Nutrition education to improve dietary intake and micronutrient nutriture among children in less-resourced areas: a randomised controlled intervention in Kabarole district, western Uganda

Objective: To determine whether nutrition education targeting the child-feeding practices of low-income rural caregivers will reduce anaemiaand improve vitamin A nutriture of the young children in their care.Design: A controlled intervention trial, based on experiential learning theory. Forty-six women completed a nine-session nutrition educationprogramme, while controls (n = 43) concurrently engaged in sewing classes.Setting: Two rural farming communities in the Kabarole district, western Uganda.Subjects: Less literate, low-income rural female caregivers and the children in their care (6-48 months).Outcome measures: Caregivers’ child-feeding practices and the children’s nutritional status were assessed at baseline, one month afterintervention (Follow-up 1) and one year from baseline (Follow-up 2).Results: Caregivers in the intervention group reported improved child snacking patterns, food-selection practices, meal adequacy, and foodvariety. Children in the intervention group recorded lower haemoglobin levels at baseline (9.86 vs. 10.70 g/dl) and caught up with controlsat Follow-up 1 (10.06 vs. 10.78 g/dl). However, changes were not sustained. Mean retinol-binding protein improved from 0.68 ìmol/l (95%CI: 0.57-0.78) to 0.91 ìmol/l (95% CI: 0.78-1.03) among intervention children, but remained approximately the same in controls. Vitamin Anutriture was influenced by infections.Conclusion: Nutrition education significantly improved feeding practices and children’s nutritional status. The effectiveness and sustainabilityof this programme can be enhanced if nutrition education is integrated into other food-production and public health programme

Poor intestinal permeability in mildly stunted Nepali children: associations with weaning practices and Giardia lamblia infection

Studies in the Gambia, using the lactulose-mannitol dual-sugar intestinal permeability test (lactulose:mannitol ratio) as a non-invasive way of investigating mucosal damage, have shown that food malabsorption is significantly associated with early growth retardation. In this cross-sectional study, 210 poor urban Nepali children, 0-60 months old, were recruited and measured for height or length and weight, 167 were examined for intestinal permeability and 173 for parasite infection. Weaning and morbidity data were collected from 172 caretakers. Children were mildly stunted (mean height-for-age z-score -1·45) and underweight (mean weight-for-age z-score -1·62). The lactulose:mannitol ratio (0·26) was poorer than that of UK children (0·12), but similar to that found in Bengali children of the same age (0·24). Two stages of weaning, the onset supplementary feeding (6 months) and the cessation of breast-feeding (23 months), were shown to have differential impact. In children currently breast-feeding, the duration of supplementation was negatively related to lactose (P<0·001) and lactose:lactulose values (P<0·0001), indicating lactose maldigestion. In children who had ceased breast-feeding, a longer period of lactation was associated with poorer intestinal permeability (P=0·031), and poorer height-for-age (P=0·024), which was an unexpected result. No significant relationships were found between intestinal permeability and growth, or with morbidity and helminth infection, except in children with Giardia lamblia who had worse lactulose:mannitol ratios than those without (0·43 v. 0·25 respectively, P=0·014). It is likely that insults to the gut (e.g. Giardia) and challenges to the immune system (weaning) have a different impact in early and late infancy

Comparison of a possession score and a poverty index in predicting anaemia and undernutrition in pre-school children and women of reproductive age in rural and urban Côte d'Ivoire

Abstract Objective To determine whether a possession score or a poverty index best predicts undernutrition and anaemia in women of reproductive age (15-49 years; WRA) and children aged 6-59 months living in Côte d'Ivoire. Design Anthropometric measurements were converted to Z-scores to assess stunting, wasting and underweight in children, and converted to BMI in WRA. A venous blood sample was drawn, and Hb concentration and Plasmodium spp. infection were determined. A possession score was generated with categories of zero to four possessions. A five-point (quintile) poverty index using household assets was created using principal component analysis. These socio-economic measures were compared for their ability to predict anaemia and malnutrition. Setting Data were from a nationally representative survey conducted in Côte d'Ivoire in 2007. Subjects A sample of 768 WRA and 717 children aged 6-59 months was analysed. Results Overall, 74·9 % of children and 50·2 % of WRA were anaemic; 39·5 % of the children were stunted, 28·1 % underweight and 12·8 % wasted, while 7·4 % of WRA had BMI < 18·5 kg/m2. In general, there were more stunted and underweight children and thin WRA in rural areas. The poverty index showed a stronger relationship with nutritional status than the possession score; mean Hb difference between the poorest and wealthiest quintiles in children and WRA was 8·2 g/l and 6·5 g/l, respectively (13·9 % and 19·8 % difference in anaemia, respectively; P < 0·001), and Z-scores and BMI were significantly better in the wealthiest quintile (P < 0·001). Conclusions The poverty index was generally a better predictor of undernutrition in WRA and pre-school children than the possession scor

