High prevalence of folic acid and vitamin B12 deficiencies in infants, children, adolescents and pregnant women in Venezuela.

BACKGROUND: There is increased worldwide concern about the consequences of folic acid and vitamin B12 deficiencies on health, which include megaloblastic anemia, neural tube defects and cardiovascular disease. OBJECTIVE: This study intended to determine the prevalence of folic acid and vitamin B12 deficiencies in vulnerable groups in labor and poor socioeconomic strata of the Venezuelan population. METHODS: A total of 5658 serum samples were processed to determine folic acid and vitamin B12 concentrations. The study involved three surveys performed during 2001-2002 and included infants, children, adolescents and pregnant women from labor and poor socioeconomic strata of the population. The method used was a radio immunoassay designed for the simultaneous measurement of serum folic acid and vitamin B12. RESULTS: The prevalence of folic acid deficiency was higher than 30% for all groups studied, reaching 81.79% in adolescents. Vitamin B12 deficiency was 11.4% in samples collected nationwide, but there was also a similar prevalence of high serum levels. The prevalence of folic acid and vitamin B12 deficiencies in pregnant women reached 36.32 and 61.34%, respectively. CONCLUSION: This work shows that there is a high prevalence of folic acid deficiency, especially in women of reproductive age, pregnant adolescents and in the whole population studied in Vargas state. This situation requires immediate intervention as supplementation or food fortification programs.

The effect of change in pH on the solubility of iron bis-glycinate chelate and other iron compounds.

The effect of a pH change from 2 to 6 was tested on the solubility of ferrous sulfate, ferrous fumarate, iron bis-glycine chelate (Ferrochel) and sodium-iron ethylenediaminetetraacetic acid (NaFeEDTA). It was found that at pH 2 ferrous sulfate, Ferrochel and NaFeEDTA were completely soluble and only 75% of iron from ferrous fumarate was soluble. When pH was raised to 6, iron from amino acid chelate and NaFeEDTA remained completely soluble while solubility from ferrous sulfate and ferrous fumarate decreased 64 and 74%, respectively compared to the amount of iron initially soluble at pH 2. These results suggest that iron solubility from iron bis-glycine chelate and NaFeEDTA is not affected by pH changes within the ranges tested, probably because iron remained associated to the respective compounds.

Iron bioavailability in humans from breakfasts enriched with iron bis-glycine chelate, phytates and polyphenols.

This study was conducted to determine the bioavailability of iron amino acid chelate (ferrochel) added to fortify breads prepared from either precooked corn flour or white wheat flour + cheese and margarine compared with the same basal breakfast enriched with either ferrous sulfate or iron-EDTA. The inhibitory effect of phytate and polyphenols on iron absorption from ferrochel was also tested. A total of 74 subjects were studied in five experiments. Iron absorption from ferrochel was about twice the absorption from ferrous sulfate (P: < 0.05). When ferrous sulfate and ferrochel were administered together or in different meals, absorption from ferrochel was about twice the absorption from ferrous sulfate (P: < 0.05). Polyphenols present in coffee and tea inhibited iron absorption in a dose-dependent manner. American-type coffee did not modify iron absorption significantly, whereas both espresso-type coffee and tea reduced iron absorption from ferrochel by 50% (P: < 0. 05). Ferrochel partially prevented the inhibitory effect of phytates. Because of its high solubility in aqueous solutions even at pH 6, its low interactions with food and high absorption, ferrochel is a suitable compound for food fortification.

New property of vitamin A and beta-carotene on human iron absorption: effect on phytate and polyphenols as inhibitors of iron absorption.

