The effect of flour fortification with iron on oxidative stress biomarkers and iron status among non anemic adult 40 - 65 years old

Trotz der Vorteile der Eisenanreicherung von Mehl, gibt es Bedenken bezüglich möglicher nachteiliger Effekte einer zusätzlichen Eisenaufnahme bei nicht-anämischen Individuen in der allgemeinen Bevölkerung. Außerdem gibt es nur wenige Studien die sich mit den Auswirkungen einer Eisenanreicherung des Mehls auf den oxidativen Stress befassten. Ziel der Studie war die Erforschung des Effekts einer Anreicherung von Mehl mit Eisen auf den Eisenstatus und auf Biomarker des oxidativen Stress bei nicht-anämischen Erwachsenen im Alter zwischen 40 und 65 Jahren. Die Studie gliedert sich in zwei Abschnitte; der erste Teil war ein randomisierter Feldversuch und der zweite Teil beschreibt die Situation vor und nach der Intervention. Aus 31 Provinzen der islamischen Republik Iran wurde die Provinz Semnan ausgewählt, in der niedrige Prävalenzen für Anämie und Eisenmangel vorherrschen. Aus den Städten dieser Provinz wurden Damgan als Kontroll- und Semnan als Interventionsstadt randomisiert ausgewählt. Für den Feldversuch wurden 393 gesunde Freiwillige beider Geschlechter aus den Städten Semnan und Damgan randomisiert ausgewählt. Die Datenerfassung erfolgte an drei Zeitpunkten: zu Beginn, nach 32 Wochen und nach 64 Wochen. Dabei wurden jeweils anthropometrische Messungen, 24-h recalls über 3 Tage, Food Frequency Questionnaires und Nüchternblutproben erhoben. Nach der ersten Messung wurde die Anreicherung in Form von Eisen(II)-sulfat ausschließlich in Semnan gestartet. Zu allen drei Zeitpunkten wurden der Eisenstatus und der oxidative Stress anhand der Serumlevels von MDA, TAC, SOD, GPx, Proteincarbonyl und oxidiertem LDL ermittelt. Im zweiten Teil der Studie (davor und danach), wurde die in Semnan durchgeführte Anreicherung beobachtet um deren Langzeiteffekte (64 Wochen) zu erforschen. Die Ergebnisse zeigten, dass es in Semnan 32 Wochen nach dem Konsum von angereichertem Mehl, verglichen mit Damgan keine statistisch signifikanten Unterschiede bezüglich Eisenstatus und Biomarkern für den oxidativen Stress gab. Ein vorher-nachher-Vergleich zeigte für die Eisenlevels im Serum bei Männern einen signifikanten Anstieg (p<0.001). Unter den Biomarkern für den oxidativen Stress nahm TAC signifikant ab (p<0.001), während SOD und GPx, verglichen mit der Basismessung, bei Männern signifikant zunahmen (p<0.05). Weder nach 32, noch nach 64 Wochen traten klinische Symptome einer Überbelastung mit Eisen auf. Der Konsum von eisenangereichertem Mehl veränderte bestimmte Biomarker der antioxidativen Abwehr die ausdrücken, dass es bei nicht-amämischen Männern nach 64 Wochen zu einem oxidativen Stress kam. Die gewonnenen Erkenntnisse unterstützen den Ansatz einer populationsbezogenen Eisenanreicherung mit 30 mg/kg um einen Eisenmangel bei nicht-anämischen gesunden Personen vorzubeugen nicht. Täglicher, ausreichender Konsum von Eisen, das Vorherrschen von Eisenmangel, regelmäßiges Monitoring und die sichere Menge die dem Mehl hinzugefügt werden soll, müssen in Betracht gezogen werden, bevor eine Eisenanreicherung auf Bevölkerungsebene realisiert wird.Despite the advantages of fortifying flour with iron, there are still special concerns regarding the possible adverse effects of the extra iron taken by non-anemic individuals in the general population. Furthermore, there are limited studies regarding the effects of flour fortification with iron on oxidative stress. This study aimed to investigate the effects of fortifying flour with iron on oxidative stress biomarkers and iron status in non-anemic 40- to 65-year-old adults. This study had two parts: the first part was a randomized field trial and the second part was a before and after study. Among 31 provinces in the Islamic Republic of Iran, Semnan with a low prevalence of anaemia and iron deficiency was selected. Among the cities of this province, Damgan and Semnan were randomized as control and intervention cities, respectively. In the field trial, 393 non-anemic apparently healthy male and female volunteers from Semnan and Damgan were randomly selected. Data gathering was performed in three stages including baseline, after 32 weeks and after 64 weeks. Anthropometric measurements, 3-day 24-hour recall, Food Frequency Questionnaire, and fasting blood samples were collected at the three stages. Following the first stage, flour fortification program started only in Semnan with 30 mg/kg iron as ferrous sulphate and all participants were followed for 32 weeks. Evaluation of oxidative stress using serum levels of malonedialdehyde (MDA), total antioxidant capacity (TAC), super oxide dismutase (SOD), Glutathione Peroxidase (GPx) activity, protein carbonyl, and oxidised-LDL as well as the assessment of iron status and endogenous and dietary antioxidants were done in all three stages. In the second part of the study (before and after), as flour fortification started in Damgan, we just followed up flour fortification in Semnan to investigate the effect of this program in a longer period (64 weeks). Results showed that there were no statistically significant changes in iron status and oxidative stress biomarkers after 32 weeks of consuming fortified flour in Semnan compared to Damgan (Field trial). Results in the before and after study showed that among iron status parameters, serum iron levels in men significantly increased compared to baseline values (p<0.001). Among oxidative stress biomarkers, mean TAC significantly decreased (p<0.001), and SOD and GPx significantly increased (p<0.05) compared to the baseline values only in men. No clinical symptoms of iron overload were observed after 32 and 64 weeks. Consumption of iron-fortified flour altered certain antioxidant defense biomarkers indicating induced oxidative stress in non-anemic men after 64 weeks. Our findings do not guarantee the safety of flour fortification with 30 mg/kg of iron as a community-based approach to control iron deficiency in non-anemic healthy individuals. Regular amounts of daily flour consumption, burden of iron deficiency, regular monitoring, and the safe amount of iron to be added to flour must be taken into consideration before implementing iron fortification in a population

