The Menu Served in Canadian Penitentiaries: A Nutritional Analysis.

The food served in Canadian penitentiaries was scrutinized following food service reform where Correctional Service Canada (CSC) created a standardized menu to feed incarcerated male individuals. Food in prison is a complex issue because penitentiaries are responsible for providing adequate nutrition to the prison population, who are vulnerable to poor health outcomes but are often seen as undeserving. This study aimed to analyse the national menu served in Canadian penitentiaries, in order to compare them with Dietary Reference Intakes (DRIs) for male adults and the internal nutritional assessment reported by CSC. The goal was to verify if the menu served was adequate and to validate CSC's nutritional assessment. The diet analysis software NutrificR was used to analyse the 4-week cycle menu. Both analyses were within range for DRIs for most nutrients. However, some nutrients were not within target. The sodium content (3404.2 mg) was higher than the Tolerable Upper Intake Levels (UL) of 2300 mg, the ω-6 (linolenic acid) content (10.8 g) was below the AI of 14 g, and the vitamin D content (16.2 µg) was below the target of 20 µg for individuals older than 70 years. When these outliers were analysed in-depth, the menu offering was consistent with the eating habits of non-incarcerated individuals. Based on this nutritional analysis and interpretation of the results in light of the complex nature of prison food, this study concludes that CSC meets its obligation to provide a nutritionally adequate menu offering to the general population during incarceration.

An elective high school cooking course improves students' cooking and food skills: a quasi-experimental study.

INTERVENTION: The Professional Cooking (PC) course is an optional 18-week experiential learning course offered in francophone high schools in New Brunswick, Canada. Students are taught how to measure ingredients, read and follow recipes, prepare and cook various foods using different culinary techniques, and apply food safety practices. RESEARCH QUESTION: What is the effectiveness of the PC course on high school girls' and boys' cooking and food skills, vegetable and fruit consumption, and other eating behaviours? METHODS: Students enrolled in the PC course (n = 124) or a mandatory Personal and Social Development (PSD) course (n = 202) in five high schools were recruited. Students' food and cooking skills, vegetable and fruit consumption, and other eating behaviours were collected through a self-administered, pre-post questionnaire. Group differences were assessed with mixed-effect regression models, and separate gender analyses were conducted. RESULTS: Students in the PC course reported greater increases in food (ß=5.74, 95% CI 1.65, 9.83) and cooking skills (ß=10.33, 95% CI 5.59, 15.06) than students in the PSD course. Girls and boys in the PC course reported greater improvements in cooking skills (ß=8.68, 95% CI 2.57, 14.80; ß=11.97, 95% CI 4.39, 19.57, respectively) than those in the PSD course. No effect was found for vegetable and fruit consumption or other eating behaviours (all p values > 0.05). CONCLUSION: The PC course effectively improved students' cooking skills. Curriculum-integrated high school cooking courses provide a foundation for healthier eating by helping students develop food literacy skills and should be mandatory in schools.

