Trans fatty acids in frequently consumed products from Serbian and Slovenian market.

OBJECTIVES: Industrially produced trans fatty acid (iTFA) have adverse health effects and thus their consumption should be limited. The aim of this study was to determine and compare the iTFA content in frequently consumed food products by young adults from the Serbian and Slovenian market with supposedly elevated iTFA content in 2015. At the time of this study, there was no recommended limit of iTFA in both countries, and reduction of iTFA in foods was on voluntary basis. METHODS: We determined iTFA content in food products, 19 from the Serbian and 22 from the Slovenian market, blinded and analysed in the same analytical run. Contents of fatty acids (FA) methyl esters were analysed by capillary gas chromatography with a flame ionisation detector. Heptadecanoic acid was used as internal standard. Individual FA along with TFA were expressed as percentages of total measured FA. The amount of each FA in the sample was then calculated from the response factor and the transformation factor of the FA from the FA methyl ester content. RESULTS: Elaidic acid (C18:1t) was found as the most abundant TFA in analysed products, ranging from 0.52 g/100 g of total FA in chocolate candy up to 60.4 g/100 g in a salami from Serbian market. In Slovenian products, the values for elaidic acid were lower, 0.04-3.95 g/100 g of total FA, except in one type of wafers (24.3 g/100 g). CONCLUSIONS: The majority of analysed products from the Serbian and three from Slovenian market exceeded the recommended WHO and EU limit of 2% iTFA of total fat in foods. Samples of frequently consumed salami, wafers, tea biscuits, and snacks were identified as products with potentially higher burden of iTFA in diets of young adults in Serbia.

Sustainable food systems for healthy diets in Europe and Central Asia: Introduction to the special issue.

This Special Issue highlights various good practices and food policy discussion in relation to the transformation of current food systems toward their social, environmental and economical sustainability. The papers describe policies, programmes and initiatives in developing and advanced economies of Europe and Central Asia that refer to the core elements of food systems, such as food supply, food environments, and consumers. The shared opinions, analyses, studies and approaches, experiences and insights contribute to a better understanding of regional specificities and support the efforts to guide the complex food systems' transformation for their improved capacity to deliver healthy diets.

Energy, macronutrients and dietary fibre intake among adults in North Macedonia.

OBJECTIVE: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. METHODS: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. RESULTS: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, ß = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, ß = -2.077) and among highly educated participants (p = 0.018, ß = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, ß = 4.213). CONCLUSION: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

Systematic Review of Observational Studies with Dose-Response Meta-Analysis between Folate Intake and Status Biomarkers in Adults and the Elderly.

BACKGROUND: Dietary reference values for folate intake vary widely across Europe. METHODS: MEDLINE and Embase through November 2016 were searched for data on the association between folate intake and biomarkers (serum/plasma folate, red blood cell [RBC] folate, plasma homocysteine) from observational studies in healthy adults and elderly. The regression coefficient of biomarkers on intake (ß) was extracted from each study, and the overall and stratified pooled ß and SE (ß) were obtained by random effects meta-analysis on a double log scale. These dose-response estimates may be used to derive folate intake reference values. RESULTS: For every doubling in folate intake, the changes in serum/plasma folate, RBC folate and plasma homocysteine were +22, +21, and -16% respectively. The overall pooled regression coefficients were ß = 0.29 (95% CI 0.21-0.37) for serum/plasma folate (26 estimates from 17 studies), ß = 0.28 (95% CI 0.21-0.36) for RBC (13 estimates from 11 studies), and ß = -0.21 (95% CI -0.31 to -0.11) for plasma homocysteine (10 estimates from 6 studies). CONCLUSION: These estimates along with those from randomized controlled trials can be used for underpinning dietary recommendations for folate in adults and elderly.

The influence of food consumption and socio-economic factors on the relationship between zinc and iron intake and status in a healthy population.

OBJECTIVE: To examine Zn and Fe nutritional status of a healthy population by means of anthropometric, dietary and biochemical measurements and to investigate the relationship of usual Zn and Fe dietary intakes to Zn and Fe status. In addition, to examine the impact of food choices and socio-economic factors on Fe and Zn dietary intakes and status with the aim to identify groups at risk of dietary deficiency and suggest factors that may influence the status of these nutrients. DESIGN: Food consumption was assessed by 24 h recall questionnaires. Twenty biochemical parameters were measured, of which Hb, haematocrit, erythrocyte count and plasma concentrations of Fe and Zn were directly related to Fe and Zn nutrition. The prevalence of study participants with inadequate micronutrient intakes was calculated using the Estimated Average Requirement cut-point method. SETTING: Serbia, Europe. SUBJECTS: Apparently healthy adults (25-65 years of age). RESULTS: Mean daily Zn and Fe intakes were 9·1 mg and 11·6 mg for males and 7·3 mg and 9·4 mg for females, respectively. Five per cent of the study population had inadequate dietary Fe intake and 15-25 % had inadequate Zn intake. Lower Hb concentrations were measured in women with lower Zn intakes. No differences in Fe and Zn intakes and status among various socio-economic groups were observed, except for Fe intake between the low-income and affluent groups. CONCLUSIONS: Regular follow-ups are needed to ensure that potential deficiencies of Zn and Fe do get recognized and addressed in a timely manner.

