Riesgos y beneficios de la profilaxis con sulfato ferroso en lactantes nacidos a término con niveles de hemoglobina y ferremia desconocidos / Risks and benefits of iron supplementation in full-term infants with unknown hemoglobin and ferritin levels

La seguridad y eficacia de los programas de suplementación con hierro a lactantes, está actualmente en discusión. El objetivo de esta revisión fue identificar estudios sobre riesgos y beneficios de la suplementación con hierro profiláctico en lactantes menores de un año, nacidos a término, con niveles de hemoglobina (Hb) y ferremia desconocidos. Se realizó una búsqueda en Pubmed y Cochrane, identificando 3 revisiones sistemáticas y metaanálisis. Estos estudios arrojaron resultados que indican mejoras en los niveles séricos de hierro y hemoglobina como resultado de la suplementación con hierro. Sin embargo, no se observó un beneficio significativo en el desarrollo cognitivo de los lactantes. Los efectos adversos más reportados son los gastrointestinales, efectos en el crecimiento (menor ganancia de talla y peso) y menor absorción de zinc. En resumen, la evidencia en cuanto a la profilaxis con hierro en lactantes es limitada, lo que nos lleva a recomendar un seguimiento cercano de los lactantes que reciben suplementos de hierro, con el objetivo de detectar posibles eventos adversos. Es fundamental evaluar cuidadosamente los riesgos y beneficios de esta intervención antes de su implementación (AU)

The safety and efficacy of iron supplementation programs for infants are currently under discussion. The objective of this review was to identify studies on the risks and benefits of prophylactic iron supplementation in infants under one year of age, born at term, with unknown hemoglobin (Hb) and serum iron levels. The search was conducted on Pubmed and Cochrane, identifying three systematic reviews and meta-analyses. The results indicate improvements in serum iron and hemoglobin levels as a result of iron supplementation. However, a significant benefit in infant cognitive development was not observed. The most reported adverse effects were gastrointestinal, effects on growth (reduced height and weight gain), and reduced zinc absorption. In summary, the evidence regarding iron prophylaxis in infants is limited, leading us to recommend close monitoring of infants receiving iron supplements to detect potential adverse events. It is crucial to carefully assess the risks and benefits of this intervention before implementation (AU)

Effects of saffron (Crocus sativus L.) supplementation on inflammatory biomarkers: A systematic review and meta-analysis.

The effect of saffron supplementation on subclinical inflammation remains inconclusive. We performed a systematic review and meta-analysis to summarize available findings on the effect of saffron supplementation on inflammatory biomarkers (C-reactive protein [CRP], tumor necrosis factor-α [TNF-α], and interleukin-6 [IL-6]) in adults. We searched PubMed/Medline, Scopus, Web of Science, and Google Scholar databases up to November 2019 using relevant keywords to identify eligible trials. All randomized controlled trials (RCTs) that examined the effect of oral saffron supplementation on plasma concentrations of CRP, TNF-α, and IL-6 were included. For each outcome, mean differences and SDs were pooled using a random-effects model. Overall, eight RCTs were included in this meta-analysis. The pooled results showed that saffron supplementation did not result in significant changes in serum CRP (weighted mean difference [WMD]: -0.43 mg/L; 95% confidence interval [CI]: -1.04 to 0.17; p = .16), serum TNF-α (WMD: -1.29 pg/mL; 95% CI: -4.13 to 1.55; p = .37), and IL-6 concentrations (WMD: 0.11 pg/mL; 95% CI: -0.79 to 1.00; p = .81). Subgroup analysis indicated a significant reduction in serum CRP levels in studies with baseline CRP of ≥3 mg/L, saffron dosage of ≤30 mg/day, and intervention duration of <12 weeks, as well as trials that used crocin. Similarly, saffron was found to decrease TNF-α in studies that recruited non-diabetic subjects, subjects with baseline levels of ≥15 pg/mL, and participants with <50 years old, as well as trials that administered saffron at the dosage of ≤30 mg/day. We also found a significant non-linear effect of saffron dosage on serum CRP concentrations (pnon-linearity = .03). The overall results indicated that saffron supplementation did not affect inflammatory cytokines. Further high-quality studies are needed to firmly establish the clinical efficacy of supplemental saffron on inflammatory biomarkers.

Primary prevention of asthma: from risk and protective factors to targeted strategies for prevention.

