Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: findings from a national study in Iran.

OBJECTIVE: The objective of this study was to investigate the association of serum levels of 25(OH)D3 (vitamin D), retinol (vitamin A) and zinc with stunting in a large sample of Iranian toddlers. STUDY DESIGN: This was a cross-sectional study. METHODS: A total of 4261 children, aged 10-36 months, who had Iranian birth certificates were included in the present study. Weight and height were measured by experienced professionals in accordance with standard protocols. Stunting was defined as a height-for-age z-score of <-1 standard deviation (SD) based on the World Health Organization (WHO) criteria (the WHO Child Growth Standards median). Serum levels of 25(OH)D3, retinol and zinc were examined based on standard methods. RESULTS: The mean age of the study participants was 19.2 ± 8.4 months. A significant inverse association was found between serum retinol concentrations and the odds of stunting such that after controlling for potential confounders, toddlers in the highest quartile of serum retinol levels had 29% lower odds of stunting than those in the lowest quartile (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.53-0.97). Furthermore, a significant inverse association was found between serum levels of retinol and stunting in girls (OR: 0.57, 95% CI: 0.34-0.94), urban toddlers (OR: 0.66, 95% CI: 0.44-0.99) and those who did not use nutritional supplements (OR: 0.70, 95% CI: 0.52-0.95). Although serum 25(OH)D3 levels were not significantly associated with stunting in the overall study population, we found a positive association among toddlers who used nutritional supplements. No significant association was found between serum levels of zinc and stunting. CONCLUSION: We found a significant inverse association between serum levels of retinol and stunting in toddlers aged 10-36 months.

The interactive effect of improvement of vitamin D status and VDR FokI variants on oxidative stress in type 2 diabetic subjects: a randomized controlled trial.

BACKGROUND/OBJECTIVES: The objectives were to evaluate the effects of improvement of vitamin D status on biomarkers of oxidative stress (OS) in type 2 diabetic (T2D) subjects and whether vitamin D receptor (VDR)-FokI polymorphisms could modulate the response to vitamin D3 intake. SUBJECTS/METHODS: Subjects with T2D were allocated to one of the two groups to receive either plain doogh (PD; containing 150 mg calcium and no vitamin D/250 ml, n1=50) or vitamin D3-fortified doogh (FD; containing 500 IU/250 ml, n1=50) twice a day for 12 weeks. Outcomes were changes in serum 25-hydroxyvitamin D (25(OH)D), superoxide dismutase, glutathione (GSH), total antioxidant capacity (TAC) and malondialdehyde (MDA). VDR genotypes in 140 T2D subjects in FD were determined by FokI restriction enzyme. RESULTS: After 12 weeks, serum 25(OH)D increased significantly in FD (from 38.5±202.2 to 72.0±23.5, P<0.001) as compared with PD (from 38.8±22.8 to 33.4±22.8, P=0.28). Comparisons between FD and PD revealed significant differences in changes of serum MDA (-0.54±0.82 µmol/l vs. +0.17±1 µmol/l, P<0.001), GSH (+8.4±40.1 ng/l vs -13.1±29.4 ng/l, P=0.002) and TAC (+0.14±0.43 mmol/l vs. +0.02±0.45 mmol/l bovine serum albumin equivalent, P=0.03). Although there was no significant association between FokI genotypes and OS biomarkers, ff variant subgroup showed the weakest response to vitamin D. CONCLUSIONS: Improvement of vitamin D status via daily intake of FD ameliorates OS biomarkers in T2D subjects and the interactive effect of FokI genotypes cannot be ruled out.

The effect of antioxidant vitamins E and C on cognitive performance of the elderly with mild cognitive impairment in Isfahan, Iran: a double-blind, randomized, placebo-controlled trial.

PURPOSE: This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran. METHODS: About 256 elderly with mild cognitive impairment, aged 60-75 years, received 300 mg of vitamin E plus 400 mg of vitamin C or placebo daily just for 1 year. BACKGROUND: Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined. RESULTS: Antioxidant supplementation reduced malondialdehyde level (P < 0.001) and raised total antioxidant capacity (P < 0.001) and glutathione (P < 0.01). The serum 8-hydroxydeoxyguanosine remained unchanged (P < 0.4). After adjusting for the covariates effects, MMSE scores following 6- (25.88 ± 0.17) and 12-month antioxidant supplementation (26.8 ± 0.17) did not differ from control group (25.86 ± 0.18 and 26.59 ± 0.18, respectively). CONCLUSION: Despite significant improvement in most of the oxidative stress biomarkers, antioxidants' supplementation was not observed to enhance cognitive performance. A large number of kinetic and/or dynamic factors could be suspected.