Validity of an FFQ assessing the vitamin D intake of young Serbian women living in a region without food fortification: the method of triads model.

OBJECTIVE: The objective of the present study was to examine the external validity of an FFQ designed to estimate dietary vitamin D intake compared with a plasma biomarker and three repeated 24 h dietary recalls in women of reproductive age in Serbia, where there is no exposure to food fortified with vitamin D. The method of triads was applied. DESIGN: In a cross-sectional study, 422 women completed the Women and Reproductive Health FFQ (WRH-FFQ) during the winter months. From a representative subgroup (n 44), three 24 h dietary recalls and anthropometric parameters were collected as well as a fasting blood sample for vitamin D biomarker analyses. Correlation coefficients were calculated between each of the dietary methods. Validity coefficients, as a correlation between the measured and estimated 'true' exposure, were calculated using the method of triads. Bland-Altman plots were also constructed. SETTING: Three major universities in Serbia. SUBJECTS: Healthy young women (n 422) aged 18-35 years. RESULTS: The WRH-FFQ estimate of vitamin D intake for all participants was 4.0 (sd 3.3) µg/d and 3.1 (sd 2.3) µg/d for the subgroup. Bland-Altman plots for these intakes showed high agreement. Validity coefficients for the FFQ, 24 h recall and biomarker were ρ QI=0.847 (95% CI 0.564, 0.928), ρ RI=0.810 (95% CI 0.537, 0.997) and ρ BI=0.499 (95% CI 0.190, 0.840), while the correlation coefficients were 0.686, 0.422 and 0.404. CONCLUSIONS: The FFQ applied in the present study is a valid tool for assessing dietary vitamin D intake in women living in Serbia, a region without mandatory vitamin D food fortification.

Professional training in nutrition in Central and Eastern Europe: current status and opportunities for capacity development.

OBJECTIVE: To examine the availability of academic programmes in nutrition and identify nutrition training needs in Central and Eastern Europe (CEE). DESIGN: A questionnaire with close-ended and open-ended questions was distributed to the members of the United Nations University Standing Committee on Nutrition, Regional Network for Capacity Development in Nutrition in CEE (NCDN CEE). SETTING: Participants' responses to the questionnaire including the comments of their colleagues from home institutions were obtained in group discussions during NCDN CEE meetings in 2010-2013. SUBJECTS: Sixteen CEE countries' experts and their colleagues from home institutions involved in NCDN CEE activities 2007-2013. RESULTS: The responses were obtained from fourteen out of sixteen participating countries; five countries have established Bachelor, Master and PhD studies in nutrition (Croatia, Czech Republic, Poland, Slovak Republic and Slovenia), whereas in Latvia and Republic of Macedonia only Bachelor and Master studies are set up. Seven countries have no Bachelor, Master or PhD studies: Bosnia and Herzegovina, Bulgaria, Estonia, Lithuania, Montenegro, Romania and Serbia. Introduction to data analysis and Nutritional epidemiology are the most needed nutrition trainings that would increase working competence of nutritionists and nutrition-related professionals in CEE. CONCLUSIONS: Availability of academic programmes in nutrition in CEE countries is limited. Opportunities for improving the competence of existing and future nutrition-related professionals should be addressed at national and regional level; distance learning courses and creation of a regional centre for nutrition training were seen as opportunities for sustainable capacity development in nutrition in CEE.

Socio-economic determinants of micronutrient intake and status in Europe: a systematic review.

OBJECTIVE: To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake. DESIGN: MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability. SETTING: Europe. SUBJECTS: Children, adults and elderly. RESULTS: Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %). CONCLUSIONS: The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases.

EURRECA-Estimating iodine requirements for deriving dietary reference values.

