Moderate zinc and vitamin A deficiency in breast milk of mothers from East-Jakarta.

OBJECTIVE: To gain information about the micronutrient status of urban, middle-income, breast-feeding mothers in relation to zinc and selected fat-soluble vitamins in plasma and breast milk and to assess possible interaction between the measured micronutrients. DESIGN: Cross-sectional study. SUBJECTS: 91 mothers and their infants living in middle-income areas of Jakarta, Indonesia. RESULTS: None of the measured anthropometric data of the mothers (e.g. BMI: 22.0+/-3.1 kg/m2) and their infants (birth weight: 3.2+/-0.5 kg) gave any indication of undernutrition. The mean concentrations in blood were 124+/-18 g/l for hemoglobin, 385+/-111 microg/l for retinol, 34+/-23 microg/l for alpha-carotene, 104+/-72 microg/l for beta-carotene, 7.7+/-3.3 mg/l for alpha-tocopherol, 0.57+/-0.23 mg/l for gamma-tocopherol, 855+/-242 microg/l for zinc, and the median concentration of lycopene was 29 microg/l. The median breast milk concentrations were 420 microg/l for retinol, 7.8 microg/l for beta-carotene, and 2.7 mg/l for zinc. With increased duration of lactation, vitamin A and zinc concentrations significantly decreased in breast milk whereas plasma zinc concentration increased. Plasma alpha- and beta-carotene were positively correlated (P < 0.0001) with each other and with plasma lycopene. Breast milk beta-carotene was positively correlated with breast milk retinol and with plasma beta-carotene (P < 0.0001). There was no correlation between zinc and vitamin A in either breast milk or plasma. Forty per cent of the mothers were anemic, 29.1% had a low plasma zinc concentration, and 23.7% had a moderately low plasma vitamin A concentration. Breast milk from 70% of the women had a low concentration of vitamin A and that from 66% had a low concentration of zinc. CONCLUSIONS: Multi-micronutrient intervention should be considered to provide a sufficient supply of zinc and vitamin A for growth of exclusively breast-fed infants.

Effect of daily vs twice weekly iron supplementation in Indonesian preschool children with low iron status.

The effect of daily vs twice weekly iron supplementation on iron status was studied in preschool children with low iron status in a randomized double-masked field trial. Subjects (n = 87) were selected on the basis of their hemoglobin concentration being < 111 g/L in finger-prick blood, and were divided into two groups. For 8 wk one group received a daily supplement of 30 mg Fe, while the other group received 30 mg Fe twice per week. A complete data set was obtained from 32 children in the group supplemented daily and from 33 children in the group supplemented twice weekly. Hemoglobin, serum ferritin, and protoporphyrin increased significantly in both groups (P < 0.001). Changes in hemoglobin and protoporphyrin were correlated with initial hemoglobin concentration (P < 0.001). The difference in treatment effect between groups was not significant after correction for the initial hemoglobin concentration. It is concluded that in preschool children with low iron status, twice weekly iron supplementation has an effect on iron status similar to that of daily supplementation.

Decreased rate of stunting among anemic Indonesian preschool children through iron supplementation.

Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool children with low weight-for-age were investigated. A treatment group (n = 39) received daily supplements of 30 mg Fe and 20 mg vitamin C, whereas a control group (n = 37) received 20 mg vitamin C only for a period of 2 mo. Supplement allocation was double blind. At the start and finish of the study, body weight, height, food intake, and hemoglobin and serum ferritin concentrations were determined. Only the treatment group showed a significant increase in all hematological values (P < 0.001). Height and weight of all children increased (P < 0.01). Increases in height and height-for-age Z score in the treatment group were larger (P = 0.001) than the increase in the control group. The positive effect of iron supplementation on linear growth was not caused by increased food intake, but seems to be influenced by decreased morbidity. Iron supplementation may be a relatively inexpensive way to help decrease the high prevalence of stunting.

Low compliance with an iron-supplementation program: a study among pregnant women in Jakarta, Indonesia.

The efficiency of an established iron-supplementation program for pregnant women in Jakarta, Indonesia was investigated. Hemoglobin, serum ferritin, and packed cell volume (PCV) were measured at the start of the study and after 2 mo supplementation with 300 mg ferrous sulphate/d. The women (n = 45) were questioned about compliance and stool samples were checked for iron content to control for tablet intake. Twelve women dropped out. Prevalence of anemia (42%) did not decrease during the study period. Of the remaining 33 women, 64% (n = 21) claimed to have taken all iron tablets. This was only confirmed by positive stool tests in 12 women. Serum ferritin and PCV increased in women with positive stool tests (P < 0.05 and P < 0.01, respectively) after supplementation. It is concluded that compliance was low and that the iron dose needs to be increased. Supplementation programs need reliable monitoring and evaluation systems.