Asthma is a complex disease that often starts in childhood. Genomic and environmental factors as well as aberrant immune maturation early in life can contribute to the onset of disease, with great disparity over time and geographical regions. Epidemiological studies have scrutinised environmental exposures and attempted to translate these exposures into prevention strategies. Some approaches for patients with asthma have been successful (eg, smoking ban, the Finnish Asthma Programme), and primary prevention of wheeze in pre-school children (age 0-5 years) by the supplementation of vitamin D or fish oil, or both, to pregnant women seems promising. Several recent prevention initiatives are based on strong asthma-protective environmental microbial exposures associated with traditional rural lifestyles. Preclinical studies with various bacterial lysates, bacterial and dietary metabolites, or helminthic compounds have yielded promising results that await translation into clinical practice. Given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to eradicate the disease.

Autocuidado y prevención del cáncer: de los nahuas prehispánicos a los nutracéuticos contemporáneos / Self-care and cancer prevention: from pre-Hispanic Nahuas to contemporary nutraceuticals

RESUMEN Hace unos cuantos siglos, en la materia médica de los nahuas prehispánicos se incluían alimentos curativos. En la actualidad, legitimado por las ciencias experimentales, nace el nutracéutico como un alimento con propiedades curativas que se utiliza en los modelos de salud preventivos del cáncer. En este artículo, comienzo por proponer que el conocimiento prehispánico puede ser validado epistémica y metodológicamente, si se apela al particular marco conceptual de los prehispánicos. Después, arguyo que el consumo de nutracéticos, como anticancerígenos, puede pensarse como parte de medidas preventivas primarias y secundarias, así como en la comprensión de las prácticas de autocuidado en el marco de la ética contemporánea del cáncer. Concretamente, que el consumo de nutracéticos y los alimentos prehispánicos mexicanos pueden legitimarse como prácticas de bienestar y prevención cada vez más pertinentes, en la intersección de la experiencia del enfermo y de su contexto. La responsabilidad de quien padece, dentro de un contexto sociopolítico cada vez más estructurado por las exigencias de vulnerabilidad del mercado terapéutico y de las estrategias confesionarias que otorgan verdad y validez a las figuras de autoridad, se gana en la práctica de conocerse y entenderse a sí mismo en la intersubjetividad contextual.(AU)

ABSTRACT The pre-Hispanic Nahuas had a medical system that included healing foods among their therapeutic practices. Nowadays, a new knowledge is born, legitimated by experimental sciences: the nutraceutical, a food with curative properties used in cancer preventive health models. In this article, I begin by proposing that pre-Hispanic knowledge can be validated epistemically and methodologically, if we appeal to the particular conceptual framework of the pre-Hispanic. Later, that the consumption of nutraceuticals, as anti-cancer drugs, can be thought of as part of primary and secondary preventive measures, as well as in the understanding of self-care practices in the framework of contemporary cancer bioethics. Specifically, that the consumption of nutraceuticals and Mexican pre-Hispanic foods can be legitimized as increasingly relevant wellness and prevention practices, at the intersection of the patient's experience and his or her context. The responsibility of those who suffer, within a sociopolitical context that is increasingly structured by the demands of vulnerability of the therapeutic market and the confessional strategies that give truth and validity to the figures of authority over whom they suffer, is gained in the practice of knowing and understanding oneself within contextual intersubjetivity.(AU)

Vitamin D Toxicity / Toxicidade da Vitamina D

Abstract Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.

Resumo A suplementação de produtos alimentares com vitamina D foi fundamental para a erradicação do raquitismo no início do século XX nos Estados Unidos. Nos quase 100 anos subsequentes, o acúmulo de evidências vinculou a deficiência de vitamina D a uma variedade de desfechos, e isso tem levantado grande interesse público e conscientização dos benefícios à saúde da vitamina D. Os suplementos que contêm vitamina D estão agora amplamente disponíveis tanto nos países desenvolvidos quanto naqueles em desenvolvimento, e muitos estão na forma de formulações não regulamentadas, vendidas ao público com poucas orientações para uma administração segura. Juntos, isso contribuiu para uma transição na qual um aumento global dramático nos casos de toxicidade da vitamina D tem sido relatado. Médicos agora enfrentam o desafio de tratar essa condição que pode apresentar um espectro de complicações assintomáticas a agudas, com risco de vida. Este artigo considera dados atualizados sobre a toxicidade da vitamina D e estratégias de diagnóstico e manejo relevantes para a prática clínica.

Food Purchasing Behavior of Food Insecure Cancer Patients Receiving Supplemental Food Vouchers.

