Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review.

BACKGROUND: Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES: In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS: A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS: Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS: VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).

Iodine nutrition status of pregnant women in Qingdao City from 2018 to 2020 / 中华地方病学杂志

Objective:To investigate the iodine nutritional status of pregnant women in Qingdao and the effect of prevention and treatment of iodine deficiency disorders (IDD), so as to provide a basis for residents to supplement iodine scientifically, and take targeted prevention measures and adjust intervention strategies.Methods:In accordance with the requirements of the "National Iodine Deficiency Disorders Surveillance Program (2016 edition)" and "Shandong Iodine Deficiency Disorders Surveillance Program", the cluster sampling method was adopted to select pregnant women from 10 districts (cities) in Qingdao from 2018 to 2020, to investigate their basic information and thyroid disease history. Meanwhile, household edible salt samples and random urine samples were collected to detect iodine content.Results:A total of 3 000 pregnant women were monitored from 2018 to 2020, the median age was 31 years, and the median gestational age was 18 weeks. There were significant differences in the distribution of age, gestational age, whether senile puerpera, and pregnancy in different years ( H/χ 2 = 29.35, 81.03, 65.62, 77.34, P < 0.001). The median salt iodine of edible salt ( n = 3 000) and iodized salt ( n = 2 700) in pregnant women's homes were 23.02 and 23.70 mg/kg, respectively. The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt were 89.59% (2 419/2 700), 90.00% (2 700/3 000) and 80.63% (2 419/3 000). The comparison of qualified rate of iodized salt, coverage rate of iodized salt and consumption rate of qualified iodized salt among different years was statistically significant (χ 2 = 48.09, 36.62, 61.08, P < 0.001), the coverage rate of iodized salt and the consumption rate of qualified iodized salt showed a downward trend year by year (χ 2trent = 35.54, 29.50, P < 0.001). A total of 3 000 urine samples were collected from pregnant women and the median urinary iodine of pregnant women was 147.85 μg/L. The urinary iodine level in the third trimester was lower than that in the first and second trimesters ( P < 0.001). The urinary iodine level in the non elderly group was higher than that in the elderly group ( Z = - 6.66, P < 0.001). The urinary iodine level in the group without thyroid disease was higher than that in the group with thyroid disease ( Z = - 1.99, P = 0.047). The urinary iodine level in iodized salt group was higher than that in non-iodized salt group ( Z = - 2.42, P = 0.015). Conclusions:The iodine nutrition of pregnant women in Qingdao is generally at an insufficient level, and the risk of iodine deficiency is high, which needs attention. In recent years, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in Qingdao have shown a downward trend, and have failed to meet the requirements of national standards. In the future, we should strengthen the monitoring and health education of IDD in pregnant women.

Investigation of iodine nutritional status of children aged 8 to 10 years in Xiamen City from 2017 to 2019 / 中华地方病学杂志

Objective:To learn about the iodine nutritional status of children aged 8 to 10 years in Xiamen City after the reform of salt industry system, and to provide scientific basis for reasonable prevention and control of iodine deficiency disorders.Methods:From 2017 to 2019, 6 districts were selected each year in Xiamen City 5 sampling districts were divided according to the oriation of east, west, south, north and center in each district. One town (street, hereinafter refered as to town) was selected from each sampling district. One primary school was selected from each town. For each primary school, at least 40 non-boarding children aged 8 to 10 years (age balanced, half male and half female) were selected. Edible salt samples in the households and random urine samples of children aged 8 to 10 years were collected, and salt iodine and urinary iodine contents were measured, while thyroid volume was examined by B-ultrasound.Results:From 2017 to 2019, the coverage rate of iodized salt in Xiamen City was 97.34% (1 206/1 239), 96.89% (1 214/1 253), and 93.33% (1 175/1 259), respectively; the consumption rate of qualified iodized salt was 96.13% (1 191/1 239), 95.61% (1 198/1 253), and 91.58% (1 153/1 259), respectively; the median urinary iodine was 182.90, 182.81, 164.00 μg/L, respectively. The prevalence of goiter of boys and girls was 1.01% (19/1 889) and 2.26% (42/1 862), respectively.Conclusions:After the reform of salt industry system, the iodine nutritional status of children aged 8 to 10 years is generally at an appropriate level in Xiamen City. However, the consumption rate of qualified iodized salt is reduced, which increases the risk of iodine deficiency for residents. Therefore, we should strengthen the propaganda of scientific iodine supplement, maintain a high consumption rate of qualified iodized salt, and prevent the harm of iodine deficiency.

