Consumption Pattern of Tea Is Associated with Serum Ferritin Levels of Women of Childbearing Age in Nandi County, Kenya: A Cross-Sectional Study.

INTRODUCTION: Tea consumption with meals affects iron absorption, increasing the risk of iron deficiency. Our study investigated the association between tea consumption patterns and serum ferritin levels among women of childbearing age (WCA) in Nandi County, Kenya. METHODS: We conducted a cross-sectional analytical study among 160 WCA selected using a systematic random sampling technique from Kapsabet Ward. Information on tea consumption practices was gathered using a researcher-administered questionnaire, and serum ferritin and C-reactive protein were measured. We assessed associations between tea consumption and iron status of respondents by multivariable regression analysis, adjusting for potential confounders, including parasitic infections and recent severe blood losses. RESULTS: The prevalence of anaemia and iron deficiency among the study participants were 86.2% and 45%, respectively. Majority (90.6%) of the respondents consumed tea or coffee, with an infusion time of more than 5 min (60.0%) and a moderate tea strength (64.1%), within 1 h before or after meals. Iron deficiency was associated the number of teacups consumed (adjusted odds ratio = 7.282, 95% CI = 3.580-14.812). CONCLUSION: High tea consumption is positively associated with iron deficiency among WCA. Lower tea infusion strength, shorter tea infusion duration, and a lower number of teacups overall consumed, as well as consuming tea 1 h before or after meals instead of with meals, may be recommended for better outcomes in iron status among WCA.

Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs.

BACKGROUND: For over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs). OBJECTIVE: The aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number. METHODS: We retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir-Assaf Harofeh Medical Center, Zerifin, Israel) during a 10-year period (2012-2021). RESULTS: Only 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety-two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number. CONCLUSIONS: FA supplementation rate was low and was unaffected by AED treatment. Patient and physician-targeted interventions should be implemented to increase FA prescription and patient adherence.

Factors Related to Anemia Prevalence Among Women of Childbearing Age in the Period of Global Pandemic.

Background Health authorities in Pakistan in collaboration with local and foreign non-government organizations are working hard to achieve the targets set by World Health Organization in 2012, that is, to reduce anemia prevalence and its related factors. However, due to the prevailing COVID-19 crisis, all resources and attention were diverted toward it, which led to ignorance of existing basic health issues. Objective This study assesses anemia prevalence and its related factors among women of childbearing age in the period of global pandemic. Methods A time-lagged, cross-sectional survey was conducted using a self-administered questionnaire among 1,702 volunteer women aged between 15 and 49 years across five major cities of Pakistan from January 2021 to December 2021 using the non-probability consecutive sampling technique. Blood sample results were analyzed to determine prevalence and anemia severity. The chi-squared test and multiple logistic regression were performed to examine the relationship and effect of related factors with hemoglobin levels using SPSS version 26. Results Among the 1,702 respondents, 788 (46.3%) were non-anemic and 914 (53.7%) were anemic. Anemia prevalence in Karachi was slightly greater (n=294, 55.48%) compared to other cities, and the mean hemoglobin level was 11.98 ± 0.92 g/dL. The chi-square test and multiple logistic regression indicated that the respondents' employment status, mother's profession, family income, living conditions, chronic health conditions, use of iron and folic acid supplements, junk food, source of drinking water, and knowledge about anemia and its preventive measures were associated significantly with anemia during the pandemic. Conclusion Results confirmed that anemia is a multi-factor health problem and that it was totally ignored during the COVID-19 pandemic, as the prevalence increased during the pandemic. Therefore, more attention should be paid to anemia surveillance, anemia awareness programs, and mobilization of community health workers and volunteers to reach a wide range of the population, including women of childbearing age even during the pandemic.

Inadequate Iodine Intake in Mothers of Young Children in Innlandet County, Norway.

