Contribution of plant-based dairy and fish alternatives to iodine nutrition in the Swiss diet: a Swiss Market Survey.

PURPOSE: With dairy products and fish being major sources of iodine in Switzerland, the growing popularity of plant-based alternatives may impact iodine nutrition. This study aimed to assess the iodine content in plant-based dairy and fish alternatives available in the Swiss market and compare them with conventional products. METHODS: In 2022, a market survey was conducted in Zurich, Switzerland, to identify the plant-based dairy and fish alternatives available and assess their iodine content. To evaluate the impact of plant-based alternatives on iodine consumption in Switzerland, we modeled dietary scenarios by substituting the intake of dairy and fish items with plant-based alternatives. In addition, we investigated fortification with calcium, vitamins B2, B12, and D. RESULTS: Out of 477 identified products, only four milk-alternative products were iodine fortified (median iodine concentration: 22.5 µg/100 ml). The median iodine concentration in unfortified plant-based alternatives was negligible compared to conventional dairy and fish products (milk: 0.21 vs 9.5 µg/100 ml; yogurt 0.36 vs 6.1 µg/100 g; cheese: 0.10 vs 20 µg/100 g; fish 0.50 vs 44 µg/100 g). Three portions of dairy per day as recommended by the Swiss Food Pyramid provide 25% of the RDA for iodine (150 µg/day), whereas substituting those with unfortified alternatives provides only 0.7% of the RDA. CONCLUSION: Only four out of 477 plant-based alternative products are iodine fortified in the Swiss market. Thus, the risk for consumers to miss out on the ca. 25% of the RDA for iodine by consuming plant-based alternatives is high, placing them at a risk for inadequate iodine intake.

Iodine intake in the Swiss population 100 years after the introduction of iodised salt: a cross-sectional national study in children and pregnant women.

PURPOSE: The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. METHODS: We conducted a nationwide cross-sectional study in children (6-12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. RESULTS: The median UIC was 127 µg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 µg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 µg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 µg/day). Compared to non-users, users had higher median UIC (129 vs. 81 µg/L, P < 0.001), lower prevalence of inadequacy (< 160 µg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 µg/L, P < 0.001). All women were euthyroid. CONCLUSIONS: The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013.

Iron status in Swiss adolescents with paediatric major depressive disorder and healthy controls: a matched case-control study.

PURPOSE: Depression is associated with low-grade systemic inflammation and impaired intestinal function, both of which may reduce dietary iron absorption. Low iron status has been associated with depression in adults and adolescents. In Swiss adolescents, we determined the associations between paediatric major depressive disorder (pMDD), inflammation, intestinal permeability and iron status. METHODS: This is a matched case-control study in 95 adolescents with diagnosed pMDD and 95 healthy controls aged 13-17 years. We assessed depression severity using the Children's Depression Rating Scale-Revised. We measured iron status (serum ferritin (SF) and soluble transferrin receptor (sTfR)), inflammation (C-reactive protein (CRP) and alpha-1-acid-glycoprotein (AGP)), and intestinal permeability (intestinal fatty acid binding protein (I-FABP)). We assessed history of ID diagnosis and treatment with a self-reported questionnaire. RESULTS: SF concentrations did not differ between adolescents with pMDD (median (IQR) SF: 31.2 (20.2, 57.0) µg/L) and controls (32.5 (22.6, 48.3) µg/L, p = 0.4). sTfR was lower among cases than controls (4.50 (4.00, 5.50) mg/L vs 5.20 (4.75, 6.10) mg/L, p < 0.001). CRP, AGP and I-FABP were higher among cases than controls (CRP: 0.16 (0.03, 0.43) mg/L vs 0.04 (0.02, 0.30) mg/L, p = 0.003; AGP: 0.57 (0.44, 0.70) g/L vs 0.52 (0.41, 0.67) g/L, p = 0.024); I-FABP: 307 (17, 515) pg/mL vs 232 (163, 357) pg/mL, p = 0.047). Of cases, 44% reported having a history of ID diagnosis compared to 26% among controls (p = 0.020). Finally, 28% of cases had iron treatment at/close to study inclusion compared to 14% among controls. CONCLUSION: Cases had significantly higher systemic inflammation and intestinal permeability than controls but did not have lower iron status. Whether this is related to the higher rate of ID diagnosis and iron treatment in adolescents with depression is uncertain.