PURPOSE: Food insecure cancer patients experience worse health outcomes and poorer quality of life than food secure patients. There has been little research in programs to alleviate food insecurity in cancer patients. The objective of this paper is to report on the food purchasing behaviors of cancer patients enrolled in a supplemental food voucher program. METHODS: This paper utilized data from a three-arm randomized controlled trial investigating the impact of food interventions on alleviating food insecurity in cancer patients receiving chemotherapy and/or radiation therapy. In one arm, patients received a monthly $230 voucher with which to purchase food. Receipts were collected for items purchased with the voucher and were coded to analyze purchasing behaviors. RESULTS: Thirty-three patients provided receipts for more than 11,000 individual items. Patients spent 50% of voucher funds on animal protein, fruits, and vegetables. Patients spent, on average, 77% of voucher funds on items categorized as "healthy." CONCLUSIONS: Patients who received a food voucher purchased more fruits and vegetables than national averages would suggest. They also spent less on sweetened beverages than national samples. Patients who were born outside of the United States or who were limited English proficient purchased significantly more healthy foods than English-speaking and American-born study patients. Supplemental food vouchers for food insecure cancer patients resulted in the purchase of healthy food items.

Hyperproteic supplementation attenuates muscle damage after simulated Olympic cross-country mountain biking competition: a randomized case-control study

Abstract Aim: We investigated the effect of high-protein (HI-PRO - 70% protein and 30% carbohydrate) and high-carbohydrate supplementation (HI-CHO - 70% carbohydrate and 30% protein) on muscle damage, haemoglobin, immune response, perceived pain and recovery post-simulated XCO. Methods: For this,10 amateur athletes (38±9.6 yrs.) were measured pre-, post- and 24-h post-trial. Results: In comparison to the pre-trial, the post-trial athletes presented leucocytosis (p≤0.001; 14.7±6.1 and 13.6±5.6 cells x103; for HI-PRO and HI-CHO, respectively) and neutropenia (p≤0.001; 11.9±5.2 and 10.7±4.9 cells x103; for HI-PRO and HI-CHO, respectively) but recovered at 24-h post-trial (Leukocytes: 6.9±1.4 and 7.1±1.4 cells x103; for HI-PRO and HI-CHO, respectively; neutrophils: 3.6±1.2 and 3.9±1.1 cells x103; for HI-PRO and HI-CHO, respectively) without a difference between conditions (p=0.808 and p=0.531; for leukocytes and neutrophils, respectively). A similar result was observed for perceived pain and recovery, where the condition did not interfere with these variables between the o measurement moments (p=0.245 and p=0.491; for pain and recovery respectively). There was an interaction effect for lactate dehydrogenase (LDH), where HI-PRO presented a lower serum concentration 24-h post-trial compared to HI-CHO (p=0.039; 181.3±21.9 and 201.0±10.4 IU/L; for HI-PRO and HI-CHO, respectively). Conclusion: HI-PRO supplementation results in better muscle damage recovery but only for LDH. Athletes should evaluate the cost-benefit of choosing the nutrients to be consumed immediately post-training or competition.

Iron salts and vitamins: use, purchase and sources of obtainment among children in Brazil.

To verify the prevalence of use, purchase and sources of iron salts and vitamins by children aged from 0 to 12 years in Brazil. Population-based transversal study (Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children up to 12 years of age. Information was obtained through questionnaires answered by the children's tutors, about the use of iron salts and vitamins 15 days before the interview; forms of financing, and sources of obtainment, sociodemographic characteristics, and presence of chronic disease. Descriptive and bivariate analyses were performed and the main variables were expressed by relative frequencies and 95% confidence intervals (95%CI). The prevalence of use of iron salts was 1.6% (95%CI: 1.2-2.1), with higher prevalence among children under 1 year old (8.5%; 95%CI: 6.3-11.5) and residents of the southeastern region (2.3%; 95%CI: 1.5-3.4). Prevalence of use of vitamins was 4.8% (95%CI: 4.2-5.6), with higher prevalence among children under 1 year old (24.3%; 95%CI: 20.3-28.7) and residents of the northern region (8.6%; 95%CI: 6.2-11.7). Purchase occurred by direct reimbursement for 41.6% (95%CI: 27.9-56.7) of the iron salts, and for 82.4% (95%CI: 76.3-87.2) of the vitamins. The iron salts were predominantly obtained from SUS pharmacies (51.5%; 95%CI: 36.4-66.4), and the vitamins from commercial pharmacies (80.6%; 95%CI: 77.4-85.6). The results suggested the use of iron salts in the Brazilian pediatric population was low, with reduction in use as age increased, regional differences and free-of-charge obtainment, predominantly from SUS.

Nutraceutical potentialities of Tunisian Argan oil based on its physicochemical properties and fatty acid content as assessed through Bayesian network analyses.