Background: Iodine has an essential role in child growth and brain development. Thus, sufficient iodine intake is particularly important in women of childbearing age and lactating women. Objectives: This cross-sectional study aimed to describe iodine intake in a large random sample of mothers of young children (aged ≤2 y) living in Innlandet County, Norway. Methods: From November 2020 to October 2021, 355 mother-child pairs were recruited from public health care centers. Dietary data were obtained using two 24-h dietary recalls (24-HRs) per woman and an electronic FFQ. The Multiple Source Method was used to estimate the usual iodine intake from the 24-HR assessment. Results: Based on the 24-HRs, the median (P25, P75) usual iodine intake from food was 117 µg/d (88, 153) in nonlactating women and 129 µg/d (95, 176) in lactating women. The median (P25, P75) total usual iodine intake (from food combined with supplements) was 141 µg/d (97, 185) in nonlactating women and 153 µg/d (107, 227) in lactating women. Based on the 24-HRs, 62% of the women had a total iodine intake below the recommendations (150 µg/d in nonlactating women and 200 µg/d in lactating women), and 23% of them had an iodine intake below the average requirement (100 µg/d). The reported use of iodine-containing supplements was 21.4% in nonlactating women and 28.9% in lactating women. In regular users of iodine-containing supplements (n = 63), supplements contributed to an average of 172 µg/d of iodine. Among regular iodine supplement users, 81% reached the recommendations compared with 26% of nonsupplement users (n = 237). The iodine intake estimated by FFQ was substantially higher than that estimated by 24-HRs. Conclusions: Maternal iodine intake in Innlandet County was inadequate. This study confirms the need for action to improve iodine intake in Norway, particularly among women of childbearing age.

Comparing two simplified questionnaire-based methods with 24-h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines.

Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.

Reproductive Healthcare in Women with Rheumatoid Arthritis and Psoriatic Diseases in Routine Clinical Practice: Survey Results of Rheumatologists and Dermatologists.

INTRODUCTION: The proportion of women being treated with biologics is growing. However, data on treatment recommendation awareness among treating physicians and women who are considering pregnancy and family planning are limited. In this study, we used a questionnaire survey to learn how rheumatologists and dermatologists address women's needs for family planning, pregnancy, and breastfeeding, as well as their possible concerns with concurrent inflammatory rheumatic disease or psoriasis. METHODS: A 55-question (in English) survey aimed at identifying surveyed physicians' current practices regarding the reproductive health needs of women with rheumatoid arthritis, psoriasis, or psoriatic arthritis. This survey included 82 rheumatologists and 38 dermatologists from the Czech Republic, Hungary, and Slovakia. RESULTS: The proportion of female patients of reproductive age with the moderate-to-severe disease was 10-30% of all patients treated by the respondents. At the time of diagnosis, approximately two-thirds of the respondents discussed family planning with their patients. Rheumatologists collaborated with other specialists more frequently than dermatologists and gynecologist-obstetricians. Half of the rheumatologists revised systemic treatment 6 months before the patient planned to become pregnant, whereas dermatologists appear to act much sooner. Rheumatologists chose systemic glucocorticoids as the first-line treatment for pregnancy flares, whereas dermatologists chose topical corticosteroids. Congresses and interdisciplinary forums were rated the most valuable sources of information by physicians. CONCLUSIONS: There is a need for more holistic, multidisciplinary, collaborative, and integrated communication between clinicians and women of childbearing age. Physicians should consider the implications of these conditions and medical treatment for women of childbearing age and family planning for those with rheumatoid arthritis and psoriatic disease. Patient-centered care that includes patients' reproductive choices should be a routine clinical practice.

Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey.

There are limited data on the prevalence of anaemia and iron deficiency (ID) in Somalia. To address this data gap, Somalia's 2019 micronutrient survey assessed the prevalence of anaemia and ID in children (6-59 months) and non-pregnant women of reproductive age (15-49 years). The survey also collected data on vitamin A deficiency, inflammation, malaria and other potential risk factors for anaemia and ID. Multivariable Poisson regressions models were used to identify the risk factors for anaemia and ID in children and women. Among children, the prevalence of anaemia and ID were 43.4% and 47.2%, respectively. Approximately 36% and 6% of anaemia were attributable to iron and vitamin A deficiencies, respectively, whereas household possession of soap was associated with approximately 11% fewer cases of anaemia. ID in children was associated with vitamin A deficiency and stunting, whereas inflammation was associated with iron sufficiency. Among women, 40.3% were anaemic, and 49.7% were iron deficient. In women, ID and number of births were significantly associated with anaemia in multivariate models, and approximately 42% of anaemia in women was attributable to ID. Increased parity was associated with ID, and incubation and early convalescent inflammation was associated with ID, whereas late convalescent inflammation was associated with iron sufficiency. ID is the main risk factor of anaemia in both women and children and contributed to a substantial portion of the anaemia cases. To tackle both anaemia and ID in Somalia, food assistance and micronutrient-specific programmes (e.g. micronutrient powders and iron supplements) should be enhanced.

Toxoplasmosis in immunocompetent Saudi women: Correlation with vitamin D.

