Nutritional peripheral neuropathies.

Nutritional peripheral neuropathies are a global problem, heavily influenced by geopolitical, cultural and socioeconomic factors. Peripheral neuropathy occurs most frequently secondary to B-vitamin deficiencies, which is suspected to increase in years to come due to the popularity of vegan and vegetarian diets and increased use of bariatric surgery.This review will focus on the common B-vitamins for which a causal link to peripheral neuropathy is more established (vitamins B1, B2, B6, B9 and B12). We will review the historical human and animal data on which much of the clinical descriptions of vitamin deficiencies are based and summarise current available tools for accurately diagnosing a nutritional deficiency. We will also review recently described genetic diseases due to pathogenic variants in genes involved in B-vitamin metabolism that have helped to inform the phenotypes and potential causality of certain B-vitamins in peripheral neuropathy (B2 and B9).Endemic outbreaks of peripheral neuropathy over the last two centuries have been linked to food shortages and nutritional deficiency. These include outbreaks in Jamaican sugar plantation workers in the nineteenth century (Strachan's syndrome), World War two prisoners of war, Cuban endemic neuropathy and also Tanzanian endemic optic neuropathy, which remains a significant public health burden today. An improved understanding of lack of which vitamins cause peripheral neuropathy and how to identify specific deficiencies may lead to prevention of significant and irreversible disability in vulnerable populations.

[Food insecurity and its association with obesity and cardiometabolic risks in Mexican women]. / Inseguridad alimentaria y su asociación con la obesidad y los riesgos cardiometabólicos en mujeres mexicanas.

INTRODUCTION: Objective: we conducted a systematic review of the main scientific evidence that associates food insecurity with a higher frequency of obesity and cardiometabolic risks in Mexican women. Design: a systematic review. Data sources: MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts and PAIS Index. Selection criteria: articles that met the journal quality criteria and integrated food status with health insecurity, in which the situation of vulnerability in the current statistics for cardiometabolic diseases and risks that are associated with food insecurity was shown in women and their homes. Data analysis: relevance and quality of the results regarding food security, the presence of overweight and obesity, and socio-environmental indicators in women. Results: households headed by women who are at higher risk of having some degree of food insecurity or food assistance associated with the presence of obesity and overweight (RR = 1.28 to 2.97; 95 % CI: 1.08-1.44 to 1.52-6.14) as well as the development of cardiometabolic diseases such as diabetes mellitus (with a history of pregnancy as risk factor for developing diabetes and hypertension) presenting premature labor, shorter stature in the adult stage, a deficiency in micronutrients such as iron and antioxidant vitamins. Conclusion: the evidence found shows an association of food insecurity as found in women and their homes with a greater risk of being overweight and obese, as well as the development of a cardiometabolic disease (diabetes, hypertension), in addition to anemia and vitamin deficiency.

INTRODUCCIÓN: Objetivo: realizar una revisión de la principal evidencia científica que asocie la inseguridad alimentaria con una mayor frecuencia de obesidad y riesgos cardiometabólicos en mujeres mexicanas. Diseño: revisión sistemática. Fuentes de datos: MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts y PAIS Index. Selección de estudios: artículos que reunieran los criterios de calidad de las revistas e integraran la situación de inseguridad alimentaria y salud, en los que se viera la situación de vulnerabilidad en las estadísticas actuales de enfermedades y riesgos cardiometabólicos asociados con la situación de inseguridad alimentaria en mujeres y sus hogares. Extracción de datos: relevancia y calidad de los resultados respecto a la seguridad alimentaria, la presencia de sobrepeso y obesidad, e indicadores socioambientales en las mujeres. Resultados: los hogares encabezados por mujeres presentaron mayor riesgo de tener algún grado de inseguridad alimentaria o carencia alimentaria, asociándose esta con la presencia de obesidad y sobrepeso (RR = 1,28 a 2,97; IC 95 %: 1,08-1,44 a 1,52-6,14) así como con el desarrollo de enfermedades cardiometabólicas como la diabetes mellitus (siendo el embarazo, como antecedente, un factor de riesgo para desarrollar diabetes e hipertensión), presentar partos prematuros, tener menor estatura en la etapa adulta, una deficiencia de micronutrimentos como el hierro y de vitaminas antioxidantes. Conclusiones: la evidencia encontrada muestra una asociación de la inseguridad alimentaria encontrada en las mujeres y sus hogares con una mayor probabilidad de presentar sobrepeso y obesidad, así como el desarrollo de una enfermedad de índole cardiometabólica (diabetes, hipertensión), además de anemia y deficiencia de vitaminas.

Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study.

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60-75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.

Factors associated with the nutritional status of children less than 5 years of age / Fatores associados ao estado nutricional de crianças menores de cinco anos

OBJECTIVE To analyze if the nutritional status of children aged less than five years is related to the biological conditions of their mothers, environmental and socioeconomic factors, and access to health services and social programs.METHODS This cross-sectional population-based study analyzed 664 mothers and 790 children using canonical correlation analysis. Dependent variables were characteristics of the children (weight/age, height/age, BMI/age, hemoglobin, and retinol serum levels). Independent variables were those related to the mothers' nutritional status (BMI, hemoglobin, and retinol serum levels), age, environmental and socioeconomic factors and access to health service and social programs. A < 0.05 significance level was adopted to select the interpreted canonical functions (CF) and ± 0.40 as canonical load value of the analyzed variables.RESULTS Three canonical functions were selected, concentrating 89.9% of the variability of the relationship among the groups. In the first canonical function, weight/age (-0.73) and height/age (-0.99) of the children were directly related to the mother's height (-0.82), prenatal appointments (-0.43), geographical area of the residence (-0.41), and household incomeper capita (-0.42). Inverse relationship between the variables related to the children and people/room (0.44) showed that the larger the number of people/room, the poorer their nutritional status. Rural residents were found to have the worse nutritional conditions. In the second canonical function, the BMI of the mother (-0.48) was related to BMI/age and retinol of the children, indicating that as women gained weight so did their children. Underweight women tended to have children with vitamin A deficiency. In the third canonical function, hemoglobin (-0.72) and retinol serum levels (-0.40) of the children were directly related to the mother's hemoglobin levels (-0.43).CONCLUSIONS Mothers and children were associated concerning anemia, vitamin A deficiency and anthropometric markers. Living in rural areas is a determining factor for the families health status.

OBJETIVO Analisar se o estado nutricional de crianças menores de cinco anos está relacionado a condições biológicas de suas mães, a fatores ambientais e socioeconômicos e ao acesso a serviços de saúde e programas sociais.MÉTODOS Este estudo transversal, de base populacional, analisou 664 mães e 790 filhos, utilizando análise de correlação canônica, tendo como variáveis dependentes as características dos filhos (peso/idade, estatura/idade, índice de massa corporal/idade, níveis de hemoglobina e retinol sérico). Como variáveis independentes, as relacionadas ao estado nutricional das mães (índice de massa corporal, níveis de hemoglobina e retinol sérico), idade materna, fatores ambientais, socioeconômicos, acesso a serviços de saúde e programas sociais. Adotou-se nível de significância < 0,05 para seleção das funções canônicas interpretadas e ± 0,40 como valor de carga canônica das variáveis analisadas.RESULTADOS Foram selecionadas três funções canônicas, concentrando 89,9% da variabilidade da relação entre os grupos. Na primeira, peso/idade (-0,73) e estatura/idade (-0,99) dos filhos relacionaram-se diretamente com estatura materna (-0,82), consultas pré-natais (-0,43), área geográfica de moradia (-0,41) e renda familiar per capita (-0,42). A relação inversa entre variáveis referentes aos filhos e moradores/cômodo (0,44) mostrou que, quanto maior o número de pessoas/cômodo, mais deficiente o estado nutricional. Residentes na área rural apresentaram piores situações nutricionais. Na segunda função, índice de massa corporal materno (-0,48) relacionou-se com índice de massa corporal/idade e retinol dos filhos, indicando que, à medida que as mulheres aumentavam de peso, o mesmo acontecia com seus filhos e que mulheres de baixo peso tendiam a ter filhos com deficiência de vitamina A. Na terceira função, os níveis de hemoglobina (-0,72) e retinol (-0,40) dos filhos estiveram diretamente relacionados ao nível de hemoglobina materna (-0,43).CONCLUSÕES Mães e filhos estavam associados em relação à anemia, deficiência de vitamina A e marcadores antropométricos. Residir na área rural ainda é um discriminante na situação de saúde das famílias.