BACKGROUND: Argan oil is traditionally produced by cold pressing in South-western Morocco where rural population uses it as edible oil as well as for its therapeutic properties which give them in counterpart valuable income. Given the economical interest of this oil, several attempts of fraudulency have been registered in the world global market leading to loss of authenticity. Our purpose is to launch a program of Tunisian Argan oil valorization since trees from this species have been introduced sixty years ago in Tunisia. The first step was thus to characterize the physicochemical properties and determine the chemical composition of Tunisian Argan oil in order to assess its quality. METHODS: Physicochemical parameters of oil quality were determined according to the international standard protocols. Fatty acid content analysis of Argan oils was performed by gas chromatography coupled to mass spectrophotometry. A comparative study was realized among Tunisian, Moroccan and Algerian samples differing also by their extraction procedure. The impact of geographical localisation on the fatty acids composition was studied by statistical and modeling Bayesian analyses. RESULTS: Physicochemical parameters analysis showed interestingly that Tunisian Argan oil could be classified as extra virgin oil. Argan oil is mainly composed by unsaturated fatty acids (80%), mainly oleic and linoleic acid (linoleic acid was positively influenced by the geographical localization (r = 0.899, p = 0.038) and the P/S index (r = 0.987, p = 0.002)) followed by saturated fatty acids (20%) with other beneficial compounds from the unsaponifiable fraction like polyphenols and carotenoids. Together with fatty acid content, these minor components are likely to be responsible for its nutraceutical properties and beneficial effects. CONCLUSION: Tunisian Argan oil displayed valuable qualitative parameters proving its competitiveness in comparison with Moroccan and Algerian oils, and could be therefore considered as extra virgin edible oil for nutraceutical purposes as well as for cosmetic use.

Iron salts and vitamins: use, purchase and sources of obtainment among children in Brazil / Sais de ferro e vitaminas: uso, aquisição e fontes de obtenção para crianças brasileiras / Sales de hierro y vitaminas: uso, adquisición y fuentes de obtención entre niños en Brasil

To verify the prevalence of use, purchase and sources of iron salts and vitamins by children aged from 0 to 12 years in Brazil. Population-based transversal study (Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children up to 12 years of age. Information was obtained through questionnaires answered by the children's tutors, about the use of iron salts and vitamins 15 days before the interview; forms of financing, and sources of obtainment, sociodemographic characteristics, and presence of chronic disease. Descriptive and bivariate analyses were performed and the main variables were expressed by relative frequencies and 95% confidence intervals (95%CI). The prevalence of use of iron salts was 1.6% (95%CI: 1.2-2.1), with higher prevalence among children under 1 year old (8.5%; 95%CI: 6.3-11.5) and residents of the southeastern region (2.3%; 95%CI: 1.5-3.4). Prevalence of use of vitamins was 4.8% (95%CI: 4.2-5.6), with higher prevalence among children under 1 year old (24.3%; 95%CI: 20.3-28.7) and residents of the northern region (8.6%; 95%CI: 6.2-11.7). Purchase occurred by direct reimbursement for 41.6% (95%CI: 27.9-56.7) of the iron salts, and for 82.4% (95%CI: 76.3-87.2) of the vitamins. The iron salts were predominantly obtained from SUS pharmacies (51.5%; 95%CI: 36.4-66.4), and the vitamins from commercial pharmacies (80.6%; 95%CI: 77.4-85.6). The results suggested the use of iron salts in the Brazilian pediatric population was low, with reduction in use as age increased, regional differences and free-of-charge obtainment, predominantly from SUS.

O estudo teve como objetivo verificar a prevalência do uso, aquisição e fontes de saís de ferro e vitaminas para crianças entre 0 e 12 anos de idade no Brasil. Foi realizado um estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças até 12 anos de idade. As informações foram obtidas através de questionários respondidos pelos pais ou responsáveis, sobre o uso de sais de ferro e vitaminas nos 15 dias anteriores à entrevista; formas de financiamento e fontes de aquisição, características sociodemográficas e presença de doenças crônicas. Foram realizadas análises descritivas e bivariadas, e as principais variáveis foram expressas como frequências relativas com intervalos de 95% de confiança (IC95%). A prevalência do uso de sais de ferros foi 1,6% (IC95%: 1,2-2,1), com prevalência maior entre crianças com menos de 1 ano de idade (8,5%; IC95%: 6,3-11,5) e residentes da Região Sudeste (2,3%; IC95%: 1,5-3,4). A prevalência do uso de vitaminas foi 4,8% (IC95%: 4,2-5,6), com prevalência maior entre crianças com menos de 1 ano (24,3%;IC95%: 20,3-28,7) e residentes da Região Norte (8,6%; IC95%: 6,2-11,7). A aquisição ocorreu por reembolso direto em 41,6% (IC95%: 27,9-56,7) dos sais de ferro e em 82,4% (IC95%: 76,3-87,2) das vitaminas. Os sais de ferro foram adquiridos predominantemente através das farmácias do SUS (51,5%; IC95%: 36,4-66,4), e as vitaminas em farmácias comerciais (80,6%; IC95%: 77,4-85,6). Os resultados sugerem que o uso de sais de ferro na população pediátrica brasileira é por baixo, com uma redução no uso conforme aumenta a idade da criança, além de diferenças regionais e aquisição gratuita, predominantemente do SUS.

