Iron Nutrition, Erythrocytes, and Erythropoietin in the NICU: Erythropoietic and Neuroprotective Effects.

Prematurity, maternal diabetes, maternal smoking, being medically underserved, and small size for gestational age are common characteristics of neonates in the NICU and can predispose them to develop congenital iron deficiency. Iron is critical for organ development. In the fetus and newborn, iron is prioritized for red blood cell production, sometimes at the expense of other tissues, including the brain. It is critical to optimize iron levels in newborns to support erythropoiesis, growth, and brain development. Available studies support improved neurodevelopmental outcomes with either iron supplementation or delayed umbilical cord clamping at birth. Erythropoietic doses of erythropoietin/erythrocyte-stimulating agents may also improve neurocognitive outcomes. However, the literature on the effect of liberal red blood cell transfusions on long-term neurodevelopment is mixed. Understanding age-specific normal values and monitoring of iron indices can help individualize and optimize the iron status of patients in the NICU.

Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study.

Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years. Dietary data was collected using a previously validated food frequency questionnaire. Subclinical hypothyroidism was categorized as thyroid-stimulating hormone levels of >4.0 IU/mL and free prohormone thyroxine levels within normal limits, without administering drugs for thyroid disease. A multiple logistic regression model was used to assess the relationship between the presence of subclinical hypothyroidism and tertiles of Se consumption. The prevalence of subclinical hypothyroidism in the study sample was 5.4% (95% confidence interval [CI], 3.8⁻7.0%). Compared with the first tertile of Se intake, the second (odds ratio [OR], 0.79; 95% CI, 0.65⁻0.96%) and third (OR, 0.72; 95% CI, 0.58⁻0.90%) tertiles were inversely associated with subclinical hypothyroidism, however further research is needed to confirm the involvement of Se in subclinical hypothyroidism using more accurate methodologies of dietary assessment and nutritional status to evaluate this relationship.

Local foods can meet micronutrient needs for women in urban Burkina Faso, but only if rarely consumed micronutrient-dense foods are included in daily diets: A linear programming exercise.

Women of reproductive age are at nutritional risk due to their need for nutrient-dense diets. Risk is further elevated in resource-poor environments. In one such environment, we evaluated feasibility of meeting micronutrient needs of women of reproductive age using local foods alone or using local foods and supplements, while minimizing cost. Based on dietary recall data from Ouagadougou, we used linear programming to identify the lowest cost options for meeting 10 micronutrient intake recommendations, while also meeting energy needs and following an acceptable macronutrient intake pattern. We modeled scenarios with maximum intake per food item constrained at the 75th percentile of reported intake and also with more liberal maxima based on recommended portions per day, with and without the addition of supplements. Some scenarios allowed only commonly consumed foods (reported on at least 10% of recall days). We modeled separately for pregnant, lactating, and nonpregnant, nonlactating women. With maxima constrained to the 75th percentile, all micronutrient needs could be met with local foods but only when several nutrient-dense but rarely consumed items were included in daily diets. When only commonly consumed foods were allowed, micronutrient needs could not be met without supplements. When larger amounts of common animal-source foods were allowed, all needs could be met for nonpregnant, nonlactating women but not for pregnant or lactating women, without supplements. We conclude that locally available foods could meet micronutrient needs but that to achieve this, strategies would be needed to increase consistent availability in markets, consistent economic access, and demand.

Erythrocyte fatty acid composition of Nepal breast-fed infants.

PURPOSE: Essential fatty acids play a critical role in the growth and development of infants, but little is known about the fatty acid status of populations in low-income countries. The objective was to describe the fatty acid composition of red blood cells (RBC) in breastfeed Nepali infants and a subsample of their mothers and to identify the main sources of fatty acids in the mother's diet, as well as the fatty acid composition of breast milk. METHODS: RBC fatty acid composition was analyzed in a random sample of 303 infants and 72 mother, along with 68 breastmilk samples. Fatty acid profiles of the most important dietary fat sources were analyzed. Information on mother's diet and intake of fat was collected by three 24-h dietary recalls. RESULTS: In infant RBC's, docosahexaenoic acid (DHA) was the main n-3 fatty acid, and arachidonic acid (AA) was the major n-6 fatty acid. Total n-6 PUFA was three times higher than total n-3 PUFA. Height-for-age (HAZ) was positively associated with DHA status and AA status in multivariable models. The concentration of all fatty acids was higher in children, compared to mothers, except Total n-6 PUFA and Linoleic acid (LA) where no differences were found. The mother's energy intake from fat was 13% and cooking oil (sesame, mustard, soybean or sunflower oil) contributed 52% of the fat intake. CONCLUSIONS: RBC-DHA levels in both infants and mother was unexpected high taking into account few dietary DHA sources and the low DHA concentrations in breastmilk.