Improvement in Activity of Daily Living and Fatigue in Multiple Sclerosis Patients: the Impact of Nutrition Education

Background: Fatigue is one of the most common complications of Multiple Sclerosis (MS). However, a few studies are available on the effect of nutrition education on fatigue and Activities of Daily Living (ADL) in patients with MS. Objectives: This study aimed to assess the effect of nutrition education on fatigue and ability to perform ADL in patients with MS. Methods: This quasi-experimental one group, pretest and posttest study was performed on 40 patients with MS, who were conveniently recruited among patients, registered at the Iranian MS Society. Data were collected through a demographic questionnaire, the Fatigue Severity Scale (FSS), a standard ADL scale, and a 24-hour food recall for two days. The instruments were completed at the start and two months after the intervention. Descriptive statistics and paired t test were used to analyze the data. Results: Sixty percent of the patients had severe fatigue before the intervention while, 90% of them reported mild fatigue after the intervention. The mean posttest ADL was increased by 12.45 units after the intervention when compared with the pretest value (P<0.001). Moreover, the daily intake of vitamin D and E, calcium and omega3 were lower than 75% of the Dietary Reference Intake (DRI) in most of the patients. Conclusions: The present study showed the beneficial effects of nutritional training on fatigue and ADL in patients with MS. Therefore, nurses and dietitians should regularly assess the patients’ dietary pattern and train them and their families about appropriate diet

Comparison of knowledge, attitude and practice of Urban and rural households toward iron deficiency anemia in three provinces of Iran

Background: Lack of nutritional knowledge is one of the most important reasons of nutritional problems and consequently improper practice, which can lead to several complications. This study has been designed in order to compare knowledge, attitude and practices of the urban and rural households regarding iron deficiency anemia (IDA) in Boushehr, Golestan and Sistan & Balouchestan provinces in 2004. Methods: The sampling method at household's level in each province was the single-stage cluster sampling with equal size clusters. The necessary data were gathered with a structured questionnaire and via the interviews between the questioners and the eligible people in each household. Comparison of frequency of variables between urban and rural areas were tested by chi square test. Results: A total of 2306 households were selected as overall sample size. In urban areas, people recognized iron food sources better than rural areas. Knowledge level of respondents about vulnerable group for IDA and the favorite attitude of households toward IDA were better in urban areas of Sistan & Blouchestan and Golestan provinces. In Sistan & Balouchestan and Golestan, rural households who drank tea immediately before or after meal was more than urban ones. The majority of pregnant and lactating mothers (except for rural areas of Bushehr) did not take iron supplement regularly. Less than 60 percent of children used iron drop regularly. Conclusion: Knowledge, attitude, and practice levels of households toward IDA were not acceptable. One of the best ways of improving nutritional practice is nutritional education with focus on applying available food resources