One hundred and seventy four human subjects were studied to find out the interaction of vitamin A or beta-carotene with the inhibitors of iron absorption, from a basal breakfast containing bread from either 100 g of precooked corn flour or 100 g of white wheat flour, 50 g of cheese and 10 g of margarine. Bread was labeled with either 55Fe or 59Fe. This bread was made from commercially flours fortified with iron as ferrous fumarate and vitamins. It was noticed that the percentage of iron absorption from the breakfast prepared with precooked corn flour given alone and with different concentrations of coffee was practically the same, while the iron absorption from the breakfast prepared from wheat flour decreased from 6% when the breakfast was given alone, to less than 2% when it was given with different concentrations of coffee. The only ingredient present in precooked corn flour and not in wheat flour was vitamin A. This difference encouraged the authors to perform further experiments using precooked corn and wheat flours fortified only with ferrous fumarate. These studies demonstrated that vitamin A inhibits the effect of the polyphenol and partially inhibits the effect phytate on iron absorption. HPLC and spectrophotometric studies demonstrated an interaction between vitamin A and iron. Other experiments, which included 100 volunteers, were performed to test the effect of vitamin A and beta-carotene on iron absorption from corn, wheat and rice. The presence of vitamin A increased iron absorption up to 3 times for rice, 2.4 times for wheat and 1.8 times for corn. beta-carotene increased absorption almost 3 times for the three cereals tested, showing that both compounds were capable of preventing the inhibitory effect of phytates on iron absorption. This information suggest that vitamin A and beta-carotene form a complex with iron keeping it soluble in the intestinal lumen and preventing the inhibitory effect of phytates and polyphenols on iron absorption.

Beta-carotene and inhibitors of iron absorption modify iron uptake by Caco-2 cells.

A National fortification program instituted in Venezuela in 1993 reduced iron deficiency and anemia by half in only 1 y. The fortification mixture contained ferrous fumarate, vitamin A and other vitamins. We conducted experiments to characterize ferrous fumarate uptake by Caco-2 cells. Increasing amounts of ferrous fumarate, vitamin A, phytate, tannic acid and beta-carotene were added to incubation mixtures using a range of concentrations that included the molar ratios used in the Venezuelan fortification program. Cells were incubated for 1 h at 37 degrees C with 37 kBq (59)Fe and the compound to be evaluated. They were then rinsed, trypsinized and counted to measure uptake. Effects of ascorbic acid, days in culture and use of flasks or inserts were also evaluated. Optimal conditions for uptake experiments were pH 5.5, in the presence of ascorbic acid and at 16 d in culture. Use of flasks or inserts did not affect uptake. Vitamin A did not significantly increase iron uptake under the experimental conditions employed. However, beta-carotene (6 micromol/L) significantly increased iron uptake compared to no beta-carotene addition (114.9 +/- 6.3 and 47.2 +/- 5.9 pmol/mg cell protein, respectively). Moreover, in the presence of phytates or tannic acid, beta-carotene generally overcame the inhibitory effects of both compounds depending on their concentrations. We conclude that beta-carotene improves iron uptake and overcomes the inhibition by potent inhibitors of iron absorption. These experiments also validated the usefulness of Caco-2 cell model system to evaluate iron metabolism.

[New alternatives in the prevention of iron deficiency. Use of genetic engineering in food modification]. / Nuevas alternativas en la prevención de la deficiencia de hierro. Uso de la ingeniería genética en la modificación de alimentos.

This article reviews the possible applications of new food biotechnology techniques to introduce some compounds into plants or animals. The potential for these plant modification methods has ample applications ranging from improvements in food production and development for human consumption, production of antibodies or therapeutic proteins, inclusion of nutrients to improve nutritional value of the food to production of vaccines. It must be clear though that currently the scope and consequences of such modifications are not completely clear. There is some concern about potential secondary effects and the hypothesis of the appearance of new viruses due to recombinant genetical transformations that have not been totally rejected. However the tendency is towards considering the process as safe. Finally some evidence is presented about the possibility of introducing the capacity to synthesize vitamin A in vegetables or produce rice with high content of iron as real alternatives to fight some of the nutritional deficiencies most common worldwide.

Vitamin A and beta-carotene can improve nonheme iron absorption from rice, wheat and corn by humans.