Iodine nutritional status and intelligence level of children in Nangqian County, Qinghai Province after 9 years of iodine supplemention / 中华地方病学杂志

Objective:To follow up the iodine nutrition and intellectual development of school children aged 8-10 years old in Nangqian County of Qinghai Province after 9 years of the implementation of iodine deficiency disorders intervention measures with iodine supplement as the main measure.Methods:In order to improve the iodine nutritional status of the population in Nangqian County, free iodized salt distribution, health education and other intervention measures for iodine deficiency disorders were implemented for 9 consecutive years since 2013. In May 2012 (before iodine supplementation) and September 2021 (after iodine supplementation), the same 5 townships (towns) were selected, and children aged 8-10 years old (half male and half female, age balanced) born locally in the central primary school of each township (town) were selected as the survey subjects. Household edible salt samples and random urine samples were collected for salt iodine and urinary iodine detection; the second revised version of the Chinese Combined Raven's Test (rural version) was used to assess the intelligence quotient (IQ) of children. The Flynn effect (FE) gain was used to adjust IQ, the corrected IQ = (IQ starting point value - current year's IQ value) - FE gain (calculated by 0.74/year). The differences of salt iodine and urinary iodine related indexes, IQ value and corrected IQ were compared before and after iodine supplementation.Results:After iodine supplementation, the coverage rate of iodized salt reached 100.00% (300/300), and the consumption rate of qualified iodized salt reached95.00% (285/300), the median urinary iodine increased to 157.20 μg/L, and all indexes met the elimination standard of iodine deficiency disorders. The IQ value of children aged 8-10 years old after iodine supplementation was 99.00 ± 14.90, significantly higher than that before iodine supplementation (82.00 ± 13.20, F = 156.82, P < 0.001). The FE gain in 9 years was 6.66, and the actual IQ gain of children aged 8-10 years old after iodine supplementation was 10.34. There were statistically significant differences in IQ value before and after iodine supplementation in male and female children ( F = 78.84, 78.88, P < 0.001). After iodine supplementation, there was a statistically significant difference in IQ value between children in the 8-year-old group and the 10-year-old group ( P = 0.010). There were statistically significant differences in IQ value before and after iodine supplementation in 8, 9 and 10 years old groups ( F = 55.23, 65.79, 36.85, P < 0.001). Conclusion:Intervention measures for iodine deficiency disorders, mainly iodine supplement, can significantly improve the iodine nutrition status of children aged 8-10 years old, and significantly promote the intellectual development of children.

[The study of blood serum trace elements in comparison with the structural and functional characteristics of goiter and the carriage of antithyroid antibodies in some regions of Russia].

The study of the sufficiency with essential trace elements in the context of thyroid pathology is especially relevant, since the development and progression of thyroid diseases have various pathogenetic mechanisms, which largest proportion is provoked by insufficient intake of key trace elements, primarily iodine. The aim of the research was obtaining primary data on the sufficiency with essential trace elements of the population in the some regions of the Russian Federation, comparing the data obtained with the prevalence of goiter and the carriage of antibodies to thyroid peroxidase (AT-TPO). Material and methods. The Cross-Sectional Population Study was conducted in medical institutions of the Republics of Crimea, Republics of Tuva and Bryansk region (persons applied for outpatient consultations). The scope of the study was 387 people aged 18 to 65 years (the average age was 40±5 years). All of them underwent: collection of medical history, endocrinologist examination with palpation of the thyroid gland (TG), ultrasound examination of TG, blood sampling to assess the levels of thyroid-stimulating hormone (TSH), AT-TPO, iodine, selenium, zinc. Ultrasound of the TG was performed in the supine position using a portable ultrasound machine LOGIQe (China) with a multi-frequency linear probe 10-15 MHz. During the study, the volume of the thyroid gland, the presence of nodular formations and their characteristics according to the TIRADS classification, TG structure and its echogenicity were assessed. Iodine, selenium and zinc level were measured using tandem mass spectrometry with ionization in inductively coupled plasma (Agilent 8900 ICP-MS Triple Quad). TSH and Ab-TPO were determined by chemiluminescent immunoassay on the Architect i2000 automatic analyzer. Results. All regions are comparable in terms of iodine availability, but differ in the severity of natural iodine deficiency. The median concentration of iodine in blood serum practically coincided in all three regions, amounting to 39.8 µg/l in the Republic of Crimea; 38.8 µg/l in the Republic of Tyva and 43.4 µg/l in the Bryansk region. Comparing these results with foreign data, as well as with our results on urinary iodine level, obtained by routine cerium-arsenite method, we can assume that iodine content in blood serum corresponded to the lower limit of the normal target values. The median concentration of selenium in blood serum also practically coincided in all three regions, amounting to 68.2, 72.1 and 62.8 µg/l, respectively, and probably meets the criteria for optimality. The median serum concentration of zinc in Bryansk region residents corresponded to a deficiency (491.3 µg/l) and was significantly lower compared to the indicator in the Republics of Crimea and Tyva (1633.2 and 1667.6 µg/l, respectively, values above optimal). Among the examined, the proportion of people with AB-TPO carriership was 23.5% (Republic of Crimea - 20.9%, Republic of Tuva - 26.4%, Bryansk region - 20.7%), with impaired thyroid function - 9.6% (6.2% - hypothyroidism, 3.4% - thyrotoxicosis). The frequency of goiter varied from 10 to 13.8%. There were no significant differences in the frequency of occurrence, ultrasonic characteristics of goiter and thyroid nodules by regions. Conclusion. However, the results obtained do not allow to unequivocally judge the absence of micronutrient deficiency in the population of the regions of the Russian Federation, since used the ICP-MS method requires the development of our own reference values of trace elements; in the absence of the latter, data from similar foreign studies were taken as standards. In addition, in further studies it will be important to take into account additional criteria for assessing trace element deficiency, for example, activity of superoxide dismutase and alkaline phosphatase as indirect markers of zinc deficiency, etc. Correlation between blood serum concentration of trace elements and the frequency and structural characteristics of goiter, the carriage of Ab-TPO, and dysfunction of the TG was not revealed.