RéSUMé: INTERVENTION: Le cours de Cuisine professionnelle (CP) est un cours d'apprentissage expérientiel optionnel, d'une durée de 18 semaines, offert dans les écoles secondaires francophones au Nouveau-Brunswick, Canada. Les élèves sont enseignés comment mesurer des ingrédients, lire et suivre des recettes, préparer et cuire une variété d'aliments en utilisant différentes techniques culinaires et appliquer des pratiques d'hygiène et de salubrité alimentaire. QUESTION DE RECHERCHE: Quelle est l'efficacité du cours de CP sur les habiletés culinaires et alimentaires, la consommation de légumes et fruits et les autres comportements alimentaires des filles et des garçons? MéTHODES: Les élèves inscrits dans un cours à option de CP (n = 124) ou d'un cours obligatoire de Formation personnelle et sociale (FPS) (n = 202) livrés dans cinq écoles secondaires ont été recrutés. Les habiletés culinaires et alimentaires, la consommation de légumes et fruits et les autres comportements alimentaires des élèves ont été recueillis par un questionnaire auto-rapporté pré- et post. Des modèles de régression à effets mixtes ont été utilisés pour évaluer les différences entre les groupes et des analyses stratifiées par genre ont été effectuées. RéSULTATS: Les élèves inscrits au cours de CP ont rapporté des améliorations plus grandes de leurs habiletés alimentaires (ß=5,74, 95% CI 1,65, 9,83) et culinaires (ß=10,33, 95% CI 5,59, 15,06) en comparaison avec les élèves du cours de FPS. Les filles et les garçons inscrits au cours de CP ont amélioré davantage leurs habiletés culinaires (ß=8,68, 95% CI 2,57, 14,80; ß=11,97, 95% CI 4,39, 19,57, respectivement) que ceux qui étaient inscrits au cours de FPS. Aucune différence significative n'a été notée entre les deux groupes quant à la consommation en légumes et fruits et aux autres comportements alimentaires (toutes les valeurs de p > 0,05). CONCLUSION: Le cours de CP a permis d'améliorer les habiletés culinaires des élèves. Les cours culinaires intégrés dans le curriculum des écoles secondaires permettent d'établir une base nécessaire pour une saine alimentation en aidant les élèves à développer leurs habiletés et devraient donc être des cours obligatoires dans les écoles.

The Association Between Adolescents' Food Literacy, Vegetable and Fruit Consumption, and Other Eating Behaviors.

Adolescents' intake of vegetables and fruits is generally low, and many demonstrate unhealthy eating behaviors. Food literacy may be key to improving adolescents' nutrition. However, the relationship between food literacy, fruit and vegetable intake, and other healthy eating behaviors remains unclear, as well as how these relationships may differ among boys and girls. This study assessed the relationship between food literacy (including food skills and cooking skills), vegetable and fruit consumption, and other eating behaviors of adolescents. This cross-sectional study included 1,054 students, including 467 boys and 570 girls from five francophone high schools in New Brunswick, Canada. Quantitative data on students' food and cooking skills, vegetable and fruit consumption, and other eating behaviors were collected with a self-reported questionnaire. Multilevel regressions were used to assess the relationship between food literacy, students' consumption of vegetables and fruits, and other eating behaviors. Better cooking skills were associated with healthier eating behaviors and greater vegetable and fruit consumption for boys and girls. Better food skills were also associated with healthier eating behaviors and greater vegetable and fruit consumption among both genders. These findings highlight the importance of improving food literacy among adolescents. Public health interventions should focus on increasing cooking and food skills to improve adolescents' nutrition.

Equity and inclusivity in research: co-creation of a digital platform with representatives of marginalized populations to enhance the involvement in research of people with limited literacy skills.

To improve health equity, as well as equity in research, community-engaged research and participatory research needs to be inclusive. Equity in health research refers to the principle that anyone affected by research or who can benefit from its outcomes should have equal opportunities to contribute to it. Many researchers advocate the importance of promoting equity in research and engage in processes that foster the research involvement of lay persons, patients, and community members who are otherwise "absent" or "silent". Still, people with limited literacy skills who experience unwarranted structural barriers to healthcare access have little involvement in research. Low literacy is a major barrier to equity in health research. Yet there exist approaches and methods that promote the engagement in research of people with literacy challenges. Building on our previous research projects conducted with community members using participatory visual and sound methods (participatory mapping, photovoice, digital storytelling, etc.), we embarked on the co-creation of a digital platform in 2017. Our aim in this commentary is to report on this co-creation experience that was based on a social justice-oriented partnership. The development of the online platform was overseen by a steering committee made up of workers from community organizations involved with people with limited literacy skills, students, and researchers. In the development process, the co-creation steps included a literature review, informal interviews with key informants, and discussion and writing sessions about format and content. After numerous challenges raised and addressed during co-creation, the Engage digital platform for engagement in research went live in the winter of 2020. This platform presents, on an equal footing, approaches and methods from academic research as well as from the literacy education community engaged with people with limited literacy skills.

