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.

Trends in Iron, Zinc, and Vitamin A Status Biomarkers Among Colombian Children: Results From 2 Nationally Representative Surveys.

BACKGROUND: Micronutrient deficiencies are still highly prevalent in countries undergoing the nutrition transition, but nationally representative data documenting their burden in children are exceedingly rare. OBJECTIVE: To examine the distribution and recent trends in micronutrient status biomarkers of Colombian children. METHODS: We compared the distributions of plasma ferritin, serum zinc, and vitamin A in Colombian children between 2005 and 2010 using 2 cross-sectional, nationally representative surveys overall and by categories of sociodemographic variables. Analysis for ferritin included boys and nonpregnant girls aged 1 to 17 years. Analyses for zinc and vitamin A included children aged 1 to 4 years. RESULTS: The mean 2010 to 2005 differences in ferritin, zinc, and vitamin A were 2.5 µg/L (95% confidence interval [CI]: 1.3 to 3.7), -34.9 µg/dL (95% CI: -39.6 to -30.2), and -11.5 µg/dL (95% CI: -12.3 to -10.7), respectively, after adjusting for sociodemographic characteristics. These differences varied significantly by region of residence. In 2010, region of residence was a significant correlate for all 3 micronutrients. Other important correlates included age and maternal education for ferritin and body mass index-for-age Z score, maternal education, wealth index, food insecurity, and urbanicity for vitamin A. CONCLUSIONS: Plasma ferritin was slightly higher in 2010 than in 2005, whereas serum zinc and vitamin A were substantially lower in 2010. In the absence of obvious causal explanations, it is uncertain whether this decline represents a worsening of micronutrient status in Colombian children or an artifact due to systematic laboratory or data management errors incurred in the surveys.

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.

Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren.

OBJECTIVE: We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren. DESIGN: A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤ 3 times/month and fruits ≤ 3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥ 1 time/week and fruits ≥ 4 times/week). SETTING: Acrelândia, Western Brazilian Amazon. SUBJECTS: A total of 702 children aged 4-10 years. RESULTS: Only 5 % of children consumed F&V ≥ 5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6.3% of children were anaemic, 3.3% were stunted, 2.7% were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1.9; 95 % CI 1.0, 3.7), vitamin E insufficiency (PR=2.5; 95% CI 1.5, 4.2), vitamin D insufficiency (PR=1.5; 95% CI 1.1, 1.9) and stunting (PR=2.6; 95% CI 1.1, 6.1). CONCLUSIONS: In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.

Fatores associados à hipovitaminose A em crianças menores de cinco anos / Factors associated with hypovitaminosis A in children aged under five years

Identificar os fatores associados à hipovitaminose A em crianças da região semiárida de Alagoas. MÉTODOS: estudo transversal com amostra probabilística de 551 crianças menores de cinco anos. Os níveis séricos de retinol foram aferidos usando-se cromatografia líquida de alta eficiência. Na identificação da associação entre as variáveis independentes e hipovitaminose A (retinol <20 µg/dL) utilizou-se a razão de prevalência (RP) e respectivo IC95 por cento calculados por regressão de Poisson com ajuste robusto da variância, tanto na análise bruta quanto na ajustada. Nesta, foram incluídas todas as variáveis que naanálise bruta atingiram p<0,1. Associações foram consideradas estatisticamente significantes quando p<0,05. RESULTADOS: a prevalência de hipovitaminose A foi de 45,4 por cento e as variáveis que se mantiveram associadas após análise multivariável foram a baixa escolaridade materna (RP=1,66; IC95 por cento: 1,12-2,44), obaixo peso ao nascer (RP=1,41; IC95 por cento: 1,01-1,98) eter de 12,1 a 24 meses (RP=1,45; IC95 por cento: 1,04-2,02). CONCLUSÕES: evidencia-se a relevância epidemiológica da hipovitaminose A em crianças do semiárido alagoano. Crianças nascidas com baixo peso, com mães de baixa escolaridade e no segundo ano de vida devem receber atenção prioritária...

To identify the factors associated with hypovitaminosis A in children in the semi-arid region of the Brazilian State of Alagoas. METHODS: a cross-sectional study was carried outwith a probabilistic sample of 551 children aged under five years. Serum levels of retinol were measured using high-efficiency liquid chromatography. In order to identify any associations between the independent variables and hypovitaminosis A (retinol <20 µg/dL) the prevalence ration (PR) was used with a confidence interval of 95 percent calculated using the Poisson regression, with a robust adjustment for variance, both in the raw analysis and in theadjusted one. The latter included all the variables from the raw analysis for which p<0.1. Associations were considered statistically significant when p<0.05. RESULTS: the prevalence of hypovitaminosis A was 45.4 percent and the variables that remained associated in the multivariable analysis were low maternal schooling (PR=1.66; CI95 percent: 1.12-2.44), low birthweight (RP=1,41; IC95 percent: 1,01-1,98) and being agedbetween 12.1 and 24 months (PR=1.45; CI95 percent: 1.04-2.02). CONCLUSIONS: this reveals that hypovitaminosis A is epidemiologically significant in children in the semi-arid region of Alagoas. Low birth weight newborns in the second year of life, born to mothers with a low level of education, should therefore receive priority health care...

Effects of oral zinc supplementation on serum leptin levels in Ache males of eastern Paraguay.

Significant population variation has been demonstrated in serum leptin levels, independent of adiposity. Included within these populations, Ache males have significantly lower leptin levels compared to American subjects with comparable adiposity. The underlying causes of these differences are not understood but zinc has been shown to be an important regulator of leptin in humans and rodents. Zinc deficiency is associated with somatic wasting and significant declines in circulating leptin levels. Zinc deficiency is common in underdeveloped regions and may therefore contribute to low leptin levels among Ache men. To ascertain the potential role of zinc on Ache male leptin profiles, zinc supplementation was conducted to observe leptin responsiveness. Ache males were given daily oral zinc supplementation (50mg zinc gluconate) (n = 8) or placebo (n = 6) for 10 days. Serum leptin levels were measured on the first and last days of the treatment/placebo period. Despite supplementation exceeding triple the USDA recommended daily requirements, serum leptin levels did not change in the zinc-supplemented group (P = 0.61) and were not significantly different from males receiving placebo (P = 0.72). It is concluded that zinc is not likely to be a contributing factor in male Ache leptin profiles and that other sources of variation such as chronic energetic stresses affecting leptin production and perhaps receptor number or sensitivity should be considered.