Staple crops biofortified with increased vitamins and minerals : considerations for a public health strategy

Biofortification of staple crops has been proposed as a strategy to address micronutrient malnutrition, particularly with respect to insufficient intake of vitamin A, iron, zinc, and folate. The World Health Organization, in collaboration with the Food and Agriculture Organization of the United Nations and the Sackler Institute for Nutrition Science at the New York Academy of Sciences, convened a technical consultation entitled "Staple Crops Biofortified with Vitamins and Minerals: Considerations for a Public Health Strategy" in April 2016. Participants of the consultation reviewed the definition of biofortification of staple crops, patterns of crops production, processing, consumption, seed varieties, and micronutrient stability and bioavailability, as well as farmers' adoption and acceptability of the modified crops. Also discussed were economic, environmental, safety, and equity aspects of biofortified crops, as well as legal, policy, regulatory, and ethical issues for the implementation of biofortification strategies in agriculture and nutrition. Consultation working groups identified important and emerging technical issues, lessons learned, and research priorities to better support the evidence of improved nutrition and unintended adverse effects of biofortification. This paper provides the background and rationale of the technical consultation, synopsizes the presentations, and provides a summary of the main considerations proposed by the working groups

Calcium‐fortified foods in public health programs: considerations for implementation

Low calcium intake is common worldwide and can result in nutritional rickets in children and osteomalacia in adults. Calcium-fortified foods could improve calcium intake. However, there is limited calcium fortification experience, with technical and practical issues that may hamper its adoption. The objective of this landscape review is to summarize these issues to help policymakers guide the planning and design of calcium fortification as a public health strategy. One challenge is the low bioavailability of calcium salts (∼20–40%); thus, large amounts need to be added to food to have a meaningful impact. Solubility is important when fortifying liquids and acidic foods. Calcium salts could change the flavor, color, and appearance of the food and may account for 70–90% of the total fortification cost. Safety is key to avoid exceeding the recommended intake; so the amount of added calcium should be based on the target calcium intake and the gap between inadequate and adequate levels. Monitoring includes the quality of the fortified food and population calcium intake using dietary assessment methods. Calcium fortification should follow regulations, implemented in an intersectorial way, and be informed by the right to health and equity. This information may help guide and plan this public health strategy.Fil: Palacios, Cristina. Florida International University; Estados UnidosFil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Universidad Nacional de La Matanza; ArgentinaFil: Hofmeyr, G. Justus. No especifíca;Fil: Garcia Casal, Maria Nieves. World Health Organization; SuizaFil: Peña Rosas, Juan Pablo. World Health Organization; SuizaFil: Betrán, Ana Pilar. World Health Organization; Suiz

Current calcium fortification experiences: a review

Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13–14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.Fil: Palacios, Cristina. Florida International University; Estados UnidosFil: Hofmeyr, G. Justus. No especifíca;Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Garcia Casal, Maria Nieves. World Health Organization; SuizaFil: Peña Rosas, Juan Pablo. World Health Organization; SuizaFil: Betrán, Ana Pilar. World Health Organization; Suiz

International values for haemoglobin distributions in healthy pregnant women.

BACKGROUND: Anaemia in pregnancy is a global health problem with associated morbidity and mortality. METHODS: A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled <14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project which involved eight geographically diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, United Kingdom and United States. At each 5 ± 1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care that complemented the study's requirements, including haemoglobin values. FINDINGS: A total of 3502 (81%) of 4321 women who delivered a live, singleton newborn with no visible congenital anomalies, contributed at least one haemoglobin value. Median haemoglobin concentrations ranged from 114.6 to 121.4 g/L, 94 to 103 g/L at the 3rd centile, and from 135 to 141 g/L at the 97th centile. The lowest values were seen between 31 and 32 weeks' gestation, representing a mean drop of 6.8 g/L compared to 14 weeks' gestation. The percentage variation in maternal haemoglobin within-site was 47% of the total variance compared to 13% between sites. INTERPRETATION: We have generated International, gestational age-specific, smoothed centiles for maternal haemoglobin concentration compatible with better pregnancy outcomes, as well as adequate neonatal and early childhood morbidity, growth and development up to 2 years of age. FUNDING: Bill & Melinda Gates Foundation Grant number 49038

Consequences of Inadequate Intakes of Vitamin A, Vitamin B

PURPOSE OF REVIEW: This review broadly discusses the consequences of inadequate consumption, by deficit or excess, of selected micronutrients on the quality of life and morbidity during aging, specifically considering increases in life expectancy and the costs of care in the older persons. RECENT FINDINGS: A literature review of the periods 2012 to 2018, focusing on vitamins A, B SUMMARY: Micronutrient deficiencies are a common and avoidable contributor to decreased quality of life and healthcare costs in the older persons. Further research is needed to determine adequate intakes and innovative uses, including appropriate thresholds for improved health outcomes for this population

