentage of transferrin saturation, and dietary iron intake than did non-lead workers, and they had significantly higher (P < 0.01) total iron-binding capacity. The occurrence of iron-deficiency cases, as assessed by hematocrit values, was significantly higher (P < 0.001) in lead workers than in non-lead workers, and the prevalence of iron deficiency was associated with high blood lead levels (P = 0.033). The dietary iron intake was inversely associated with zinc protoporphyrin (P = 0.032). CONCLUSIONS: This study confirmed the adverse effects of high blood lead levels on hematologic pathways and the effectiveness of dietary iron intake as a secondary preventive intervention against lead toxicity. To promote health and to prevent toxic effects of lead exposure in Korean lead workers, an adequate intake of dietary iron is strongly recommended.     

Influence of dietary and socio-demographic factors on the iron status of married adolescent girls from Indian urban slums

To explore the influence of dietary factors of iron bioavailability and socio-demographic conditions on blood iron status of married adolescent girls (MAG), a cross-sectional study was conducted in 173 MAG (15–19 years old) from urban slums near Pune city, India. Diet was assessed by two random 24-h recalls. The age, weight, height, education, family size, income, physical work, and number of days of menstrual loss were recorded. Fasting blood was analyzed for hemoglobin and serum ferritin. Mean intakes of micronutrients were 40–75% less than the recommended dietary intakes for Indian adolescent girls. High intake of phytates (171±6 mg/day) and low intakes of vitamin C (25±1 mg/day) resulted in low bioavailable iron intakes. The mean bioavailable iron intake was 0.76±0.3 mg/day, which is one-half of the basal iron requirement of adolescent girls. The prevalence of iron deficiency (serum ferritin<12 µg/l) was 25.1%, and anemia (hemoglobin <12 g/l) was seen in 46.4% of MAG. A multiple regression model adjusted for energy intake indicated that intakes of β-carotene and riboflavin were associated with hemoglobin (P<0.001) and those of zinc, riboflavin and thiamin associated with serum ferritin (P<0.01). Multiple regressions including socio-demographic factors revealed that the family size, number of menstrual days lost and total bioavailable iron intake were the influencing factors for low iron status. In conclusion, there is a need to increase intakes of vitamin C and other micronutrients of the MAGs and to improve iron bioavailability through diet modifications.     

Influence of dietary and socio-demographic factors on the iron status of married adolescent girls from Indian urban slums

To explore the influence of dietary factors of iron bioavailability and socio-demographic conditions on blood iron status of married adolescent girls (MAG), a cross-sectional study was conducted in 173 MAG (15-19 years old) from urban slums near Pune city, India. Diet was assessed by two random 24-h recalls. The age, weight, height, education, family size, income, physical work, and number of days of menstrual loss were recorded. Fasting blood was analyzed for hemoglobin and serum ferritin. Mean intakes of micronutrients were 40-75% less than the recommended dietary intakes for Indian adolescent girls. High intake of phytates (171+/-6 mg/day) and low intakes of vitamin C (25+/-1 mg/day) resulted in low bioavailable iron intakes. The mean bioavailable iron intake was 0.76+/-0.3 mg/day, which is one-half of the basal iron requirement of adolescent girls. The prevalence of iron deficiency (serum ferritin<12 microg/l) was 25.1%, and anemia (hemoglobin <12 g/l) was seen in 46.4% of MAG. A multiple regression model adjusted for energy intake indicated that intakes of beta-carotene and riboflavin were associated with hemoglobin (P<0.001) and those of zinc, riboflavin and thiamin associated with serum ferritin (P<0.01). Multiple regressions including socio-demographic factors revealed that the family size, number of menstrual days lost and total bioavailable iron intake were the influencing factors for low iron status. In conclusion, there is a need to increase intakes of vitamin C and other micronutrients of the MAGs and to improve iron bioavailability through diet modifications.     

Nutritional status of an institutionalised elderly group in Segovia (Spain)

The nutritional status of a randomly selected sample of healthy persons, aged 68-91 years, living in an institution of the Spanish Social Services, was evaluated according to the adequation of diet to Recommended Dietary Intakes (DR) and by biochemical measurements. The individual weighing method was used to make the control of food intake covering a week. Mean values obtained suggested that intakes were less than recommended ones for energy, calcium, magnesium, zinc, riboflavin, folic acid and A and D vitamins. Mean intake of protein, iodine, iron, thiamin, niacin, B12 and C vitamins was adequate. For biochemical data most of the individuals present acceptable values, only a few aged show a deficiency status. Serum vitamin A values were low in 13.3% of men and 37.5% of women and serum cholesterol values were high in 8.3% of women.     

Dietary studies of children from a biracial population: intakes of fat and fatty acids in 10- and 13-year olds

Dietary intakes of fat and fatty acids were examined in children randomly selected from a biracial community, Bogalusa, LA. Between two 10-yr-old groups examined 3 yr apart, temporal trends of 1) higher intakes of polyunsaturated fatty acids, linoleic and linolenic acids, and 2) lower intakes of animal fat, saturated fatty acids, and palmitic acid were documented. No racial differences were found, and the only difference between sexes was for myristic acid (boys greater than girls). Longitudinal comparisons of a cohort of 148 children examined at both 10 and 13 yr showed higher intakes over time of unsaturated fatty acids, polyunsaturated fatty acids, vegetable fat, oleic, linoleic, and linolenic acids, and lower intakes of cholesterol, saturated fatty acids, animal fat, and myristic acid. The percentage of energy intake from fat, saturated fatty acids and polyunsaturated fatty acids was quite similar to other reports of US children and adults. Few children's intakes of cholesterol, fat, and fatty acids were compatible with current recommendations for prudent diets. Patterns of dietary fat and fatty acid intake of Bogalusa children reflect reported food market trends of increased use of vegetable fats.