People with limited literacy skills are often excluded from health research. Engaging patients and community members with limited literacy in research requires tailored approaches and methods that have been tried and tested with them. In 2017, building on an existing partnership between researchers well-versed in using participatory visual and sound methods and community partners, we undertook the co-creation of a digital platform. Our aim was to empower both academic researchers and community researchers and partners (lay persons, clinicians, stakeholders, community organizations) to engage in research projects with people with limited literacy skills. The result was a digital platform ( https://www.engageplus.org ) comprising several modules and resources available in French and English and accessible on the Web. In this commentary, we share our experience in co-creating this digital platform and discuss the facilitators and challenges encountered.

Unveiling the Roles of Low-Density Lipoprotein Receptor-Related Protein 6 in Intestinal Homeostasis, Regeneration and Oncogenesis.

Intestinal epithelial self-renewal is tightly regulated by signaling pathways controlling stem cell proliferation, determination and differentiation. In particular, Wnt/ß-catenin signaling controls intestinal crypt cell division, survival and maintenance of the stem cell niche. Most colorectal cancers are initiated by mutations activating the Wnt/ß-catenin pathway. Wnt signals are transduced through Frizzled receptors and LRP5/LRP6 coreceptors to downregulate GSK3ß activity, resulting in increased nuclear ß-catenin. Herein, we explored if LRP6 expression is required for maintenance of intestinal homeostasis, regeneration and oncogenesis. Mice with an intestinal epithelial cell-specific deletion of Lrp6 (Lrp6IEC-KO) were generated and their phenotype analyzed. No difference in intestinal architecture nor in proliferative and stem cell numbers was found in Lrp6IEC-KO mice in comparison to controls. Nevertheless, using ex vivo intestinal organoid cultures, we found that LRP6 expression was critical for crypt cell proliferation and stem cell maintenance. When exposed to dextran sodium sulfate, Lrp6IEC-KO mice developed more severe colitis than control mice. However, loss of LRP6 did not affect tumorigenesis in ApcMin/+ mice nor growth of human colorectal cancer cells. By contrast, Lrp6 silencing diminished anchorage-independent growth of BRafV600E-transformed intestinal epithelial cells (IEC). Thus, LRP6 controls intestinal stem cell functionality and is necessary for BRAF-induced IEC oncogenesis.

Mitigated Impact of Provision of Local Foods Combined with Nutrition Education and Counseling on Young Child Nutritional Status in Cambodia.

BACKGROUND: In Cambodia, stunting and wasting affect, respectively, 32% and 10% of children 0⁻59 months while 55% are anemic. Our research aims to assess the efficiency of two local foods combined with nutritional education and counseling (CEN) activities as compared to CEN alone on improving child nutritional status and dietary intake. METHODS: A cluster-randomized controlled trial was conducted in Soth Nikum area over a six-month period among children 6⁻23 months (n = 360) assigned to receive either moringa +CEN, cricket +CEN or CEN alone. Anthropometric measurements were performed and hemoglobin and ferritin levels assessed. RESULTS: Overall, no significant increase in the mean length/height-for-age z-score was observed, although a small increase of the weight-for-length/height was noted in intervention groups. Hemoglobin and ferritin mean values increased in all groups. The degree of satisfaction of energy, proteins, iron, and zinc requirements improved in all groups, but to a greater extent in the intervention groups and more children were healthy. CONCLUSION: Our research shows no significant impact of the provision of two local foods combined with CEN on the improvement of child nutritional status as compared to CEN alone. However, children consuming them better fulfilled their energy, iron, and zinc requirements and were healthier.

Epithelial Src homology region 2 domain-containing phosphatase-1 restrains intestinal growth, secretory cell differentiation, and tumorigenesis.