Analysis of surveillance results of iodine deficiency disorders in Jingdezhen City of Jiangxi Province from 2017 to 2020 / 中华地方病学杂志

Objective:To analyze the iodine content distribution of drinking water in Jingdezhen City, and master the status of prevention and control of iodine deficiency disorders (IDD), so as to provide a basis for adopting targeted control measures and scientific adjustment of control and prevention strategies.Methods:According to the "National Iodine Deficiency Disorders Surveillance Program" and the "National Water Iodine Content Survey Program for Drinking Water", the surveillance of IDD in Jingdezhen City was carried out from 2017 to 2020. Household edible salt samples from pregnant women and students aged 8 to 10 were collected to detect salt iodine content, and urine samples were collected to detect urinary iodine. Thyroid volume of students was measured by B-ultrasonography, and the rate of goiter was calculated. In 2017, the iodine content of drinking water in Jingdezhen City was investigated, and the results were analyzed.Results:From 2017 to 2020, a total of 1 800 students were examined for thyroid gland, and 11 students were found to have goiter, with an goiter rate of 0.61%. A total of 3 201 edible salt samples and 3 201 urine samples were collected from students, the median of salt iodine was 24.96-26.40 mg/kg, the consumption rate of qualified iodized salt was 98.50%-99.50%, and the median of urinary iodine was 172.56-218.35 μg/L. A total of 1 600 edible salt samples and 1 600 urine samples were collected from pregnant women, the median of salt iodine was 24.40-25.38 mg/kg, the consumption rate of qualified iodized salt was 97.25%-98.00%, and the median of urinary iodine was 161.55-205.60 μg/L. In 2017, a total of 667 water samples were collected from 52 villages and towns in 4 counties and districts. The median of water iodine of the 4 counties and districts was 0.6-3.2 μg/L, and that of the 52 villages and towns was 0.3-12.3 μg/L.Conclusions:The iodine nutrition level of students and pregnant women in Jingdezhen City is generally at an appropriate level, but the iodine content of drinking water is low. It is suggested to strengthen the health education and health promotion of IDD among key population, guide the residents to supplement iodine scientifically, and continuously eliminate the harm of IDD.

Surveillance results of iodine deficiency disorders in children aged 8-10 years in Qingdao City from 2018 to 2020 / 中华地方病学杂志

Objective:To investigate the iodine nutritional status of children in Qingdao City and the effects of prevention and treatment measures on iodine deficiency disorders (IDD), and to provide a scientific basis for guiding residents to scientifically supplement iodine, taking timely targeted prevention and control measures, and scientifically adjusting intervention strategies.Methods:According to "National Iodine Deficiency Disorders Surveillance Program (2016 edition)" and "Iodine Deficiency Disorders Surveillance Program of Shandong Province", from 2018 to 2020, using the cluster sampling method, children aged 8-10 years in Qingdao City were chosen to test their household salt iodine content and random urinary iodine content, and to examine their thyroid volume by B-ultrasonography, and the correlation between thyroid volume and physical development indexes was analyzed.Results:From 2018 to 2020, a total of 6 057 children were monitored, including 3 068 boys and 2 989 girls. The median of salt iodine and iodized salt iodine of children was 23.50 and 24.10 mg/kg. The qualified rate of iodized salt was 89.95% (4 832/5 372), the coverage rate of iodized salt was 88.69% (5 372/6 057), and the consumption rate of qualified iodized salt was 79.78% (4 832/6 057). There were significant differences in the qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt between different years (χ 2 = 135.26, 314.71, 342.87, P < 0.001). A total of 6 057 urine samples were collected from children, and the median of urinary iodine was 193.92 μg/L, of which 16.2% (979/6 057) were < 100 μg/L, and 22.5% (1 361/6 057) were ≥300 μg/L. There were statistically significant differences in the medians of urinary iodine between different years, gender and whether eating iodized salt ( H/Z = 37.25,-3.89,-5.69, P < 0.001), the median of urinary iodine in boys was higher than that of girls, and the median of urinary iodine in eating iodized salt group was higher than that of eating non-iodized salt group. There was no significant difference in the median of urinary iodine between different age ( H = 4.33, P = 0.119). The rate of goiter in children was 3.45% (71/2 057), and the difference between different years was statistically significant (χ 2 = 42.68, P < 0.001). The incidence of goiter in 2020 [7.31% (45/616)] was significantly higher than that in 2018 and 2019 [2.81% (18/641), 1.00% (8/800), P < 0.001]. Thyroid volume of children was positively correlated with height and weight ( r = 0.20, 0.22, P < 0.001). Conclusions:The iodine nutritional level of children aged 8-10 years in Qingdao City is appropriate. However, the incidence of goiter in children in some years is relatively high. The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt are all lower than the national standard for elimination of IDD, which should be paid attention to.