OBJECTIVE: Toxoplasma gondii (T. gondii) is a life-threatening parasite particularly infecting the immunocompromised women. Deficiency of vitamin D is well reported in several infectious disorders. This study was undertaken to investigate a correlation of vitamin D deficiency with the onset of T. gondii infection in immunocompetent women from the central of Saudi Arabia. METHODS: Blood samples were collected from 304 Saudi women from the Qassim region of Saudi Arabia. Specific immunoassays were used to determine the levels of T. gondii immunoglobulin G and vitamin D. The SPSS and the Prism Graph Pad statistical software were used for the data analysis. RESULTS: Out of 304 women, 18.8% were found to be positive for toxoplasmosis. Interestingly, the serum levels of vitamin D in toxoplasma positive cases were found to be significantly low as compared with the levels of vitamin D in toxoplasma negative cases. Moreover, sociodemographic risk factors such as age, residence location, and consumption of fruits/vegetables were also found to be associated with vitamin D deficiency and with the seroprevalence of toxoplasmosis. CONCLUSION: This study investigated a direct correlation of vitamin D deficiency with the severity of the toxoplasmosis in Saudi women. Therefore, it is predicted that vitamin D supplementation may provide protection against toxoplasma infection.

Total mercury exposure risk and selenium content measuring on fishery products consumed by women of childbearing age from Bogota, Colombia / Riesgo de exposición a mercurio total y medición del contenido de selenio en productos de la pesca consumidos por mujeres en edad fértil de Bogotá, Colombia

Background: Dietary exposure to mercury in women of childbearing age could result in neurological effects on the fetus. A health risk assessment of total mercury by fishery products intake has not been conducted in this population group in Bogota, Colombia. On the other hand, it has been suggested that selenium content on fishery products may have a protective effect against mercury toxicity. Nevertheless, selenium content on fish species marketed in Bogota has not been determined. Objective: Exposure risk to total mercury and selenium content on fishery products consumed by women of childbearing age from Bogota, Colombia, were assessed. Methods: Total mercury and selenium concentrations for products available at fish stores and supermarkets were determined. The exposure risk to total mercury was estimated considering the intake of these products by women of childbearing age group. Results: Total mercury highest concentrations were 0.8166 mg/kg in mota (Calophysusmacropterus), and 0.6275 mg/kg in catfish (Pseudoplatystoma tigrinum). On the other hand, the highest selenium concentration was 0.6471 mg/kg in nicuro (Pimelodus blochii). Finally, it was established that for women of childbearing age group, health risk of exposure to total mercury due to mota intake exceeded by 8.56-fold the reference dose. Conclusions:Mota intake considerably increases exposure risk to total mercury on women of childbearing age from Bogota, Colombia. The selenium levels established in the fishery products assessed, except for catfish and mota, are theoretically suggestive of a protective effect of selenium against mercury toxicity. Consequently, continuous total mercury concentrations monitoring is required to protect health of women of childbearing age and the general population from Bogota, Colombia

Antecedentes: La exposición dietética al mercurio en mujeres en edad fértil podría provocar efectos neurológicos en el feto. En Bogotá, Colombia no se han realizado evaluaciones de riesgo por la exposición al mercurio total debido a la ingesta de productos de la pesca en este grupo de la población. Por otro lado, ha sido sugerido que el contenido de selenio en los productos de la pesca podría tener un efecto protector frente a la toxicidad por mercurio, sin embargo, el contenido de selenio en las especies de peces comercializadas en Bogotá, Colombia no ha sido determinado. Objetivo: Evaluar el riesgo de exposición al mercurio total y el contenido de selenio en los productos de la pesca consumidos por las mujeres en edad fértil de Bogotá, Colombia. Métodos: Se determinaron las concentraciones de mercurio total y selenio en distintos productos de la pesca disponibles en pescaderías y supermercados. El riesgo de exposición a mercurio total se estimó considerando la ingesta de estos productos por parte de un grupo de mujeres en edad fértil. Resultados: Las concentraciones más altas de mercurio total fueron de 0.8166 mg/kg en mota (Calophysus macropterus) y 0.6275 mg/kg en bagre (Pseudoplatystoma tigrinum). Por otro lado, la concentración más alta de selenio fue de 0.6471 mg/kg en nicuro (Pimelodus blochii). Finalmente, se estableció que el riesgo de exposición a mercurio total, debido a la ingesta de mota, excedió en 8.56 veces la dosis de referencia en el grupo de mujeres en edad fértil. Conclusiones: La ingesta de mota aumenta el riesgo de exposición al mercurio total en las mujeres en edad fértil de Bogotá, Colombia. Por otro lado, los niveles de selenio identificados en los productos evaluados, excepto en bagre y mota, teóricamente sugieren un posible efecto protector del selenio contra la toxicidad por mercurio. Considerando lo indicado, es necesario realizar un monitoreo continuo de las concentraciones de mercurio total en los productos de la pesca, con el fin de proteger la salud de las mujeres en edad fértil y de la población general de Bogotá, Colombia

Nutritional status of Tajik children and women: Transition towards a double burden of malnutrition.