Iodine is an essential component of thyroid hormones, and current recommendations for intake are based on urinary iodine excretion, assessment of thyroid size, thyroidal iodine accumulation and turnover, radioactive iodine uptake, balance studies, and epidemiological studies. Dietary iodine is rapidly and almost completely absorbed. The prevalence of inadequate iodine intake is high: 29% of the world's population lives in iodine-deficient areas and 44% of Europe remains mildly iodine deficient. To assess current data and update evidence for setting dietary recommendations for iodine, the EURRECA Network of Excellence has undertaken systematic review and evaluation of (i) the usefulness of iodine status biomarkers (ii) the relationship between iodine status biomarkers and dietary iodine intake, and (iii) the relationship between iodine intake and health outcomes (endemic goiter, hypothyroidism, and cognitive function). This review summarizes the main research outputs: the key findings of the literature review, results of the meta-analyses, and discussion of the main conclusions. Currently, data for relevant intake-status-health relationships for iodine are limited, particularly for population groups such as children under two years, pregnant women, and the elderly. The EURRECA Network developed best practice guidelines for the identification of pertinent iodine studies based on a systematic review approach. This approach aimed to identify comparable data, suitable for meta-analysis, for different countries and across all age ranges. When new data are available, the EURRECA Network best practice guidelines will provide a better understanding of iodine requirements for different health outcomes which could be used to set evidence-based dietary iodine recommendations for optimal health.

EURRECA-Estimating selenium requirements for deriving dietary reference values.

Current reference values for selenium, an essential micronutrient, are based on the intake of selenium that is required to achieve maximal glutathione peroxidase activity in plasma or erythrocytes. In order to assess the evidence of relevance to setting dietary reference values for selenium, the EURRECA Network of Excellence focused on systematic searches, review, and evaluation of (i) selenium status biomarkers and evidence for relationships between intake and status biomarkers, (ii) selenium and health (including the effect of intake and/or status biomarkers on cancer risk, immune function, HIV, cognition, and fertility), (iii) bioavailability of selenium from the diet, and (iv) impact of genotype/single nucleotide polymorphisms on status or health outcomes associated with selenium. The main research outputs for selenium and future research priorities are discussed further in this review.

EURRECA-Estimating iron requirements for deriving dietary reference values.

Currently, a factorial approach is used to derive reference values for iron. Calculations include the use of a bioavailability factor to convert the physiological requirement, derived from obligatory losses and requirements for growth and development, into a dietary intake value. A series of systematic reviews undertaken by the EURRECA Network of Excellence aimed to identify data that may increase the accuracy of factorial calculations across all population groups. The selection of robust data was guided by the use of standardized review methodology and the evidence-based selection of status biomarkers and dietary intake assessment techniques. Results corroborated the dearth of relevant factorial data, including whole-diet bioavailability data, and confirmed the need to continue extrapolating physiological requirements across population groups. Data were also unavailable that would allow reference values to be based on selected health outcomes associated with iron intake or status. Ideally, a series of observational and randomized controlled trial (RCT) studies need to be undertaken across all population groups and life stages to generate robust data for setting dietary reference values for iron. It will also be essential to include information on polymorphisms that potentially influence iron absorption and status in the derivation process.

EURRECA-Principles and future for deriving micronutrient recommendations.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence (NoE) explored an approach for setting micronutrient recommendations, which would address the variation in recommendations across Europe. Therefore, a framework for deriving and using micronutrient Dietary Reference Values (DRVs) has been developed. This framework comprises four stages (defining the problem-monitoring and evaluating-deriving dietary reference values-using dietary reference values in policy making). The aim of the present paper is to use this framework to identify specific research gaps and needs related to (1) knowledge available on specific micronutrients (folate, iodine, iron, selenium, vitamin B12, vitamin D, and zinc) and (2) the methodology presented in the framework. Furthermore, the paper describes the different outputs that support the process like protocols, guidelines, systematic review databases, and peer-reviewed publications, as well as the principal routes of dissemination of these outputs to ensure their optimal uptake in policy, practice, and research collaborations. The importance of ensuring transparency in risk assessment and risk management, systematic searching the literature, and taking into account policy options is highlighted. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional tables.].

EURRECA-Evidence-based methodology for deriving micronutrient recommendations.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one "Defining the problem" describes Activities 1 and 2: "Identifying the nutrition-related health problem" and "Defining the process"; stage two "Monitoring and evaluating" describes Activities 3 and 7: "Establishing appropriate methods," and "Nutrient intake and status of population groups"; stage three "Deriving dietary reference values" describes Activities 4, 5, and 6: "Collating sources of evidence," "Appraisal of the evidence," and "Integrating the evidence"; stage four "Using dietary reference values in policy making" describes Activities 8 and 9: "Identifying policy options," and "Evaluating policy implementation." These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].