Deficiency of vitamins C and E in women of childbearing age in Brazil: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Despite the several options available for supplements containing vitamins C and E, evidence regarding the prevalence of deficiency or insufficiency of these vitamins is weak. OBJECTIVES: To estimate the prevalence of deficiency or insufficiency of vitamins C and E and associated factors among women of childbearing age, in Brazil. DESIGN AND SETTING: Systematic review and meta-analysis conducted at a Brazilian public university. METHODS: A search from index inception until May 2020 was conducted. Meta-analyses were performed using inverse variance for fixed models, with summary proportions calculation using Freeman-Tukey double arcsine (base case). Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. RESULTS: Our review identified 12 studies, comprising 1,316 participants, especially breastfeeding women. There was at least one quality weakness in all studies, mainly regarding sampling method (i.e. convenience sampling) and small sample size. The prevalence of vitamin C deficiency ranged from 0% to 40%. Only vitamin E deficiency was synthetized in meta-analyses, with mean prevalences of 6% regardless of the alpha-tocopherol cutoff in plasma, and 5% and 16% for cutoffs of < 1.6-12.0 mmol/l and < 16.2 mmol/l, respectively. The cumulative meta-analysis suggested that a trend to lower prevalence of vitamin E deficiency occurred in recent studies. CONCLUSIONS: Although the studies identified in this systematic review had poor methodological and reporting quality, mild-moderate vitamin C and E deficiencies were identified, especially in breastfeeding women. Thus, designing and implementing policies does not seem to be a priority, because the need has not been properly dimensioned among women of childbearing age in Brazil. REGISTRATION NUMBER IN PROSPERO: CRD42020221605.

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

Thirty-year follow-up observation of the impact of iodine fortification strategy on intellectual development of children / 中华地方病学杂志

Objective:To follow up and observe the intellectual development of school children aged 8 to 10 in Baicheng County, Xinjiang Uygur Autonomous Region, which was a severe iodine deficiency disorders region in history, before and after effective control of the disease, in order to evaluate the impact of iodine supplementation on protection of children's intellectual development and provide a theoretical basis for scientific supplements of iodine.Methods:From 1989 to 2018, Combined Raven's Test for Rural in China (CRT-RC) was used to observe the intellectual development status of 660 Uyghur school children aged 8 to 10 in Baicheng County in 1989, 2002, 2006, 2012 and 2018, respectively. Children's intelligence quotient (IQ) was calculated using CRT-RC's 1987 normal sample of rural children in the same age group; the data of average iodized salt coverage rate (C-IS) and childhood goiter rate (GR) from multiple local surveys and the median urinary iodine (MUIC) of children were collected, combined with the "Criteria for Elimination of Iodine Deficiency Disorders" (GB 16006-2008) and the United Nations International Children's Emergency Fund (UNICEF) recommended standards, the status of iodine deficiency during children's growth (IDG) was divided into complete exposure to iodine deficiency, no exposure, and semi-exposed. The Flynn effect (FE) gain was calculated using norm samples of children aged 8 to 10 in 1987, 1996 and 2006 of CRT-RC, and the differences in children's intellectual development after FE correction before and after IDG reached the standard were compared.Results:The IQ of children were (81.67 ± 14.13), (83.26 ± 14.05), (89.68 ± 13.58), (98.50 ± 14.33) and (103.23 ± 15.25) points in Baicheng County in 1989, 2002, 2006, 2012 and 2018, respectively, the difference between different years was statistically significant ( F = 58.357, P < 0.01). The three indicators of C-IS, GR, and MUIC didn't meet the standards during the IDG evaluation period in the 1989, 2002, and 2006 groups, which were the complete exposure to iodine deficiency; in the 2012 group, only the MUIC met the standard, which was semi-exposed; in the 2018 group, three indicators all met the standard, which was no exposure. The FE gains of 1987 with 1996, 1996 with 2006 were 0.96 points/year and 0.74 points/year, respectively; after FE correction, the actual gains of IQ of 2002 and 2006 compared with 1989, 2012 and 2018 compared with 2006 were - 9.57, - 6.11, 4.38, and 4.67 points, respectively. Conclusions:In iodine deficiency areas, intermittent iodine supplementation (1989 - 2009) for children exposed to iodine deficiency during growth still cannot effectively protect children's intellectual development; continuous and effective iodine supplementation (2010 - 2018) with iodized salt as the core and covering children's growth period has obvious positive effects on protection of children's normal intellectual development. In the future, we will continue to observe the influence of IDG full-cycle suitable iodine nutrition on children's intellectual development.