Prebiotic Galacto-Oligosaccharides and Fructo-Oligosaccharides, but Not Acacia Gum, Increase Iron Absorption from a Single High-Dose Ferrous Fumarate Supplement in Iron-Depleted Women.

BACKGROUND: Prebiotic galacto-oligosaccharides (GOS) increase iron absorption from fortification-level iron doses given as ferrous fumarate (FeFum) in women and children. Whether GOS or other fibers, such as prebiotic fructo-oligosaccharides (FOS) and acacia gum, increase iron absorption from higher supplemental doses of FeFum is unclear. OBJECTIVES: In iron-depleted [serum ferritin (SF) <25 µg/L] women, we tested if oral coadministration of 15 g GOS, FOS, or acacia gum increased iron absorption from a 100 mg Fe supplement given as FeFum. METHODS: In a randomized, single-blind, crossover study, 30 women (median age: 26.2 y; median SF: 12.9 µg/L) consumed a 100 mg Fe tablet labeled with 4 mg 57Fe or 58Fe, given with either 1) 15 g GOS; 2) 15 g FOS; 3) 15 g acacia gum; or 4) 6.1 g lactose and 1.5 g sucrose (control; matching the amounts of sucrose and lactose present in the GOS powder providing 15 g GOS), dissolved in water. The primary outcome, fractional iron absorption (FIA), was assessed by erythrocyte isotopic incorporation 14 d after administration. Data were analyzed using a linear mixed-effect model. We also tested, in vitro, iron solubility at different pH and dialyzability from the different supplement combinations administered in vivo. RESULTS: FIA from FeFum given with GOS and FOS was significantly higher (+45% and +51%, respectively; P < 0.001 for both) than control; median [IQR] total iron absorption was 34.6 mg [28.4-49.1 mg], 36.1 mg [29.0-46.2 mg], and 23.9 mg [20.5-34.0 mg], respectively. Acacia gum did not significantly affect FIA from FeFum (P = 0.688). In vitro, iron dialyzability of FeFum + GOS was 46% higher than that of FeFum alone (P = 0.003). CONCLUSIONS: In iron-depleted women, both GOS and FOS coadministration with FeFum increased iron absorption by ∼50% from a 100 mg oral iron dose, resulting in an additional 10-12 mg of absorbed iron. Thus, GOS and FOS may be promising new enhancers of supplemental iron absorption.This trial was registered at clinicaltrials.gov as NCT04194255.

Prebiotic Galacto-Oligosaccharides and Fructo-Oligosaccharides, but Not Acacia Gum, Increase Iron Absorption from a Single High-Dose Ferrous Fumarate Supplement in Iron-Depleted Women.

BACKGROUND: Prebiotic galacto-oligosaccharides (GOS) increase iron absorption from fortification-level iron doses given as ferrous fumarate (FeFum) in women and children. Whether GOS or other fibers, such as prebiotic fructo-oligosaccharides (FOS) and acacia gum, increase iron absorption from higher supplemental doses of FeFum is unclear. OBJECTIVES: In iron-depleted [serum ferritin (SF) <25 µg/L] women, we tested if oral coadministration of 15 g GOS, FOS, or acacia gum increased iron absorption from a 100 mg Fe supplement given as FeFum. METHODS: In a randomized, single-blind, crossover study, 30 women (median age: 26.2 y; median SF: 12.9 µg/L) consumed a 100 mg Fe tablet labeled with 4 mg 57Fe or 58Fe, given with either 1) 15 g GOS; 2) 15 g FOS; 3) 15 g acacia gum; or 4) 6.1 g lactose and 1.5 g sucrose (control; matching the amounts of sucrose and lactose present in the GOS powder providing 15 g GOS), dissolved in water. The primary outcome, fractional iron absorption (FIA), was assessed by erythrocyte isotopic incorporation 14 d after administration. Data were analyzed using a linear mixed-effect model. We also tested, in vitro, iron solubility at different pH and dialyzability from the different supplement combinations administered in vivo. RESULTS: FIA from FeFum given with GOS and FOS was significantly higher (+45% and +51%, respectively; P < 0.001 for both) than control; median [IQR] total iron absorption was 34.6 mg [28.4-49.1 mg], 36.1 mg [29.0-46.2 mg], and 23.9 mg [20.5-34.0 mg], respectively. Acacia gum did not significantly affect FIA from FeFum (P = 0.688). In vitro, iron dialyzability of FeFum + GOS was 46% higher than that of FeFum alone (P = 0.003). CONCLUSIONS: In iron-depleted women, both GOS and FOS coadministration with FeFum increased iron absorption by ∼50% from a 100 mg oral iron dose, resulting in an additional 10-12 mg of absorbed iron. Thus, GOS and FOS may be promising new enhancers of supplemental iron absorption. This trial was registered at clinicaltrials.gov as NCT04194255.

