Association of all forms of malnutrition and socioeconomic status, educational level and ethnicity in Colombian children and non-pregnant women.

OBJECTIVE: To examine the association of all forms of malnutrition and socioeconomic status (SES), educational level and ethnicity in children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years) in Colombia. DESIGN: Cross-sectional analysis of data from the 2010 Colombian National Nutrition Survey. The prevalence of malnutrition was compared across categories of SES, educational level and ethnicity. SETTING: Colombia. PARTICIPANTS: The sample for the current analysis comprised children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years). RESULTS: In children <5 years, a low SES and maternal educational level were significantly associated with a lower prevalence of overweight/obesity compared with high levels of SES and maternal education, that is, the prevalence of overweight/obesity was 1·4 and 1·6 times lower in categories of low SES and educational levels, respectively. In contrast, the prevalence of wasting, stunting and anaemia was higher in the lowest SES and maternal educational categories (the prevalence was between 1·1 and 1·8 times higher for these indicators). In women, the lowest SES (11 and 19 years) and educational levels (20 and 49 years) exhibited a higher prevalence in all forms of malnutrition compared with their counterparts in the highest categories (i.e. overweight/obesity, stunting and anaemia). Additionally, indigenous or Afro-Colombian children and women had the highest prevalence of malnutrition in comparison with other ethnicities. CONCLUSIONS: These results suggest that public policies should address all forms of malnutrition that occur in the most vulnerable populations in Colombia using multiple strategies.

The increasing trend in the consumption of ultra-processed food products is associated with a diet related to chronic diseases in Colombia-Evidence from national nutrition surveys 2005 and 2015.

INTRODUCTION: Ultra-processed food products (UPF) have been related to chronic diseases (CD). Public health politics has been establishing strategies to decrease the consumption of these products in the country. OBJECTIVES: i) To assess the trend of the consumption of UPF between 2005 and 2015. (ii) its association with sociodemographic factors and the overall dietary content of nutrients related to CD in 2015. (iii) to estimate the Population Attributable Fraction of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption. METHODS: We used data from the first (2005) and the last (2015) National Surveys of the Nutritional Status in Colombia. Food consumption was assessed using a 24-hour food recall. The NOVA classification classified the food items according to the extent and purpose of industrial processing. RESULTS: The consumption of processed and UPF increased in Colombia between 2005 and 2015. In 2015, no significant differences were found in the consumption of UPF between men and women but significant differences by age, wealth index, area of residence, and ethnicity (p<0.001). A significant positive association was found between the dietary share of UPF and the content of CD-related nutrients such as free sugars, total fats, saturated fats, trans-fats, and sodium. The prevalence of excessive intake of all CD-related nutrients (according to WHO recommendations) increased across quintiles of the dietary share of UPF. With the reduction of UPF consumption to the level seen among the 20% lowest consumers [1.0% (0-4.5%) of the total energy from UPF], the prevalence of excessive nutrient intake was almost three-fourths lower for trans fats; around one third lower for free sugar and saturated fats, 26% lower for sodium and 15% lower for total fat. CONCLUSIONS: In Colombia, the increasing trend in the consumption of UPF is associated with increasing intake of CD-related nutrients. Thus, reducing the consumption of UPF is a potentially effective way to achieve the nutritional goals of the WHO for the prevention of CD.

[Folate, vitamin B12 and human health]. / Folatos y vitamina B12 en la salud humana.

During the past decade the role of folate and vitamin B12 in human nutrition have been under constant re-examination. Basic knowledge on the metabolism and interactions between these essential nutrients has expanded and multiple complexities have been unraveled. These micronutrients have shared functions and intertwined metabolic pathways that define the size of the "methyl donor" pool utilized in multiple metabolic pathways; these include DNA methylation and synthesis of nucleic acids. In Chile, folate deficiency is virtually nonexistent, while vitamin B12 deficiency affects approximately 8.5-51% depending on the cut-off value used to define deficiency. Folate is found naturally mainly in vegetables or added as folic acid to staple foods. Vitamin B12 in its natural form is present only in foods of animal origin, which is why deficit is more common among strict vegetarians and populations with a low intake of animal foods. Poor folate status in vulnerable women of childbearing age increases the risk of neural tube birth defects, so the critical time for the contribution of folic acid is several months before conception since neural tube closure occurs during the first weeks of life. The absorption of vitamin B12 from food is lower in older adults, who are considered to have higher risk of gastric mucosa atrophy, altered production of intrinsic factor and acid secretion. Deficiency of these vitamins is associated with hematological disorders. Vitamin B12 deficiency can also induce clinical and sub-clinical neurological and of other disorders. The purpose of this review is to provide an update on recent advances in the basic and applied knowledge of these vitamins relative to human health.

Calcium does not inhibit the absorption of 5 milligrams of nonheme or heme iron at doses less than 800 milligrams in nonpregnant women.

Calcium is the only known component in the diet that may affect absorption of both nonheme and heme iron. However, the evidence for a calcium effect on iron absorption mainly comes from studies that did not isolate the effect of calcium from that of other dietary components, because it was detected in single-meal studies. Our objective was to establish potential effects of calcium on absorption of nonheme and heme iron and the dose response for this effect in the absence of a meal. Fifty-four healthy, nonpregnant women were selected to participate in 4 iron absorption studies using iron radioactive tracers. We evaluated the effects of calcium doses between 200 and 1500 mg on absorption of 5 mg nonheme iron (as ferrous sulfate). We also evaluated the effects of calcium doses between 200 and 800 mg on absorption of 5 mg heme iron [as concentrated RBC (CRBC)]. Calcium was administered as calcium chloride in all studies and minerals were ingested on an empty stomach. Calcium doses ≥1000 mg diminished nonheme iron absorption by an average of 49.6%. A calcium dose of 800 mg diminished absorption of 5 mg heme iron by 37.7%. In conclusion, we demonstrated an isolated effect of calcium (as chloride) on absorption of 5 mg of iron provided as nonheme (as sulfate) and heme (as CRBC) iron. This effect was observed at doses higher than previously reported from single-meal studies, starting at ~800 mg of calcium.

Concentrations of Plasma Free Palmitoleic and Dihomo-Gamma Linoleic Fatty Acids Are Higher in Children with Abdominal Obesity.

Increased plasma free fatty acids (FFAs) are associated with cardiometabolic risk factors in adults with abdominal obesity (AO). However, this association remains controversial in children. This study analyzed plasma FFA concentration in children with and without AO. Twenty-nine children classified with AO were matched by age and sex with 29 non-obese individuals. Blood samples were collected after fasting for 10-12 h. Plasma concentration of glucose, insulin, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined by automatized methods. FFAs were analyzed by gas chromatography. Children with and without AO had similar age (7.1 ± 2.6 vs. 7.2 ± 2.7 years; p > 0.05) but obese children showed higher (p < 0.05) body mass index (BMI) (+4.3 kg/m²), systolic blood pressure (+5.1 mmHg), and insulin (+27.8 pmol/L). There were no significant differences in plasma total FFA concentration between groups (1.02 ± 0.61 vs. 0.89 ± 0.37 mmol/L; p > 0.05). However, children with AO had higher palmitoleic acid (0.94 vs. 0.70 wt %; p < 0.05) and dihomo-gamma linoleic acid (DHGL) (2.76 vs. 2.07 wt %; p < 0.05). Palmitoleic and DHGL acids correlated (p < 0.05) with BMI (r = 0.397; r = 0.296, respectively) and with waist circumference (r = 0.380; r = 0.276, respectively). Palmitoleic acid correlated positively with systolic blood pressure (r = 0.386; p < 0.05) and negatively with HDL-C (-0.572; p < 0.01). In summary, children with AO have higher plasmatic concentrations of free palmitoleic and DHGL fatty acids, which correlate with cardiometabolic risk factors.

Iron Absorption from Two Milk Formulas Fortified with Iron Sulfate Stabilized with Maltodextrin and Citric Acid.

BACKGROUND: Fortification of milk formulas with iron is a strategy widely used, but the absorption of non-heme iron is low. The purpose of this study was to measure the bioavailability of two iron fortified milk formulas designed to cover toddlers´ nutritional needs. These milks were fortified with iron sulfate stabilized with maltodextrin and citric acid. METHODS: 15 women (33-47 years old) participated in study. They received on different days, after an overnight fast, 200 mL of Formula A; 200 mL of Formula B; 30 mL of a solution of iron and ascorbic acid as reference dose and 200 mL of full fat cow's milk fortified with iron as ferrous sulfate. Milk formulas and reference dose were labeled with radioisotopes (59)Fe or (55)Fe, and the absorption of iron measured by erythrocyte incorporation of radioactive Fe. RESULTS: The geometric mean iron absorption corrected to 40% of the reference dose was 20.6% for Formula A and 20.7% for Formula B, versus 7.5% of iron fortified cow's milk (p < 0.001). The post hoc Sheffé indeed differences between the milk formulas and the cow's milk (p < 0.001). CONCLUSION: Formulas A and B contain highly bioavailable iron, which contributes to covering toddlers´ requirements of this micronutrient.

Conocimientos, actitudes y prácticas sobre el consumo de sal/sodio en niños del departamento de Antioquia, Colombia / Knowledge, attitudes and practices regarding salt/sodium consumption in children of Antioquia, Colombia

El presente estudio tiene como objetivo identificar los conocimientos, actitudes y prácticas (CAP) relacionados con la ingesta de sal/sodio en niños, desde la perspectiva de los cuidadores. Este, es un estudio de corte transversal en el que participaron 2997 cuidadores que asistieron a una sesión educativa sobre alimentación saludable realizada en el marco del proyecto "Acciones Complementarias del Programa de Alimentación Escolar y Maná Infantil" de la Gobernación de Antioquia, liderado por la Escuela de Nutrición y Dietética de la Universidad de Antioquia, entre agosto y septiembre de 2015. Al recolectar la información, se obtuvo que un alto porcentaje de encuestados refieren no conocer la diferencia entre sal y sodio (79,1%) y desconocen la cantidad de sodio contenida en los alimentos que consumen sus hijos; no obstante, consideran importante limitar la ingesta de sal en los niños. Finalmente, se identifica un alto número de personas dispuestas a disminuir la ingesta de sal en sus hijos, pero no sucede lo mismo cuando se hace referencia al sodio, debido a que se requiere un conocimiento más especializado y específico para tomar decisiones relacionadas con el contenido de este mineral en los alimentos, dado que está oculto.

The present study aims to identify the knowledge, attitudes and practices related to salt / sodium intake in children from the perspective of caregivers. We conducted a crosssectional study involving 2997 caregivers who attended an educational session on healthy eating carried out within the framework of the project "Complementary Actions of the School Feeding Program and Children's Mana" carried out by the Government of Antioquia and led by the School of Nutrition and Dietetics of the University of Antioquia between August and September 2015. When collecting the information, it was found that a high percentage of persons surveyed reported not knowing the difference between salt and sodium (79.1%) and not knowing the amount of sodium contained in their child's foods; however, they considered the limiting of salt intake important for their children. Finally, a high percentage of participants were willing to reduce the salt intake of their children, but this was not the case with regard to sodium, because more specialized and specific knowledge is required to make decisions related to the content of this mineral in food, since it is hidden.

Non-heme iron as ferrous sulfate does not interact with heme iron absorption in humans.

The absorption of heme iron has been described as distinctly different from that of non-heme iron. Moreover, whether heme and non-heme iron compete for absorption has not been well established. Our objective was to investigate the potential competition between heme and non-heme iron as ferrous sulfate for absorption, when both iron forms are ingested on an empty stomach. Twenty-six healthy nonpregnant women were selected to participate in two iron absorption studies using iron radioactive tracers. We obtained the dose-response curve for absorption of 0.5, 10, 20, and 50 mg heme iron doses, as concentrated red blood cells. Then, we evaluated the absorption of the same doses, but additionally we added non-heme iron, as ferrous sulfate, at constant heme/non-heme iron molar ratio (1:1). Finally, we compare the two curves by a two-way ANOVA. Iron sources were administered on an empty stomach. One factor analysis showed that heme iron absorption was diminished just by increasing total heme iron (P < 0.0001). The addition of non-heme iron as ferrous sulfate did not have any effect on heme iron absorption (P = NS). We reported evidence that heme and non-heme iron as ferrous sulfate does not compete for absorption. The mechanism behind the absorption of these iron sources is not clear.

The effect of calcium on non-heme iron uptake, efflux, and transport in intestinal-like epithelial cells (Caco-2 cells).

It has been suggested that calcium inhibits the absorption of dietary iron by directly affecting enterocytes. However, it is not clear if this effect is due to a decreased uptake of iron or its efflux from enterocytes. We studied the effect of calcium on the uptake, efflux, and net absorption of non-heme iron using the intestinal-like epithelial cell line Caco-2 as an in vitro model. Caco-2 cells were incubated for 60 min in a buffer supplemented with non-heme iron (as sulfate) and calcium to achieve calcium to iron molar ratios ranging from 50:1 to 1,000:1. The uptake, efflux, and net absorption of non-heme iron were calculated by following a radioisotope tracer of (55)Fe that had been added to the buffer. Administration of calcium and iron at molar ratios between 500 and 1,000:1 increased the uptake of non-heme iron and decreased efflux. Calcium did not have an effect on the net absorption of non-heme iron. At typical supplementary doses for calcium and non-heme iron, calcium may not have an effect on the absorption of non-heme iron. The effect of higher calcium to iron molar ratios on the efflux of non-heme iron may be large enough to explain results from human studies.

Effect of trypsin and mucin on heme iron bioavailability in humans.

UNLABELLED: In the human gastrointestinal tract, trypsin and mucin may affect the absorption of heme iron. However, these interactions have not been well-established. We determined the effect of trypsin and mucin on heme iron absorption in humans. DESIGN: Twenty-eight apparently healthy females participated in two studies (14 per study). Study A evaluated the effect of trypsin on iron bioavailability. Subjects ingested 100 mg trypsin and 1.7 g mucin on 5 mg heme iron bioavailability on days 1, 2, 14, and 15, respectively. In study B, which assessed the effect of mucin on heme iron bioavailability, the subjects ingested hemin, hemin plus mucin, hemoglobin (Hb), and Hb plus mucin, on days 1, 2, 14, and 15, respectively. RESULTS: In study A, the geometric means ± 1 SD of heme iron absorption were 5.1 % (3.1-8.3), 2.9 % (1.6-5.1), 7.3 % (4.1-13.1), and 6 % (2.7-13) for hemin, hemin plus trypsin, Hb plus trypsin, and Hb plus mucin plus trypsin, respectively. In study B, the geometric means ± 1 SD of heme iron absorption were 16.4 % (10.5-25.7), 13.1 % (9.0-18.9), 13.7 % (9.0-20.7), and 11.8 % (7.6-18.3) for hemin, hemin plus mucin, Hb, and Hb plus mucin, respectively. The ratio increased when Hb plus trypsin was ingested and decreased when hemin plus trypsin was ingested. There were no differences in other ratios with respect to the ratio on day 1 (P < 0.05). CONCLUSION: Trypsin is the only human gastrointestinal protein that evaluated the affects of heme iron absorption. However, this effect depends on how heme iron is ingested.

Alimentos fuentes de sodio: análisis basado en una encuesta nacional en Colombia / Food sources of sodium: analysis based on a national survey in Colombia

La ingesta elevada de sodio es un factor de riesgo independiente para el desarrollo de enfermedades cardiovasculares -ECV-. Por este motivo, a nivel global se promueve la implementación de la «reducción de la ingesta de sal/sodio como estrategia para la reducción de las ECV». Para tal fin es importante identificar las fuentes de sodio en la dieta, lo cual hasta la fecha solo se ha realizado, fundamentalmente, en países desarrollados. Objetivos: identificar los alimentos que más sodio aportan a la dieta de los colombianos, basados en los datos de la Encuesta Nacional de la Situación Nutricional -ENSIN- de Colombia. Además, se pretende determinar el nivel de ingesta de sodio proveniente de alimentos en el país. Métodos: se analizaron datos de 39.413 individuos aparentemente sanos, no gestantes, entre los 2 y los 64 años de edad, obtenidos mediante R24h en la ENSIN. Se determinaron los grupos de alimentos que suponen una fuente de sodio, así como el sodio ingerido a partir de dichos alimentos. Resultados: se reportaron 1.274 alimentos y la agrupación de alimentos se realizó con un total de 95, los cuales aportaron un 72% del sodio total proveniente de los alimentos. Estos últimos se dividieron en 12 grupos. Dentro de estos, el de mayor aporte de sodio a la dieta fue el de productos de panadería (30,5%). El promedio de ingesta de sodio por persona proveniente del total de alimentos, sin adición de sal, fue 816,4 ± 474,1 mg/d. La mediana de la misma variable a nivel nacional fue de 721,0 mg/d (RQ = 476,0-1051,0). La ingesta fue mayor en hombres (784,0 mg/d; RQ = 511,0-1156,0) que en mujeres (665,0 mg/d; RQ = 448,0-953,0); p < 0,001. Conclusión: el presente trabajo identificó las principales fuentes de sodio en la dieta de los colombianos y sugiere la conveniencia de priorizar estrategias para la disminución del contenido de sodio en estos grupos, en especial el grupo de productos de panadería. Igualmente, es necesario tener en cuenta la pertinencia de las estrategias según zona geográfica a la cual estén destinadas (AU)

A high sodium intake is an independent risk factor for Cardiovascular diseases -CVD-. Thus, a strategy to reduce blood pressure and CVD risk throughout reducing sodium intake is promoted worldwide. In order to design an adequate strategy, it is important to identify the main sources of sodium in food, which has been evaluated mainly in developed countries. Objectives: to identify foods that provide sodium in Colombians diet, based on data from the National Nutritional Survey -ENSIN-. Furthermore, to determine sodium amount intake from foods. Methods: data obtained by 24 hours recall (R24h) from 39 413 apparently healthy, non-pregnant population between 2-64 y old population were analyzed. Food groups source of sodium and sodium were determined. Results: 1 274 food were reported by R24h. 95 foods contributed with 72% of total sodium from foods and were divided into 12 groups. The mayor sodium source in the diet was bakery products (30.5%). Average and median sodium intake without salt addition were: 816.4 ± 474.1 and 721.0 mg/d variable (RQ = 476.0 to 1051.0) mg/d, respectively. Sodium intake from food was higher in men (784.0 mg/d; RQ = 511.0 to 1156.0) than in females (665.0 mg/d; RQ = 448.0 to 953.0); p < 0.001. Conclusion: the present study identified the main sources of sodium in Colombians diet. Based on this analysis it is important to prioritize strategies in some groups, especially bakery products. It is also necessary to consider geographical area to implement a relevant strategy (AU)

Folatos y vitamina B12 en la salud humana / Folate, vitamin B12 and human health

During the past decade the role of folate and vitamin B12 in human nutrition have been under constant re-examination. Basic knowledge on the metabolism and interactions between these essential nutrients has expanded and multiple complexities have been unraveled. These micronutrients have shared functions and intertwined metabolic pathways that define the size of the "methyl donor" pool utilized in multiple metabolic pathways; these include DNA methylation and synthesis of nucleic acids. In Chile, folate deficiency is virtually nonexistent, while vitamin B12 deficiency affects approximately 8.5-51% depending on the cut-off value used to define deficiency. Folate is found naturally mainly in vegetables or added as folic acid to staple foods. Vitamin B12 in its natural form is present only in foods of animal origin, which is why deficit is more common among strict vegetarians and populations with a low intake of animal foods. Poorfolate status in vulnerable women of childbearing age increases the risk of neural tube birth defects, so the critical time for the contribution of folic acid is several months before conception since neural tube closure occurs during the first weeks of life. The absorption of vitamin B12 from food is lower in older adults, who are considered to have higher risk of gastric mucosa atrophy, altered production of intrinsic factor and acid secretion. Deficiency of these vitamins is associated with hematological disorders. Vitamin B12 deficiency can also induce clinical and sub-clinical neurological and of other disorders. The purpose of this review is to provide an update on recent advances in the basic and applied knowledge of these vitamins relative to human health.