The double burden of malnutrition, an emerging concern in developing countries, can exist at various levels: individual, household, and population. Here, we explore the nutritional status of Tajik women (15-49 years) and children (5-59 months) focusing on overweight/obesity along with undernutrition (underweight, stunting, and micronutrient deficiencies). For this, nutritional markers (haemoglobin (Hb), transferrin receptor (TfR), serum ferritin (Sf), retinol binding protein (RBP), vitamin D, serum folate, and urinary iodine), height, and weight were assessed from 2,145 women and 2,149 children. Dietary intake, weaning, and breastfeeding habits were recorded using a 24-hr recall and a questionnaire. Overweight (24.5%) and obesity (13.0%) are increasing among Tajik women compared with previous national surveys (2003 and 2009). Prevalence of iron deficiency and anaemia was 38.0% and 25.8%, respectively; 64.5% of women were iodine deficient, 46.5% vitamin A deficient, and 20.5% had insufficient folate levels. Women in rural areas had significantly lower iron status and body mass index and higher iodine intake compared with urban areas; 20.9% of children were stunted, 2.8% wasted, 6.2% underweight, 52.4% iron deficient, and 25.8% anaemic; all more prominent in rural areas. Dietary diversity was higher among urban women. Intraindividual or household double burden was not seen. In summary, double burden of malnutrition constituted an increase in overweight among women, especially in urban areas, and persisting levels of undernutrition (stunting, iron, and vitamin A deficiency), predominately in rural areas. A holistic, innovative approach is needed to improve infant and young children feeding and advise mothers to maintain an adequate diet.

Effect of enhanced homestead food production on anaemia among Cambodian women and children: A cluster randomized controlled trial.

There is inconsistent evidence on the efficacy of agriculture programmes at improving women and children's anaemia and nutritional status. The primary aim of this study was to evaluate the impact of a nutrition-sensitive enhanced homestead food production (EHFP) programme on anaemia in women (18-45 years) and children (6-59 months) in rural Cambodia. Secondary outcomes were women's micronutrient status and women and children's anthropometry. In this cluster-randomized controlled trial, 900 households from 90 villages (clusters) were randomized to either (a) home gardens and behaviour change communication (BCC) on nutrition, hygiene, women's empowerment, and marketing (EHFP); (b) home gardens plus fishponds and BCC (EHFP + F); or (c) control (no intervention). Haemoglobin concentration and anthropometry were measured in women and children at baseline and at 22 months. Venous blood samples were collected in a subset of women (n = 450) at baseline and at 22 months. Generalized linear mixed effect models with repeated measures were used to evaluate the difference across groups and the change from baseline to end of study. Ninety clusters, 552 women, and 754 children completed the trial. Compared with control, we found a statistically significant impact on anaemia prevalence in children (-14.0 percentage points; P = 0.02) and retinol binding protein concentrations in women (difference in difference: 0.34; P = 0.02) randomized to EHFP and EHFP + F groups, respectively. No other statistically significant effects on anaemia, nutritional biomarker concentrations, or anthropometry were observed. Future research is needed to examine longer term impacts of EHFP on anthropometry in women and children and into the nutritional causes of anaemia among children in Cambodia.

Knowledge, attitude and practice of good nutrition among women of childbearing age in Somolu Local Government, Lagos State.

Women of child-bearing age (especially pregnant and lactating women) are in the most nutritionally-vulnerable stages of the life cycle. The aim of this study was to assess the knowledge, attitude and practice of good nutrition among women of childbearing age in Somolu Local Government (LG), Lagos state. This study was a crosssectional descriptive survey of 244 women of childbearing age (15-49 years). Excellent knowledge and good attitude towards good nutrition was observed among 61.89% and 86.89% respectively. During pregnancy, greater than 80% took folic acid, iron supplements and increased daily consumption of fruits and vegetables while 43.59% avoided eggs, fish, meat and chocolate beverage because of taboos. Seven days prior to interview, over 90% had consumed fast foods, 56.15% and 50.01% of the respondents ate fruits and vegetables every day to ≥4 times in a day respectively. A majority of the respondents knew and had a good attitude towards good nutrition supporting studies from Kenya and Northern Nigeria. This, however, did not translate to good practice for about half of the respondents.