The effects of reducing chronic inflammation in overweight women on serum hepcidin and iron absorption with and without supplemental ascorbic acid.

Although hepcidin synthesis is stimulated by inflammation and inhibited by Fe deficiency, the strength of their opposing effects on serum hepcidin (SHep) in humans remains unclear. It was recently shown that an inflammatory stimulus in anaemic women did not increase SHep or decrease Fe absorption. The enhancing effect of ascorbic acid on Fe absorption may not be effective during inflammation because of increased SHep. Our study aim was to test whether reducing inflammation in Fe-depleted overweight (OW) women with low-grade inflammation would lower SHep and improve Fe absorption with and without ascorbic acid, compared with normal-weight (NW) women without inflammation. Before and after 14 d of anti-inflammatory treatment (3 × 600 mg ibuprofen daily) in OW and NW women (n 36; 19-46 years of age), we measured SHep and fractional Fe absorption (FIA) (erythrocyte Fe incorporation) from 57Fe- and 58Fe-labelled test meals with and without ascorbic acid. There were significant group effects on IL-6, C-reactive protein, serum ferritin and SHep (for all, P < 0·05). There was a significant treatment effect on SHep (P < 0·05): in OW women, treatment decreased IL-6 by approximately 30 % and SHep by approximately 45 %. However, there were no significant treatment or group effects on FIA. Body Fe stores (BIS) were a significant positive predictor of SHep before and after treatment (P < 0·001), but IL-6 was not. Reducing chronic inflammation in OW women halved SHep but did not affect Fe absorption with or without ascorbic acid, and the main predictor of Fe absorption was BIS.

The effect of central obesity on inflammation, hepcidin, and iron metabolism in young women.

BACKGROUND/OBJECTIVES: In overweight and obesity (OW/OB), greater total body fat predicts higher serum hepcidin (SHep) which can impair iron homeostasis and increase risk for iron deficiency (ID). However, the effect of body fat distribution on SHep and iron homeostasis is unclear. In central obesity, interleukin (IL)-6 released from visceral adipose tissue into portal blood could strongly stimulate hepatic hepcidin synthesis. Thus, our hypothesis was that higher amounts of android fat, rather than gynoid fat, would predict impaired iron metabolism in OW/OB. SUBJECTS/METHODS: In this cross-sectional study, we enrolled 117 otherwise-healthy women into two groups: normal weight; BMI < 25 (n = 36) and OW/OB; BMI ≥ 25 (n = 81); we then subdivided the OW/OB using DEXA into tertiles based on the ratio of android fat/total body fat (AF/TBF). We measured inflammation and iron status, and assessed iron absorption in two ways: by measuring erythrocyte isotope incorporation from a labeled test meal containing 6 mg 57Fe (representing dietary iron); and by measuring change in serum iron (ΔSeFe) after a 100 mg oral iron challenge (representing supplemental iron). RESULTS: Greater AF/TBF correlated with higher CRP, AGP, SHep, and TIBC, and lower transferrin saturation and SeFe/SHep ratio (for all, p < 0.05). Greater AF/TBF correlated with lower supplemental iron absorption (ΔSeFe) (p = 0.08) but not lower dietary iron absorption. In multiple regressions, AF/TBF positively predicted CRP (p < 0.001) and SHep (p < 0.05); a model including AF/TBF and serum ferritin as covariates explained 65% of the variance in SHep. AF/TBF negatively predicted TSAT (p < 0.05) and iron absorption (ΔSeFe) (p = 0.07). In contrast, the ratio of gynoid fat/total body fat was not significantly associated with these variables. CONCLUSION: Body fat distribution affects iron metabolism: women with greater central adiposity have higher SHep, greater impairments in iron homeostasis, and reduced iron absorption from a supplemental iron dose.