EURRECA-Estimating zinc requirements for deriving dietary reference values.

Zinc was selected as a priority micronutrient for EURRECA, because there is significant heterogeneity in the Dietary Reference Values (DRVs) across Europe. In addition, the prevalence of inadequate zinc intakes was thought to be high among all population groups worldwide, and the public health concern is considerable. In accordance with the EURRECA consortium principles and protocols, a series of literature reviews were undertaken in order to develop best practice guidelines for assessing dietary zinc intake and zinc status. These were incorporated into subsequent literature search strategies and protocols for studies investigating the relationships between zinc intake, status and health, as well as studies relating to the factorial approach (including bioavailability) for setting dietary recommendations. EMBASE (Ovid), Cochrane Library CENTRAL, and MEDLINE (Ovid) databases were searched for studies published up to February 2010 and collated into a series of Endnote databases that are available for the use of future DRV panels. Meta-analyses of data extracted from these publications were performed where possible in order to address specific questions relating to factors affecting dietary recommendations. This review has highlighted the need for more high quality studies to address gaps in current knowledge, in particular the continued search for a reliable biomarker of zinc status and the influence of genetic polymorphisms on individual dietary requirements. In addition, there is a need to further develop models of the effect of dietary inhibitors of zinc absorption and their impact on population dietary zinc requirements.

Micronutrient intake and status in Central and Eastern Europe compared with other European countries, results from the EURRECA network.

OBJECTIVE: To compare micronutrient intakes and status in Central and Eastern Europe (CEE) with those in other European countries and with reference values. DESIGN: Review of the micronutrient intake/status data from open access and grey literature sources from CEE. SETTING: Micronutrients studied were folate, iodine, Fe, vitamin B12 and Zn (for intake and status) and Ca, Cu, Se, vitamin C and vitamin D (for intake). Intake data were based on validated dietary assessment methods; mean intakes were compared with average nutrient requirements set by the Nordic countries or the US Institute of Medicine. Nutritional status was assessed using the status biomarkers and cut-off levels recommended primarily by the WHO. SUBJECTS: For all population groups in CEE, the mean intake and mean/median status levels were compared between countries and regions: CEE, Scandinavia, Western Europe and Mediterranean. RESULTS: Mean micronutrient intakes of adults in the CEE region were in the same range as those from other European regions, with exception of Ca (lower in CEE). CEE children and adolescents had poorer iodine status, and intakes of Ca, folate and vitamin D were below the reference values. CONCLUSIONS: CEE countries are lacking comparable studies on micronutrient intake/status across all age ranges, especially in children. Available evidence showed no differences in micronutrient intake/status in CEE populations in comparison with other European regions, except for Ca intake in adults and iodine and Fe status in children. The identified knowledge gaps urge further research on micronutrient intake/status of CEE populations to make a basis for evidence-based nutrition policy.

Underutilized plants increase biodiversity, improve food and nutrition security, reduce malnutrition, and enhance human health and well-being. Let's put them back on the plate!

The global food system depends on a limited number of plant species. Plants with unsatisfactory nutritional value are overproduced, whereas the wide variety of nutrient-rich plant species used in earlier times remains neglected. Basing our diet on a few crops has wide-ranging negative consequences on nutrition and food security. Although still under-researched, underutilized plants are slowly starting to receive increased recognition. These plants have superior nutritional content and immense potential to contribute to food and nutrition security and increased sustainability. This narrative review provides evidence to encourage the promotion, domestication, and commercialization of underutilized plants. The anti-inflammatory, antidiabetic, and anticancer effects of some of underutilized plants are presented in this review. The outstanding ability of forgotten plants to increase food and nutrition security, boost dietary diversity, reduce malnutrition, and enhance human health and well-being is demonstrated. The main barriers and obstacles to reintroducing underutilized foods are reviewed and recommendations for overcoming nutrition and dietary-related challenges for re-establishing underutilized plants into the global food system are presented. The expansion of underutilized plants for human use is of paramount importance. The exceptional nutritional properties, bioactive potential, and proven health benefits of underutilized plants indicate that increased promotion, domestication, and commercialization of these plants should be strongly supported. Besides health benefits, marginalized plants have the potential to enhance human well-being and improve people's lives in many ways, retain biodiversity, and develop local economies. Therefore, underutilized plants should be used in the broader context of well-balanced and healthy diets.

Exposure to Phosphates and Nitrites through Meat Products: Estimation of the Potential Risk to Pregnant Women.