Shp-1 (Src homology region 2 domain-containing protein tyrosine phosphatase-1) is a phosphatase that is highly expressed in hematopoietic and epithelial cells. Whereas its function is largely characterized in hematopoietic cells, its role in epithelial cells, such as intestinal epithelial cells (IECs), is not well known. Here, we generated mice with an IEC-specific knockout of Shp-1 (Src homology region 2 domain-containing phosphatase-1; Shp-1IEC-KO). We showed that the loss of epithelial Shp-1 leads to an intestinalomegaly that is associated with an increase in epithelial cell proliferation and size. Histologic analysis demonstrates significant perturbation of the crypt-villus architecture with an apparent increase in the number of goblet and Paneth cells and increased expression of their respective markers {Muc2 (mucin 2), αDef, and Sox9 [SRY (sex determining region Y)-box 9]}. Expansion of intermediate cells-common progenitors of goblet and Paneth cell lineages-is also observed in Shp-1IEC-KO mice. Although sustained activation of Wnt/ß-catenin and PI3K/Akt/mammalian target of rapamycin signaling is observed, Shp-1IEC-KO mice fail to develop any intestinal tumors after 15 mo; however, the loss of Shp-1 in IECs markedly enhances tumor load ApcMin/+ mice. These findings show a novel role for Shp-1 in the regulation of IEC growth and secretory lineage allocation, possibly via modulation of PI3K/Akt-dependent signaling pathways. Finally, Shp-1 does not function as a classic tumor suppressor gene in the intestinal epithelium.-Leblanc, C., Langlois, M.-J., Coulombe, G., Vaillancourt-Lavigueur, V., Jones, C., Carrier, J. C., Boudreau, F., Rivard, N. Epithelial Src homology region 2 domain-containing phosphatase-1 restrains intestinal growth, secretory cell differentiation, and tumorigenesis.

Dietary Intake of DHA and EPA in a Group of Pregnant Women in the Moncton Area.

PURPOSE: To compare docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and fish intake of pregnant women at 30 weeks of gestation to current recommendations and to determine the factors associated with omega-3 (ω-3) intake. METHODS: A food frequency questionnaire was completed by 54 women (54/131 = 41%) at 30 ± 0.8 weeks gestation. Supplement intake, sociodemographic characteristics, and ω-3 food habits were evaluated. RESULTS: Among this high socioeconomic status (SES) group, 66.7% and 64.8% met the Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) recommendation of 200 mg/d DHA and 300 mg/d DHA + EPA, respectively, and only 48.1% met the Academy of Nutrition and Dietetics (Academy) recommendation of 500 mg/d DHA + EPA. Eighteen of the 54 women took a ω-3 supplement during the third trimester. This significantly improved their total intake to meet the FAO/WHO (88.9% ≥200 mg/d DHA and 94.4% ≥300 mg/d DHA + EPA) and the Academy (77.8% ≥500 mg/d DHA + EPA) recommendations. Among nonsupplement users (36/54), 50% met the FAO/WHO recommendations and only 33.3% met the Academy recommendations. CONCLUSIONS: Results suggest that the majority of high SES women did not meet ω-3 recommendations from food alone. Continued prenatal education on the importance of fish intake and on the addition of ω-3 prenatal supplement is essential.

Evaluation of a continuous quality improvement program in anticoagulant therapy: Feasibility, satisfaction and perception.