Concurrent iron and zinc deficiencies in lactating mothers and their children 6-23 months of age in two agro-ecological zones of rural Ethiopia.

PURPOSE: The aim of this study is to examine the co-occurrences of low serum ferritin and zinc and anaemia among mothers and their children in two agro-ecological zones of rural Ethiopia. METHODS: Data were collected from 162 lactating mothers and their breast fed children aged 6-23 months. The data were collected via a structured interview, anthropometric measurements, and blood tests for zinc, ferritin and anaemia. Correlation, Chi-square and multivariable analysis were used to determine the association between nutritional status of mothers and children, and agro-ecological zones. RESULTS: Low serum levels of iron and zinc, anaemia and iron deficiency anaemia were found in 44.4, 72.2, 52.5 and 29.6% of children and 19.8, 67.3, 21.8, 10.5% of mothers, respectively. There was a strong correlation between the micronutrient status of the mothers and the children for ferritin, zinc and anaemia (p < 0.005). Deficiency in both zinc and ferritin and one of the two was observed in 19.1, and 53.7% of the mothers and 32.7 and 46.3%, of their children, respectively. In the 24 h before the survey, 82.1% of mothers and 91.9% of their infants consumed foods that can decrease zinc bioavailability while only 2.5% of mothers and 3.7% of their infants consumed flesh foods. CONCLUSION: This study shows that micronutrient deficiencies were prevalent among lactating mothers and their children, with variation in prevalence across the agro-ecological zones. This finding calls for a need to design effective preventive public health nutrition programs to address both the mothers' and their children's needs.

Decreased, but still sufficient, iodine intake of children and adults in the Netherlands.

Sufficient I intake is important for the synthesis of thyroid hormones, which play an important role in normal growth and development. Our aim was to estimate habitual I intake for the Dutch population and the risk of inadequate or excessive intakes. Further, we aimed to provide an insight into the dietary sources of I and the association with socio-demographic factors. Data from the Dutch National Food Consumption Survey 2007-2010 (n 3819; 7-69 years), and from the Dutch food and supplement composition tables were used to estimate habitual I intake with a calculation model. Contribution of food groups to I intake were computed and multiple linear regression was used to examine associations of intakes with socio-demographic factors. A total of ≤2 % of the population had an intake below the estimated average requirement or above the upper level. The main sources of I were bread containing iodised salt (39 %), dairy products (14 %) and non-alcoholic drinks (6 %). I intake (natural sources only, excluding iodised salt and supplements) was positively associated with (parental) education, which could at least partly be attributed to a higher consumption of dairy products. Among children, the consumption of bread, often containing iodised bakery salt, was positively associated with parental education. The I intake of the Dutch population (7-69 years) seems adequate, although it has decreased since the period before 2008. With the current effort to reduce salt intake and changing dietary patterns (i.e. less bread, more organic foods) it is important to keep a close track on the I status, important sources and potential risk groups.

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions.

Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem. Based on the availability of more recent data, this review is primarily focused on countries that are in advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports indicate that food fortification in the region is sporadic and ineffective, and the use of dietary supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information present challenges for implementing new policies and approaches to address the problem. Government-sponsored initiatives are necessary to assess current dietary intakes/patterns, support nutrition education, and to reduce food insecurity, especially among vulnerable population groups. Public-private partnerships should be considered in targeting micronutrient fortification programs and supplementation recommendations as approaches to help alleviate the burden of micronutrient deficiencies and inadequacies in the Middle East.

Reliability of thyroglobulin in serum compared with urinary iodine when assessing individual and population iodine nutrition status.

