Iodine Nutritional Status and Related Factors among Chinese School-Age Children in Three Different Areas: A Cross-Sectional Study

We evaluated the iodine nutritional status and related factors among school-age children based on the 2016 National Nutrition and Health Surveillance of Children and Lactating Women; 3808 children from Hebei, Guangxi, and Zhejiang province were included in the study. Urinary iodine concentration (UIC), thyroid-stimulating hormone (TSH), body mass index (BMI), vitamin A (VA), and vitamin D (VD) were measured. The abnormal rate of UIC and TSH were assessed. Relationships between UIC/TSH and the possible factors were analyzed. The overall median UIC was 185.14 µg/L, and the median UIC of children aged 8–10 was 164.60 µg/L. Prevalence of iodine deficiency and excess was 13.84% and 14.36%, respectively, and 12.87% of children showed TSH excess. UIC, as well as the abnormal rates of iodine deficiency (ID) and TSH, were significantly different among the three provinces. The median UICs and excess rates increased with age, reaching 211.45 µg/L and 21.35% at age of 14~, while TSH showed the opposite trend. Overweight children tended to have lower UIC and higher TSH. Higher UIC and TSH were found in VA sufficient group (p < 0.01). Further, the VD deficient group had a higher TSH compared to the sufficient group (p < 0.01). Moreover, UI and TSH distribution was obviously different among different vitamin A/D status (p < 0.05). Although the median UIC of school-age children was optimal, there were pockets of inadequate and excessive UI in the three provinces. Compared to the national IDD monitoring results in 2014, the iodine nutritional status of children was greatly improved. Considerations of region, age, BMI, VA, or VD are needed in the future iodine evaluation and surveillance.     

Micronutrient Status and Dietary Diversity of Women of Reproductive Age in Rural Pakistan

Consuming a diverse diet is essential to ensure an adequate intake of micronutrients. The aim of this study was to assess the nutritional status and dietary diversity of women of reproductive age (WRA) living in a marginalized community in rural Pakistan. Forty-seven WRA (35 ± 7 years old) who were not pregnant or lactating at enrollment, were recruited to participate in the study. Twenty-four-hour dietary recall interviews were conducted by the study nutritionist, and the data collected were used to create a minimum dietary diversity for women score (MDD-W) on five occasions during the monsoon and winter seasons (October to February). Nutritional status was assessed using anthropometry and biochemical markers of micronutrient status. Height and weight were used to determine body mass index (BMI), and mid-upper-arm circumference was measured. Plasma zinc, iron, and selenium concentrations were measured using inductively coupled mass spectrometry, and iron status was assessed using serum ferritin and blood hemoglobin concentrations. The mean (±SD) food group diversity score was 4 ± 1 with between 26% and 41% of participants achieving an MDD-W of 5. BMI was 27.2 ± 5.5 kg/m² with 28% obese, 34% overweight, and 6% underweight. The prevalence of zinc deficiency, based on plasma zinc concentration, was 29.8%; 17% of the participants had low plasma selenium levels; 8.5% were iron deficient; and 2% were suffering from iron deficiency anemia. The findings indicate that the women living in this community consume a diet that has a low diversity, consistent with a diet low in micronutrients, and that zinc deficiency is prevalent. Public health interventions aimed at increasing the dietary diversity of WRA are needed to improve the micronutrient intake, particularly of zinc, in this population.     

Consumption of Micronutrient Powder,Syrup or Fortified Food Significantly Improves Zinc and Iron Status in Young Mexican Children: A Cluster Randomized Trial

The objective of this study was to compare the effect of three micronutrient products on biomarkers of iron and zinc status of Mexican children 6–12 months of age. As part of research to improve the impact of a national program, 54 communities were randomly assigned to receive: (1) fortified food (FF), provided by the program at the time, or (2) micronutrient powders (MNP) or (3) syrup. Each product contained 10 mg each of zinc and iron, plus other micronutrients. Children consumed the product 6 days/week for four months. Primary outcomes were changes in serum zinc, ferritin, soluble transferrin receptor, hemoglobin concentrations, and their deficiencies. Zinc concentration increased significantly from baseline to follow-up in all groups, with the largest change in the syrup group (geometric mean difference: +4.4 µmol/L; 95%CI: 3.2, 5.5), followed by MNP (+2.9 µmol/L; 95%CI: 2.1, 3.6) and FF (+0.9 µmol/L; 95%CI: 0.3, 1.6). There was a significant increase in hemoglobin concentration (+5.5 g/L; 2.5, 8.4) and a significant reduction in anemia prevalence (44.2% to 26.8%, p < 0.01) only in the MNP group. Compliance differed significantly among groups (MNP vs. FF, p = 0.04; MNP vs. syrup, p = 0.04), but may not fully explain the greater improvement in zinc and iron status in the syrup and MNP groups. The food matrix may influence nutrient utilization from supplements.     

