The Effect of Iron-Fortified Lentils on Blood and Cognitive Status among Adolescent Girls in Bangladesh.

BACKGROUND: Iron deficiency is highly prevalent in South Asia, especially among women and children in Bangladesh. Declines in cognitive performance are among the many functional consequences of iron deficiency. OBJECTIVE: We tested the hypothesis that, over the course of a 4-month iron fortification trial, cognitive performance would improve, and that improvement would be related to improvements in iron status. METHODS: Participants included 359 adolescent girls attending Bangladesh Rural Advancement Committee (BRAC) clubs as a subsample of a larger double-blind, cluster-randomized community trial in which participants were assigned to one of three conditions: a condition in which no lentils were supplied (NL, n = 118, but which had the usual intake of lentils), a control (non-fortified) lentil condition (CL, n = 124), and an iron-fortified lentil condition (FL, n = 117). In the FL and CL conditions, approximately 200 g of cooked lentils were served five days per week for a total of 85 feeding days. In addition to biomarkers of iron status, five cognitive tasks were measured at baseline (BL) and endline (EL): simple reaction time task (SRT), go/no-go task (GNG), attentional network task (ANT), the Sternberg memory search Task (SMS), and a cued recognition task (CRT). RESULTS: Cognitive performance at EL was significantly better for those in the FL relative to the CL and NL conditions, with this being true for at least one variable in each task, except for the GNG. In addition, there were consistent improvements in cognitive performance for those participants whose iron status improved. Although there were overall declines in iron status from BL to EL, the declines were smallest for those in the FL condition, and iron status was significantly better for those in FL condition at EL, relative to those in the CL and NL conditions. CONCLUSIONS: the provision of iron-fortified lentils provided a protective effect on iron status in the context of declines in iron status and supported higher levels of cognitive performance for adolescent girls at-risk of developing iron deficiency.

Synbiotic Supplementation Improves Response to Iron Supplementation in Female Athletes during Training.

OBJECTIVE: Iron deficiency (ID) affects ∼30% of female athletes, and its consequences are highly relevant to athletic performance. Poor iron (Fe) uptake remains a major factor in the development of ID. While studies suggest that consumption of either prebiotics or probiotics may improve Fe uptake, consumption of synbiotics has not been well-studied. The main objective of this study was to determine the effects of synbiotic supplementation on the Fe status of female athletes during Fe repletion. METHODS: The Fe status of 32 female athletes was screened early in the season. Twenty eligible athletes (hemoglobin:12.3 ± 0.9g/dL; serum ferritin, sFer:18.1 ± 9.2 µg/L) were randomized to receive either a daily synbiotic supplement (5 g prebiotic fiber + 8 billion colony forming units, CFU probiotic B. lactis) or placebo, along with Fe supplementation (140 mg ferrous sulfate, FeSO4/d) for 8 weeks using a double-blind design. Fe status was assessed again at mid-point and after the trial. RESULTS: Nineteen athletes (n = 9 supplement, 10 placebo) completed the trial and there were no differences in compliance or GI symptoms reported between groups. After controlling for baseline Fe status, regression analyses revealed improvements in log sFer in the supplement group after both 4 and 8 weeks (p = 0.01 and p = 0.05, respectively), compared to placebo. CONCLUSIONS: Synbiotic supplementation along with FeSO4 improved athletes' Fe status over 8 weeks. This data is essential to advancing our understanding of how dietary and supplemental Fe uptake in active women can be enhanced by synbiotic supplementation, as well as by foods containing pre- and probiotics.

Determination of an Acceptable Portion Size of Daal for a Bangladeshi Community-Based Iron Intervention in Adolescent Girls: A Feasibility Study.

Widely consumed daal (lentils) in Bangladesh are an ideal vehicle for iron (Fe) fortification; however, an acceptable portion size in meals needs to be determined to carry out a community feeding study in at-risk adolescent girls. A non-randomized crossover trial was conducted with n = 100 Bangladeshi girls (12.9 ± 2.0 years of age). Two recipes (thin and thick) and three portion sizes (25 g, 37.5 g, 50 g of raw lentil) of daal were served with 250 g of cooked white rice in a counter-balanced manner over 12 weeks. Each meal was fed to participants 5 days/week for two weeks. Ratings of hunger, satiety, and palatability were measured before and after each meal using Visual Analog Scales (VAS). The thick preparation in the 37.5 g portion (~200 g cooked) elicited higher VAS ratings of hunger, satiety, and palatability compared to all other meals. The 50 g portion of the thin preparation had VAS ratings similar to those of the 37.5 g thick preparation. Consuming the 37.5 g portion of fortified daal would provide 6.9 mg Fe/day to girls in a community-based effectiveness study. This would meet ~86% and ~46% of the Recommended Dietary Allowance (RDA) for Fe for girls aged 9-13 and 14-18 years, respectively.