After the rapid decrease in the prevalence of iron deficiency and iron-deficiency anemia in the Venezuelan population when a national program for fortification of flours with iron and vitamins was instituted, we studied micronutrient interactions in Venezuelan diets. One hundred human adults were fed three cereal-based diets, labelled with either 59Fe or 55Fe in six studies. Each diet contained different concentrations of vitamin A (from 0.37 to 2.78 micromol/100 g cereal) or beta-carotene (from 0.58 to 2.06 micromol/100 g cereal). The presence of vitamin A increased iron absorption up to twofold for rice, 0.8-fold for wheat and 1.4-fold for corn. beta-carotene increased absorption more than threefold for rice and 1.8-fold for wheat and corn, suggesting that both compounds prevented the inhibitory effect of phytates on iron absorption. Increasing the doses of vitamin A or beta-carotene did not further significantly increase iron absorption. We measured the iron remaining in solution performing in vitro studies in which the pH of solutions was adjusted from 2 to 6 in the presence of vitamin A or beta-carotene. All of the iron from ferrous fumarate was soluble after changing the pH of the solution containing 3.4 micromol of beta-carotene to 6.0. Vitamin A was less effective. However, 78 +/- 18% of iron was soluble in the presence of 3.3 micromol of vitamin A, whereas with no vitamin addition, only 26 +/- 13% of iron was soluble (<0.05). Vitamin A and beta-carotene may form a complex with iron, keeping it soluble in the intestinal lumen and preventing the inhibitory effect of phytates and polyphenols on iron absorption.

[Dietary iron absorption. Role of vitamin A]. / Absorción del hierro de los alimentos. Papel de la vitamina A.

Iron and vitamin A are essential nutrients for human growing, development and maintenance. Deficiency of these elements is a public health problem especially in developing countries. Recently it has been reported that vitamin A has a favorable effect on iron absorption, probably due to the formation of an iron-vitamin A chelate, that keeps iron soluble and available for absorption. This vitamin establishes a competence with other iron-binding molecules (phytates and polyphenols) that are not absorbed and render insoluble iron. Food enrichment programs with both iron and vitamin A, will provide these two essential nutrients and also an enhanced iron absorption even from diets with a high content of inhibitors.

Strategies for the prevention of iron deficiency through foods in the household.

Iron deficiency can be caused not only by diets deficient in iron but by poor absorption of available dietary iron. Extrinsically tagging foods with radioiron allows the exact measurement of iron absorbed from heme and nonheme iron foods. It has furthered the study of the effect of enhancers and inhibitors of iron absorption. As a result, we have a greater understanding of why iron deficiency and iron deficiency anemia are prevalent in populations of low socioeconomic status and of which food vehicles and iron compounds are most suitable for iron fortification.

Iron bioavailability from diets consumed by different socioeconomic strata of the Venezuelan population.

The iron bioavailability from three typical diets consumed by socioeconomic stratum IV (SES IV--working class) of the Venezuelan population was determined by the extrinsic label method. Although the iron content of the SES IV diets was about the same (250 mumol/d) as that of upper (SES I-III) and lower (SES V) socioeconomic strata diets, iron-replete subjects absorbed 43 and 61% more iron from the SES I-III diets than from the SES IV and V diets, respectively, and absorption from the main meal of the SES I-III diets was 100% greater. However, iron deficient subjects absorbed about the same amount of iron (45 mumol/d) from the SES IV diets as from the SES I-III diets. The SES I-III diets contained more iron absorption enhancers (ascorbic acid and meat protein) and less of the inhibitor phytate, than the SES IV and V diets. Iron absorption from the meals of four diets consumed at different times during the day was also measured. There was no significant difference in the percentage iron absorption from the same meals eaten in the morning after an overnight fast, and when eaten at the customary time of day.

Fortification of precooked maize flour with coarse defatted maize germ.