Iodine content in drinking water and drawing of water iodine distribution map in Qinghai Province / 中华地方病学杂志

Objective:To understand the water iodine content in Qinghai Province and draw a distribution map of water iodine, so as to provide a basis for scientific supplementation of iodine and continuous elimination of iodine deficiency hazards.Methods:In 2017, in all counties (cities, districts) in Qinghai Province, with townships (towns, streets, referred to as townships) as the unit, the residents' drinking water samples were collected, water iodine content was tested, the median water iodine was calculated, and the water iodine distribution map of Qinghai Province was drew.Results:Totally 1 836 drinking water samples were collected in 392 townships, the median water iodine was 1.7 μg/L. Townships that had the median water iodine < 5 μg/L, in the range of 5 to 10 μg/L and > 10 μg/L accounted for 80.6% (316/392), 17.1% (67/392) and 2.3% (9/392), respectively. Among all townships, the highest of the median water iodine was 24.8 μg/L. Based on the results, water iodine distribution map of Qinghai Province, water iodine distribution map of Xining City and water iodine distribution map of Haidong City were compiled.Conclusions:Iodine deficiency is widespread throughout natural environment in Qinghai Province. Hence, salt iodization measures to prevent iodine deficiency disorders should be implemented continuously. According to the water iodine distribution map, the people should be guided to supplement iodine scientifically.

An investigation on current situation of salt sales outlets in Hangzhou after the reform of salt industry system / 中华地方病学杂志

Objective:To investigate the situation of salt sales and education on prevention and treatment of iodine deficiency disorders in salt sales outlets in Hangzhou after the reform of salt industry system, and provide a basis for promotion of scientific iodine supplementation for the public.Methods:In 2020, 4 townships (towns, streets) were selected from 13 districts (counties, cities) of Hangzhou by stratified sampling method. Each township (town, street) delimited 5 survey areas according to the directions of east, west, south, north and middle, and a salt sales place was selected as the survey site in each investigation area. A face-to-face questionnaire was used to investigate the sales of salt in sales outlets and the publicity and education of iodine deficiency disorders prevention and treatment.Results:A total of 238 edible salt sales outlets were effectively investigated, including 113 urban outlets, 78 suburban outlets, and 47 rural outlets; 55.9% (133/238) of the outlets sold non-iodized salt. A total of 68 072 bags of small packaged salt were sold every month, the overall sales of iodized salt was significantly higher than that of non-iodized salt ( Z = - 2.865, P < 0.05), and the sales of iodized salt in urban and suburban sales outlets were higher than that of non-iodized salt ( Z = - 2.313, - 2.237, P < 0.05). The sales of salt in urban and suburban sales outlets were the highest with the price of 2-5 yuan of salt, accounting for 78.6% (33 562/42 705) and 82.3% (13 970/16 979), respectively; in rural sales outlets, with the price of 1-2 yuan of salt was the highest, accounting for 72.8% (6 110/8 388). Among the 238 salt sales outlets, 29.4% (70/238) of the outlets had set up a prevention and treatment of iodine deficiency disorders sign, and 39.9% (95/238) of the outlets salt sales staff known "recommended salt for pregnant women", 31.1% (74/238) of the outlets whose salt sales staff had actively informed salt buyers about the prevention and treatment of iodine deficiency disorders. The total monthly sales of salt and the sales of iodized salt at outlets where the prevention and treatment of iodine deficiency disorders signs were set up and the salt sales staff were aware of the "recommended salt for pregnant women" were higher than outlets where no signs were set up and the sales staff were not aware ( Z = - 3.733, - 3.722, - 2.109, - 2.324, P < 0.05). Conclusions:After the reform of salt industry system, the iodized salt supply of salt sales outlets in Hangzhou is sufficient. With the increase of non-iodized salt supply channels, we should strengthen the active publicity and education on prevention and treatment of iodine deficiency disorders in the sales section.

Cobalt deficiency in cattle and its impact on production / Deficiência de cobalto em bovinos e seu impacto na produção

Two outbreaks of cobalt deficiency in beef cattle were diagnosed in Midwestern Brazil. We discuss the clinical, epidemiological, pathological features, therapeutic measures, and impact aspects of the production system associated with these outbreaks occurring outbreaks in two farms of extensive cattle raising-system in the state of Mato Grosso do Sul. Seven affected cattle were euthanized and necropsied. Tissues for histopathology and microelements dosage were secured. At Farm A, 3100 cattle of all ages got sick, and 396 died; at Farm B, 148 were affected, and 110 died. In both farms, cattle were fed the same mineral supplement. The main clinical signs were weight loss and weakness, even though a good supply of forage was available in the paddocks. Many cattle stop grazing and chew at tree barks, wood chips from fence posts, and bones. In addition to the deaths, there was a compromised growth, and the reproductive rates fell sharply. The necropsied cattle were thin, with rough hair coat and pale mucous membranes. The liver was diffusely orange and showed a lobular pattern. The bone marrow was gelatinous and diffusely yellow. Histological changes included hemosiderosis in the liver and spleen, hepatocellular vacuolar degeneration, and myeloid and erythroid hypoplasia of the bone marrow. In the white matter of four cattle's brains, the myelin sheath was markedly distended (spongy degeneration). Proliferative parasitic abomasitis was observed in three cattle. The presumptive diagnosis was based on the association of the clinical picture, the necropsy findings, and the ruling out of other possible causes. The diagnosis was confirmed by the favorable response to treatment with cobalt and vitamin B12 orally and by mineral supplementation.(AU)