Este trabajo tiene el fin de verificar la prevalencia de uso, adquisición y fuentes de sales de hierro y vitaminas por parte de niños desde 0 a 12 años de edad en Brasil. Se trata de un estudio transversal, basado en población (Encuesta Nacional sobre el Acceso, Uso y Promoción de Uso Racional de Medicinas - PNAUM por sus siglas en portugués), que incluye a 7.528 niños de hasta 12 años de edad. La información se obtuvo a través de cuestionarios respondidos por los tutores de los niños, sobre el uso de sales de hierro y vitaminas 15 días antes de la entrevista; formas de financiación, y fuentes de adquisición, características sociodemográficas, y presencia de alguna enfermedad crónica. Se realizaron análisis descriptivos y bivariados, además las variables principales se plasmaron mediante frecuencias relativas e intervalos del 95% de confianza (IC95%). La prevalencia del uso de sales de hierro fue de un 1,6% (IC95%: 1,2-2,1), con una prevalencia más alta entre niños por debajo de un 1 año de edad (8,5%; IC95%: 6,3-11,5) y residentes de la Región sudeste (2,3%; IC95%: 1,5-3,4). La prevalencia del uso de vitaminas fue de un 4,8% (IC95%: 4,2-5,6), con una prevalencia más alta con niños menores de 1 año de edad (24,3%; IC95%: 20,3-28,7) y residentes de la Región nordeste (8,6%; IC95%: 6,2-11,7). La adquisición tuvo lugar por reembolso directo en un 41,6% (IC95%: 27,9-56,7) de sales de hierro, y por un 82,4% (IC95%: 76,3-87,2) de las vitaminas. Las sales de hierro se obtuvieron predominantemente en farmacias del SUS (51,5%; IC95%: 36,4-66,4), y las vitaminas en farmacias comerciales (80,6%; IC95%: 77,4-85,6). Los resultados sugirieron el consumo de las sales de hierro en la población pediátrica brasileña fue por bajo, con una reducción en su consumo a medida que la edad aumentaba, además de diferencias regionales, y su obtención gratuita, predominantemente del SUS.

Influence of pharmacological education on perceptions, attitudes and use of dietary supplements by medical students.

BACKGROUND: The ready availability and use of dietary supplements (DS) by the public means that healthcare professionals require education in this area. In the Republic of Serbia, education related to use of DS is included in undergraduate medical training and it is therefore important to assess the effectiveness of this education. The aim of our survey was to investigate the influence of pharmacological education on the use, attitudes and perceptions of risks associated with DS among medical students. METHODS: Medical students at the University of Kosovska Mitrovica participated in the survey. Three hundred eighty questionnaires were distributed, yielding a response rate of 89% (n = 334). Data were categorized by year of study, completion of a one-year course in pharmacology and having passed the final exam. The results were compared between 192 (58%) medical students educated in pharmacology (MSEP) and 142 (42%) medical students not educated in pharmacology (MSNEP). The questionnaire was divided into 4 parts: socio-demographic and lifestyle/behavioral characteristics, use of DS, attitudes about efficacy, safety and perception of risk due to DS use. Chi-square test, Student's t-test, and Mann-Whitney U test were used for statistical analysis. RESULTS: About 53% of respondents used some form of DS. Attitudes regarding the safety of DS consumption showed a difference between the groups. MSEP were more likely to agree that DS have the potential to cause adverse reactions (Likert scale mean 4.1 vs. 3.5, p < 0.001) as well as interactions with conventional drugs (Likert scale mean 4.2 vs. 3.2, p < 0.001) than MSNEP. Finally, MSEP ranked St. John's wort and ginkgo as the most dangerous DS, but creatine and vitamin C were both ranked as relatively safe. Conversely, MSNEP considered ginkgo and vitamin C the most harmful DS, claiming that omega-3 fatty acids and vitamin D had the least hazardous side effects. CONCLUSION: Our results showed that pharmacological education gives young medical students a better understanding of the risks of DS-drug interactions and potential adverse effects. However, their overall attitudes and perception of risk indicate the need for further education.