The occurrence of thyroid disorders relies on I nutrition and monitoring of all populations is recommended. Measuring I in urine is standard but thyroglobulin in serum is an alternative. This led us to assess the reliability of studies using serum thyroglobulin compared with urinary I to assess the I nutrition level and calculate the number of participants needed in a study with repeated data sampling in the same individuals for 1 year. Diet, supplement use and life style factors were assessed by questionnaires. We measured thyroglobulin and thyroglobulin antibodies in serum and I in urine. Participants were thirty-three Caucasians and sixty-four Inuit living in Greenland aged 30-49 years. Serum thyroglobulin decreased with rising I excretion (Kendall's τ -0·29, P=0·005) and did not differ with ethnicity. Variation in individuals was lower for serum-thyroglobulin than for urinary I (mean individual CV: 15·1 v. 46·1 %; P<0·01). It required 245 urine samples to be 95 % certain of having a urinary I excretion within 10 % of the true mean of the population. For serum-thyroglobulin the same precision required 206 samples. In an individual ten times more samples were needed to depict I deficiency when using urinary I excretion compared with serum-thyroglobulin. In conclusion, more participants are need to portray I deficiency in a population when using urinary I compared with serum-thyroglobulin, and about ten times more samples are needed in an individual. Adding serum-thyroglobulin to urinary I may inform surveys of I nutrition by allowing subgroup analysis with similar reliability.

Lebanese children are iodine deficient and urinary sodium and fluoride excretion are weak positive predictors of urinary iodine.

PURPOSE: To assess iodine and fluoride status among Lebanese children. METHODS: A nationally representative cross-sectional study of 6- to 10-year-old schoolchildren was conducted using multistage cluster sampling. Spot urine samples were collected from 1403 children, and urinary iodine, fluoride, creatinine and sodium levels were measured. Salt samples from markets (n = 30) were tested for iodine concentration by titration. RESULTS: Median urinary iodine concentration was 66.0 µg/l, indicating mild deficiency, and almost 75 % of Lebanese children had a urinary iodine concentration (UIC) <100 µg/l. UIC was higher among children from private schools and in areas of higher socioeconomic status. Most salt samples were fortified at levels far below the legislated requirement, and 56 % of samples contained less than 15 ppm iodine. Fluoride-to-creatinine ratio (F/Cr) was 0.250 (0.159-0.448) mg/g. There were weak positive correlations between UIC and urinary sodium (r 2 = 0.039, P value <0.001) and UIC and urinary fluoride (r 2 = 0.009, P value <0.001). CONCLUSIONS: Lebanese elementary school children are iodine deficient due to inadequately iodized salt. The weak correlation between UIC and urinary sodium suggests most dietary iodine does not come from iodized salt. The poor correlation between UIC and urinary fluoride suggests that fluoride intake is not affecting iodine metabolism. Efforts are needed in Lebanon to improve industry compliance with salt fortification through improved monitoring and enforcement of legislation.

Iodine Status of New Zealand Elderly Residents in Long-Term Residential Care.

In response to the re-emergence of iodine deficiency in New Zealand, in 2009 the government mandated that all commercially made breads be fortified with iodized salt. There has been no evaluation of the impact of the program on iodine status of the elderly, despite this population group being vulnerable to iodine deficiency or excess. The aim of this study was to describe the iodine status of elderly New Zealanders in residential aged-care homes following the implementation of the bread fortification program. A cross-sectional survey was conducted, involving 309 residents (median age 85 years) from 16 aged-care homes throughout NZ. Information on socio-demographic, anthropometric, dietary and health characteristics were collected. Casual spot urine samples were analysed for urinary iodine concentration (UIC). Blood samples were analysed for serum thyroglobulin, thyroglobulin antibodies, and other biochemical indices. The median UIC (MUIC) of the residents was 72 µg/L, indicating mild iodine deficiency, and 29% had a UIC < 50 µg/L. Median thyroglobulin concentration was 18 ng/mL and 26% had elevated thyroglobulin concentration (>40 ng/mL), suggesting iodine insufficiency. Diuretic use was associated with lower MUIC (p = 0.043). Synthetic thyroxine use was associated with lower odds of having a UIC < 50 µg/L (OR 0.32, p = 0.030)) and lower median thyroglobulin (-15.2 ng/mL, p = 0.001), compared with untreated participants. Frailty was associated with elevated thyroglobulin (p = 0.029), whereas anemia was associated with lower thyroglobulin (p = 0.016). Iodine insufficiency persists in New Zealanders residing in residential aged-care homes despite increasing iodine intake from fortified bread. Research is required to establish optimal iodine intake and status in the elderly.