Micronutrient Adequacy in the Diet of Reproductive-Aged Adolescent Girls and Adult Women in Rural Bangladesh

Micronutrient deficiencies remain a serious nutritional concern in Bangladesh, especially among rural women of reproductive age (WRA). This study assesses the diet quality of reproductive-aged adolescent girls and adult women (referred to together as WRA in this study), including socio-demographic factors associated with their diet quality. The diet quality of adolescent girls was compared with that of adult women to assess which group was most at risk. The diet quality was measured by calculating the nutrient adequacy ratio (NAR), using the preceding 24 h dietary recall method. The mean adequacy ratio (MAR) was calculated as an overall measure of diet quality using the NAR. Nearly three quarters of WRA (adolescents: 73.1–88.5%; adult women: 72.9–86.4%) had an inadequate intake of calcium, vitamin A, folic acid, and vitamin B12. The prevalence of inadequate dietary intakes of calcium, zinc, and energy was significantly higher in adolescent girls (p < 0.001) than in adult women. Overall diet quality was significantly better in adult women (0.51 ± 0.21, p < 0.001) than in adolescent girls (0.49 ± 0.22). Age, marital status, educational level, and monthly household income were important factors associated with the diet quality of WRA. Micronutrient inadequacy is widely prevalent in the diets of WRA in Bangladesh, and adolescent girls with poor socio-economic status and lower educational levels are at higher risk.     

Probiotic Supplementation and Micronutrient Status in Healthy Subjects: A Systematic Review of Clinical Trials

Micronutrient deficiencies are a worldwide public health concern. Emerging evidence supports the ability of probiotics to enhance micronutrient status, which could aid in the prevention of non-communicable disease-associated malnutrition. This systematic review evaluated evidence of the efficacy of probiotic supplementation to improve micronutrient status in healthy subjects. The authors searched for published English language peer-reviewed journal articles in PubMed, Scopus, Embase, and Google Scholar databases from inception to July 2020 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of eligible studies was assessed using the Revised Cochrane Risk-of-Bias tool (RoB)2 and Risk of Bias in Non-Randomized Studies of Interventions tool (ROBINS-I tool). Fourteen original studies out of 2790 met the inclusion criteria. The results indicated that, despite varying degrees of efficacy, the intake of certain probiotics in healthy subjects was associated with a positive impact on the status of certain micronutrients (vitamin B12, calcium, folate, iron and zinc). A limitation was that studies were widely heterogeneous in terms of participant age, probiotic strain, species, dosage, intervention duration, and form of administration. Additional clinical trials are warranted to determine the most effective strains of probiotics, doses and durations of interventions.     

The Impact of Consuming Zinc-Biofortified Wheat Flour on Haematological Indices of Zinc and Iron Status in Adolescent Girls in Rural Pakistan: A Cluster-Randomised,Double-Blind,Controlled Effectiveness Trial

Biofortification of wheat is potentially a sustainable strategy to improve zinc intake; however, evidence of its effectiveness is needed. A household-based, double-blind, cluster-randomized controlled trial (RCT) was conducted in rural Pakistan. The primary objective was to examine the effects of consuming zinc-biofortified wheat flour on the zinc status of adolescent girls aged 10–16 years (n = 517). Households received either zinc-biofortified flour or control flour for 25 weeks; blood samples and 24-h dietary recalls were collected for mineral status and zinc intake assessment. Plasma concentrations of zinc (PZC), selenium and copper were measured via inductively coupled plasma mass spectrometry and serum ferritin (SF), transferrin receptor, alpha 1-acid glycoprotein and C-reactive protein by immunoassay. Consumption of the zinc-biofortified flour resulted in a moderate increase in intakes of zinc (1.5 mg/day) and iron (1.2 mg/day). This had no significant effect on PZC (control 641.6 ± 95.3 µg/L vs. intervention 643.8 ± 106.2 µg/L; p = 0.455), however there was an overall reduction in the rate of storage iron deficiency (SF < 15 µg/L; control 11.8% vs. 1.0% intervention). Consumption of zinc-biofortified flour increased zinc intake (21%) but was not associated with an increase in PZC. Establishing a sensitive biomarker of zinc status is an ongoing priority.     