BACKGROUND: The ACO Program (Programme ACO), a continuous quality improvement program (CQIP) in anticoagulation therapy, was offered in community pharmacies as a pilot project. OBJECTIVE: To evaluate the participants' appreciation for the various activities of the program. METHODS: Participants had access to training activities, including an audit with feedback, online training activities (OTA), clinical tools and support from facilitators. Cognitive behavioural learning determinants were evaluated before and 5 months after the beginning of the program. Participants' satisfaction and perception were documented via online questionnaires and a semistructured interview. RESULTS: Of the 52 pharmacists in the ACO Program, 47 participated in this evaluation. Seventy-seven percent of the participants completed at least 1 OTA and 6% published on the forum. The feeling of personal effectiveness rose from 8.01 (7.67-8.35) to 8.62 (8.24-8.99). The audit and feedback, as well as the high-quality OTA and their lecturers, were the most appreciated elements. DISCUSSION: There was a high OTA participation rate. The facilitators seemed to play a key role in the CQIP. The low level of participation in the forum reflects the known phenomenon of social loafing. Technical difficulties affecting the platform and data collection for the audit with feedback constituted limitations. CONCLUSION: The CQIP in anticoagulation therapy is appreciated by community pharmacists and is associated with an improved feeling of personal effectiveness.

Functional impact of colorectal cancer-associated mutations in the transcription factor E2F4.

The transcription factor E2F4 plays a critical role in cell cycle progression of normal and cancerous intestinal epithelial cells. Contrary to other E2Fs, the coding region of the E2F4 gene contains a longer spacer segment of a CAG trinucleotide repeat sequence encoding 13 consecutive serine residues, which is highly vulnerable to frameshift mutations in situations of genetic instability. Mutations in this region of the E2F4 gene have been observed in colorectal tumors with microsatellite instability. However, the effect of these changes on its function in colorectal cancer cells is currently unknown. We generated E2F4(CAG)12 and E2F4(CAG)14 mutants and compared their activity to the E2F4 wild-type, E2F4(CAG)13. Luciferase assays with the thymidine kinase-luc reporter gene revealed that the mutants were more transcriptionally active than wild-type E2F4. The mechanism of increased activity of E2F4 was primarily related to protein stability, due to a significantly enhanced half-life of E2F4 mutants comparatively to that of wild-type E2F4. However, the association with the pocket protein p130/RBL2 did not account for this increased protein stability. Sequencing analysis of the endogenous E2F4 gene in a series of colorectal cancer cell lines showed that the microsatellite-unstable cell line SW48 exhibited a serine deletion in this gene. Accordingly, E2F4 half-life was much more elevated in SW48 cells in comparison to Caco-2/15, a microsatellite-stable cell line. Notably, in soft-agar assays, both mutants more potently increased anchorage-independent growth in comparison to wild-type E2F4. In conclusion, our data demonstrate that cancer-associated E2F4 mutations enhance the capacity of colorectal cancer cells to grow without anchorage, thereby contributing to tumor progression.

ERK-associated changes in E2F4 phosphorylation, localization and transcriptional activity during mitogenic stimulation in human intestinal epithelial crypt cells.

BACKGROUND: The transcription factor E2F4 controls proliferation of normal and cancerous intestinal epithelial cells. E2F4 localization in normal human intestinal epithelial cells (HIEC) is cell cycle-dependent, being cytoplasmic in quiescent differentiated cells but nuclear in proliferative cells. However, the intracellular signaling mechanisms regulating such E2F4 localization remain unknown. RESULTS: Treatment of quiescent HIEC with serum induced ERK1/2 activation, E2F4 phosphorylation, E2F4 nuclear translocation and G1/S phase transition while inhibition of MEK/ERK signaling by U0126 prevented these events. Stimulation of HIEC with epidermal growth factor (EGF) also led to the activation of ERK1/2 but, in contrast to serum or lysophosphatidic acid (LPA), EGF failed to induce E2F4 phosphorylation, E2F4 nuclear translocation and G1/S phase transition. Furthermore, Akt and GSK3ß phosphorylation levels were markedly enhanced in serum- or LPA-stimulated HIEC but not by EGF. Importantly, E2F4 phosphorylation, E2F4 nuclear translocation and G1/S phase transition were all observed in response to EGF when GSK3 activity was concomitantly inhibited by SB216763. Finally, E2F4 was found to be overexpressed, phosphorylated and nuclear localized in epithelial cells from human colorectal adenomas exhibiting mutations in APC and KRAS or BRAF genes, known to deregulate GSK3/ß-catenin and MEK/ERK signaling, respectively. CONCLUSIONS: The present results indicate that MEK/ERK activation and GSK3 inhibition are both required for E2F4 phosphorylation as well as its nuclear translocation and S phase entry in HIEC. This finding suggests that dysregulated E2F4 nuclear localization may be an instigating event leading to hyperproliferation and hence, of tumor initiation and promotion in the colon and rectum.