Acute Consumption of Prebiotic Galacto-Oligosaccharides Increases Iron Absorption from Ferrous Fumarate, but not from Ferrous Sulfate and Ferric Pyrophosphate: Stable Iron Isotope Studies in Iron-Depleted Young Women.

BACKGROUND: Although acute consumption of high doses of prebiotic galacto-oligosaccharides (GOS) increases fractional iron absorption (FIA) from ferrous fumarate (FeFum), it is uncertain if low doses of GOS have this effect. Furthermore, whether GOS improve iron absorption from other commonly used iron compounds and whether ascorbic acid (AA) enhances the effect of GOS on iron absorption from FeFum is unclear. OBJECTIVES: In iron-depleted women [serum ferritin (SF) <30 µg/L], we assessed: 1) whether the acute enhancing effect of GOS on FeFum is dose dependent; 2) if GOS would affect FIA from ferrous sulfate (FeSO4) or ferric pyrophosphate (FePP); and 3) if AA and GOS given together enhance FIA from FeFum to a greater extent compared with GOS alone. METHODS: We recruited 46 women (mean age 22.0 y, mean BMI 21.3 kg/m2, median SF 17.1 µg/L), and measured FIA from 14 mg iron labeled with stable isotopes in the following conditions: 1) FIA from FeFum given with 3.5 g, 7 g GOS, and without GOS; 2) FIA from FeSO4 and FePP given with and without 15 g GOS; and 3) FIA from FeFum given with 7 g GOS with and without 93 mg AA. FIA was measured as erythrocyte incorporation of stable isotopes after 14 d. Comparisons were made using paired samples t-test or Wilcoxon rank sum test where appropriate. RESULTS: Giving 7 g of GOS significantly increased FIA from FeFum (+26%; P = 0.039), whereas 3.5 g GOS did not (P = 0.130). GOS did not significantly increase FIA from FeSO4 (P = 0.998) or FePP (P = 0.059). FIA from FeFum given with GOS and AA was significantly higher compared with FeFum given with GOS alone (+30%; P <0.001). CONCLUSIONS: In iron-depleted women, GOS does not increase FIA from FeSO4 or FePP, but it increases FIA from FeFum. Thus, a combination of FeFum and GOS may be a well-absorbed formula for iron supplements. The study was registered at clinicaltrials.gov as NCT03762148.

Addition of Whole Wheat Flour During Injera Fermentation Degrades Phytic Acid and Triples Iron Absorption from Fortified Tef in Young Women.

BACKGROUND: Iron deficiency is a major public health concern in Ethiopia, where the traditional diet is based on tef injera. Iron absorption from injera is low due to its high phytic acid (PA) content. OBJECTIVES: We investigated ways to increase iron absorption from FeSO4-fortified tef injera in normal-weight healthy women (aged 21-29 y). METHODS: Study A (n = 22) investigated the influence on fractional iron absorption (FIA) from FeSO4-fortified injera of 1) replacing 10% tef flour with whole wheat flour (a source of wheat phytase), or 2) adding an isolated phytase from Aspergillus niger. Study B (n = 18) investigated the influence on FIA of replacing FeSO4 in tef injera with different amounts of NaFeEDTA. In both studies, the iron fortificants were labeled with stable isotopes and FIA was calculated from erythrocyte incorporation of stable iron isotopes 14 d after administration. RESULTS: In study A, the median (IQR) FIA from the 100% tef injera meal was 1.5% (0.7-2.8%). This increased significantly (P < 0.05) to 5.3% (2.4-7.1%) on addition of 10% whole wheat flour, and to 3.6% (1.6-6.2%) on addition of A. niger phytase. PA content of the 3 meals was 0.62, 0.20, and 0.02 g/meal, respectively. In study B, the median (IQR) FIA from the 100% tef injera meal was 3.3% (1.1-4.4%) and did not change significantly (P > 0.05) on replacing 50% or 75% of FeSO4 with NaFeEDTA. CONCLUSIONS: FIA from tef injera by young women was very low. NaFeEDTA was ineffective at increasing iron absorption, presumably due to the relatively low EDTA:Fe molar ratios. Phytate degradation, however, greatly increased during tef fermentation on addition of native or isolated phytases. Replacing 10% tef with whole wheat flour during injera fermentation tripled FIA in young women and should be considered as a potential strategy to improve iron status in Ethiopia.