Effect of n-3 supplementation on hyperactivity, oxidative stress and inflammatory mediators in children with attention-deficit-hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with difficulties in learning, behaviour and psychosocial adjustment that persist into adulthood. Decreased omega-3 fatty acids and increased inflammation or oxidative stress may contribute to neuro-developmental and psychiatric disorders such as ADHD. The aim of this study was to determine the effect of n-3 supplementation on hyperactivity, oxidative stress and inflammatory mediators in children with ADHD. METHODS: In this double blind study, 103 children (6-12 years) with ADHD receiving maintenance therapy were assigned randomly into two groups. The n-3 group received n-3 fatty acids (635 mg eicosapentaenoic acid (EPA), 195 mg docosahexaenoic acid (DHA)), and the placebo group received olive oil capsules which were visually similar to the n-3 capsules. The duration of supplementation was 8 weeks. Plasma C-reactive protein (CRP), interleukin-6 (IL-6) and the activity of glutathione reductase (GR), catalase (CAT) and superoxide dismutase (SOD) were determined before and after the intervention. Likewise the Conners' Abbreviated Questionnaires (ASQ-P) was applied. RESULTS: After 8-week intervention, a significant reduction was observed in the levels of CRP ( P < 0.05, 95% CI = 0.72-2.02) and IL-6 (P < 0.001, 95% CI = 1.93-24.33) in the n-3 group. There was also a significant increase in activity of SOD and GR (P < 0.001). A significant improvement was seen in the ASQ-P scores in the n-3 group (P < 005). CONCLUSION: Eight weeks of EPA and DHA supplementation decreased plasma inflammatory mediators and oxidative stress in the children with ADHD. These results suggest that n-3 fatty acid supplementation may offer a safe and efficacious treatment for children with ADHD.

Efficacy of flour fortification with folic acid in women of childbearing age in Iran.

BACKGROUND: Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran. OBJECTIVES: To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age. METHODS: In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15-49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B(12), folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined. RESULTS: The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 µg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 µg/day after fortification (p < 0.001). Folate intake increased by an average of 226 µg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007). CONCLUSIONS: Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.

Serum zinc levels in children and adolescents with type-1 diabetes mellitus.

BACKGROUND: There have been very few studies, with contradictory results, on the zinc status of children and adolescents with type-1 diabetes mellitus. The objective of this cross-sectional study was to determine zinc status based on the serum zinc concentration in type-1 diabetic children and adolescents and compare it with that of healthy controls. METHODS: Thirty children and adolescents with type-1 diabetes mellitus, aged 6 to 18 years, and 30 age- and sex-matched healthy controls participated in the study. Serum zinc, fasting blood sugar, hemoglobin A(1c) and serum albumin were measured by flame atomic absorption spectrophotometry, enzymatic colorimetry, ion-exchange chromatography and colorimetry using bromocresol green methods, respectively. RESULTS: No statistically significant difference was found in the mean serum zinc concentration between diabetic patients and healthy controls (111.0 ± 3.1 and 107.1 ± 3.8 mg/dl respectively, P= 0.4). No correlations were found between the serum zinc levels and fasting blood sugar, hemoglobin A(1c), or the duration of the disease in the patients. CONCLUSION: The zinc levels of diabetic children and adolescents are not noticeably different compared to those of healthy controls and are independent of glycemic control and the duration of the disease.

Regional overview of maternal and child malnutrition: trends, interventions and outcomes.

The proportions of underweight, wasted, and stunted children, as well as the infant and under-5 mortality rates, have all exhibited downward trends in the Region over the past 2 decades. This is in part attributable to maternal and child nutrition intervention programmes, especially those in which women were actively involved. Programmes which support and promote breastfeeding, such as the Baby Friendly Hospital Initiative, have also contributed to this trend, although the number of baby friendly hospitals varies considerably between countries. Available information also shows that anemia is quite common among women, many of whom also have a low weight and stature and seem to suffer from osteoporosis. In several countries of the Region a number of micronutrient deficiency control programmes are in progress, such as iron supplementation for pregnant women, fortification of flour and iodization of salt. Iodine deficiency disorders are under control in 2 countries of the Region and legislation for salt iodization is in place in 17 countries. Prevalence of severe malnutrition in children is much lower than that of milder levels, thus, promotion of the nutrition status of mildly to moderately malnourished children could lead to a sizeable reduction in child mortality.