Epithelial tyrosine phosphatase SHP-2 protects against intestinal inflammation in mice.

Polymorphisms of PTPN11 encoding SHP-2 are biomarkers for ulcerative colitis (UC) susceptibility. However, their functional relevance is unknown. We thus investigated the role of epithelial SHP-2 in the control of intestinal homeostasis. Mice with an intestinal epithelial cell-specific SHP-2 deletion (SHP-2(IEC-KO) mice) were generated. Control and SHP-2(IEC-KO) mice were monitored for clinical symptoms and sacrificed for histological staining and Western blot analyses. Cytokines and chemokines, as well as intestinal permeability, were quantified. SHP-2 mRNA expression was evaluated in control and UC patients. SHP-2(IEC-KO) mice showed growth retardation compared to control littermates and rapidly developed severe colitis. Colon architecture was markedly altered with infiltration of immune cells, crypt abscesses, neutrophil accumulation, and reduced goblet cell numbers. Decreased expression of claudins was associated with enhanced intestinal permeability in mutant SHP-2(IEC-KO) mice. Inflammatory transcription factors Stat3 and NF-κB were hyperactivated early in the mutant colonic epithelium. Levels of several epithelial chemokines and cytokines were markedly enhanced in SHP-2(IEC-KO) mice. Of note, antibiotic treatment remarkably impaired the development of colitis in SHP-2(IEC-KO) mice. Finally, SHP-2 mRNA levels were significantly reduced in intestinal biopsy specimens from UC patients. Our results establish intestinal epithelial SHP-2 as a critical determinant for prevention of gut inflammation.

Relationship between maternal DHA and iron status and infants' cognitive performance.

PURPOSE: The dietary nutrients iron and long-chain polyunsaturated fatty acids are believed to play an important role in early brain development. We investigated the relationship between pregnant women's iron and docosahexaenoic acid (DHA) status and their infants' cognitive performance at age six months. METHODS: Blood iron and DHA status were analyzed in pregnant women at 28 to 32 weeks of gestation. The women's dietary habits, sociodemographic background, and cognitive performance were assessed using questionnaires. At age six months, infants' blood hemoglobin was analyzed, feeding practices assessed, and weight, length, and head circumference recorded. Each infant's cognitive performance was assessed using the Brunet-Lézine Scale of Psychomotor Development of Early Childhood and the Bayley Scales of Infant Development. Sixty-three mother-infant dyads completed the study. RESULTS: During pregnancy, 9.5% of pregnant women were anemic, 34.9% had low iron stores, and 3.2% suffered from iron deficiency anemia. The DHA represented 4.36% and 2.15% in erythrocyte and plasma total fatty acids, respectively. These levels were considered adequate. No significant relationship was observed between gestational iron or DHA status and infants' cognitive performance. CONCLUSIONS: In this small group of infants born to mothers with relatively good feeding practices and a privileged socioeconomic background, cognitive testing with the instruments above was not associated with maternal iron and DHA levels at age six months.

Maternal iron deficiency alters essential fatty acid and eicosanoid metabolism and increases locomotion in adult guinea pig offspring.