Iron-fortified lentils to improve iron (Fe) status among adolescent girls in Bangladesh - study protocol for a double-blind community-based randomized controlled trial.

BACKGROUND: Lentils are generally considered to be a nutrient-dense food, and a good source of iron (Fe). This study aims to establish novel evidence of the effectiveness of the consumption of Fe-fortified lentils in improving the body Fe status and thus cognitive performance in non-pregnant adolescent girls in rural Bangladesh, compared to consumption of ordinary lentils. METHODS: We have designed a double-blind (both trial participants and outcome assessors), community-based, cluster-randomized controlled trial among 1260 Bangladeshi adolescent girls between the ages of 10-17 years who are non-smoking, not married, not pregnant, not breastfeeding, and generally healthy at the time of enrollment. The intervention will include three arms who will receive: (1) Fe-fortified lentils; (2) unfortified lentils; or (3) usual intake. Participants will be served a thick preparation of cooked Fe-fortified lentils (37.5 g raw lentils, approximately 200 g cooked lentils) 5 days per week for 85 feeding days (around 4 months) using a locally acceptable recipe. Lentils were fortified with Fe in the laboratory at the Department of Plant Sciences at the University of Saskatchewan in Canada. A subsample of participants (n = 360) will be randomly invited to be included in cognitive testing. DISCUSSION: Data on socio-demographic characteristics, household food security status, adolescent food habits and cognitive testing will be collected at baseline and endline (4 months). Venous blood samples will be collected at baseline, midline (2 months) and endline to measure adolescents' Fe status. Computerized cognitive testing will include five common measures of attentional (three of attention) and mnemonic functioning (two of memory) carried out using DMDX software. The results of this study will be used to garner support for and to substantiate large-scale production and market expansion of Fe-fortified lentils, and will contribute to knowledge about how to enhance Fe status in adolescents worldwide in resource-poor settings, using staple food crops. TRIAL REGISTRATION: ClinicalTrials.gov NCT03516734 . Registered on 24 May 2018.

Iron Fortification of Lentil (Lens culinaris Medik.) to Address Iron Deficiency.

Iron (Fe) deficiency is a major human health concern in areas of the world in which diets are often Fe deficient. In the current study, we aimed to identify appropriate methods and optimal dosage for Fe fortification of lentil (Lens culinaris Medik.) dal with FeSO4·7H2O (ferrous sulphate hepta-hydrate), NaFeEDTA (ethylenediaminetetraacetic acid iron (III) sodium salt) and FeSO4·H2O (ferrous sulphate mono-hydrate). We used a colorimetric method to determine the appearance of the dal fortified with fortificants at different Fe concentrations and under different storage conditions. Relative Fe bioavailability was assessed using an in vitro cell culture bioassay. We found that NaFeEDTA was the most suitable fortificant for red lentil dal, and at 1600 ppm, NaFeEDTA provides 13-14 mg of additional Fe per 100 g of dal. Lentil dal sprayed with fortificant solutions, followed by shaking and drying at 75 °C, performed best with respect to drying time and color change. Total Fe and phytic acid concentrations differed significantly between cooked unfortified and fortified lentil, ranging from 68.7 to 238.5 ppm and 7.2 to 8.0 mg g-1, respectively. The relative Fe bioavailability of cooked fortified lentil was increased by 32.2-36.6% compared to unfortified cooked lentil. We conclude that fortification of lentil dal is effective and could provide significant health benefits to dal-consuming populations vulnerable to Fe deficiency.

2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults.

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals.

Iron Absorption from an Intrinsically Labeled Lentil Meal Is Low but Upregulated in Women with Poor Iron Status.