Promoting multi-micronutrient powders (MNP) in Peru: acceptance by caregivers and role of health personnel.

UNLABELLED: Iron deficiency causes anaemia and other adverse effects on the nutritional status and development of millions of children. Multi-micronutrient powders (MNP) have been shown to reduce anaemia in young children. In Peru, 50% of children 6-36 months are anaemic. Since 2009, the government has started distributing MNP. This qualitative study explored the acceptability of MNP by caregivers and the role of health personnel (HP) in three regions (Apurimac, Ayacucho and Cajamarca), piloting the MNP programme between 2009 and 2011. Data collection consisted of interviews (35) and observations (13) with caregivers and HP (11). In Cajamarca, 16 families were visited three times in their homes to understand caregivers' use and difficulties. Results showed the critical role HP has in influencing caregiver understanding and use of the MNP, as well as the need for training to avoid confusing messages and provide counselling techniques that consider cultural sensitivity to optimize HP interactions with caregivers and adapt the recommendations for MNP use to local family feeding routines. There was greater acceptance of MNP by caregivers giving semi-solid foods (e.g. purees) to their children than those who served dilute preparations (e.g. soups). Acceptance was similar across regions, but there were some differences between urban and rural settings. Home visits were shown to be a key in improving the use of MNP by caregivers as misunderstandings on preparation, required consistency and optimum practices were common. These findings can contribute to strategies to enhance acceptability and use. KEY MESSAGES: Acceptance and use of multi-micronutrient powders (MNP) by caregivers greatly depend upon how it is presented, promoted and counselled by health personnel. Counselling for MNP use needs to consider and adapt to the local cultural context and incorporate family and child feeding routines. MNP are presented as part of appropriate feeding practices, encouraging caregivers to find simple and acceptable ways of giving semi-solid or solid foods with which to mix it.

Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua.

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.

Effectiveness in improving knowledge, practices, and intakes of "key problem nutrients" of a complementary feeding intervention developed by using linear programming: experience in Lombok, Indonesia.

BACKGROUND: Complementary feeding recommendations (CFRs) with the use of locally available foods can be developed by using linear programming (LP). Although its potential has been shown for planning phases of food-based interventions, the effectiveness in the community setting has not been tested to our knowledge. OBJECTIVE: We aimed to assess effectiveness of promoting optimized CFRs for improving maternal knowledge, feeding practices, and child intakes of key problem nutrients (calcium, iron, niacin, and zinc). DESIGN: A community-intervention trial with a quasi-experimental design was conducted in East Lombok, West Nusa Tenggara Province, Indonesia, on children aged 9-16 mo at baseline. A CFR group (n = 240) was compared with a non-CFR group (n = 215). The CFRs, which were developed using LP, were promoted in an intervention that included monthly cooking sessions and weekly home visits. The mother's nutrition knowledge and her child's feeding practices and the child's nutrient intakes were measured before and after the 6-mo intervention by using a structured interview, 24-h recall, and 1-wk food-frequency questionnaire. RESULTS: The CFR intervention improved mothers' knowledge and children's feeding practices and improved children's intakes of calcium, iron, and zinc. At the end line, median (IQR) nutrient densities were significantly higher in the CFR group than in the non-CFR group for iron [i.e., 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal) compared with 0.5 mg/100 kcal (0.4-0.7 mg/100 kcal)] and niacin [i.e., 0.8 mg/100 kcal (0.5-1.0 mg/100 kcal) compared with 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal)]. However, median nutrient densities for calcium, iron, niacin, and zinc in the CFR group (23, 0.6, 0.7, and 0.5 mg/100 kcal, respectively) were still below desired densities (63, 1.0, 0.9, and 0.6 mg/100 kcal, respectively). CONCLUSIONS: The CFRs significantly increased intakes of calcium, iron, niacin, and zinc, but nutrient densities were still below desired nutrient densities. When the adoption of optimized CFRs is constrained by economic access for or acceptability of nutrient-dense foods, other strategies need to be incorporated into interventions to ensure adequate intakes of these nutrients.

Effects of a food-based intervention on markers of micronutrient status among Indian women of low socio-economic status.