A Novel Approach to Evaluating the Iron and Folate Status of Women of Reproductive Age in Uzbekistan after 3 Years of Flour Fortification with Micronutrients

Background: The Uzbekistan 1996 Demographic Health Survey reported 60.4% of women of reproductive age (WRA) had low hemoglobin concentrations (5 mg/L). Severe anemia was more prevalent among folate deficient than iron depleted WRA. Presence of UDM first grade flour or the grey loaf was reported in 71.3% of households. Among WRA, 32.1% were aware of UDM fortification; only 3.7% mentioned the benefits of fortification and 12.5% understood causes of anemia. Consumption of heme iron-containing food (91%) and iron absorption enhancers (97%) was high, as was the consumption of iron absorption inhibitors (95%). Conclusions/Significance: The NFFP coincided with a substantial decline in the prevalence of anemia. Folate deficiency was a stronger predictor of severe anemia than iron depletion. However, the prevalence of iron depletion was high, suggesting that women are not eating enough iron or iron absorption is inhibited. Fortified products were prevalent throughout Uzbekistan, though UDM flour must be adequately fortified and monitored in the future. Knowledge of fortification and anemia was low, suggesting consumer education should be prioritized

Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Background: The accurate estimation of iron deficiency is important in planning and implementing interventions. Ferritin is recommended as the primary measure of iron status, but interpretability is challenging in settings with infection and inflammation

Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis

Background: The World Health Organization recommends serum ferritin concentrations as the best indicator of iron deficiency (ID). Unfortunately, ferritin increases with infections; hence, the prevalence of ID is underestimated. Objective: The objective was to estimate the increase in ferritin in 32 studies of apparently healthy persons by using 2 acute-phase proteins (APPs). C-reactive protein (CRP) and alpha(1)-acid glycoprotein (AGP), individually and in combination, and to calculate factors to remove the influence of inflammation from ferritin concentrations. Design: We estimated the increase in ferritin associated with inflammation (ie, CRP >5 mg/L and/or AGP >1 g/L). The 32 studies comprised infants (5 studies), children (7 studies), men (4 studies), and women (16 studies) (n = 8796 subjects). In 2-group analyses (either CRP or AGP), we compared the ratios of log ferritin with or without inflammation in 30 studies. In addition, in 22 studies, the data allowed a comparison of ratios of log ferritin between 4 subgroups: reference (no elevated APP), incubation (elevated CRP only), early convalescence (both APP and CRP elevated), and late convalescence (elevated AGP only). Results: In the 2-group analysis, inflammation increased ferritin by 49.6% (CRP) or 38.2% (AGP; both P <0.001). Elevated AGP was more common than CRP in young persons than in adults. In the 4-group analysis, ferritin was 30%, 90%, and 36% (all P < 0.001) higher in the incubation, early convalescence, and late convalescence subgroups, respectively, with corresponding correction factors of 0.77, 0.53, and 0.75. Overall, inflammation increased ferritin by approximate to 30% and was associated with a 14% (CI: 7%, 21%) underestimation of ID. Conclusions: Measures of both APP and CRP are needed to estimate the full effect of inflammation and can be used to correct ferritin concentrations. Few differences were observed between age and sex subgroups. Am J Clin Nutr 2010;92:546-55

Exploration of the Protection of Riboflavin Laurate on Oral Mucositis Induced by Chemotherapy or Radiotherapy at the Cellular Level: What Is the Leading Contributor?