Effectiveness of increased salt iodine concentration on iodine status: trend analysis of cross-sectional national studies in Switzerland.

PURPOSE: Despite longstanding voluntary salt iodisation in Switzerland, data suggest inadequate iodine intake in vulnerable population groups. In response, the salt iodine concentration was increased from 20 to 25 mg/kg and we assessed the impact on iodine status. METHODS: We conducted a cross-sectional national study in school-age children (n = 731), women of reproductive age (n = 353) and pregnant women (n = 363). We measured urinary iodine concentration (UIC) and urinary sodium concentration (UNaC) in spot urine samples. The current median UIC was compared with national data from 1999, 2004 and 2009. We measured TSH, total T4 and thyroglobulin (Tg) on dried blood spot samples collected in women. RESULTS: The median UIC (bootstrapped 95% CI) was 137 µg/L (131, 143 µg/L) in school children, 88 µg/L (72, 103 µg/L) in women of reproductive age and 140 µg/L (124, 159 µg/L) in pregnant women. Compared to 2009, the median UIC increased modestly in school children (P < 0.001), but did not significantly change in pregnant women (P = 0.417). Estimated sodium intake exceeded the recommendations in all population groups. The prevalence of thyroid disorders in women was low, but Tg was elevated in 13% of the pregnant women. CONCLUSION: Iodine intake is overall adequate in Swiss school-age children, but only borderline sufficient in pregnant and non-pregnant women, despite high salt intakes and satisfactory household coverage with iodized salt. Our findings suggest increasing the concentration of iodine in salt may not improve iodine intakes in women if iodised salt is not widely used in processed foods. REGISTRATION: This trial was registered at clinicaltrials.gov as NCT02312466.

Greater blood volume and Hb mass in obese women quantified by the carbon monoxide-rebreathing method affects interpretation of iron biomarkers and iron requirements.

BACKGROUND/OBJECTIVE: Iron deficiency (ID) is common in overweight and obese individuals (OW/OB) but the mechanism is uncertain. Greater blood volume (BV) in OW/OB may increase hemoglobin (Hb) mass and iron requirements, and confound iron biomarkers by hemodilution. Quantification of BV/PV changes in OW/OB is challenging and a formula to estimate BV/PV based on anthropometric indices would be valuable. In normal weight (NW) and OW/OB women, we aimed at: (1) measure BV and assess whether differences in BV affect concentrations and total circulating mass of Hb and iron biomarkers; (2) develop an algorithm describing BV in OW/OB. SUBJECTS/METHODS: In a cross-sectional study, we measured BV in NW, OW, and OB non-anemic women (n = 62) by using the carbon monoxide-rebreathing method, body composition by dual energy X-ray absorptiometry, and iron and inflammatory status. RESULTS: OW and OB women had 11 and 16% higher mean BV and PV compared to NW (P < 0.05), respectively. In OW/OB compared to NW, total circulating masses of IL-6, hepcidin, Hb, and sTfR were higher, while total mass of serum iron was lower (for all, P < 0.05). An equation including height, body mass and lean mass to estimate BV in all BMI groups (R2 = 0.76). CONCLUSION: An equation based on anthropometric indices provides a good estimate of increased BV in OW/OB women. In OW/OB women, there is an increase in Hb mass that likely increases iron requirements for erythropoiesis and circulating TfR mass. At the same time, higher hepcidin concentrations may lower serum iron mass. Both these mechanisms may increase risk for ID in OW/OB women.

Consumption of Galacto-Oligosaccharides Increases Iron Absorption from Ferrous Fumarate: A Stable Iron Isotope Study in Iron-Depleted Young Women.