Intakes of micronutrient-rich foods are low among Indian women of reproductive age. We investigated whether consumption of a food-based micronutrient-rich snack increased markers of blood micronutrient concentrations when compared with a control snack. Non-pregnant women (n 222) aged 14-35 years living in a Mumbai slum were randomised to receive a treatment snack (containing green leafy vegetables, dried fruit and whole milk powder), or a control snack containing foods of low micronutrient content such as wheat flour, potato and tapioca. The snacks were consumed under observation 6 d per week for 12 weeks, compliance was recorded, and blood was collected at 0 and 12 weeks. Food-frequency data were collected at both time points. Compliance (defined as the proportion of women who consumed ≥ 3 snacks/week) was >85 % in both groups. We assessed the effects of group allocation on 12-week nutrient concentrations using ANCOVA models with respective 0-week concentrations, BMI, compliance, standard of living, fruit and green leafy vegetable consumption and use of synthetic nutrients as covariates. The treatment snack significantly increased ß-carotene concentrations (treatment effect: 47·1 nmol/l, 95 % CI 6·5, 87·7). There was no effect of group allocation on concentrations of ferritin, retinol, ascorbate, folate or vitamin B12. The present study shows that locally sourced foods can be made into acceptable snacks that may increase serum ß-carotene concentrations among women of reproductive age. However, no increase in circulating concentrations of the other nutrients measured was observed.

Breakfast consumption is positively associated with nutrient adequacy in Canadian children and adolescents.

Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12,281 children and adolescents aged 4-18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10% were breakfast non-consumers, 33% were consumers of RTEC breakfasts and 57% were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4-8 years: 2%; 9-13 years: 9%; 14-18 years: 18%). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted.

A probabilistic model to evaluate population dietary recommendations.

Food-based dietary recommendations (FBR) play an essential role in promoting a healthy diet. To support the process of formulating a set of population-specific FBR, a probabilistic model was developed specifically to predict the changes in the percentage of a population at risk of inadequate nutrient intakes after the adoption of alternative sets of FBR. The model simulates the distribution of the number of servings per week from food groups or food items at baseline and after the hypothetical successful adoption of alternative sets of FBR, while ensuring that the population's energy intake distribution remains similar. The simulated changes from baseline in median nutrient intakes and the percentage of the population at risk of inadequate nutrient intakes are calculated and compared across the alternative sets of FBR. The model was illustrated using a hypothetical population of 12- to 18-month-old breast-feeding children consuming a cereal-based diet low in animal source foods.

Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.

OBJECTIVE: To assess sociodemographic correlates of micronutrient intakes from food and dietary supplements in an urban, ethnically diverse sample of pregnant women in the USA. DESIGN: Cross-sectional analyses of data collected using a validated semi-quantitative FFQ. Associations between racial, ethnic and sociodemographic factors and micronutrient intakes were examined using logistic regression controlling for pre-pregnancy BMI, maternal age and smoking status. SETTING: Prenatal clinics, Boston, MA, USA. SUBJECTS: Analyses included pregnant women (n 274) in the PRogramming of Intergenerational Stress Mechanisms (PRISM) study, an urban longitudinal cohort designed to examine how stress influences respiratory health in children when controlling for other environmental exposures (chemical stressors, nutrition). RESULTS: High frequencies of vitamin E (52 %), Mg (38 %), Fe (57 %) and vitamin D (77 %) inadequacies as well as suboptimal intakes of choline (95 %) and K (99 %) were observed. Factors associated with multiple antioxidant inadequacies included being Hispanic or African American, lower education and self-reported economic-related food insecurity. Hispanics had a higher prevalence of multiple methyl-nutrient inadequacies compared with African Americans; both had suboptimal betaine intakes and higher odds for vitamin B6 and Fe inadequacies compared with Caucasians. Nearly all women (98 %) reported Na intakes above the tolerable upper limit; excessive intakes of Mg (35 %), folate (37 %) and niacin (38 %) were also observed. Women reporting excessive intakes of these nutrients were more likely Caucasian or Hispanic, more highly educated, US-born and did not report food insecurity. CONCLUSIONS: Racial/ethnic and other sociodemographic factors should be considered when tailoring periconceptional dietary interventions for urban ethnic women in the USA.

Prevalence and public health relevance of micronutrient deficiencies and undernutrition in pre-school children and women of reproductive age in Côte d'Ivoire, West Africa.