Oral or gastrointestinal mucositis is a frequent phenomenon in cancer patients receiving chemotherapy or radiotherapy. In addition, several clinical investigations have demonstrated in recent years that riboflavin laurate has the potential to protect the patients from the disease induced by chemotherapy or radiotherapy. In our studies, it is observed that riboflavin laurate can ameliorate either chemotherapy- or radiotherapy-induced toxicities on Helf cells, and the effect is greater than that of riboflavin. In addition, riboflavin laurate is able to transport through the Caco-2 cell monolayer as the prototype, indicating the protective effects may be produced by the prototype of riboflavin laurate, rather than simply by the released riboflavin

Prevalence and public health relevance of micronutrient deficiencies and undernutrition in pre-school children and women of reproductive age in Côte d'Ivoire, West Africa

Abstract Objective To provide nationally representative data on the prevalence of anaemia, vitamin A and Fe deficiencies among pre-school age children (pre-SAC) and non-pregnant women of reproductive age (WRA), and on vitamin B12 and folate deficiencies in WRA, and the influence of inflammation on their interpretation. Design A cross-sectional survey to measure anthropometry, malaria parasitaemia and micronutrient status. Specifically, blood samples were analysed for Hb, plasma ferritin, soluble transferrin receptors, C-reactive protein, α1-acid glycoprotein, retinol-binding protein, vitamin B12 and folate. Setting Côte d'Ivoire in 2007. Subjects Nine hundred and twenty-eight WRA and 879 pre-SAC. Results In WRA, prevalence of Plasmodium parasitaemia (5 %) was low, but inflammation (34 %) was higher. Anaemia was a severe public health problem and prevalence differed by residency and eco-region. Inflammation-adjusted Fe deficiency was highest in urban areas (20 %). Nationally, folate deficiency was 86 %, higher in urban areas and varied by eco-region. Prevalence of vitamin B12 deficiency was low but higher in the rural areas and the north. Inflammation-adjusted vitamin A deficiency was very low (1 %). In pre-SAC, prevalence of inflammation (67 %) and Plasmodium parasites (25 %) was high; the latter was associated with poverty, rural residency and higher ferritin concentrations. Anaemia was classified as a severe public health problem (72 %), and was higher in rural areas (76 %) and the north (87 %). A quarter of pre-SAC suffered from vitamin A deficiency (inflammation-adjusted) and prevalence of undernutrition was high. Conclusions Prevalence of inflammation, Plasmodium parasitaemia and micronutrient deficiencies were high in Côte d'Ivoire, particularly in pre-SAC. Nutritional interventions should be accompanied by strategies to reduce exposure to infection

Maternal selenium, copper and zinc concentrations in pregnancy associated with small-for-gestational-age infants

Pregnancy during adolescence increases the risk of adverse pregnancy outcome, especially risk of small-for gestational-age (SGA) birth, which has been linked to micronutrient deficiencies. Likewise, smoking has been shown to be related with lower micronutrient concentrations. Different ethnicities have not previously been examined. We used a subset from a prospective observational study, the About Teenage Eating (ATE) study consisting of 126 pregnant adolescents (14-18 years old) between 28-32 weeks' gestation. Micronutrient status was assessed by inductively-coupled mass spectrometry. Smoking was assessed by self-report and plasma cotinine, and SGA was defined as infants born < 10th corrected birthweight centile. The main outcome measures were: 1) Maternal plasma selenium, copper and zinc concentrations in adolescent mothers giving birth to SGA versus appropriate-for-gestational-age (AGA) infants. 2) Comparison of micronutrient concentrations between women of different ethnicities and smoking habits. The plasma selenium (mean ± SD [95% CI]) concentration was lower in the SGA (n = 19: 49.4 ± 7.3 [CI: 45.9, 52.9] μg/L) compared to the AGA (n = 107: 65.1 ± 12.5 [CI: 62.7, 67.5] μg/L; P < 0.0001) group. Smoking mothers had a lower selenium concentration compared to non-smokers (P = 0.01) and Afro-Caribbean women had higher selenium concentrations compared to White Europeans (P = 0.02). Neither copper nor zinc concentrations varied between groups, but selenium and copper were moderately correlated (P < 0.05). Selenium is an essential trace element which exerts its biological effects through the expression of a variety of important selenoproteins. Low plasma selenium concentration in adolescent mothers could contribute to the risk of delivering an SGA infant, possibly through lowering the placental antioxidant defence, thus direclty affecting fetal growth. The differences in plasma selenium between different ethnicities may relate to variation in nutritional intake, which requires further investigation