BACKGROUND: Animal studies suggest prebiotics can increase iron absorption, but results from human studies are equivocal. OBJECTIVES: In iron-depleted women, before (baseline) and after daily consumption of galacto-oligosaccharides (GOS) for 4 wk, we sought to assess fractional iron absorption (FIA) from an iron supplement given with and without single doses of GOS in test meals or water. METHODS: In all women (n = 34; median serum ferritin concentration = 16.4 µg/L), FIA from doses of 14 mg iron labeled with stable isotopes was measured in the following conditions at baseline: 1) FIA from ferrous fumarate (FeFum) in water given with and without 15 g GOS; 2) FIA from FeFum in a test meal given with and without 15 g GOS; 3) FIA from ferrous sulfate (FeSO4) in a test meal given without 15 g GOS. All subjects then consumed âˆ¼15 g GOS daily for 4 wk. Then the following conditions were tested: 4) FIA from FeFum in a test meal with and without 15 g GOS; and 5) FIA from FeSO4 in a test meal with 15 g GOS. FIA was measured as erythrocyte incorporation of stable isotopes. RESULTS: At baseline, GOS significantly increased FIA from FeFum when given with water (+61%; P < 0.001) and the meal (+28%; P = 0.002). After 4 wk of GOS consumption, GOS again significantly increased FIA from FeFum in the meal (+29%; P = 0.044). However, compared with baseline, consumption of GOS for 4 wk did not significantly enhance absorption from FeFum in the meal given without GOS. FIA from FeSO4 given with GOS in a meal after 4 wk of GOS consumption was not significantly greater than FIA from FeSO4 in a meal without GOS at baseline. CONCLUSIONS: In iron-depleted women, GOS given with FeFum increases FIA, but 4 wk of GOS consumption did not enhance this effect. The study was registered at clinicaltrials.gov as NCT03325270.

Effects of feed iodine concentrations and milk processing on iodine concentrations of cows' milk and dairy products, and potential impact on iodine intake in Swiss adults.

The contribution of milk and dairy products to daily iodine intake is high but variable in many industrialised countries. Factors that affect iodine concentrations in milk and dairy products are only poorly understood. Our aim was to: (1) assess the effect of feed iodine concentration on milk iodine by supplementing five groups of five cows each with one of five dosages from 0-2 mg iodine/kg DM; (2) quantify iodine losses during manufacturing of cheese and yogurt from milk with varying iodine concentrations and assess the effect of cellar-ripening; and (3) systematically measure iodine partitioning during heat treatment and skimming of milk. Milk iodine reached a near-steady state after 3 weeks of feeding. Median milk iodine (17-302 µg/l for 0-2 mg iodine/kg DM) increased linearly with feed iodine (R2 0·96; P < 0·001). At curd separation, 75-84 % of iodine was lost in whey. Dairy iodine increased linearly with milk iodine (semi-hard cheese: R2 0·95; P < 0·001; fresh cheese and yogurt: R2 1·00; P < 0·001), and cellar-ripening had no effect. Heat treatment had no significant effect, whereas skimming increased (P < 0·001) milk iodine concentration by only 1-2 µg/l. Mean daily intake of dairy products by Swiss adults is estimated at 213 g, which would contribute 13-52 % of the adults' RDA for iodine if cow feed is supplemented with 0·5-2 mg iodine/kg DM. Thus, modulation of feed iodine levels can help achieve desirable iodine concentrations in milk and dairy products, and thereby optimise their contribution to human iodine nutrition to avoid both deficiency and excess.

Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial.