Diet during pregnancy is one of the most important nutritional challenges associated with some risks for the mother and the fetus. For the first time, the study aims to estimate long-term (2018-2022) exposure to nitrate and phosphates in Serbian pregnant women, based on individual consumption data and accurate values measured in frequently consumed meat products. For this purpose, seven types of meat products, consisting of 3047 and 1943 samples, were collected from retail markets across Serbia, to analyze nitrites and phosphorus content, respectively. These data were combined with meat product consumption data from the Serbian National Food Consumption Survey to assess dietary intake of nitrites and phosphate. The results were compared with the acceptable daily intake (ADI) proposed by the European Food Safety Authority. The average dietary exposure (EDI) to phosphorus ranged from 0.733 mg/kg bw/day (liver sausage and pate) to 2.441 mg/kg bw/day (finely minced cooked sausages). Considering nitrite intake, the major sources were bacon (0.030 mg/kg bw/day) and coarsely minced cooked sausages (0.0189 mg/kg bw/day). In our study, average nitrite and phosphorus exposure in the Serbian pregnant women population are far below the EFSA recommendations (ADI 0.07 mg/kg bw/day and 40 mg/kg bw/day, respectively).

Evaluation of Dietary Intake and Anthropometric Status in 1-9-Year-Old Children Living in Serbia: National Food Consumption Survey according to the EU Menu Methodology.

The Serbian Food Consumption Survey among 1-9-year-old-children was conceptualized and conducted in compliance with the principles, established protocols, and guidelines of the EU Menu project between 2017 and 2021. Valid data were collected for 576 individuals (290 1-3-year-old toddlers and 276 3-9-year-old children). Regardless of age and gender category, the majority (68.80%) of children had normal weights according to the Body Mass Index-for-age classification system. The median daily energy intake was 1406.71 kcal with no differences between the settlement types. The overall median contributions of carbohydrates, protein, and fat to the total energy intake were 47.54%, 14.06%, and 37.88%, respectively. The proportions of the macronutrient intake deviated from the dietary reference values with compliance to the recommendations being particularly poor for fat and fiber. The consumption of energy-dense food groups such as meat and meat products, fat and oil, sugar, and confections was more pronounced among older children. The survey results provide a valuable insight into the nutritional status and dietary habits of toddlers and children 1-9 years old living in Serbia. They may serve as an evidence platform for public health programs, a valuable asset for decision-makers, and a reliable reference to guide nutritional policies, diet monitoring, and interventions targeting this population group in the future.

The Intake of Phosphorus and Nitrites through Meat Products: A Health Risk Assessment of Children Aged 1 to 9 Years Old in Serbia.

This study provides the data on dietary exposure of Serbian children to nitrites and phosphorus from meat products by combining individual consumption data with available analytical data of meat products. A total of 2603 and 1900 commercially available meat products were categorized into seven groups and analysed for nitrite and phosphorous content. The highest mean levels of nitrite content, expressed as NaNO2, were found in finely minced cooked sausages (40.25 ± 20.37 mg/kg), followed by canned meat (34.95 ± 22.12 mg/kg) and coarsely minced cooked sausages (32.85 ± 23.25 mg/kg). The EDI (estimated daily intake) of nitrites from meat products, calculated from a National Food Consumption Survey in 576 children aged 1-9 years, indicated that the Serbian children population exceeded the nitrite ADI (acceptable daily intake) proposed by EFSA (European Food Safety Authority) in 6.4% of children, with a higher proportion in 1-3-year-old participants. The mean phosphorus concentration varied from 2.71 ± 1.05 g/kg to 6.12 ± 1.33 g/kg in liver sausage and pate and smoked meat products, respectively. The EDI of phosphorus from meat products was far below the ADI proposed by EFSA, indicating that the use of phosphorus additives in Serbian meat products is generally in line with legislation.

The effect of iron on cognitive development and function in infants, children and adolescents: a systematic review.

A systematic review was conducted to summarize the evidence currently available from randomized controlled trials (RCTs) concerning the effect of iron intake of infants, children and adolescents on measures of cognitive development and function. The Cochrane Library, MEDLINE and Embase were searched up to and including February 2010. Studies were also identified by checking the bibliographies of the articles retrieved. All RCTs with an adequate control group in which iron supply was provided by natural food sources, fortified foods, formula or supplements to infants, children or adolescents until the age of 18 years were considered for inclusion. No language restrictions were applied. Fourteen studies met the selection criteria. Twelve out of these 14 studies had a high or moderate risk of bias. A large degree of heterogeneity of study populations, iron dosages and outcome measures precluded performing a quantitative meta-analysis. Overall, the studies suggest a modest positive effect of iron supplementation on cognition and psychomotor outcomes in anemic infants and children after supplementation periods of at least 2 months of duration.