Allostatic load: a useful concept for advancing nursing research.

AIMS AND OBJECTIVES: To elucidate the historical development of the allostatic load concept, alongside its use in nursing research, and to explore how allostatic load has been investigated among two stress-vulnerable populations. BACKGROUND: 'Stress' is a prominent term in understanding the development of disease. Allostatic load is among several approaches undertaken to quantify the magnitude of stress and understand how stress can affect health. METHOD: We explored the advent of allostatic load including its antecedents, and consequences. We used an exemplar case to apply the concept. We reviewed studies that used allostatic load among workers and women of childbearing age. RESULTS: There remains a need to consolidate a common definition and operationalisation of allostatic load. Despite this need for further work, allostatic load is a good fit for nursing science which focuses on the client, environment and health. Only 12 studies explored allostatic load among workers (n = 6) and women of childbearing age (n = 6). In some studies, allostatic load was used as a predictor while in others it was used as an outcome. None of the studies considered it as a mediator. CONCLUSIONS: The concept of allostatic load holds promise for nursing researchers to operationalise a holistic view of multiple stressors and to quantify their effects on health. Studies are needed to affirm the role of allostatic load as a potential mediator between multiple stressors and outcomes. Longitudinal studies are also needed to demonstrate a causal pathway from stressor exposure to tertiary outcomes such as chronic conditions and morbidity. RELEVANCE TO CLINICAL PRACTICE: Allostatic load is a useful concept for nurses working with stress-vulnerable populations. With the use of an interpretable allostatic load index, nurses will be able to intervene at various stages of the allostasis-adaptation process (stress-response) and adjust interventions accordingly.

Folate, vitamin B12, ferritin and haemoglobin levels among women of childbearing age from a rural district in South India.

BACKGROUND: Low folate and vitamin B12 levels have negative effect on pregnancy outcomes but there is paucity of data on their levels among Indian women. Ferritin and haemoglobin are associated with maternal mortality and low birth-weight. Our aim was to estimate the prevalence of deficiency of serum folate and vitamin B12, and low levels of serum ferritin and blood haemoglobin among women of childbearing age from a rural population of South India. METHODS: We conducted a community-based cross-sectional study among 15-35 year women in a rural district. We used multistage stratified random sampling. Trained staff interviewed women to collect socio-demographic information and draw blood samples. We analysed samples for serum folate, vitamin B12, ferritin and blood haemoglobin levels and computed means and medians. We computed the proportion of deficiency based on cut-offs recommended by WHO. We examined the association of levels with age, parity and current pregnancy or breastfeeding by multi-variable regression using Stata 13.0. RESULTS: We recruited 979 women. One-fifth (185, 19%) were pregnant and one-fifth (196, 20%)were breastfeeding. Median serum folate levels were 2.5 ng/ml (IQR, 1.2-4.8), median vitamin B12 levels were 228.0 pg/ml (IQR, 121 - 390), median ferritin levels were 13.0 µg/l (IQR, 6.0 - 20.0) and median blood haemoglobin levels were 12.1 mg/dl (IQR, 10.7 - 13.6). Low levels of serum folate, vitamin B12, ferritin and haemoglobin were found in 57% (95% CI, 54-60%), 44% (95% CI, 41-48%), 46% (95% CI, 43-49%) and 28% (95% CI, 25-31%) respectively. Women with folic acid deficiency had two times higher prevalence of having vitamin B12 deficiency. In adjusted regression analysis folate levels were lower in older and breastfeeding women, but not associated with parity and were higher among pregnant women. Similar associations were not found with Vitamin B12 deficiency. Ferritin levels were higher in older women; but not associated with parity, pregnancy or breastfeeding. Haemoglobin levels were lower in pregnant and breastfeeding women. CONCLUSION: Our findings suggest that folic acid, vitamin B12 and iron deficiency are important public health problems in India. We observed that half of the women of childbearing age were deficient in these nutrients. Folic acid and vitamin B12 deficiencies co-exist and should be supplemented together.

Folate intakes from diet and supplements may place certain Canadians at risk for folic acid toxicity.