Perceptions of antenatal iron-folic acid supplements in urban and rural Pakistan: a qualitative study.

BACKGROUND: In Pakistan, 51% of women are anaemic in pregnancy yet only 44% of women use antenatal iron-folic acid (IFA) supplements. Little information exits on the perception and barriers to the use of IFA supplements during pregnancy in Pakistan. The aim of the study was to understand women and healthcare providers' perceptions, and to investigate the cultural and behavioural factors influencing the use of antenatal IFA supplements in rural and urban settings of Pakistan. METHODS: We conducted 10 focus group discussions with mothers, 10 in-depth interviews with currently pregnant women, 6 in-depth interviews with Lady Health Workers and 4 in-depth interviews with doctors providing antenatal care services. The study was conducted in two districts of Pakistan--district Swabi and Islamabad for rural and urban samples, respectively. Data was collected between August and November 2012. RESULTS: The majority of women were aware of the perceived benefits of antenatal IFA supplements. However, the rural women had more limited information about the benefits of IFA supplements than the urban women. The facilitating factors for the women's use of supplements were: they had knowledge of benefits; they had trust in the healthcare providers; the supplements were available; they had the financial capacity to buy them; they felt better after taking these supplements; and they received support from family members. The barriers to the women's use of supplements were: they forgot to take them; the non-availability of supplements; their limited financial capacity to buy them; the lack of antenatal care services; family members not allowing use of the supplements; not knowing about the benefits or no education; fear or experience of side effects; considering them as contraceptives; and felt better thus stopped. CONCLUSION: The coverage of antenatal IFA supplementation can be improved by reducing the barriers related to the use of antenatal IFA supplementation in Pakistan. Interventions focused on providing adequate awareness, good quality counselling, reminder messages, availability of free supplements throughout pregnancy and reducing the side effects should be developed and implemented.

Alternative sources of omega-3 fats: can we find a sustainable substitute for fish?

Increasing demand for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) containing fish oils is putting pressure on fish species and numbers. Fisheries provide fish for human consumption, supplement production and fish feeds and are currently supplying fish at a maximum historical rate, suggesting mass-scale fishing is no longer sustainable. However, the health properties of EPA and DHA long-chain (LC) omega-3 polyunsaturated fatty acids (PUFA) demonstrate the necessity for these oils in our diets. EPA and DHA from fish oils show favourable effects in inflammatory bowel disease, some cancers and cardiovascular complications. The high prevalence of these diseases worldwide indicates the requirement for alternative sources of LC-PUFA. Strategies have included plant-based fish diets, although this may compromise the health benefits associated with fish oils. Alternatively, stearidonic acid, the product of α-linolenic acid desaturation, may act as an EPA-enhancing fatty acid. Additionally, algae oils may be a promising omega-3 PUFA source for the future. Algae are beneficial for multiple industries, offering a source of biodiesel and livestock feeds. However, further research is required to develop efficient and sustainable LC-PUFA production from algae. This paper summarises the recent research for developing prospective substitutes for omega-3 PUFA and the current limitations that are faced.

[Biotechnological cultivation of edible macrofungi: an alternative for obtaining nutraceutics]. / Cultivo biotecnológico de macrohongos comestibles: una alternativa en la obtención de nutracéuticos.

Macromycetes have been part of the human culture for thousand years, and have been reported as food in the most important civilizations in history. Many nutraceutical properties of macromycetes have been described, such as anti-cancer, anti-tumour, cholesterol lowering, antiviral, antibacterial, or immunomodulatory, among others. Given that production of mushrooms by traditional cultivation and extraction of bioactive metabolites is very difficult in some cases, biotechnology is essential for the development of profitable and productive techniques for obtaining these metabolites. It is the development of this technology, and the ease in which it enables the use of its variables that has allowed mycelium to be cultivated in liquid medium of macrofungi, with a significant reduction in time and an increased production of metabolites. This increased production has led to the study of compounds that have medicinal, nutriceutical and quasi-farmaceutical potential, in the exhausted media and the mycelium. The aim of this review is to provide an overview of the use of liquid-state fermentation as a technological tool for obtaining edible fungi, and the study of these and their metabolites, by describing the different cultivation conditions used in recent years, as well as the results obtained. The relevance of Agaricus, Flammulina, Grifola, Pleurotus and Lentinula genera, will also be discussed, with emphasis on the last one, since Shiitake has been always considered as the ultimate medicinal mushroom.

Factors associated with household food security of participants of the MANA food supplement program in Colombia.