Health needs of refugee children younger than 5 years arriving in New Zealand.

BACKGROUND: New Zealand accepts 750 refugees annually who enter via the Mangere Refugee Resettlement Centre. AIMS: To evaluate the health needs of refugee children less than 5 years of age. METHODS: Retrospective audit on the outcomes of health screening and referrals in children less than 5 years of age at the Mangere Refugee Resettlement Centre between 2007 and 2011. RESULTS: Of the 343 children, the most common infectious diseases were latent tuberculosis (15%) and parasitic infections (15%). In those older than 1 year old who had rubella and measles serology information, immunity was found in 50% and 59%, respectively. Hepatitis B immunity was found in 68%. Complete vaccination certificates were available for 66% on arrival to New Zealand. Vaccinations were administered to 73% while at the Mangere Refugee Resettlement Centre. Iron deficiency and vitamin D deficiency were the main noninfectious diseases found and were present in 33% and 12%, respectively. The total requiring referral for further medical assessment or support was 58% with 19% requiring referral to more than one service. CONCLUSIONS: Screening identified health needs in otherwise asymptomatic newly arriving refugee children. A proportion of children required access to multiple specialized medical services and may benefit from a comprehensive pediatric service.

Nutrition of children and women in Bangladesh: trends and directions for the future.

Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations' Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.

Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania.

BACKGROUND/OBJECTIVES: There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. SUBJECTS/METHODS: This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. RESULTS: Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). CONCLUSIONS: Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.

Nutrition assessment of patients with inflammatory bowel disease.

BACKGROUND: Malnutrition among inflammatory bowel disease (IBD) subjects is well documented in the literature and may arise from factors including inadequate dietary intake, malabsorption, and disease activity. The aims of this present study were to complete a comprehensive nutrition assessment of IBD subjects. METHODS: One hundred twenty-six consecutive adults with IBD completed anthropometric measures, 4-day food-record assessments, and biochemical markers of nutrition. RESULTS: A high prevalence of inadequate nutrient consumption was observed: vitamin E (63%), vitamin D (36%), vitamin A (26%), calcium (23%), folate (19%), iron (13%), and vitamin C (11%). Several biochemical deficiencies were also observed. The prevalence of subnormal serum levels was hemoglobin (40%), ferritin (39.2%), vitamin B(6) (29%), carotene (23.4%), vitamin B(12) (18.4%), vitamin D (17.6%), albumin (17.6%), and zinc (15.2%). Dietary intake was not correlated with serum levels in all instances; there was a highly significant correlation between diet and serum values of vitamin B(12), folate, and vitamin B(6) for all IBD subjects, independent of disease activity, and for vitamin D among all IBD subjects in remission. CONCLUSIONS: Subjects with IBD have a high rate of iron deficiency and anemia, which are most likely not secondary to diet. Supplementing with iron should be warranted only if a true iron deficiency exists. The routine evaluation of serum vitamin B(6) and vitamin D levels is recommended. Routine multivitamin supplementation is warranted in IBD in view of numerous dietary and biochemical deficiencies observed among adult IBD subjects. Even if subjects with IBD seem to be well nourished, they may harbor vitamin/mineral deficiencies.