Iron deficiency (ID) is the most prevalent worldwide nutritional deficiency. Groups at risk of developing ID anemia are infants and pregnant women, even in industrialized countries. Our goal in this study was to evaluate the long-term consequences of maternal ID on the offspring's fatty acid and eicosanoid metabolism, behavior, and spatial memory. Female guinea pigs consumed iron-sufficient (IS) and -deficient (ID) diets for 14 d before mating and throughout pregnancy and lactation. Dietary iron restriction resulted in ID in pregnant females. On postnatal d 9, all offspring (ID and IS) were weaned to the IS diet and at 42 d, all offspring were iron replete. Locomotion was tested in pups on postnatal d 24 and 40 and spatial memory from d 25 to 40. Pups from the ID group were significantly more active in the open field at both times of testing, whereas spatial memory, tested in a Morris water maze, was comparable in both groups. On postnatal d 42, liver, RBC, and brain fatty acid composition were measured. Dihomogammalinolenic [20:3(n-6)], docosapentaenoic [22:5(n-3)], and docosahexaenoic [22:6(n-3)] acid contents were significantly higher in brain phospholipids of offspring born to ID dams. Prostaglandin E(2) and F(2alpha) concentrations were also significantly higher in brains of offspring born to ID dams. This demonstrates that moderate ID during gestation and lactation results in alterations of brain fatty acid and eicosanoid metabolism and perturbation in behavior in adult offspring.

Iron deficiency anemia following prenatal nutrition interventions.

PURPOSE: Iron deficiency anemia (IDA) during pregnancy and infancy is still common in developed countries, especially in low-income groups. We examined the prevalence of anemia and IDA in healthy low-income pregnant women participating in the Early Childhood Initiatives (ECI) program, and in their infants when they reached six months of age. METHODS: Pregnant women were recruited by nutritionists. In mothers, hemoglobin (Hb), mean corpuscular volume, and serum ferritin (SF) were measured at 36 +/- 2 weeks of gestation. In infants, Hb, mean corpuscular volume, SF, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) were measured at six months of age. Thirty-one mother-infant pairs participated. RESULTS: Among the 31 pregnant women participating in the ECI program, six (19.4%) were anemic (Hb <110 g/L) and five (16.1%) suffered from IDA (Hb <110 g/L and SF <10 microg/L). Among infants, seven of 23 (30.4%) were anemic (Hb <110 g/L) and five of 23 (21.7%) suffered from IDA (Hb <110 g/L plus two of the following: TIBC >60 micromol/L, SF <10 microg/L, serum iron <5.3 micromol/L, TS < or = 15%). CONCLUSIONS: The prevalence of anemia in this group of low-income pregnant women is comparable to that in privileged women. The prevalence of IDA in infants is comparable to that observed in other high-risk groups. Effective strategies are needed to prevent IDA in vulnerable groups.

Iron supplementation during pregnancy: what are the risks and benefits of current practices?

Iron-deficiency anemia is still prevalent among pregnant women living in industrialized countries such as Canada. To prevent this deficiency, iron supplements (30 mg/d) are routinely prescribed to Canadian pregnant women. Recently, dietary reference intakes for iron have increased from 18 and 23 mg/d during the second and third trimesters, respectively, to 27 mg/d throughout the pregnancy for all age groups. Whether this new recommendation implies an increase of iron dosage in supplements has not been answered. Are there any benefits or risks for the mother and her infant associated with iron supplementation during pregnancy? If iron supplementation is recommended, what should be the ideal dosage? This article reviews current knowledge on the potential negative or positive impact of iron supplementation during pregnancy on the outcomes of both infants and mothers. Based on the literature reviewed, a low daily dose of iron (30 mg elemental iron) during pregnancy improves women's iron status and seems to protect their infants from iron-deficiency anemia. Several studies have also shown that a low daily dose of iron may improve birth weight even in non-anemic pregnant women. However, higher dosages are not recommended because of the potential negative effects on mineral absorption, oxidative pathways, and adverse gastrointestinal symptoms. To date, it is still not clear if health professionals should recommend routine or selective supplementation. However, neither routine nor selective iron supplementation during pregnancy is able to eliminate iron-deficiency anemia. Even though the dietary reference intake for iron during pregnancy has been recently increased, we do not recommend higher doses of iron in supplements designed for pregnant women.