Regional overview of maternal and child malnutrition: trends, interventions and outcomes

The proportions of underweight, wasted, and stunted children, as well as the infant and under-5 mortality rates, have all exhibited downward trends in the Region over the past 2 decades. This is in part attributable to maternal and child nutrition intervention programmes, especially those in which women were actively involved. Programmes which support and promote breastfeeding, such as the Baby Friendly Hospital Initiative, have also contributed to this trend, although the number of baby friendly hospitals varies considerably between countries. Available information also shows that anemia is quite common among women, many of whom also have a low weight and stature and seem to suffer from osteoporosis. In several countries of the Region a number of micronutrient deficiency control programmes are in progress, such as iron supplementation for pregnant women, fortification of flour and iodization of salt. Iodine deficiency disorders are under control in 2 countries of the Region and legislation for salt iodization is in place in 17 countries. Prevalence of severe malnutrition in children is much lower than that of milder levels, thus, promotion of the nutrition status of mildly to moderately malnourished children could lead to a sizeable reduction in child mortality

Association of body mass index with educational level in Iranian men and women.

OBJECTIVE: Investigation of the relationship between educational level, body mass index (BMI), waist-to-hip ratio (WHR), physical activity and parity in a group of Iranian men and women living in Tehran. DESIGN: A cross-sectional study in a group of Iranian men and women. The subjects were classified into two educational levels: low education (< or =12 y schooling) and high education (>12 y schooling); and BMI, WHR, physical activity and parity (in women) were compared in two groups in men and women, separately. SETTING: Metabolic Unit of Tehran University of Medical Sciences in Tehran. SUBJECTS: Three hundred and fifteen men aged 33.1 (22-46) and 403 women aged 27.9 (22-45). RESULTS: After controlling for age and smoking, women with a higher level of education showed a significantly lower mean BMI than less educated women (24.8+/-4.2 vs 28.3+/-4.9, P <0.01), while more educated men had a higher mean BMI than less educated men (28.4+/-4.3 vs 26.7+/-4.5). In multiple regression analysis, physical activity in leisure time in men and years of education in women were the only determinants of BMI. After controlling for BMI, WHR was not related to the level of education in either men or women. CONCLUSION: The present data indicated an educational difference in BMI for the study population. In Iranian women, like the women in developed countries, the level of education was negatively related to BMI, while in men the association was positive. SPONSORSHIP: This work was financially supported by the Institute of Public Health, Tehran University of Medical Sciences.

Iron status and socioeconomic determinants of the quantity and quality of dietary iron in a group of rural Iranian women.

Iron intake and status were investigated in 471 mothers (age range: 16-53 years) from rural areas in Khorramabad, Islamic Republic of Iran. Although average total iron intake was acceptable, only 6.4% of women derived at least 4% of their total intake from animal iron. Average energy and protein intakes were inadequate. Low iron status was seen in 8.2%-28.7%, depending on the parameter used, with 28.3% experiencing iron-deficiency anaemia. Significantly higher animal iron intakes were found in literate or employed women, or those of family size fewer than six people. Increasing employment opportunities, income levels and literacy rates for women will result in better iron intake and status and should receive particular attention in national planning.

Iron status and socioeconomic determinants of the quantity and quality of dietary iron in a group of rural Iranian women

Iron intake and status were investigated in 471 mothers [age range: 16-53 years] from rural areas in Khorramabad, Islamic Republic of Iran. Although average total iron intake was acceptable, only 6.4% of women derived at least 4% of their total intake from animal iron. Average energy and protein intakes were inadequate. Low iron status was seen in 8.2%-28.7%, depending on the parameter used, with 28.3% experiencing iron-deficiency anaemia. Significantly higher animal iron intakes were found in literate or employed women, or those of family size fewer than six people. Increasing employment opportunities, income levels and literacy rates for women will result in better iron intake and status and should receive particular attention in national planning

Evaluation of rural primary health care services in Iran: report on vital statistics in West Azarbaijan.

Iranian indigenous front-line health workers (FLHW) were locally trained to deliver environmental and primary health care services to mothers and children. After two years, there was a significant decline in crude birth and death rates and in infant and 1-5 year mortality rates in the test area as compared to a control area. One out of four encounters was referred to a health center physician, the remainder being handled by the FLHWs themselves. (Am J Public Health 1981;71:739-742.)

Energy balances in obese mice.

According to most existing theories, the regulation of energy balance is achieved by control of energy intake. This study was undertaken to find out whether there was control of energy output as well. Food intake, energy balance and the feed efficiency of weanling female mice made obese with injections of gold-thioglucose and monosodium glutamate indicate that the obesity is primarly due to an increased energetic efficiency, and suggest that the hypothalamus plays a role in controlling energy output. In the case of treatment with MSG, a relative obesity was observed, i.e. an increase in body fat without any change in body weight. This indicates that the CNS centres for the regulation of body weight and body fat are probably not the same. It is suggested that MSG obesity will be a suitable model for comparative studies of body weight and the regulation of fat content. It is concluded that chemically induced obesity is due more to a lower metabolic rate than to an elevated food intake.