BACKGROUND: Older adults often suffer from age- and behavior-related brain changes affecting neuronal functioning and, therefore, cognitive and motor functions. The improvement of these functions might decrease falls and improve mobility. Previous studies indicate that video game-based physical exercise, so-called exergames, or omega-3 fatty acids (FAs) improve motor and cognitive functioning through brain adaptations. The aim of this study was to assess the effects of exergame training combined with fish oil supplementation on neuronal system levels in the brain and behavioral measurements in older adults. We hypothesized that the combination would differently affect these factors compared to the sole administration of exergame. METHODS: Fifty-eight participants were randomly assigned to one of two groups (N = 29 each group) in a parallel, double-blind, randomized controlled trial lasting 26 weeks. The experimental group received daily fish oil, whereas the control group received daily olive oil. After 16 weeks, both groups started with an exergame training. Measurements were performed pre, during, and post intervention. Primary outcomes were recruitment curves using transcranial magnetic stimulation and response-locked potentials using electroencephalography. Secondary outcomes included executive functions and gait parameters. Blood samples were taken to control for FAs. RESULTS: Forty-three individuals (mean age 69.4 ± 4.6 years) completed the study (Nexperimental = 22, Ncontrol = 21). The results showed no significant time × group interaction effects for any parameters. Blood samples demonstrated significant time × group interaction effects. Post-hoc tests showed a significant increase of omega-3 FAs (p < .001) and a significant decrease of omega-6 FAs (p < .001) for the experimental group. CONCLUSION: The combination of exergame training and fish oil did not lead to additional beneficial effects. To trigger possible effects, future studies should carefully consider study design aspects; e.g. study duration, individual nutritional supplementation dose, omega-3 FAs supplementation composition, and placebo. Furthermore, studies should consider neuroimaging methods as these might be more sensitive to assess early brain adaptations. Thus, future studies should be aware of several aspects running a combinatory study that includes omega-3 FAs according to their expected effects. TRIAL REGISTRATION: Swiss National Clinical Trials SNCTP000001623 and ISRCTN12084831 registered 30 November 2015.

The main determinants of iodine in cows' milk in Switzerland are farm type, season and teat dipping.

Milk and dairy products are important iodine sources and contribute about 30-40 % of total iodine in the Swiss diet. Information about variation in milk iodine concentration (MIC) in Switzerland is limited. We examined MIC and its potential determinants in milk from organic and conventional farms. We collected bulk milk samples at 3-month intervals over 1 year from thirty-two farms throughout Switzerland and Aosta valley, North-West Italy. We sampled all feed components including tap water, collected information on farm characteristics, feeding and teat disinfection practices by questionnaire and estimated the cows' winter and summer iodine intake. Iodine in milk and feed components was measured using inductively coupled plasma MS. The overall median MIC was 87 (range 5-371) µg/l. In multivariate analysis, predictors of MIC were as follows: (1) farm type: median MIC from organic and conventional farms was 55 and 93 µg/l (P=0·022); (2) season: 53, 97 and 101 µg/l in September, December and March (P<0·002); and (3) teat dipping: 97 µg/l with v. 56 µg/l without (P=0·028). In conclusion, MIC varied widely between farms because of diverse farming practices that result in large differences in dairy cow exposure to iodine via ingestion or skin application. Standardisation of MIC is potentially achievable by controlling these iodine exposures. In order for milk to be a stable iodine source all year round, dietary iodine could be added at a set level to one feed component whose intake is regular and controllable, such as the mineral supplement, and by limiting the use of iodine-containing teat disinfectants.

Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women.

Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) µg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) µg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) µg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.

In Haitian women and preschool children, iron absorption from wheat flour-based meals fortified with sodium iron EDTA is higher than that from meals fortified with ferrous fumarate, and is not affected by Helicobacter pylori infection in children.

Fe fortification of wheat flour was proposed in Haiti to combat Fe deficiency, but Fe bioavailability from fortificants has never been investigated in Haitian women or preschool children, two key target groups. We aimed to investigate the bioavailability of ferrous fumarate (FeFum), NaFeEDTA and their combination from fortified wheat flour. We recruited twenty-two healthy mother-child pairs in Port au Prince, Haiti, for an Fe-absorption study. We administered stable Fe isotopes as FeFum or NaFeEDTA individually in low-extraction wheat flour bread rolls consumed by all participants in a randomised, cross-over design. In a final, identical meal, consumed only by the women, FeFum+NaFeEDTA was administered. We measured Fe absorption by using erythrocyte incorporation of stable isotopes 14 d after consumption of each meal, and determined Fe status, inflammatory markers and Helicobacter pylori infection. Fe absorption (geometric mean was 9·24 (95 % CI 6·35, 13·44) and 9·26 (95 % CI 7·00, 12·31) from FeFum and 13·06 (95 % CI 9·23, 19·10) and 12·99 (95 % CI 9·18, 18·39) from NaFeEDTA in mothers and children, respectively (P<0·05 between compounds). Fe absorption from FeFum+NaFeEDTA was 11·09 (95 % CI 7·45, 17·34) and did not differ from the other two meals. H. pylori infection did not influence Fe absorption in children. In conclusion, in Haitian women and children, Fe absorption from NaFeEDTA was 40 % higher than from FeFum, and the combination FeFum+NaFeEDTA did not significantly increase Fe absorption compared with FeFum alone. In the context of Haiti, where the high costs of NaFeEDTA may not be affordable, the use of FeFum at 60 mg Fe/kg flour may be a preferable, cost-effective fortification strategy.