Dois surtos de deficiência de cobalto em bovinos de corte foram diagnosticados. Os aspectos clínicos, epidemiológicos, anatomopatológicos, terapêuticos e impactos no sistema de produção são descritos e discutidos. Os surtos ocorreram em duas fazendas de criação extensiva estado de Mato Grosso do Sul, Centro-Oeste brasileiro. Sete bovinos afetados foram eutanasiados e necropsiados. Na necropsia foram colhidas amostras para exames histopatológicos e dosagem de microelementos. Na Fazenda A, 3100 bovinos de todas as idades adoeceram e 396 morreram e na Fazenda B, 148 bovinos adoeceram e 110 morreram. Ambas as fazendas utilizavam o mesmo suplemento mineral. Os principais sinais clínicos observados foram emagrecimento e fraqueza, apesar da boa oferta de forragem nos piquetes, muitos bovinos deixaram de pastejar e comiam cascas de árvores, madeira das porteiras e ossos. Além das mortes, tiveram crescimento comprometido e os índices reprodutivos tiveram queda acentuada. Os bovinos necropsiados estavam magros, com os pelos arrepiados e mucosas pálidas. O fígado estava difusamente alaranjado e com evidenciação do padrão lobular. A medula óssea estava de consistência gelatinosa e difusamente amarelada. Alterações histológicas incluíam degeneração vacuolar hemossiderose que era moderada no fígado e marcada no baço. Hipoplasia mieloide e eritoide era vista na medula óssea. Na substância branca do encéfalo de quatro bovinos, a bainha de mielina estava marcadamente distendida (degeneração esponjosa). Abomasite parasitária proliferativa foi observada em três bovinos. O diagnóstico presuntivo baseou-se na associação do quadro clínico, nos achados de necropsia e na eliminação de outras possíveis causas. O diagnóstico foi confirmado pela resposta favorável ao tratamento com cobalto e vitamina B12 por via oral, e a suplementação mineral.(AU)

Essential trace elements in Norwegian obese patients before and 12 months after Roux-en-Y gastric bypass surgery: Copper, manganese, selenium and zinc.

OBJECTIVES: The objective of the present study was to assess trace element status in morbidly obese subjects before and one year after Roux-en-Y gastric bypass (RYGB) in order to identify possible deficiencies. METHODS: The study population included 46 patients in the age range 27-59 years, the majority (85 %) were women. The enrolled patients attended an eight week course on lifestyle changes before bariatric surgery. After RYGB they were recommended daily micronutrient supplements with a commonly used multivitamin-mineral tablet in addition to intramuscular vitamin B12 injections (1 mg) every third month for 12 months. Whole blood concentrations of Cu, Mn, Se and Zn were determined using high resolution inductively coupled plasma mass spectrometry. RESULTS: During the 12 months follow up after bariatric surgery, the patients had lost mean 32.3 kg and median whole blood concentrations of Cu (-16 %) were reduced, Mn (+14 %) and Zn (+6%) were increased, while the Se values were essentially unchanged. Compared with reference ranges, median postoperative concentrations of all essential trace elements were either below (Zn) or in the lower reference range (Cu, Mn, Se). CONCLUSION: Essential trace elements were below or in the lower reference range twelve months after RYGB. Our results indicate a need for updated guidelines in Nordic countries for trace metal monitoring and supplements in patients after bariatric surgery, especially when gastric bypass surgery is used. Further studies are required to explore and prevent trace element deficiency related to obesity and bariatric surgery.

Impacto nutricional da cirurgia bariátrica: estudo comparativo do Bypass gástrico em Y de Roux e do Sleeve entre pacientes dos sistemas público e privado de saúde / Nutritional impact of bariatric surgery: a comparative study of Roux-en-Y Gastric Bypass and Sleeve gastrectomy between patients from the public and private health systems

RESUMO Objetivos: Comparar a evolução do perfil nutricional de pacientes submetidos ao bypass gástrico em Y de Roux (BGYR) e ao Sleeve, em hospitais dos setores público e privado da Saúde de Pernambuco. Método: O estudo incluiu pacientes submetidos à cirurgia bariátrica nos setores público e privado de saúde de Pernambuco no período de 2008 a 2016. Foram avaliados dados antropométricos e bioquímicos (Hemoglobina, Vitamina B12, Ferro e Ferritina) no período pré-operatório e com 3, 6 e 12 meses de pós-operatório. Resultados: Não foram registradas diferenças significativas entre os pacientes internados nos dois setores da Saúde no tocante às variáveis: níveis hemoglobina, anemia por deficiência de ferro e vitamina B12 em nenhuma das avaliações e conforme o tipo de cirurgia. Entre os pacientes submetidos ao BGYR, os níveis de ferro sérico foram significativamente menores nos pacientes do setor privado da Saúde apenas na primeira avaliação. Baixos níveis de ferritina sérica foram observados na segunda avaliação, sendo os pacientes do setor privado os que apresentaram menores valores. O sucesso cirúrgico foi significativamente maior no grupo que realizou o BGYR na rede privada. Conclusões: Com um seguimento de 12 meses pós-cirurgia bariátrica, não foi observada diferença estatisticamente significante no que diz respeito às deficiências de micronutrientes entre pacientes usuários dos setores público e privado de Saúde.