[Assessment of vitamins contents in the food rations of low physically active women]. / Ocena zawartosci witamin w racjach pokarmowych kobiet o niskiej aktywnosci fizycznej.

The aim of paper was to assess the vitamins of low physically active women (n=100). The information about vitamins intake were collected using 24-hour recall and diet history questionnaire. The intake of vitamins B1, B2, and B6 was too low. Vitamin B1--64.7% recommended level, vitamin B2--81.2% recommended level, vitamin B6--72.2% recommended level, niacin--63.5% recommended level and folacin--71.8% recommended level. The study showed unsatisfactory low consumption of milk and dietary products, cereal products, vegetables and fruits.

Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India.

OBJECTIVE: The present study was undertaken to assess the impact of drought on the nutritional status of pre-school children aged 0-5 years from a rural population in a desert area facing drought conditions very frequently. DESIGN: The sampling design for assessment was the three-stage sampling technique. SETTING: The study was carried out in 24 villages belonging to six tehsils (sub-units of district) of Jodhpur District, a drought-affected desert district of western Rajasthan, during a drought in 2003. SUBJECTS: A total of 914 children were examined at household level, with nutritional status assessed by anthropometry, dietary intake and clinical signs of nutritional deficiency. RESULTS: The results revealed growth retardation. Stunting (malnutrition of long duration) was observed in 53% of children and underweight in 60%. Wasting, an indicator of short-duration malnutrition, was present in 28% of children. The extent of malnutrition was significantly higher in girls than boys (P<0.05). Vitamin A and B complex deficiencies were found in 0.7 and 3.0% of children, respectively. Prevalence of marasmus (protein-energy malnutrition, PEM) was 1.7% (2.3% in boys and 1.1% in girls). Overall deficits in mean energy and protein intakes were very high (76 and 54%, respectively). Comparison of the present drought results with earlier studies in desert normal and desert drought conditions showed higher prevalence of PEM and higher dietary energy and protein deficiencies. CONCLUSIONS: The prevalence of wasting was high, greater than the cut-off point of 15% stated by the World Health Organization to indicate that the severity of malnutrition is critical. PEM, vitamin A and B complex deficiencies and anaemia, along with dietary deficits of energy and protein, were observed to be higher than in non-desert areas. This may be due to the harsh environmental conditions in desert areas where drought occurs quite frequently and adversely affects the economy, largely by eroding the coping capacity and economic potential of the people as a result of heavy livestock losses and reduced harvests, leading to increased poverty and poor food intake of the inhabitants. Due to inadequate consumption of daily food the children were suffering from wasting and PEM. Efforts should be made to incorporate measures, such as ensuring the supply of adequate energy and protein to all age groups and especially pre-school children, into ongoing nutrition programmes in order to improve the food security of local inhabitants in this area.

[Energy and nutrient intake and risk of inadequate intakes in Canary Islands (1997-98)]. / Ingesta de energía y nutrientes y riesgo de ingestas inadecuadas en Canarias (1997-98).

OBJECTIVES: To evaluate the consumption of energy and nutrients and to identify the risk of inadequate intakes in the Canary Island population (1997-98). DESIGN: Cross-sectional epidemiological study. METHODS: A dietary survey was conducted in a representative sample of the Canary Island population (n = 1747; 821 men and 926 women) aged 6 to 75 years. Two 24-hour recalls were utilised as the dietary survey instrument, carried out over non-consecutive days. Spanish Food Composition Tables were used and data was adjusted for intraindividual variability. RESULTS: The mean daily intakes were 1760 kcal for energy, 73 g for protein, 228 g for carbohydrates, 15 g for fibre and 62 g for fat (24 g SFA, 25 g MUFA and 8 g PUFA). Energy and nutrient consumption decreased with age excluding vitamins A. C and folate. Nutrient density increased with age, with the lowest intakes seen in children and adolescents. As for social class, decreased calorie intake was observed in the lowest category, with the highest income level showing the greatest intakes for vitamin A, B12, niacin and folate. Noteworthy findings include an overall low calorie intake, and elevated risks of inadequate intakes (percentages of the population with intakes below 2/3 of the RDI) for vitamins D (92.5%), E(87.4%), A(74%), folate(44.7%), iron(30.1%) magnesium (14.9%) and vitamin C (5.4%). Risk for inadequate protein intake was not observed.