Anemia among Adolescent Girls in West Java,Indonesia: Related Factors and Consequences on the Quality of Life

Anemia in adolescent girls is still a problem in Indonesia. The impact of anemia is quite significant for adolescent health. This study aims to analyze related factors of anemia among adolescent girls, and the effect of anemia on the quality of life. The study was conducted in the Soreang District, West Java, Indonesia. This cross-sectional study involved 286 female students (15–19 years). A 24-h recall questionnaire was used to collect the nutrient intake. We use the WHOQOL-BREF to analyze the quality of life. The study assessed height, weight, body mass index (BMI), mid-upper arm circumference (MUAC), and a capillary blood sample to determine hemoglobin levels. Bivariate and multiple logistic regression tests were measured to find the factors most influencing anemia. The prevalence of anemia was 14.3%. Related factors of anemia in this study were: duration of blood show per menses, iron consumption, weight, height, and MUAC. From bivariate analyses, anemia influenced the social relationships domain with p < 0.05. Multivariate logistic regression showed that the most influencing factors for anemia were MUAC and duration of blood per menses. Anemia impacted the social relationships domain. In this study, the two main factors that affected anemia were MUAC and duration of blood each menstrual cycle.     

Associations between Serum Vitamin A and Metabolic Risk Factors among Eastern Chinese Children and Adolescents

Vitamin A, a fat-soluble essential vitamin, is implicated in a large range of physiological processes. Up to now, the associations between vitamin A and metabolic syndrome (MetS) or other metabolic risk factors are controversial in children and adolescents. Thus, we aimed to dig into the relationship of vitamin A with MetS and many other metabolic risk factors. This was a cross-sectional study derived from the China National Nutrition and Health Surveillance of Children and Lactating Mothers. A total of 3025 school-aged (7–17 years) children and adolescents were selected by applying multistage stratified cluster random sampling methods in the Jiangsu Province of eastern China. Through enquiry survey, anthropometric measurement and laboratory examination, relevant information and blood biochemical indexes of the participants were collected in this study. MetS was identified according to the modified criteria of the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III). Multivariate logistic analysis and the generalized additive model (GAM) were used to analyze the relationship between vitamin A and various metabolic risk factors. The overweight, obesity and MetS prevalence of children and adolescents in this study was 14.0%, 11.9% and 5.1%, respectively. The risk of prevalent MetS, general obesity, high low-density lipoprotein (LDL), high total cholesterol (TC) and hyperuricemia increased with vitamin A in a dose-dependent way. Logistic regression analysis showed that serum vitamin A Z scores were positively associated with MetS and central obesity, elevated blood pressure (BP) and elevated triglyceride (TG). Sex stratification analysis showed that both in male and female participants, the risk of prevalent MetS, general obesity, high LDL, high TC and hyperuricemia still increased with vitamin A levels. MetS was at a high prevalence level in children and adolescents in Jiangsu that were 7–17 years old. Vitamin A was positively associated with obesity, MetS, dyslipidemia and hyperuricemia. More public health measures and new visions should focus on the effects of retinol on children and adolescents.     

Association of Dietary Pattern with Cardiovascular Risk Factors among Postmenopausal Women in Taiwan: A Cross-Sectional Study from 2001 to 2015

Unhealthy diet and inappropriate lifestyle contribute to an imbalance in cardiometabolic profiles among postmenopausal women. This research aimed to analyze the association between dietary pattern and changes in cardiovascular risk factors among postmenopausal Taiwanese women using binary logistic regression. This cross-sectional study involved 5689 postmenopausal Taiwanese women aged 45 years and above, and the data were obtained from Mei Jau Health Management Institution database between 2001 and 2015. The cardiovascular risk dietary pattern characterized by high intakes of processed food, rice/flour products, organ meat, and sauce was derived by reduced rank regression. Participants in the highest quartile of the cardiovascular risk dietary pattern were more likely to have high levels of systolic blood pressure (OR = 1.29, 95% CI 1.08–1.53), diastolic blood pressure (OR = 1.28, 95% CI 1.01–1.62), atherogenic index of plasma (OR = 1.26, 95% CI 1.06–1.49), triglycerides (OR = 1.38, 95% CI 1.17–1.62), and fasting blood glucose (Q3: OR = 1.45, 95% CI 1.07–1.97). However, this dietary pattern was not correlated with total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and C-reactive protein. Therefore, adherence to the cardiovascular risk dietary pattern increases the risk of having higher levels of blood pressure, triglycerides, fasting blood glucose in postmenopausal Taiwanese women.     