The Potential of Fermentation and Contamination of Teff by Soil to Influence Iron Intake and Bioavailability from Injera Flatbread.

The high phytic acid (PA) concentration in the diet based on teff injera is a likely contributing cause of iron deficiency in Ethiopia. We monitored PA during teff injera fermentation in 30 households in Debre Zeyit, Ethiopia and evaluated its influence on iron bioavailability, considering contaminant soil iron in teff flour. After fermentation (48h), mean PA concentration in injera batter decreased from 0.87 to 0.58 g/100 g dm (P < 0.001). Low phytase activity in teff flour (0.44 µmol phosphate/min/g) and a rapid drop in pH, indicated that PA degradation was driven by microbial phytases. The iron concentration in injera batter among the households ranged widely from 14.5-160.4 mg/100 g dm (mean: 34.7 mg/100 g dm) principally due to contamination with soil. Estimated intrinsic iron concentration of teff based on the strong correlation between total iron and aluminium concentrations (P < 0.001; aluminium concentrations in injera batter: 28.7-184.9 mg/100 g dm) was 4.4 mg/100 g dm, indicating that 86-97 % is extrinsic iron from soil. The median daily iron intakes from 3-day weighed food records in 10 young children were 18.9 mg/day including soil iron vs. 4.9 mg/day without soil iron (P < 0.01). The PA:iron molar ratios indicated low iron bioavailability from teff injera, particularly when soil iron was excluded. Traditional fermentation thus has a modest influence on PA levels and more complete degradation is needed to improve iron bioavailability. There is an urgent need to better understand the bioavailability of contamination iron from soil before considering national fortification or biofortification strategies in Ethiopia.

Increased risk of iron deficiency and reduced iron absorption but no difference in zinc, vitamin A or B-vitamin status in obese women in India.

PURPOSE: Two objectives were investigated: (1) to assess the risk of micronutrient deficiencies in relation to weight status in Indian women with a focus on iron but also including zinc, vitamin A and B vitamins and (2) to compare fractional iron absorption between obese (OB) and normal weight (NW) women. METHODS: Part 1 was a cross-sectional study including 146 healthy, middle-class women from Bangalore, India, with a BMI between 19 and 40 kg/m2. Anthropometrics and blood pressure were measured, and a fasting blood sample was obtained for the analysis of vitamin and mineral status, hepcidin, blood lipids and glucose. In part 2, 16 OB and 13 NW women consumed a standardized test meal labeled with the stable iron isotope 57Fe. Incorporation of the iron isotope into erythrocytes was measured 14 days later. In addition, iron status, hepcidin and inflammatory markers were determined. RESULTS: In part 1, compared to NW women, overweight/OB subjects had significantly higher C-reactive protein, serum ferritin, soluble transferrin receptor (sTfR) and hepcidin concentrations (p < 0.05). The odds ratio for having high sTfR concentrations (i.e., low iron status) with increasing BMI was 1.09 (95 % CI 1.02-1.17). None of the other micronutrients investigated showed any differences between weight status groups. In part 2, fractional iron absorption was significantly lower in the OB group compared to the NW group even after controlling for differences in iron status (10.0 ± 6.5 vs. 16.7 ± 4.6 %; p = 0.038). CONCLUSIONS: OB women in Bangalore have an increased risk of low iron status and absorb less dietary iron; however, their risk of other micronutrient deficiencies was similar to NW women. Our results clearly demonstrate the importance of considering the double burden of malnutrition in the planning of prevention strategies especially in transition countries with emerging obesity epidemics.