The objective of this study was to explore demographic and economic characteristics associated with household food security of 2,784 low-income households with pre-school aged children receiving food supplements from the Colombian Plan for Improving Food and Nutrition in Antioquia - MANA (Mejoramiento Alimentario y Nutricional de Antioquia) in the Department of Antioquia, Colombia. Included in the study was a 12-item household food security survey was collected from a cross-sectional, stratified random sample of MANA participants in which households were characterized as food secure, mildly food insecure, moderately food insecure, and severely food insecure. It was hypothesized that household food security status would be strongly associated with demographic characteristics, food expenditure variables, and food supplement consumption by children in MANA. Food insecure households were characterized by more members, older parents, and lower income (p < 0.0001). Rural residence and female head of households had higher rates of food insecurity (p < 0.01). Food insecure households had the lowest monthly expenditures food (p < 0.0001). Severely food insecure households saved the highest percentage of per capita food expenditure from consuming MANA supplements (p < 0.0001), similarly, MANA food supplement intakes were greatest in households reporting the most food insecurity (p < 0.001). The results of this study are important to describe characteristics of the population benefiting from the MANA nutrition intervention by their unique level of household food security status.

Nepal's vitamin A supplementation programme, 15 years on: Sustained growth in coverage and equity and children still missed.

Nepal's national vitamin A programme, that started in a few districts in 1993, was incrementally and systematically expanded to cover the targeted population - children ages 6-59 months - in all the 75 districts of the country over a decade. By 2001, four-fifths of the eligible children had received vitamin A supplementation. Based on data from the 2006 Nepal Demographic and Health Survey, this paper analyses the extent to which the levels and patterns of the programme's coverage have continued to sustain over time, and identifies the children who are still missed by the programme. The overall coverage in 2006 increased to 87.5% nationally, ranging between 80 and 93% (except for two population subgroups), indicating that the programme has been effective in eliminating large inequities in access and utilisation of programme services. The children still missed by the programme (12.5%) have been found to disproportionately represent the poorest of the poor families, mothers with no education, and residents of rural areas and certain ecological and development subregions. The programme is most likely to sustain its achievements thus far, assuming that programme support ingredients and inputs are not interrupted or affected adversely in any way. Emerging policy and programmatic issues are discussed.

Micronutrient profile of children and women in rural Bangladesh: study on available data for iron and vitamin A supplementation.

BACKGROUND: Micronutrient deficiencies are so important to public health outcomes, particularly in the developing world, that a series of global goals have been established, and significant amounts of donor and national funds have been directed at them. OBJECTIVES: This paper makes an attempt to compile the micronutrient profile of children and mothers (available data on vitamin A and iron supplementation) in rural Bangladesh and to identify the factors influencing with respect to these micronutrients intake. METHODOLOGY: To reach our goal Bangladesh Demographic and Health Survey of 2004 data for last five years (N = 3329) has been used. Descriptive and multivariate logistic regression methods were employed in analyzing the data. RESULTS: It is observed that only 64% of targeted children had received vitamin A dose in the six months preceding the survey and overall, 14% and 45% mothers received a postpartum vitamin A dose and iron tablets. The study elucidates that the rate of receiving vitamin A dose by children lower in Barisal division than among other five divisions. Inequalities were observed in receiving vitamin A and iron supplementation, regarding household quality and assets index. The proportion of receiving vitamin A dose by children and intake of iron by mothers was found higher living in the upper quality houses. Middle aged mothers more received iron tablet and vitamin A dose and less sufferer form from difficulty with night blindness and day light vision during pregnancy than among the adolescence and older aged mothers. Multivariate logistic regression analysis considering mothers vitamin "A" dose and iron supplementation as a dependent variable shows that higher educated women were approximately two times higher probability of receiving vitamin "A" supplement of their child than women with no education. Women whose husbands had a lower status of job were less likely to receive vitamin A dose and iron supplements. The other main contributing factors likely to affect micronutrients intake among women were mass media, mother's age at last birth, mother's and husband's education and husband occupation. CONCLUSIONS: The results indicate several policy options: (a) there is need to ensure availability of iron and vitamin a supplements; (b) there is also the need for creation of awareness regarding micronutrient intake among mothers and children through programmes like mass media campaign; (d) The high-risk group such as adolescents and higher aged women need special care and the existing health management system may be strengthened to create awareness among mothers of these groups for micronutrient intake from the beginning of pregnancy; (c) it is equally important that education for women and increased cash incomes is emphasized to bring about a lasting impact on the overall nutrition status of women and children.

Comparison of hormonal activity of isoflavone-containing supplements used to treat menopausal complaints.