Co-Occurrence of Overweight/Obesity,Anemia and Micronutrient Deficiencies among Non-Pregnant Women of Reproductive Age in Ghana: Results from a Nationally Representative Survey

Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.     

The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study

Vitamin D and zinc are important components of nutritional immunity. This study compared the serum concentrations of 25-hydroxyvitamin D (25(OH)D) and zinc in COVID-19 outpatients with those of potentially non-infected participants. The association of clinical symptoms with vitamin D and zinc status was also examined. A checklist and laboratory examination were applied to collect data in a cross-sectional study conducted on 53 infected outpatients with COVID-19 and 53 potentially non-infected participants. Serum concentration of 25(OH)D were not significantly lower in patients with moderate illness (19 ± 12 ng/mL) than patients with asymptomatic or mild illness (29 ± 18 ng/mL), with a trend noted for a lower serum concentration of 25(OH)D in moderate than asymptomatic or mild illness patients (p = 0.054). Infected patients (101 ± 18 µg/dL) showed a lower serum concentration of zinc than potentially non-infected participants (114 ± 13 µg/dL) (p = 0.01). Patients with normal (odds ratio (OR), 0.19; p ≤ 0.001) and insufficient (OR, 0.3; p = 0.007) vitamin D status at the second to seventh days of disease had decreased OR of general symptoms compared to patients with vitamin D deficiency. This study revealed the importance of 25(OH)D measurement to predict the progression of general and pulmonary symptoms and showed that infected patients had significantly lower zinc concentrations than potentially non-infected participants.     

Dietary Determinants of and Possible Solutions to Iron Deficiency for Young Women Living in Industrialized Countries: A Review

Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency.     

农村已婚妇女阴道滴虫感染危险因素病例对照研究

目的探讨农村已婚妇女阴道滴虫感染危险因素,为实施干预措施提供依据。方法应用病例对照研究,对212例阴道滴虫感染者和308例阴道滴虫检查呈阴性者做对照,进行阴道滴虫感染因素问卷调查和有关知识水平考核,并用SAS统计软件进行单因素分析和多因素Logistic多元回归分析。结果影响农村已婚妇女阴道滴虫感染的主要危险因素为:洁阴用具是否自用(OR=2.65、95%CI=1.70～4.14)、每周清洗会阴次数(OR=2.06、95%CI=1.52～2.80)、避孕套防病知识知晓(OR=3.31、95%CI=2.02～5.43)、性病知识知晓水平(OR=2.68、95%CI=1.73～4.16)。结论农村已婚妇女阴道滴虫感染与防病知识和洁阴习惯有关。     

Association of Suboptimal Health Status and Cardiovascular Risk Factors in Urban Chinese Workers

Suboptimal health status (SHS) has become a new public health challenge in urban China. Despite indications that SHS may be associated with progression or development of chronic diseases such as cardiovascular and metabolic diseases, there are few reports on SHS investigations. To explore the relationship between SHS and traditional cardiovascular risk factors, a cross-sectional study was conducted in a sample of 4,881 workers employed in 21 companies in urban Beijing. Blood pressure, glucose, lipid levels (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol and triglycerides), cortisol, and body mass index were measured. SHS score was derived from data collection in the SHS questionnaire (SHSQ-25). Univariate analysis and linear two-level model were used to analyze the association of SHS with the cardiovascular risk factors. Serum cortisol level was much higher among the SHS high-score group than that among the low SHS score group (204.31 versus 161.33 ng/ml, P < 0.001). In a linear two-level model, we found correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol, and HDL cholesterol among men, and correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, and HDL cholesterol among women after controlling for age, education background, occupation, smoking, and physical activity. SHS is associated with cardiovascular risk factors and contributes to the development of cardiovascular disease. SHS should be recognized in the health care system, especially in primary care.     