[Food consumption among rural schoolchildren from the metropolitan area of Chile. A comparative study. 1989]. / Ingesta alimentaria de escolares rurales de la región metropolitana de Chile. Un estudio comparativo. 1989.

A comparative study of dietary intake of a representative sample of 651 rural school children from Chile's Metropolitan Region was carried out between two periods: 1986-1987 and 1989. Standard procedures for 24 hr dietary recall individual interviews were used to collect data. The percentage of adequacy of energy and protein intake was calculated based on FAO/OMS/UNU (1985), and vitamins and minerals according to National Research Council Recommended Dietary Allowances. Socioeconomic status (SES) was measured through Graffar's Modified Method. Statistical procedures included chi-square test, analysis of variance and Student "t" test. Between 1986-1987 and 1989 not significant difference was found for dietary intake, despite the socioeconomic conditions had improved. Most part of the sample satisfied energy and protein requirements, but approximately 1/3 of the sample presented a low energy intake; the same was observed for protein intake. Protein contributed 12.0% of the dietary energy, fat 23.0% and carbohydrates 65.0%. Animal and vegetable protein intake was found in the proportion 4:6. Dietary intake significantly differed according to age and SES, and deficiencies in calcium, vitamin A, riboflavin and niacin intake were detected in both sexes. These results could be useful for food and nutrition planning related to school feeding programs and nutrition education.

Vitamin deficiencies and public interventions in the Federal Republic of Germany.

Vitamin supply of adults in the Federal Republic of Germany is - on the average of the population - satisfactory; i.e. the great majority of test persons who underwent biochemical tests (in each case more than 70%) has been found to show at least satisfactory values of vitamin supply with the usual diet. Measuring values of folic acid, thiamin and vitamin B6 were most frequent in the critical range. Uncertain supply with riboflavin, vitamin A and vitamin C has been found in some age and professional groups only; supply with vitamin B12, vitamin E and niacin was not certain in some exceptional cases only. Groups of above-average risk of uncertain vitamin supply so far are young women (18-24 years) and senior men (above 65 years). The pattern of supply gaps is clearly different: in young women, uncertain supply includes folic acid, riboflavin, vitamin B6 and (as the only group) vitamin E; in older men, it includes vitamin C, vitamin A and riboflavin). The educational level is another important factor of influence which has to be taken into account. This is pleasant finding because it gives reason to assume that improved capability to inform oneself leads, at least in part of the population, to a more balanced diet. In cases of lower educational levels, on the other hand, the interest in questions of health and maintenance of health is much lower. This also becomes manifest in a clearly reduced readiness to participate in nutritional inquiries.(ABSTRACT TRUNCATED AT 250 WORDS)

Appropriateness of vitamin and mineral prescription orders for residents of health related facilities.

A study was made of the medical charts of 433 elderly patients admitted to four Health Related Facilities in upper New York State, to determine whether the respective prescription orders for vitamins and minerals were appropriate to the given diagnoses and, if not, identify the variables correlated with inappropriateness. For 11.1 percent of the patients, vitamins or minerals were prescribed when there was no specific diagnostic indication, or they were not prescribed when the medical diagnosis indicated that they should have been. Women and medicaid patients were more likely than men and self-paying patients to be treated inappropriately with respect to vitamins and minerals, but the differences were not satistically significant.