OBJECTIVE: To provide nationally representative data on the prevalence of anaemia, vitamin A and Fe deficiencies among pre-school age children (pre-SAC) and non-pregnant women of reproductive age (WRA), and on vitamin B12 and folate deficiencies in WRA, and the influence of inflammation on their interpretation. DESIGN: A cross-sectional survey to measure anthropometry, malaria parasitaemia and micronutrient status. Specifically, blood samples were analysed for Hb, plasma ferritin, soluble transferrin receptors, C-reactive protein, α1-acid glycoprotein, retinol-binding protein, vitamin B12 and folate. SETTING: Côte d'Ivoire in 2007. SUBJECTS: Nine hundred and twenty-eight WRA and 879 pre-SAC. RESULTS: In WRA, prevalence of Plasmodium parasitaemia (5 %) was low, but inflammation (34 %) was higher. Anaemia was a severe public health problem and prevalence differed by residency and eco-region. Inflammation-adjusted Fe deficiency was highest in urban areas (20 %). Nationally, folate deficiency was 86 %, higher in urban areas and varied by eco-region. Prevalence of vitamin B12 deficiency was low but higher in the rural areas and the north. Inflammation-adjusted vitamin A deficiency was very low (1 %). In pre-SAC, prevalence of inflammation (67 %) and Plasmodium parasites (25 %) was high; the latter was associated with poverty, rural residency and higher ferritin concentrations. Anaemia was classified as a severe public health problem (72 %), and was higher in rural areas (76 %) and the north (87 %). A quarter of pre-SAC suffered from vitamin A deficiency (inflammation-adjusted) and prevalence of undernutrition was high. CONCLUSIONS: Prevalence of inflammation, Plasmodium parasitaemia and micronutrient deficiencies were high in Côte d'Ivoire, particularly in pre-SAC. Nutritional interventions should be accompanied by strategies to reduce exposure to infections.

Public health policy to redress iodine insufficiency in pregnant women may widen sociodemographic disparities.

OBJECTIVE: To evaluate the impact of a mandatory bread fortification programme on estimated iodine intakes of childbearing women and to describe the extent to which uptake of a maternal iodine supplement recommendation is associated with sociodemographic characteristics. DESIGN: A postpartum survey was conducted using a self-administered questionnaire. Details on pre- and post-conceptional supplement use, bread intake, iodized salt use and maternal sociodemographic and obstetric characteristics were obtained. SETTING: Eleven maternity wards and hospitals located across New Zealand. SUBJECTS: Seven hundred and twenty-three postpartum New Zealand women. RESULTS: Mean iodine intake from fortified bread was 37 µg/d prior to conception. Younger women, women with higher parity, single women and those with unplanned pregnancies were less likely to meet the pregnancy Estimated Average Requirement (EAR) for iodine (all P ≤ 0·022). Although not statistically significant for all months of pregnancy, women with less education and income were less likely to meet the EAR (P ≤ 0·11 and P ≤ 0·2 for all months, respectively) and indigenous Maori women and Pacific women were less likely than New Zealand Europeans to meet the EAR (P ≤ 0·17 and P ≤ 0·051 for all months, respectively). During pregnancy, iodine-containing supplement uptake at the recommended level (150 µg/d) was non-uniform across sociodemographic subgroups, with the most disadvantaged women benefiting the least from this public health policy. CONCLUSIONS: The disparities in supplement uptake noted here highlight the need for prioritizing further efforts towards universal salt iodization, such as the mandatory fortification of additional processed foods with iodized salt.

Anemia in Cambodia: prevalence, etiology and research needs.

Anemia is a severe global public health problem with serious consequences for both the human and socio-economic health. This paper presents a situation analysis of the burden of anemia in Cambodia, including a discussion of the country-specific etiologies and future research needs. All available literature on the prevalence and etiology of anemia in Cambodia was collected using standard search protocols. Prevalence data was readily identified for pre-school aged children and women of reproductive age, but there is a dearth of information for school-aged children, men and the elderly. Despite progress in nation-wide programming over the past decade, anemia remains a significant public health problem in Cambodia, especially for women and children. Anemia is a multifaceted disease and both nutritional and non-nutritional etiologies were identified, with iron deficiency accounting for the majority of the burden of disease. The current study highlights the need for a national nutrition survey, including collection of data on the iron status and prevalence of anemia in all population groups. It is impossible to develop effective intervention programs without a clear picture of the burden and cause of disease in the country.