Stability and Transformation of Metabolic Syndrome in Adolescents: A Prospective Assessment in Relation to the Change of Cardiometabolic Risk Factors

Underlying pathophysiological mechanisms drive excessive clustering of cardiometabolic risk factors, causing metabolic syndrome (MetS). MetS status may transform as adolescents transition to young adulthood. This study investigated the latent clustering structure and its stability for MetS during adolescence, and assessed the anthropometric and clinical metabolic determinants for MetS transformation. A community-based representative adolescent cohort (n = 1516) was evaluated for MetS using four diagnostic criteria, and was followed for 2.2 years to identify new-onset MetS. The clustering structure underlying cardiometabolic parameters was stable across adolescence; both comprised a fat—blood pressure (BP)—glucose three-factor structure (total variance explained: 68.8% and 69.7% at baseline and follow-up, respectively). Among adolescents with MetS-negative at baseline, 3.2–4.4% had incident MetS after 2.2 years. Among adolescents with MetS-positive at baseline, 52.0–61.9% experienced MetS remission, and 38.1–48.0% experienced MetS persistence. Increased systolic BP (SBP) was associated with a high MetS incidence risk, while decreased levels of SBP and glucose were associated with MetS remission. Compared with adolescents with a normal metabolic status at baseline, those with an initial abdominal obesity and increased triglycerides level had a 15.0- and 5.7-fold greater risk for persistent abnormality, respectively. Abdominal obesity and low high-density lipoprotein cholesterol are two abnormal MetS components that highly persist during adolescence, and are the intervention targets for reducing the future risk of cardiometabolic disorders.     

High Prevalence of Vitamin D Deficiency in Pregnant Korean Women: The First Trimester and the Winter Season as Risk Factors for Vitamin D Deficiency

We investigated the vitamin D status of Korean women during pregnancy and assessed the effects of vitamin D deficiency on two pregnancy outcomes; preterm births and the births of small for gestational age. We measured the serum 25-hydroxyvitamin D levels in 220 pregnant Korean women who were recruited prospectively and compared these levels with those of 500 healthy non-pregnant women. We analyzed vitamin D status according to patient demographics, season, and obstetrical characteristics; moreover, we also assessed pregnancy outcomes. The overall prevalence of vitamin D deficiency(<20 ng/mL) in pregnant women and healthy non-pregnant women was 77.3% and 79.2%; respectively; and the prevalence of severe vitamin D deficiency (<10 ng/mL) was 28.6% and 7.2%; respectively (p < 0.05). Vitamin D deficiency was more prevalent in the winter (100%) than in the summer (45.5%) in pregnant Korean women. A higher risk of vitamin D deficiency was observed in the first trimester than in the third trimester (adjusted OR 4.3; p < 0.05). No significant association was observed between vitamin D deficiency and any of the pregnancy outcomes examined. Further research focusing on the long-term consequences of vitamin D deficiency during pregnancy in Korean women is warranted.     

The Role of Value-Based Payment in Promoting Innovation to Address Social Risks: A Cross-Sectional Study of Social Risk Screening by US Physicians

Policy Points

• One of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs.
• At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low‐income populations, but not exposure to value‐based payment.
• Expanding social risk screening by physician practices may require standardization and technical assistance for practices that have less innovative capacity.

ContextOne of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value‐based payment will encourage health care providers to innovate to address upstream social risks.MethodsWe used the 2017‐2018 National Survey of Healthcare Organizations and Systems (NSHOS), a nationally representative survey of physician practices (n = 2,178), to ascertain (1) the number of social risks for which practices systematically screen patients; (2) the extent of practices’ participation in value‐based payment models; and (3) measures of practices’ capacity for innovation. We used multivariate regression models to examine predictors of social risk screening.FindingsOn average, physician practices systematically screened for 2.4 out of 7 (34%) social risks assessed by the survey. In the fully adjusted model, implementing social risk screening was not associated with the practices’ overall exposure to value‐based payment. Being in the top quartile on any of three innovation capacity scales, however, was associated with screening for 0.95 to 1.00 additional social risk (p < 0.001 for all three results) relative to the bottom quartile. In subanalysis examining specific payment models, participating in a Medicaid accountable care organization was associated with screening for 0.37 more social risks (p = 0.015). Expecting more exposure to accountable care in the future was associated with greater social risk screening, but the effect size was small compared with practices’ capacity for innovation.ConclusionsOur results indicate that implementation of social risk screening—an initial step in enhancing awareness of social needs in health care—is not associated with overall exposure to value‐based payment for physician practices. Expanding social risk screening by physician practices may require standardized approaches and implementation assistance to reduce the level of innovative capacity required.