OBJECTIVES: The isoflavones present in red clover and soy are used as an alternative treatment for menopausal complaints and are commercially available as high-dose food supplements. These preparations contain varying amounts of active ingredients, often without detailed specifications. Thus, it is difficult to derive a recommended daily dose, and the reliability of these products is rather low. METHODS: We quantified the isoflavone content of 19 different isoflavone-containing preparations and compared their binding and transactivational activities with regard to estrogen receptor alpha, estrogen receptor beta, androgen receptor, progesterone receptor, peroxisome-proliferator-activated receptor, and aryl hydrocarbon receptor. RESULTS: The food supplements that we tested bound to and transactivated both the estrogen receptors and the other receptors. After comparing the isoflavone content quantified by us with the isoflavone content specified on the package labels, we found that at least the specified isoflavone content or more could be detected in only 5 of the 19 food supplements that we tested. CONCLUSIONS: Preparations containing isoflavones should be standardized for the isoflavone aglycone content to facilitate the prediction of theoretical hormonal activity, facilitate the intake of a controlled amount of isoflavones, and ensure greater product reliability.

Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002. 3 - o Programa Nacional de Controle da Deficiência de Vitamina A / Evaluation of public policies to promote food security and the fight against hunger, 1995-2002. 3 - the Brazilian National Program to Control Vitamin A Deficiency

A distribuição de vitamina A em Dias Nacionais de Vacinação ocorre desde 1983; o Brasil foi pioneiro nesse tipo de intervenção. O estudo avaliou o programa no período de 1995-2002 na perspectiva de estrutura-processo-resultado. A metodologia envolveu pesquisa documental, entrevistas com gestores e estudo de caso em 44 municípios da Bahia, resultando em 1.344 questionários domiciliares. Em relação à estrutura, o programa operou sem instrumento normativo a partir de 1998, decorrente da extinção do Instituto Nacional de Alimentação e Nutrição. Melhorias nos processos de aquisição e distribuição do suplemento impactaram positivamente na sua cobertura; em 2002, foram distribuídas 3,5 milhões de cápsulas (cobertura 72 por cento). Nas 2.546 crianças estudadas na Bahia, não houve regularidade na distribuição e a cobertura anual variou de 8 por cento a 26 por cento. As limitações de tempo e recursos humanos, informadas pelos gestores, corroboram a hipótese de que essa estratégia não contribui para esclarecer a população sobre a importância da vitamina. Os achados mostram ser necessária a articulação sistemática entre esferas de governo para que o programa seja executado e monitorado em sua plenitude.

Vitamin A supplements have been distributed during National Immunization Days since 1983, and Brazil has been a pioneer in this kind of strategy. The current study evaluated the National Program from 1995 to 2002, from a structure-process-results perspective. The methodology involved document research, interviews with health services managers, and a case study in 44 municipalities in Bahia State, resulting in 1,344 household interviews. In relation to structure, from 1998 on the program operated without a normative instrument due to the extinction of the National Institute of Nutrition. Improvements in the processes of vitamin supply procurement and distribution had a positive impact on coverage, reaching 3.5 million capsules in 2002 (72 percent coverage). For the 2,546 children studied in Bahia, vitamin A distribution was irregular, with annual coverage varying from 8 percent to 26 percent. Program managers reported time constraints and insufficient human resources, consistent with the hypothesis that this type of strategy does not help inform the population about the importance of vitamin A. These findings point to the need for systematic linkage between different levels of government in order to fully implement and monitor the program.

[Evaluation of public policies to promote food security and the fight against hunger, 1995-2002. 3--the Brazilian National Program to Control Vitamin A Deficiency]. / Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002. 3--o Programa Nacional de Controle da Deficiência de Vitamina A.

Vitamin A supplements have been distributed during National Immunization Days since 1983, and Brazil has been a pioneer in this kind of strategy. The current study evaluated the National Program from 1995 to 2002, from a structure-process-results perspective. The methodology involved document research, interviews with health services managers, and a case study in 44 municipalities in Bahia State, resulting in 1,344 household interviews. In relation to structure, from 1998 on the program operated without a normative instrument due to the extinction of the National Institute of Nutrition. Improvements in the processes of vitamin supply procurement and distribution had a positive impact on coverage, reaching 3.5 million capsules in 2002 (72% coverage). For the 2,546 children studied in Bahia, vitamin A distribution was irregular, with annual coverage varying from 8% to 26%. Program managers reported time constraints and insufficient human resources, consistent with the hypothesis that this type of strategy does not help inform the population about the importance of vitamin A. These findings point to the need for systematic linkage between different levels of government in order to fully implement and monitor the program.