An infant and mother with severe B12 deficiency: vitamin B12 status assessment should be determined in pregnant women with anaemia.

The vitamin B12 status of infants depends on maternal B12 status during pregnancy, and during lactation if breastfed. We present a 9-month-old girl who was admitted to the metabolic unit for assessment of developmental delay. She was exclusively breastfed and the introduction of solids at 5 months was unsuccessful. Investigations revealed pancytopenia, undetectable B12 and highly elevated methylmalonic acid and homocysteine. Methylmalonic acid and homocysteine normalised following B12 injections. Marked catch-up of developmental milestones was noted after treatment with B12. Investigations of parents showed normal B12 in the father and combined B12 and iron deficiency in the mother. Maternal B12 deficiency, most likely masked by iron deficiency, led to severe B12 deficiency in the infant. Exclusive breastfeeding and a subsequent failure to wean exacerbated the infant's B12 deficiency leading to developmental delay. This case highlights the need for development of guidelines for better assessment of B12 status during pregnancy.

The Role of Food Fortification in Addressing Iron Deficiency in Infants and Young Children.

Iron deficiency, one of the most widespread nutritional disorders, affects millions of people in emerging economies and, increasingly, in industrialized countries. Due to the high iron requirements during growth and development, infants and young children are among those most severely affected by iron deficiency. Iron deficiency that occurs during the critical phases of early life development has long-lasting health consequences that are reflected in increased risk of disease, reduced economic productivity and premature death, underscoring the importance of infants and young children as a key target group for addressing iron deficiency. This chapter focuses on the use of fortified foods as a cost-effective mechanism to address iron deficiency in this particularly vulnerable subpopulation. Nutritional policies that include food fortification need to be implemented within the context of effective public-private partnerships in order to address the fundamental mechanisms of accessibility, affordability and availability of nutritious food items for those in the lowest socio-economic strata.

In vivo assessment of iron bioavailability from fortified pearl millet based weaning food.

BACKGROUND: Iron is an essential micronutrient required for normal growth and development of the body. Infants are more vulnerable to develop iron-deficiency anaemia due to inadequate iron supply in early stages. The objective of the study was in vivo assessment of iron bioavailability from pearl millet based weaning food fortified with iron and vitamin A, and to investigate the role of vitamin A in iron absorption in animal models. RESULTS: Results revealed that anaemic group showed significantly (P < 0.05) higher bioavailability than that of normal rat models. Animals fed vitamin A supplemented pearl-millet diet exhibited comparable results with a sub-group provided commercially available weaning diet in both normal and anaemic groups, but significantly (P < 0.05) higher values for studied biological indices than that of a sub-group provided iron fortified pearl-millet or synthetic diet. When the anaemic rats were provided iron + vitamin A fortified diet, iron bioavailability increased and liver iron stores returned to the normal levels after 30 days, indicating a promoter role of vitamin A in intestinal iron absorption. CONCLUSIONS: Overall, bioavailability of electrolytic iron could be improved by supplementation of vitamin A, and this mixture can be considered as a useful fortificant for pearl millet based complementary foods fortification designed to prevent iron deficiency. © 2016 Society of Chemical Industry.

Is there a mismatch between who gets iron supplementation and who needs it? A cross-sectional study of iron supplements, iron deficiency anaemia and socio-economic status in Australia.

Fe deficiency anaemia (IDA) is more prevalent in lower socio-economic groups; however, little is known about who actually receives Fe supplements. This paper aims to determine whether the groups most likely to have IDA are the most likely to be taking Fe supplements. Logistic regression analysis was conducted using the cross-sectional, nationally representative National Nutrition and Physical Activity Survey and National Health Measures Survey. After adjusting for other factors, those whose main language spoken at home was not English had twice the odds of having IDA compared with those whose main language spoken at home was English (95% CI 1·00, 4·32). Those who were not in the labour force also had twice the odds of having IDA as those who were employed (95% CI 1·16, 3·41). Those in income quintile 1 had 3·7 times the odds of having IDA compared with those in income quintile 5 (95% CI 1·42, 9·63). Those whose main language spoken at home was not English were significantly less likely to take Fe supplements (P=0·002) than those whose main language spoken at home was English. There was no significant difference in the likelihood of taking Fe supplements between those who were not in the labour force and those who were employed (P=0·618); between those who were in income quintile 1 and in higher income quintiles; and between males and females (P=0·854), after adjusting for other factors. There is a mismatch between those who are most in need of Fe supplements and those who currently receive them.