ABSTRACT Purpose: To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco. Methods: This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation. Results: There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system. Conclusions: After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.

Multiple Micronutrient Powder Reduces Vitamin E Deficiency in Brazilian Children: A Pragmatic, Controlled Clinical Trial.

Multiple micronutrient powder supplementation is a health promotion strategy, but data on its effectiveness regarding vitamin E are rare. The objective was to evaluate the impact of home fortification with powdered micronutrients on α-tocopherol concentrations, growth, and inflammation in Brazilian children aged 6-15 months. This is a pragmatic, controlled clinical trial, in which the intervention group received micronutrient powder sachets for up to 3 months. Vitamin E deficiency was considered when α-tocopherol was less than 11.6 µmol/L. The Poisson regression model was used to estimate adjusted values for prevalence ratios (PR) for the outcome variable. A total of 224 children participated in the study. The intervention group had a higher median α-tocopherol level (17.2 versus 3.6 µmol/L; p < 0.001) and an 82.0% reduction in the prevalence of vitamin deficiency (PR = 0.18; 95% CI 0.11-0.30) when compared with the control group. Consumption of multiple micronutrients in powder increases serum α-tocopherol concentrations, promotes better linear growth, and reduces morbidity in children.

The Evolving Role of Multivitamin/Multimineral Supplement Use among Adults in the Age of Personalized Nutrition.

Micronutrient deficiencies occur in segments of the adult population in the United States. Multivitamin/multimineral supplements (MVMS) are widely used by this population, which reduces inadequacies in micronutrient intake, but the potential for exceeding tolerable upper intake levels in others should be considered. There are concerns associated with the excessive intake of certain nutrients, particularly folic acid, and potential untoward consequences. The advent of nutrigenomics and the enhanced ability to directly study the interactions between nutrition and genetic variants and expression will allow for the conduct of more targeted studies with specific endpoints and may ultimately lead to progress in the field of personalized nutrition. The role of MVMS in health maintenance and chronic disease prevention remains controversial. Conducting studies in this area has been hampered by, among other factors, inconsistent definitions of MVMS, ranging from as few as three vitamins to broad-spectrum products containing more than two dozen vitamins and minerals. Results from some observational studies and large-scale, randomized, controlled trials suggest that MVMS may reduce the risk of some forms of cancer and, potentially, cardiovascular disease. The ongoing COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is expected to build on this research and provide additional insights into these areas.

An investigation of the iodine status among children aged from 8-10 in both urban and rural areas of Xiamen after 3 years promotion of new standard iodized salt / 中华地方病学杂志

Objective To investigate the coverage of iodized salt and the iodine status among children aged from 8-10 years in both urban and rural areas of Xiamen after promotion of new standard iodized salt,and to provide scientific evidence for adjustment of control strategy.Methods After 3 year promotion of new standard iodized salt,Huli and Xiang'an were selected as the urban and rural investigation sites,respectively in 2015.Each investigation site was further divided into five sampling areas,namely east,west,south,north and central.In each sampling area,one town was randomly selected and 2 tapping water samples were collected to determine the iodine level;in each town,4 villages were randomly selected and 15 residents were selected and edible salt samples were collected to determine the iodine level.Moreover,one primary school was selected in each town,and 40 children aged from 8-10 years old were randomly selected to perform thyroid examination and urinary iodine level determination.The water iodine was detected by arsenic cerium catalytic spectrophotometry;salt iodine was detected by direct titration;urinary iodine was detected by arsenic cerium catalytic spectrophotometry;thyroid was examined by B ultrasound.Results The iodine concentration was lower than 10 μg/L in drinking water in both urban and rural areas.The coverage rate of iodized salt in urban and rural areas was 99.3％ (298/300) and 94.0％ (282/300),respectively.The consumption rate of qualified iodized salt was 93.7％ (281/300) and 90.7％ (272/300),respectively.The prevalence of goiter was 3.8％ (8/210) both in urban and rural areas.The prevalence of thyroid nodule was 17.6％ (37/210) and 19.5％ (41/210),respectively.No significance was found when comparing the prevalence of goiter and the prevalence of thyroid nodule (x2 =0.000,0.252,all P ＞ 0.05).The median of urinary iodine was 208.9 and 167.2 μg/L,respectively.The statistical analysis found that the urban children had higher iodine level when comparing with rural counterparts (Z =4.030,P ＜ 0.01).The prevalence of goiter in male and female was 2.4％ (5/208) and 5.2％ (11/212),respectively,and no significant difference was detected (x2=2.222,P＞ 0.05).The prevalence of thyroid nodule in male and female children was 13.5％ (28/208) and 23.6％ (50/212),respectively,the analysis showed that the female children had higher prevalence of thyroid nodule (x2 =7.115,P ＜ 0.01).The median of urinary iodine in male and female children was 197.8 and 169.6 μg/L,respectively,and the urinary iodine level was significantly higher in male when comparing with female children (Z =2.218,P ＜ 0.05).Conclusions After promotion of new standard iodized salt,the iodine nutrition of children aged from 8-10 years in both urban and rural areas of Xiamen were good.The goal of eliminating iodine deficiency disorders was achieved.The iodine supplement measure should be further promoted to ensure the adequate level of iodine in residents,adhere to the iodine supplement measure,promote a healthy lifestyle,ensure the amount of iodine intake.