Dieta e inflamación

La inflamaci&oacute;n puede definirse como una respuesta local al da&ntilde;o celular, que se caracteriza por aumento del flujo sangu&iacute;neo, vasodilataci&oacute;n capilar, infiltraci&oacute;n de leucocitos y la producci&oacute;n local de mediadores de inflamaci&oacute;n por parte del hu&eacute;sped. La inflamaci&oacute;n es parte de la respuesta y es necesario el retorno a la homeostasis luego de da&ntilde;o producido por un agente infeccioso, da&ntilde;o f&iacute;sico o estr&eacute;s metab&oacute;lico. Cuando persiste el est&iacute;mulo que dispara el proceso, la inflamaci&oacute;n puede hacerse cr&oacute;nica y contribuir a la patog&eacute;nesis de enfermedades como la diabetes mellitus tipo 2 y la hipertensi&oacute;n. En estas enfermedades, &aacute;cidos grasos saturados, lipoprote&iacute;nas y agregados proteicos disparan la respuesta inmunitaria y producen inflamaci&oacute;n, que al no poder ser f&aacute;cilmente eliminados, perpet&uacute;an la respuesta y contribuyen con la persistencia de la enfermedad. Los patrones de consumo saludable se han asociado con bajas concentraciones de marcadores de inflamaci&oacute;n. Entre los componentes de una dieta saludable el consumo de cereales integrales, pescado, frutas y verduras se asocian con menor inflamaci&oacute;n. La vitamina C, E y los carotenoides disminuyen la concentraci&oacute;n de marcadores de inflamaci&oacute;n, mientras otros nutrientes como los l&iacute;pidos, tienen efectos opuestos: los &aacute;cidos grasos saturados y los transmonosaturados son pro-inflamatorios, mientras que los &aacute;cidos grasos poliinsaturados, especialmente los de cadena larga, son antiinflamatorios. Tambi&eacute;n se revisan los productos de glicosilaci&oacute;n avanzada y su papel en la producci&oacute;n de inflamaci&oacute;n de bajo grado.Inflammation could be defined as a local response to cell damage, characterized by increased blood flow, capillary vasodilation, leukocyte infiltration and local production of inflammation mediators by the host. Inflammation is part of the response and the return to homeostasis after an insult by a pathogen, physical damage or metabolic stress is also required. When the stimulus that triggers the response is not eliminated, inflammation could become chronic and contribute to the pathogenesis of diseases such as diabetes and hypertension. In these diseases saturated fatty acids, lipoproteins and protein aggregates trigger the immune response and produce inflammation. If they are not properly eliminated, the response is maintained and the disease continues. Healthy consumption patterns have been associated with low levels of inflammation markers. Some of the components identified as part of a healthy diet include whole grains, fish, fruits and vegetables. Vitamins C and E, as well as carotenoids, diminish the concentration of markers of inflammation, while other nutrients have opposite effects: saturated, as well as trans-monosaturated fatty acids are pro-inflammatory whereas polyunsaturated fatty acid, especially long chain, are anti-inflammatory. Advanced glycation end products and their role in inflammation are also reviewed

A rapid landscape review of postpartum anaemia measurement: challenges and opportunities

Abstract Background Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50–80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia. Methods A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews. Results In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases. Conclusions This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting

Update on the Transmission of Zika Virus Through Breast Milk and Breastfeeding: A Systematic Review of the Evidence

We systematically searched regional and international databases and screened 1658 non-duplicate records describing women with suspected or confirmed ZIKV infection, intending to breastfeed or give breast milk to an infant to examine the potential of mother-to-child transmission of Zika virus (ZIKV) through breast milk or breastfeeding-related practices. Fourteen studies met our inclusion criteria and inform this analysis. These studies reported on 97 mother&ndash;children pairs who provided breast milk for ZIKV assessment. Seventeen breast milk samples from different women were found positive for ZIKV via RT-PCR, and ZIKV replication was found in cell cultures from five out of seven breast milk samples from different women. Only three out of six infants who had ZIKV infection were breastfed, no evidence of clinical complications was found to be associated with ZIKV RNA in breast milk. This review updates our previous report by including 12 new articles, in which we found no evidence of ZIKV mother-to-child transmission through breast milk intake or breastfeeding. As the certainty of the present evidence is low, additional studies are still warranted to determine if ZIKV can be transmitted through breastfeeding