Discrimination of various thalassemia syndromes and iron deficiency and utilization of reticulocyte measurements in monitoring response to iron therapy.

Decreased hemoglobinization of red cells resulting in hypochromia and microcytosis are the main features of thalassemia syndromes, and also of iron deficiency anemia (IDA). A simple and reliable method is required to distinguish the two conditions in the routine laboratories. In this study we analyzed the red cell and reticulocyte parameters from 414 samples of various types of thalassemias and IDA and discovered a variety of discriminating criteria including a discrimination index (DI) which should be useful for differential diagnosis. Slightly decreased MCV and CH are suggestive of α-thalassemia 2, Hb CS, and Hb E heterozygotes whereas the increased Rbc counts are obvious in α-thalassemia 1 and ß-thalassemia. In Hb E, the number of microcytic red cells was greater than the number of hypochromic red cells resulting in an increased M/H ratio. Hb H diseases are characterized by a higher number of hypochromic red cells and decreased CHCM, while broadening of hemoglobin concentration histogram results in increased HDW in ß-thalassemia diseases. Iron deficiency anemia results in hypochromic-microcytic red cells and increased RDW. The number of reticulocyte with %High Retic and CHr value were increased in the first month of iron supplementation indicating the response to iron therapy.

Social determinants of iron supplementation among women of reproductive age: a systematic review of qualitative data.

Iron supplementation for women of reproductive age is a main part of an interdisciplinary strategy recommended for the control and prevention of iron deficiency and the treatment of mild-to-moderate iron-deficiency anaemia. This systematic review reports the findings from a meta-synthesis of qualitative data concerning the experiences and perceptions of iron supplementation among women of reproductive age and health service providers worldwide. Qualitative systematic review methods were used to conduct a search of published literature, define inclusion and exclusion criteria, appraise quality of studies and extract data on the use of iron supplementation among women of reproductive age. Coding, thematic analysis, reciprocal translation and line of argument synthesis were used to synthesize data. Twelve studies spanning 17 countries met inclusion criteria and were included in the analysis. Seven domains emerged from the review: cultural norms and societal values including explanatory models and medical pluralism; political and socio-economic circumstances; education and communication; social organization and social relationships; health care access and supplement supply; food and nutrition availability; and adherence. In addition, 16 sub-domains are highlighted. Connecting review findings to a conceptual framework of social determinants of health highlights salient issues that policy makers must consider when adapting global iron supplementation recommendations to the local context.

Pilot-scale commercialization of iron-fortified rice: effects on anemia status.

BACKGROUND: Rice, the staple food of the Philippines, is an appropriate vehicle for iron fortification to combat the high prevalence of iron-deficiency anemia. A previous study among schoolchildren supplemented with iron-fortified rice showed a significant reduction in the rate of iron-deficiency anemia from 100% to 33%. OBJECTIVE: To document the processes involved in commercializing iron-fortified rice and to determine its effects on anemia prevalence. SUBJECTS AND METHODS: This study was conducted on 766 mothers and their children aged 6 to 9 years in Orion, Bataan. Soliciting political support, networking with local organizations, market surveys, and social marketing activities were conducted. The iron content of iron-fortified rice was tested for each production run. Hemoglobin measurements were performed on the mothers and children at baseline and endline. RESULTS: A municipal ordinance to sell iron-fortified rice was issued, while the local federation provided funds to kick off the sale of iron-fortified rice. Sales of iron-fortified rice were highest when the rice was sold at Php 27 (Php 1 = US$0.025) per kilogram and lowest when the price was Php 37 per kilogram or greater. The municipal ordinance was not strictly enforced because of the global rice crisis. Social marketing activities encouraged families to buy iron-fortified rice. The iron content of the iron-rice premix was within the set specification limits of 600 to 760 mg of iron per 100 g of premix, while the iron-fortified rice was within 3 to 3.8 mg of iron and 1 to 2 mg (BC No. 2009-010) per 100 g of raw and cooked fortified rice, respectively. The decrease in the rate of anemia was significant among children (from 17.5% to 12.8%) but not among mothers (from 13.0% to 12.5%) after 9 months of study implementation. CONCLUSIONS: Strong political support and intensive social marketing activities are crucial inputs in commercializing iron-fortified rice. Keeping the cost affordable and maintaining the commitment of identified partners were the key factors for providing a continuous supply of iron-fortified rice. Commercializing iron-fortified rice can be considered as one of the strategies for decreasing anemia prevalence.

Research needed to strengthen science and programs for the control of iron deficiency and its consequences in young children.