Dietary pattern of adolescent girls in relation to socio-economic factors; A comparison between North and South Tehran

Comparing dietary pattern and related socio-economic factors among adolescent girls in the North and South of Tehran, the capital of Iran. This cross-sectional and analytical study 210 adolescent girls, aged 14-17 years, from high schools in the North district of Tehran (n=105; high socio-economic level) and the South district (n=105; low socio-economic level) were selected by the two-step, cluster random sampling method. Demographic data, including mothers´ and fathers´ educational levels and parents´ occupation were gathered, using a validated self-administered questionnaire. Three questionnaires of food frequency, one-day 24-hour food recall and one-day 24-hour food record were used for assessing dietary pattern. The results showed that the frequency consumption of certain fatty foods, including dairy products and meat group, and fats in district 1 are higher than in district 19 adolescent girls; based on many differences such as life style and food accessibility. This indicated that there is a significant difference in the quality pattern of fat intake between the two districts. It is suggested to design and implement nutritional intervention programs for adolescent girls, particularly in the low socio- economic districts

The nutrition knowledge level of physicians, nurses and nutritionists in some educational hospitals

Nutritional care is an important part of medical care of patients and plays a key role in improvement, prevention and control of malnutrition in hospitals. The current study aimed to determine the nutrition knowledge level of doctors, nurses and nutritionists in some teaching hospitals in Tehran in 2008. In a cross-sectional study a total of 198 samples including 28 nutritionists, 81 nurses and 89 physicians were selected using simple random sampling. The current study was conducted in 9 hospitals affiliated with the Shahid Beheshti University of Medical Sciences (SBMU) in Tehran. A self-administered multiple choice questionnaire about different aspects of basic and clinical nutrition was completed. Then nutrition knowledge levels of each individual was determined by calculating correct knowledge, perceived knowledge and accuracy of knowledge scores. The median knowledge score of the nutritionists, physicians, and nurses was 85%,77%, and 75%, respectively. The median perceived knowledge of all the groups was above 90%. The mean accuracy score in the 3 groups of nutritionists, physicians and nurses was 87%,79%, and 76%, respectively. The results indicated that all groups have a poor knowledge, especially in clinical nutrition topics. Based on the current results, knowledge level of clinical staff is an effective factor in not paying attention to the importance of nutritional care as a part of medical care of the patients. Enhancing awareness level of all groups especially physicians and nutritionists in clinical division plays an important role in enhancing clinical nutrition care and treatment regime

The effects of subsidies on foods in Iran: A narrative review

Background: Subsidy payments are used to support low-income groups and may improve income distribution and increase social welfare. The food subsidy programs and their long-term effects have been considered as major developmental issues in many developing countries. This review study aimed to examine the effects of subsidies on the food and nutritional status of Iranian people. Methods: English and Persian language databases were searched using related keywords to discover studies on the effects of subsidies on food and nutritional status in Iran. A manual search was also conducted encompassing national and local research projects in Iran. In total, 12 articles were finally included out of an initial total of 70 studies. Results: Subsidy payment affects many socio-economic variables. In Iran, subsidies are often paid for the basic goods and commodities that are a main part of the consumption patterns of most Iranian people. So, if the basic needs of the people are not well-understood, changes in economic structures may lead to a change in consumption patterns. In addition, physical payments for food may lead to an increase in the consumption of different groups, but cash payments do not necessarily lead to an increase in food intake. Conclusion: The method of payment should be chosen correctly to improve the protection of vulnerable populations. The distribution of targeted subsidies for food security is inevitable due to limited resources available to support vulnerable populations

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.

BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. FUNDING: Wellcome Trust, AstraZeneca Young Health Programme

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified