The effect of vitamin A supplementation on retinol concentrations of children with anaemia / El efecto de suplementos de vitamina A en las concentraciones de retinol de niños con anemia

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Evolución de la ingesta y del estado nutricional de zinc, hierro y cobre en mujeres sometidas a cirugía bariátrica hasta el segundo año postoperatorio / Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery

Introducción: La cirugía bariátrica permite una reducción significativa de peso y mejoría de comorbilidades asociadas a la obesidad a largo plazo, pero también puede afectar negativamente el estado nutricional de algunos micronutrientes. Objetivos: Evaluar cambios en ingesta e indicadores del estado nutricional de zinc, hierro y cobre en mujeres sometidas a bypass gástrico en Y de Roux (BPG) o gastrectomía tubular (GT), hasta el segundo año postoperatorio. Métodos: Se estudió prospectivamente 45 mujeres sometidas a BPG o GT (edad promedio 35,2 ± 8,4 años, IMC promedio 39,8 ± 4,0 kg/m2), cada 6 meses se realizaron determinaciones de ingesta e indicadores del estado nutricional de zinc, hierro y cobre, y en forma anual se evaluó la composición corporal. El aporte de minerales a través de los suplementos representaba dos veces la ingesta recomendada para una mujer sana en las pacientes sometidas a GT y tres veces para BPG. Resultados: 20 mujeres se sometieron a GT y 25 a BPG. En ambos grupos se produjo una reducción significativa de peso y del porcentaje de masa grasa, que se mantuvo hasta el segundo año postoperatorio. Las mujeres sometidas a BPG presentaron un mayor compromiso del estado nutricional de zinc, hierro y cobre, que las pacientes sometidas a GT. Conclusiones: El bypass gástrico en Y de Roux produce un compromiso mayor del estado nutricional de zinc, hierro y cobre que la gastrectomía tubular. Se debería evaluar si la administración fraccionada de la suplementación mejoraría la absorción de estos nutrientes (AU)

Introduction: Bariatric surgery allows a significant reduction in weight and improvement of comorbidities associated with obesity in the long term, but it can also adversely affect the nutritional status of some micronutrients. Objectives: To evaluate changes in intake and parameters of nutritional status of zinc, iron and copper in patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG), until the second postoperative year. Methods: We prospectively studied 45 women undergoing GBP or SG (mean age 35.2 ± 8.4 years, mean BMI 39.8 ± 4.0 kg/m2), every 6 months We measured intake and status indications nutritional zinc, iron and copper, and annually evaluated body composition. The contribution of minerals through supplements represented twice the recommended intake for a healthy woman in patients undergoing GT and three times for GBP. Results: 20 women underwent GBP and 25 SG. In both groups there was a significant reduction in weight and body fat percentage, which was maintained until the second postoperative year. Women who have had a greater commitment GBP nutritional status of zinc, iron and copper, that patients undergoing SG. Conclusions: Gastric bypass Roux-Y produces a greater commitment of nutritional status of zinc, iron and copper sleeve gastrectomy. It should evaluate whether administration of supplementation fractional improve the absorption of these nutrients (AU)

[Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery]. / Evolución de la ingesta y del estado nutricional de zinc, hierro y cobre en mujeres sometidas a cirugía bariátrica hasta el segundo año postoperatorio.

INTRODUCTION: Bariatric surgery allows a significant reduction in weight and improvement of comorbidities associated with obesity in the long term, but it can also adversely affect the nutritional status of some micronutrients. OBJECTIVES: To evaluate changes in intake and parameters of nutritional status of zinc, iron and copper in patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG), until the second postoperative year. METHODS: We prospectively studied 45 women undergoing GBP or SG (mean age 35.2 ± 8.4 years, mean BMI 39.8 ± 4.0 kg/m²), every 6 months We measured intake and status indications nutritional zinc, iron and copper, and annually evaluated body composition. The contribution of minerals through supplements represented twice the recommended intake for a healthy woman in patients undergoing GT and three times for GBP. RESULTS: 20 women underwent GBP and 25 SG. In both groups there was a significant reduction in weight and body fat percentage, which was maintained until the second postoperative year. Women who have had a greater commitment GBP nutritional status of zinc, iron and copper, that patients undergoing SG. CONCLUSIONS: Gastric bypass Roux-Y produces a greater commitment of nutritional status of zinc, iron and copper sleeve gastrectomy. It should evaluate whether administration of supplementation fractional improve the absorption of these nutrients.

[Alopecia in women with severe and morbid obesity who undergo bariatric surgery]. / Alopecia en mujeres con obesidad severa y mórbida sometidas a cirugía bariátrica.

INTRODUCTION: Bariatric surgery leads to a significant body weigh reduction although it is associated to a higher risk of presenting some nutritional deficiencies. A common complication, little studied and mainly related to zinc deficiency is alopecia. OBJECTIVES: To compare the nutritional status of zinc, iron, copper, selenium and protein-visceral in women with different degrees of hair loss at 6 months after gastric bypass or tubular gastrectomy. METHODS: The patients were categorized into two groups according to the degree of hair loss: group 1 or mild loss (n = 42) and group 2 or severe hair loss (n = 45). Zinc, iron, copper, and selenium, as well as the indicators of the nutritional status of zinc, iron, copper, and proteinvisceral were assessed before and after 6 months of the surgery. RESULTS: In both groups there was a significant body weight reduction at 6 months post-surgery (-38.9% ± 16.4%). Patients in group 1 presented a significantly higher intake of zinc (20.6 ± 8.1 vs. 17.1 ± 7.7 mg/d) and iron (39.7 ± 35.9 vs. 23.8 ± 21.3 mg/d.), and lower compromise in the nutritional status of zinc and iron than group 2. However, patients in group 2 had lower compromise in the nutritional status of copper. There were no differences regarding the plasma concentrations of albumin. CONCLUSIONS: The patients having lower hair loss at six months after surgery had higher zinc and iron intake and lower compromise of the nutritional status of both minerals.

Zinc inhibits nonheme iron bioavailability in humans.

There is increasing concern about potential negative interactions in combined iron and zinc supplementation. The aim of the present study was to determine the dose-response effect of zinc, given as a solution, on iron bioavailability. Twenty-two healthy adult women were selected to participate in the study. Iron, with or without zinc was given as an aqueous solution on d 1,2,14, and 15 of the study. Iron bioavailability was measured on the basis of erythrocyte incorporation of 55Fe or 59Fe 14 d after administration. Subjects received 0.5 mg of iron together with graded zinc concentrations (0-11.71 mg). No significant effect of zinc on iron absorption was found at Zn:Fe molar ratios up to 2:1. At 5:1,10:1, and 20:1 molar ratios, a dose-dependent inhibitory effect on iron absorption was observed (28-40% of iron absorption inhibition; one-way repeated-measures ANOVA, F=4.48, p=0.02). In conclusion, zinc administration combined with iron in an aqueous solution leads to the inhibition of iron bioavailability, which occurs in a dose-dependent way. This negative interaction should be considered for supplementation programs with both microminerals.

Low environmental selenium availability as an additional determinant for goiter in East Java, Indonesia?

Iodine deficiency, which is most visibly indicated by goiter, is highly prevalent in Indonesia. Since 1994, Indonesia has a decree that all salt used for human, livestock, and industry must be iodized. However, despite the increased distribution of iodized salt, pockets with significantly higher prevalence of goiter still remain. This situation may be consequence of selenium (Se) deficiency. This study aimed to assess the Se level in the environment of goiter prevalent areas. Five hundred eleven school children participated in this study. Goiter was measured using both ultrasound and palpation. Ninety-nine eggs were collected from free-living chicken in 11 villages, and the Se contents of egg yolk and egg white were determined by neutron activation analysis. In the villages studied, Se concentration in egg yolk ranged from 0.15 to 1.52 microg/g and in egg white from 0.18 to 2.97 microg/g. The prevalence of goiter measured by palpation ranged from 18.4% to 70% and by ultrasound from 0% to 100%. Because of the inconsistency of goiter rate measured by palpation and ultrasonography, the question remains whether low availability of Se in the environment might be an additional contributing factor for goiter.

Single and multiple selenium-zinc-iodine deficiencies affect rat thyroid metabolism and ultrastructure.

This study was conducted to evaluate the effects of single and combined deficiencies of Se, Zn and I on thyroid function in rats. Rats were fed amino acid-based diets for 6 wk starting from weaning. The diets contained either low or adequate amounts of these minerals. In addition to the control and control pair-fed groups, seven experimental groups were formed: Se deficient (Se-); I deficient (I-); Zn deficient (Zn-); Se and I deficient (Se-I-); Zn and I deficient (Zn-I-); Se and Zn deficient (Se-Zn); and Se, I and Zn deficient (Se-I-Zn-). Serum triiodothyronine (T3) was significantly lower than in controls in Zn-, Se-Zn- and Se-I- groups. Serum total thyroxine (T4) and free T4 were significantly lower and thyroid-stimulating hormone (TSH) greater in all iodine-deficient groups, regardless of Se or Zn status. Thyroid glutathione peroxidase activity was significantly reduced in Se- and Se-Zn- groups. Nevertheless, in the groups with a concurrent I deficiency, the activity of this enzyme was significantly greater than in controls. Severe alterations of the follicle cellular architecture, including signs compatible with apoptosis, were observed in the Zn- and Se-Zn- groups. These alterations appeared to be less severe when iodine deficiency was simultaneously present. Single and multiple deficiencies of Se, Zn and I have distinct effects on thyroid metabolism and structure.

A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children.

Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

Characterization of the regional distribution of selenium in Chile using selenium in hens' eggs as a monitor.

Regional distribution of selenium (Se) in Chile was investigated by using the concentration of Se in hens' eggs as a monitor. Forty-one locations along the entire length of the country were sampled. Average (+/- SD) egg-white Se content (mg/kg dry) was 0.79 +/- 0.41, range 0.22-2.23. Corresponding yolk Se values were, mean 0.81 +/- 0.43, (mg/kg dry) range 0.26-2.23. Locations grouped in five main areas, according to their geographic-climatic characteristics, showed significant differences regarding both egg-white Se and yolk Se. Analyzed dietary Se intake from two distinct areas reflected the trends observed in the Se content of egg fractions from such regions. These data support the utilization of the concentration of Se in hens' eggs as a useful monitor of dietary selenium consumed by selected populations.

Alteration of circulating micronutrients with overt and occult infections in anaemic Guatemalan preschool children.

Clinical and laboratory data to define conditions of apparent health, localised infection or inapparent infection were available for 74 anaemic Guatemalan preschool children in the baseline phase of a clinical trial of the effect of iron and vitamin A on haematological status to be correlated with serum levels of four circulating micronutrients--iron, zinc, copper and retinol--known to be influenced by activation of the acute-phase reaction. Upon enrolment, only 29.7% of the children were free of all evidence of infection, 36.5% had one or more localised conditions detected on clinical examination, and 33.8% had an elevated white cell count and/or sedimentation rate, without localising features. These were classified as 'inapparent infections'. With respect to the healthy children, levels of iron, zinc, and retinol declined and copper generally increased in the four categories of clinical infections (acute respiratory infection, dermal infections, conjunctivitis, and 'other') but were also displaced in inapparent infections. Some activation of the acute-phase response in anaemic children may occur in the absence of clinical findings. Care must be taken in interpreting circulating micronutrient levels in relation to nutritional status in such population.

[Preoperative preparation and nutrition in colorectal cancer]. / Preparación preoperatoria y nutrición en el cáncer colorrectal.

Pre-operative nutrition in patients with colon/rectum cancer is important in ensuring that they are suitably prepared for the operation. Two pre-operative methods for preparation on the colon were compared: the first is that we normally use, of five days of residue-free hospital meals, cleansing enemas, laxatives and three litres of polyethylene glucol solution. The new method we describe is easy enough to be implemented by the patient at home, and combines enhanced nutrition with an excellent level of intra-colon cleaning: it involves the exclusive administration for four days of Ensure HN (a complete, defined, pre-prepared low-fibre diet, in a variety of flavours) and the application of two cleansing enemas the evening prior to the operation. Eighteen parameters were assessed, on the entry of each patient to the study, on the day of the operation, and six days following the operations; the parameters obtained after the trial show statistically significant differences (p < 0.05-p < 0.001) in favour of the second method for 17 of the parameters, following preparation; when each group was compared within itself prior to and following preparation. The values for all but two parameters were seen to drop, notably proteins, by 28.37% (p < 0.01), weight by 8.17%, albumin by 3.43% and hemoglobin by 17.72%, in the first group while, in the second, there were rises in proteins (3.72%), albumin (7.26%), hemoglobin (5.48%), leukocytes, calcium and triglycerides. The level of cleansing of the intestine continued to be excellent, without significant differences between the two methods.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of zinc supplementation on parasitic reinfestation of Guatemalan schoolchildren.

One hundred thirty children (65-95 mo old) from a low-socioeconomic neighborhood of Guatemala City participated in a randomized, double-blind, controlled trial of zinc supplementation. One group received 10 mg Zn/d (n = 65) and the other group received a placebo (n = 65); 90 +/- 9.2 doses were given over 120-150 d. Stools were examined for prevalence and intensity of helminths and prevalence of protozoa at the beginning and end of the study. The initial prevalence was 42% for helminths and 18% for protozoa, with no differences between groups. Mebendazole was administered to all children, and protozoal infections were treated specifically at the beginning of the study. The reinfection rates were 17% (11 of 65) for helminths and 12.3% (8 of 65) for protozoa in the zinc group and 15% (10 of 65) and 10.7% (7 of 65), respectively, in the placebo group (P > 0.05). Analysis by specific parasites revealed no treatment effect. We conclude that neither plasma or hair zinc status nor oral zinc supplementation had an effect on parasite status in children.

Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial.

Changes in growth, body composition, and zinc indexes were evaluated after 25 wk in a double-blind zinc-supplementation study of 162 periurban Guatemalan children aged 81.5 +/- 7.0 mo (mean +/- SD). Children receiving the zinc supplement (10 mg Zn/d as amino acid chelate) for 90.1 +/- 9.2 d had higher mean fasting plasma zinc (16.2 +/- 2.9 vs 14.9 +/- 2.1 mumol/L, P < 0.01), a greater increase in median triceps skinfold Z score (0.50 vs 0.38, P < 0.05), and a smaller deficit in median midarm circumference (MAC) Z score (-0.03 vs -0.20, P < 0.05) compared with the placebo group. Initial hair zinc classified as < 1.68 and > 1.68 mumol/g was the only laboratory variable that explained some of the variance in final Z scores of midarm-muscle area (P < 0.05) and MAC (P < 0.01). Children responded to the zinc supplement with changes in indexes of body composition rather than growth.

Erythrocytes, erythrocyte membranes, neutrophils and platelets as biopsy materials for the assessment of zinc status in humans.

During a controlled zinc depletion-repletion study, fifteen men aged 25.3 (SD 3.3) years were fed on a low-Zn diet with high phytate:Zn and phytate x calcium:Zn molar ratios for 7 weeks, followed by a 2 week repletion period when 30 mg supplemental Zn/d was given. Changes in plasma, urine, and hair Zn concentrations, taste acuity, and cellular immune response confirmed the development of mild Zn deficiency. Zn concentrations in neutrophils, platelets, erythrocytes and erythrocyte membranes, mean platelet volume, and activities of alkaline phosphatase (EC 3.1.3.1) and alpha-D-mannosidase (EC 3.2.1.24) in neutrophils did not respond to changes in Zn status. In contrast, alkaline phosphatase activity in erythrocyte membranes showed a significant decline which was consistent in all subjects (nmol product formed/min per mg protein; baseline v. 7-week Zn depletion, 0.656 (SD 0.279) v. 0.506 (SD 0.230), at 7 weeks; P < 0.05); neutral phosphatase activity remained unchanged. Alkaline phosphatase activity in erythrocyte membranes may be a potential index of Zn status in humans.

[Index of nutritional quality per volume: a new indicator to evaluate the nutritional quality of food preparations and diets]. / Indice de calidad nutricional por volumen (ICNV): un nuevo indicador para evaluar la calidad nutricional de preparaciones y dietas.

The purpose of this study was to propose a new dietary index to evaluate the nutritional quality of common dishes and diets: the index of nutritional quality per volume (INQV). In its expression, this index takes into account the nutrient density (amount of nutrient/1,000 g of diet) and the nutrient density per reference volume. The last one is the ratio between the recommended allowances of the nutrient and the volume that it is possible to consume during the day, when the diet is offered freely. Zinc was used as example in the analysis. A total of 14 dishes of habitual consumption in Chile were studied in relation to its consumption by 30 preschool children. The volume that children were able to consume was determined by differential weighing between the amount offered and the amount left on the dish, during a period of 180 days. The percentage of water and energy value were established by means of chemical analysis performed according to the AOAC, and the zinc concentration by atomic absorption spectrophotometry. The results of the INQV were then compared with those of the index of nutritional quality (INQ), which considers zinc density/1,000 kcal, and zinc and energy requirements. This comparison demonstrated that the INQV values were lower than those of the INQ in dishes with energy densities lower than 1.0 kcal/g. The opposite tendency was observed in the case of those dishes with energy densities higher than 1.0 kcal/g. The analysis herein presented demonstrates the usefulness of the INQV in diets which are voluminous and with low energy densities, commonly consumed by the low socioeconomic strata of developing countries.