The purpose of this article is to highlight critical research needs for the effective prevention and control of iron deficiency and its consequences in children living in low-income countries. Four types of research are highlighted: The first involves scaling up interventions that we know are effective, namely iron supplementation of pregnant women, delayed cord clamping at delivery, immediate and exclusive breast-feeding, and continued exclusive breast-feeding for approximately 6 mo. The second entails evaluation research of alternative interventions that are likely to work, to find the most cost-effective strategies for a given social, economic, and epidemiological context. This research is especially needed to expand the implementation of appropriate complementary feeding interventions. In this area, research needs to be designed to provide causal evidence, to measure cost-effectiveness, and to measure potential effect modifiers. The third is efficacy research to discover promising practices where we lack proven interventions. Examples include how to detect infants younger than 6 mo who are at high risk of iron deficiency, efficacious and safe interventions for those young high-risk infants, and best protocols for the treatment of severe anemia. The fourth includes basic research to elucidate physiological processes and mechanisms underlying the risks and benefits of supplemental iron for children exposed to infectious diseases, especially malaria. Strategic research in all 4 areas will ensure that interventions to control pediatric iron deficiency are integrated into national programs and global initiatives to make pregnancy safer, reduce newborn deaths, and promote child development, health, and survival.

Biodisponibilidade do ferro como fator de proteção contra anemia entre crianças de 12 a 16 meses / Iron bioavailability as a protective factor against anemia among children aged 12 to 16 months

OBJETIVO: Este estudo investiga os fatores dietéticos determinantes da ausência de anemia entre lactentes de famílias de baixo nível socioeconômico submetidos a um programa de intervenção nutricional, bem como a adequação do consumo de ferro de acordo com as recomendações. METODOLOGIA: O estudo compreendeu 369 crianças pertencentes a uma coorte do município de São Leopoldo (RS), as quais foram randomizadas ao nascimento para constituírem dois grupos: intervenção e controle. O grupo intervenção foi submetido a orientações dietéticas no primeiro ano de vida, com visitas domiciliares mensais, e o grupo controle foi visitado aos 6 e 12 meses, sem intervenção dietética. Ao final do primeiro ano de vida, realizou-se inquérito alimentar recordatório de 24 horas. O diagnóstico de anemia foi determinado pelo nível de hemoglobina inferior a 11 g/dL. As dietas das crianças foram classificadas de acordo com a biodisponiblidade do ferro presente. RESULTADOS: A prevalência de anemia encontrada neste estudo foi de 63,7 por cento. A proporção de crianças com consumo adequado em relação às recomendações foi estatisticamente mais elevada no grupo sem anemia (26,8 por cento) do que no grupo com anemia (17,7 por cento). As crianças que não apresentaram anemia mostraram maior consumo de ferro (p = 0,019), vitamina C (p = 0,001), densidade energética no jantar (p = 0,006), densidade de ferro por 1.000 calorias (p = 0,045), e 16,3 por cento delas apresentaram dieta com alta biodisponibilidade em ferro (p = 0,002). CONCLUSÕES: A prática alimentar que garante alta biodisponibilidade de ferro protege a criança contra anemia e pode ser usada como proposta de intervenção na rede básica de saúde e no âmbito das secretarias municipais de educação infantil.

OBJECTIVE: This study investigates the nutritional factors that determine the absence of anemia in infants from families with a low socioeconomic background submitted to a nutrition intervention program, as well as iron intake according to recommendations. METHODS: The study included 369 children from a cohort of inhabitants of São Leopoldo, state of Rio Grande do Sul, Brazil, who were randomized at birth into an intervention group and into a control group. The intervention group had nutritional guidance in the first year of life, with monthly follow-up home visits, whereas the control group was visited at 6 and 12 months, without nutritional intervention. At the end of the first year of life, a 24-hour recall was used. Anemia was diagnosed based on a hemoglobin level less than 11 g/dL. The children's diets were classified according to iron bioavailability. RESULTS: The prevalence of anemia amounted to 63.7 percent in this study. The proportion of children with adequate iron intake relative to the recommendations was statistically higher in the nonanemic group (26.8 percent) than in the anemic one (17.7 percent). Nonanemic children had a greater intake of iron (p = 0.019), vitamin C (p = 0.001), energy density at dinner (p = 0.006), iron density per 1,000 calories (p = 0.045); and 16.3 percent of them had a diet with high iron bioavailability (p = 0.002). CONCLUSIONS: A diet with high iron bioavailability protects children from anemia and can be used as an intervention measure by basic health services and by the municipal departments of children's education.