A survey of iodine content in drinking water of Yi County in Hebei Province in 2012 / 中华地方病学杂志

Objective To find out the iodine content in drinking water in Yi County,and to provide a scientific basis for prevention of iodine deficiency disorders.Methods An administrative village was taken as a unit in Yi County,Hebei Province.One drinking water sample was randomly selected from each village with centralized water supply.For villages with decentralized water supply,five drinking water samples were randomly selected according to directions (east,west,south,north and center) if there were more than five water sources in the village ; all the water source samples were taken if there were less than five water sources.Water iodine content of all of the water samples was tested; geomorphological feature,water type and well depth were surveyed.Water iodine content was determined through arsenic cerium catalytic spectrophotometric method.Results The range of water iodine content was 0.00-18.39 μg/L,and water iodine median was 2.08 μg/L in 1 024 water samples in the county.Water samples of 490,505 and 29 copies were collected in the hills,plains and mountains,and water iodine median was 1.74,2.26,3.15 μg/L,respectively.Concerning water iodine medians in drinking water,mountains were less than hills and plains(x2 =37.36,34.25,all P＜ 0.01),hills were less than (x2=15.27,P ＜ 0.01).Water samples of 742,228,54 copies were collected,respectively,in household well water,tap water and mountain spring water,and water iodine median was 2.08,2.24 and 0.73 μg/L,respectively.There was no significant difference between the water iodine median in tap water and household well water (x2 =2.97,P ＞ 0.05),and the iodine in mountain spring water was less than that of tap water and household well water (x2 =38.23,43.82,P ＜ 0.01).Water samples of 583 and 441 copies were collected,respectively,in the well depth ＜ 40 m and well depth ≥40 m,and water iodine median was 1.81 and 2.24 μg/L,respectively,and there was no significant difference between the water iodine median in the well depth ＜ 40 m and well depth ≥40 m(x2 =2.32,P ＞ 0.05).Conclusions Residents iodine content of drinking water in Yi County is lower; the natural environment is seriously iodine deficiency,and iodine supplementation should be strengthened.

Iodine nutritional status in high-risk areas of iodine deficiency disorders in Tianjin / 中华地方病学杂志

Objective To investigate the nutritional status of children and women of childbearing age in high-risk areas of iodine deficiency disorders in Tianjin in 2008-2010 and to provide a scientific basis for iodine supplementation.Methods Hangu District was selected as survey point from 2008 to 2010,Dagang District and Jingan County were increased in 2010.Hangu District was divided into five areas,one township(town) that was not high iodine was selected from each area,four administrative villages were selected from each township(town),and 15 households were selected from each administrative village.Three township(town) were selected from Dagang and Jingan County,respectively.Two administrative villages were selected from each township(town),and 20 households were selected from each administrative village.Iodine level of salt samples from each household was determined.In 2009,one primary school was selected from each survey township(town),thyroid volume of 40 8-10-year-old students was examined,and urine iodine of 20 students was tested.In 2010,three township(town) were selected from each survey point,two primary school were selected from each survey township(town),40 8-l0-year-old students were selected from each primary school,urine iodine and thyroid volume of the students were determined.150,50 and 60 women of childbearing age from Hangu District were selected from 2008 to 2010,and 60 were selected from Dagang District and Jingan County,respectively.Urine iodine of the women was tested.Iodine content of salt was tested by a semi-quantitative test kit; diagnosis of endemic goiter was based on the Diagnostic Criteria of Endemic Goiter (WS 276-2007); urinary iodine test was based on the Arsenic Cerium Catalytic Spectrophotometry (WS/T 107-2006).Results Coverage rates of iodized salt in Hangu District in the 3 years were 65.0％ (195/300),70.3％ (211/300) and 90.8％ (274/300),respectively.Coverage rates of iodized salt in Dagang District and Jinghai County were 40.0％(48/120) and 38.3％(46/120).In 2009,the median urinary iodine of children aged 8-10 in Hangu District was 205.4 μg/L and in 2010,the medians urinary iodine of children aged 8-10 of the three survey point were 193.0,293.1 and 216.8 μg/L.Goiter rates of children aged 8-10 in Hangu District were 4.24％(9/212) and 3.59％ (9/251),and in Dagang District and Jinghai County were 3.60％ (9/250) and 5.44％(13/239).The medians urinary iodine in women of childbearing age in Hangu District in the 3 years were 134.9,196.1 and 229.5 μg/L,respectively.The medians urinary iodine in women of childbearing age in Dagang District and Jinghai County were 316.9 and 190.9 μg/L.Conclusions The nutritional status of high-risk areas of iodine deficiency disorders in Tianjin are better than the national limit of enhanced iodine requirements.Due to higher water iodine in the same areas,some people are iodine excess,to which we should pay more attention.