BACKGROUND: Low iron absorption from important staple foods may contribute to iron deficiency in developing countries. To date, few studies have examined the iron bioavailability of pulse crops as commonly prepared and consumed by humans. OBJECTIVE: The objectives were to characterize the iron absorption from a test meal of intrinsically labeled (57)Fe lentils prepared as dal, to compare the bioavailability of iron from (57)Fe in dal with that observed for a reference dose of (58)Fe as ferrous sulfate, and to assess associations between iron absorption and iron status indicators. METHODS: This crossover study included 19 nonpregnant women (n = 6 anemic; hemoglobin: <12.0 g/dL) who consumed 2 test meals on consecutive days in a counter-balanced order, ferrous sulfate (7 mg FeSO4 plus 1 mg (58)Fe) and 330 g dal (lentils enriched to 85.1% with (57)Fe, 8 mg native (57)Fe). Iron absorption was determined by analyzing blood samples taken 14 d after dosing with the use of magnetic sector thermal ionization mass spectrometry. RESULTS: We found that the mean iron absorption from the dal was 2.20% ± 3.40% and was significantly lower than the 23.6% ± 13.2% observed from the same iron load given as ferrous sulfate (P < 0.001). Absorption of non-heme iron from dal and from ferrous sulfate was inversely associated with serum ferritin (SF; r = -0.50, P = 0.05 and r = -0.81, P < 0.001, respectively) and serum hepcidin (r = -0.45, P = 0.05 and r = -0.60, P = 0.007, respectively). Anemic women absorbed more iron from either source (1.20% from dal, P = 0.10; 18.3% from ferrous sulfate, P = 0.001) compared with women who were iron replete. CONCLUSIONS: Iron absorption from the dal was low overall but upregulated in anemic women. Both SF and hepcidin were inversely associated with iron absorption from both a supplemental and a food-based non-heme iron source in nonanemic and anemic women.

Iron supplementation improves energetic efficiency in iron-depleted female rowers.

PURPOSE: Studies in both animals and humans show a relationship between iron depletion without anemia (IDNA) and physical performance. Compared with their sedentary counterparts, female endurance athletes are at greater risk of IDNA, and consequences relevant to endurance athletes include reduced work capacity and energetic efficiency (EF). We conducted a randomized placebo-controlled trial to investigate the effects of iron (Fe) supplementation on Fe status and performance in nonanemic female rowers during training. METHODS: At the beginning of a training season, 40 rowers were randomized to receive either 100 mg·d FeSO4 (n = 21) or placebo (n = 19) using a double-blind design. Thirty-one (n = 15 Fe, 16 placebo) completed the 6-wk trial. Fe status (hemoglobin, serum ferritin, soluble transferrin receptor), body composition, and laboratory tests of physical performance (4-km time trial, V˙O2peak, energetic EF, and blood lactate) were assessed at baseline and after training. RESULTS: Rowers in both groups increased their fat-free mass (P < 0.001) and V˙O2peak (P < 0.001) after training. Multiple regression analyses revealed improvements in Fe stores (serum ferritin) in the Fe treatment group after controlling for baseline Fe stores (P = 0.07). Rowers in the Fe group had slower lactate response during the first half of the time trial and after 5 min of recovery (P = 0.05) and showed greater improvements in energy expenditure (P = 0.01 for group-by time) and energetic EF compared with placebo (P = 0.03 for group-by time). CONCLUSIONS: Female rowers with depleted Fe stores who consumed supplemental Fe during training improved their Fe status and energetic EF during endurance exercise. These results are important for endurance athletes whose dietary patterns and physical training increase their risk of IDNA and suggest that Fe supplementation may maximize the benefits of endurance training.

Iron supplementation for female athletes: effects on iron status and performance outcomes.

Iron is an essential micronutrient involved in oxidative metabolism and critical to exercise performance. The prevalence of iron deficiency (ID) is much higher in active women for a variety of reasons, and poor iron status has been shown to be detrimental to overall health as well as physical performance. Iron status can be assessed using a number of indicators; however clinical cut-offs for active populations remain controversial. Randomized, placebo-controlled supplementation trials of iron-depleted female athletes have shown that oral iron supplementation in doses of 100-mg FeSO4·d (approximately 20 mg elemental iron) improves iron status and may improve measures of physical performance. It is recommended that female athletes most at risk of ID be screened at the beginning of and during the training season using hemoglobin and serum ferritin, and appropriate dietary and/or supplementation recommendations be made to those with compromised iron status.