Suboptimal biochemical riboflavin status is associated with lower hemoglobin and higher rates of anemia in a sample of Canadian and Malaysian women of reproductive age

Background: Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood. Objectives: We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia. Methods: Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia. Results: EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40. Conclusions: Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation

Evaluating the Relative Effectiveness of Two Supplemental Foods for the Treatment of Moderate Acute Malnutrition in Children 6 to 60 Months of Age in Southern Ethiopia

The purpose of this cluster-randomized equivalence trial was to investigate the effectiveness of two supplemental foods in children with moderate malnutrition by comparing: (i) time to recovery by survival analysis, and (ii) recovery rates (after 16 weeks of treatment). A total of 2,600 children 6-60 months of age were randomized by cluster (district) to receive 16 weeks of conventional (Corn-Soya Blended flour, CSB) or intervention (Ready-to-Use Supplemental Food, RUSF) foods. Overall, time to recovery from malnutrition (mean 74 days) and recovery rates (mean 76%) were equivalent with both foods. The time to recovery outcomes were equivalent, independent of location, whereas the recovery rate in children receiving CSB was significantly higher in the more food insecure southern region. Intra-household food sharing was significantly higher in the CSB group compared to RUSF. Overall, the response to the two different supplemental foods was equivalent for the treatment of moderately malnourished children in Ethiopia.MAS

Is iron deficiency a major cause of the high prevalence of anemia in non-pregnant Cambodian women of reproductive age? : evidence from a cross-sectional survey and a randomized controlled trial

Despite a high prevalence of anemia among non-pregnant Cambodian women, recent reports suggest iron deficiency prevalence is low. If true, iron supplementation will not reduce anemia. In Phase I, we investigated factors associated with hemoglobin, ferritin, and soluble transferrin receptor (sTfR) concentrations in 450 women 18-45 years in Prey Veng province. Overall, 54% had a genetic hemoglobin disorder, 29.5% had anemia (hemoglobin 8.3 mg/L), respectively. The hemoglobin E homozygous genotype was associated with 50% (95% CI: 14%, 96%) and 51% (95% CI: 37%, 66%) higher mean ferritin and sTfR concentrations as compared to normal hemoglobin structure. These findings challenged the diagnostic accuracy of ferritin and sTfR to estimate iron deficiency. In Phase II, we measured the effect of oral iron (Fe) with or without multiple micronutrients (MMN) on hemoglobin concentration as a direct way to determine the extent to which iron deficiency (or other micronutrient deficiencies) was a cause of anemia. A total of 809 non-pregnant women 18-45 years with hemoglobin ≤117 g/L (HemoCue®) were recruited from Kampong Chhnang province to a 2x2 factorial double-blind randomized trial. Women received 12 weeks of daily Fe (60 mg), MMN (14 other micronutrients), Fe+MMN, or placebo capsules. Baseline anemia prevalence was 58% (Sysmex analyzer). Mean (95% CI) hemoglobin at 12 weeks did not differ in the Fe and Fe+MMN groups (121 [120, 122] vs. 123 [122, 124] g/L); both were higher than MMN and placebo (both 116 [115, 117] g/L, P<0.05). Mean (95% CI) increase in hemoglobin was 5.6 (3.8, 7.4) g/L (P<0.001) among women who received Fe (n=383) and 1.1 (-0.7, 2.9) g/L (P=0.24) among women who received MMN (n=382), with no interaction between interventions (P=0.61). At 12 weeks, 19% and 30% of women had a hemoglobin response ≥10 g/L in Fe and Fe+MMN groups, compared to 8% and 5% in MMN and placebo, respectively. Daily iron supplementation for 12 weeks increased hemoglobin in non-pregnant Cambodian women; however, MMN did not confer additional benefit. Only ~25% of our predominantly anemic study population was responsive to iron.Land and Food Systems, Faculty ofGraduat

Feasibility of an At-Home Adult Stool Specimen Collection Method in Rural Cambodia

The human microbiome has received significant attention over the past decade regarding its potential impact on health. Epidemiological and intervention studies often rely on at-home stool collection methods designed for high-resource settings, such as access to an improved toilet with a modern toilet seat. However, this is not always appropriate or applicable to low-resource settings. Therefore, the design of a user-friendly stool collection kit for low-resource rural settings is needed. We describe the development, assembly, and user experience of a simple and low-cost at-home stool collection kit for women living in rural Cambodia as part of a randomized controlled trial in 2020. Participants were provided with the stool collection kit and detailed verbal instruction. Enrolled women (n = 480) provided two stool specimens (at the start of the trial and after 12 weeks) at their home and brought them to the health centre that morning in a sterile collection container. User specimen collection compliance was high, with 90% (n = 434) of women providing a stool specimen at the end of the trial (after 12 weeks). This feasible and straightforward method has strong potential for similar or adapted use among adults residing in other rural or low-resource contexts.Land and Food Systems, Faculty ofOther UBCReviewedFacult

The Biology of The First 1000 Days : Proceedings

xxiv, 494 hlm.; 30 x 22 c

The Effect of Daily Iron Supplementation with 60 mg Ferrous Sulfate for 12 Weeks on Non-Transferrin Bound Iron Concentrations in Women with a High Prevalence of Hemoglobinopathies