To examine the prevalence of folate inadequacy and toxicity based on usual intakes from food and supplements, as well as biomarkers of folate, secondary data analyses were performed using cross-sectional, nationally representative data from the Canadian Community Health Survey, Cycle 2.2 (n 32 776), as well as biomarker data from the Canadian Health Measures Survey, Cycles 1, 2 and 3 (n 15 754). On the basis of unfortified food sources, Canadians would struggle to consume adequate amounts of folate. When folate intakes from all food sources were considered, the overall prevalence of folate inadequacy was low across all age/sex groups, with the exception of females >70 years. However, >10 % of supplement users were above the tolerable upper intake level, increasing to almost 18 % when overage factors were accounted for. In addition, between 20 and 52 % of supplement users had elevated erythrocyte folate concentrations, depending on the cut-off used. Results from this study suggest that insufficient dietary intakes of folate in Canadians have been ameliorated because of the fortification policy, although folate inadequacy still exists across all age groups. However, supplement users appear to be at an increased risk of folic acid (FA) overconsumption as well as elevated erythrocyte folate. As such, the general population should be informed of the potential risks of FA overconsumption resulting from supplement use. This study suggests a need for more careful assessment of the risks and benefits of food fortification, particularly fortification above mandated levels, and FA supplement use in the general population.

Serum and erythrocyte folate status of New Zealand women of childbearing age following a countrywide voluntary programme by the baking industry to fortify bread with folic acid.

OBJECTIVE: To estimate the folate status of New Zealand women of childbearing age following the introduction, in 2010, of a new voluntary folic acid fortification of bread programme. DESIGN: The 2011 Folate and Women's Health Survey was a cross-sectional survey of women aged 18-44 years carried out in 2011. The survey used a stratified random sampling technique with the Electoral Roll as the sampling frame. Women were asked about consumption of folic-acid-fortified breads and breakfast cereals in a telephone interview. During a clinic visit, blood was collected for serum and erythrocyte folate measurement by microbiological assay. SETTING: A North Island (Wellington) and South Island (Dunedin) city centre in New Zealand. SUBJECTS: Two hundred and eighty-eight women, of whom 278 completed a clinic visit. RESULTS: Geometric mean serum and erythrocyte folate concentrations were 30 nmol/l and 996 nmol/l, respectively. Folate status was 30-40 % higher compared with women of childbearing age sampled as part of a national survey in 2008/09, prior to the introduction of the voluntary folic acid bread fortification programme. In the 2011 Folate and Women's Health Survey, reported consumption of fortified bread and fortified breakfast cereal in the past week was associated with 25 % (P=0·01) and 15 % (P=0·04) higher serum folate concentrations, respectively. CONCLUSIONS: Serum and erythrocyte folate concentrations have increased in New Zealand women of childbearing age since the number of folic-acid-fortified breads was increased voluntarily in 2010. Consumption of fortified breads and breakfast cereals was associated with a higher folate status.

Iron deficiency, cognition, mental health and fatigue in women of childbearing age: a systematic review.

It is known that Fe deficiency has a negative impact on cognitive function in children by altering brain energy metabolism and neurotransmitter function. It is unclear whether Fe deficiency has detrimental effects on cognition, mental health and fatigue in women of childbearing age. Our aim was to systematically review the literature to determine whether Fe deficiency in women of childbearing age affects cognition, mental health and fatigue, and whether a change in Fe status results in improvements in cognition, mental health and fatigue. Studies using Fe supplement interventions were reviewed to examine the effect of Fe deficiency in women of childbearing age (13-45 years) on their cognition, mental health and fatigue. English-language articles ranging from the earliest record to the year 2011 were sourced. The quality of retrieved articles was assessed and the Fe pathology, cognitive, mental health and fatigue data were extracted. Means and standard deviations from cognitive test data were included in meta-analyses of combined effects. Of the 1348 studies identified, ten were included in the review. Three studies showed poorer cognition and mental health scores and increased fatigue with Fe deficiency at baseline. Seven studies reported an improvement in cognitive test scores after Fe treatment. Results of three of these studies were included in meta-analyses of the effect of Fe supplement intervention on cognition. The results of the meta-analyses showed a significant improvement in Arithmetic scores after treatment (P < 0·01), but no effect on Digit Symbol, Digit Span or Block Design. While an improvement in cognition after Fe treatment was seen in seven out of ten studies, the evidence base is limited by poor study quality and heterogeneity across studies. Additional high-quality studies using consistent measures are warranted.