The possibility of improving the dietary value of precooked maize flour through fortification with 11% coarse defatted maize germ was investigated. The results of tests in humans presented here show that the total iron absorption from the fortified preparation is similar to that from the precooked maize alone, but with the advantage of being richer in several nutrients: protein (25%), zinc (61%), potassium (47%) and magnesium (112%), as well as fiber (34%). Fortification lowers (by 20%) rather than raises the cost of the flour, and may be an important contribution to the diet of those populations where maize bread is a major component of the diet.

Relationships among iron absorption, percent saturation of plasma transferrin and serum ferritin concentration in humans.

The percent absorption of iron from four dietary sources was compared in 2018 human subjects with three indicators of iron status, serum ferritin concentration, percent saturation of plasma transferrin and iron absorption from a reference dose of ferrous sulfate. Higher correlation coefficients (r) were obtained by comparing dietary iron absorption with the reference dose absorption rather than with serum ferritin; for example, r = +0.61 and r = -0.38, respectively, for a meat and vegetable meal. However, in practice serum ferritin is almost as efficient as the reference dose absorption in estimating dietary iron absorption, because the 95% confidence limits calculated from the regression equations were very similar. The values of r calculated for iron absorption versus transferrin saturation were comparable to those obtained with the other indicators only in the range of transferrin saturation values below 25%, whereas in more iron-replete subjects (transferrin saturation greater than 25%), this correlation virtually disappeared. This indicates that, although both serum ferritin and transferrin saturation reflect iron status in iron-depleted subjects, the control of iron absorption in iron-replete subjects is more dependent on iron stores as reflected in the serum ferritin concentration than the percent saturation of transferrin.

Carcinoma erisipelatoide de origen endometrial / Erysipeloides carcinoma of endometrial origin

Las metástasis erisipelatoides son raras y provienen en general de tumores primitivos de mama. Se mencionan casos aislados originados en tumores de páncreas, recto, útero, estómago, pulmón y vulva. Clínicamente se caracterizan por placas eritematosas, calientes, dolorosas que localizan en las cercanías del tumor primitivo. Desde el punto de vista histológico se observa oclusión linfática por células tumorales e infiltrado inflamatorio escaso. Se presenta el caso de una paciente de 52 años con carcinoma erisipelatoide de origen endometrial a nivel de muslos y pared abdominal con evolución fatal a los dos meses y medio de la aparición de las metástasis cutáneas, comprobándose diseminación visceral en la necropsia

Carcinoma erisipelatoide de origen endometrial / Erysipeloides carcinoma of endometrial origin

Las metástasis erisipelatoides son raras y provienen en general de tumores primitivos de mama. Se mencionan casos aislados originados en tumores de páncreas, recto, útero, estómago, pulmón y vulva. Clínicamente se caracterizan por placas eritematosas, calientes, dolorosas que localizan en las cercanías del tumor primitivo. Desde el punto de vista histológico se observa oclusión linfática por células tumorales e infiltrado inflamatorio escaso. Se presenta el caso de una paciente de 52 años con carcinoma erisipelatoide de origen endometrial a nivel de muslos y pared abdominal con evolución fatal a los dos meses y medio de la aparición de las metástasis cutáneas, comprobándose diseminación visceral en la necropsia (AU)

Metástasis en pene de adenocarcinoma colónico / Penile metastasis of colonic adenocarcinoma

Se presenta un paciente de 39 años con metástasis peniana de adenocarcinoma colorrectal. Se recalca la infrecuencia de tumores secundarios en pene pese a su rica irrigación y conexiones con órganos adyacentes, como así también la rareza de su origen colónico, y la importancia de la utilización de técnica de inmunoperoxidasas para la determinación del antígeno carcino-embrionario tisular

Metástasis en pene de adenocarcinoma colónico / Penile metastasis of colonic adenocarcinoma

Se presenta un paciente de 39 años con metástasis peniana de adenocarcinoma colorrectal. Se recalca la infrecuencia de tumores secundarios en pene pese a su rica irrigación y conexiones con órganos adyacentes, como así también la rareza de su origen colónico, y la importancia de la utilización de técnica de inmunoperoxidasas para la determinación del antígeno carcino-embrionario tisular (AU)