There is a lack of evidence for the safety of untargeted daily iron supplementation in women, especially in countries such as Cambodia, where both anemia and hemoglobinopathies are common. Our aim was to assess serum non-transferrin bound iron (NTBI), a toxic biochemical that accumulates in blood when too much iron is absorbed, in Cambodian women who received daily iron supplements in accordance with the 2016 global World Health Organization (WHO) guidelines. We used fasting venous blood samples that were collected in a 2015 supplementation trial among predominantly anemic Cambodian women (18–45 years). Serum NTBI was measured with use of the FeROS™ eLPI assay (Aferrix Ltd., Tel-Aviv, Israel) in randomly selected sub-groups of women who received 60 mg daily elemental iron as ferrous sulfate (n = 50) or a placebo (n = 50) for 12 weeks. Overall, n = 17/100 (17%) of women had an elevated serum NTBI concentration (≥0.1 μmol/L) at 12 weeks; n = 9 in the Fe group and n = 8 in the placebo group. Elevated serum NTBI concentration was not associated with age, iron supplementation, transferrin saturation or severe hemoglobinopathies (p > 0.05). In this population of women with a high prevalence of hemoglobinopathies, we found that daily iron supplementation was not associated with elevated serum NTBI concentrations at 12 weeks, as compared to placebo.Land and Food Systems, Faculty ofOther UBCNon UBCReviewedFacult

Iron-Containing Oral Contraceptives and Their Effect on Hemoglobin and Biomarkers of Iron Status: A Narrative Review

Oral contraceptive use has been associated with decreased menstrual blood losses; thus, can independently reduce the risk of anemia and iron deficiency in women. Manufacturers have recently started to include supplemental iron in the non-hormonal placebo tablets of some contraceptives. The aims of this narrative review are: (i) to describe the relationship between oral contraceptive use and both anemia and iron status in women; (ii) to describe the current formulations of iron-containing oral contraceptives (ICOC) available on the market; and (iii) to systematically review the existing literature on the effect of ICOC on biomarkers of anemia and iron status in women. We discovered 21 brands of ICOC, most commonly including 25 mg elemental iron as ferrous fumarate, for seven days, per monthly tablet package. Our search identified one randomized trial evaluating the effectiveness of ICOC use compared to two non-ICOC on increasing hemoglobin (Hb) and iron status biomarker concentrations in women; whereafter 12 months of contraception use, there were no significant differences in Hb concentration nor markers of iron status between the groups. ICOC has the potential to be a cost-effective solution to address both family planning needs and iron deficiency anemia. Yet, more rigorous trials evaluating the effectiveness of ICOC on improving markers of anemia and iron deficiency, as well as investigating the safety of its consumption among iron-replete populations, are warranted.Land and Food Systems, Faculty ofOther UBCReviewedFacultyResearche

The effect of inflammation on serum zinc concentrations and the prevalence estimates of population-level zinc status among Congolese children aged 6-59 months

PRIFPRI3; ISI; HarvestPlus; CRP4HarvestPlus; A4NHCGIAR Research Programs on Agriculture for Nutrition and Health (A4NH

Comparison of four immunoassays to measure serum ferritin concentrations and iron deficiency prevalence among non-pregnant Cambodian women and Congolese children

PRIFPRI3; CRP4; ISIHarvestPlus; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

Poor thiamin and riboflavin status is common among women of childbearing age in rural and urban Cambodia

Background: Thiamin deficiency in infancy is the underlying cause of beriberi, which can be fatal without rapid treatment. Reports of thiamin deficiency are common in Cambodia; however, population representative data are unavailable. Because B-complex vitamin deficiencies commonly occur in combination, riboflavin was also investigated. Objective: We determined the biomarker status of thiamin and riboflavin in women of childbearing age in rural and urban Cambodia. Methods: We measured thiamin (erythrocyte thiamin diphosphate; TDP) and riboflavin (erythrocyte glutathione reductase activity coefficient; EGRac) status in a representative sample of Cambodian women (aged 20–45 y) in urban Phnom Penh (n = 146) and rural Prey Veng (n = 156), Cambodia, and, for comparison purposes, in a convenience sample of women in urban Vancouver, British Columbia, Canada (n = 49). Results: Thiamin insufficiency (TDP # 90nmol/L) was common among both urban (39%) and rural (59%) Cambodian women (P < 0.001), whereas <20% of Vancouver women were thiamin insufficient (P < 0.001). The prevalence of suboptimal and deficient riboflavin status (EGRac $ 1.3) was 89%, 92%, and 70% among women in Phnom Penh, Prey Veng, and Vancouver, respectively (P < 0.001). Conclusions: Suboptimal status of both thiamin and riboflavin were common in Cambodian women, with substantially higher rates among women living in rural Prey Veng than in urban Phnom Penh. Strategies may be needed to improve the thiamin and riboflavin status of women in Cambodia. The unexpected finding of high riboflavin inadequacy status in Vancouver women warrants further investigation