Low Iodine Intake May Decrease Women's Fecundity: A Population-Based Cross-Sectional Study.

Salt iodization is one of the most cost-effective strategies to eliminate iodine deficiency disorders (IDD). However, China's dismantling of salt monopoly has reduced the availability of iodized salt in the susceptible population in pregnancy, which might cause IDD and have adverse health effects on both themselves and their offspring. The aim of our study was therefore to explore the association between IDD and women's reproductive health. This is a population-based cross-sectional study conducted in 2018 in Zhejiang Province, China. A total of 1653 pregnant women participated in this study. Median urinary iodine concentration (UIC) in the population was used to assess iodine intake. Cox regression analyses were used to estimate the association between iodine intake and time to pregnancy, which was indicated with fecundability ratio (FR) and 95% confidence interval (CI). The percentage of participants with iodine deficiency who had been waiting longer than 13 months to get pregnant (20%; median UIC 119.6 µg/L) was significantly higher than those with iodine sufficiency (14%; median UIC 147.1 µg/L). A significant decrease in fecundity was observed in participants with iodine deficiency (FR, 0.820; 95% CI, 0.725-0.929) than those with iodine sufficiency. These findings indicate the importance of ongoing monitoring of iodine nutrition in women of reproductive age. Keeping a safe and optimal level of iodine nutrition during pregnancy should be emphasized.

Assessment of Micronutrient Situation among Reproductive-Age Women (15-49) and Under-Five Children in Sudan.

BACKGROUND: Micronutrient malnutrition is a form of undernutrition that causes diseases, and this is mainly due to insufficient intake of nutrients in daily foods. The status of micronutrients for people in Sudan remains scarce, and information is limited. The aim of this study is to highlight the status of micronutrients among women of reproductive age (15-49 years of age) and their children in Sudan. METHODS: This manuscript is a quantitative descriptive study, based on the data from Sudan Micronutrient Survey (SMS); it is part of the second round of the Simple Spatial Survey Method (S3M II) in Sudan (a total of 93,882 households). RESULTS: The level of consumption of vitamin A-rich foods was found to be moderate at 67.36% for reproductive-age women and low at 23.44% for under-five children. Similarly, consumption rate of vitamin B-rich foods among reproductive-age women was 62.13%, and low for children at 11.02%. The consumption of iron-, calcium-, and zinc-rich foods was moderate among women (66.75%, 47.69%, 69.72%, respectively) and very low in children (12.28%, 17.62%, 14.99%, respectively). The iron deficiency prevalence was 47% in non-pregnant women, 58% in pregnant women, and 54% in children. The prevalence of anemia was 30% in non-pregnant women, 37% in pregnant women, and 48% in children. Generally, urinary iodine concentration was inadequate in lactating and non-pregnant women as well as in pregnant women. Most indicators of micronutrients in Sudan for children and women of reproductive age were highly significant. Sudan needs more efforts to create an enabling environment through legislation, policies, and strategies to strengthen the nutrition-sensitive and specific interventions and improving status of micronutrients among women and children, focusing on food fortification, food supplements, and counseling on micronutrients intake for mothers during antenatal and postnatal services as well as raising community awareness.

Obesity and Monitoring Iodine Nutritional Status in Schoolchildren: is Body Mass Index a Factor to Consider?

Background: The frequency of overweight (OW) and obese (OB) children has increased worldwide, particularly in economically developed countries. No studies have been conducted to verify whether the increasing frequency of OW and obesity in schoolchildren may affect the evaluation of iodine nutritional status in populations. The aim of this study was to verify whether urinary iodine concentration (UIC), thyroid volume (TV), and thyroid hypoechoic pattern may be affected by body mass index (BMI) in schoolchildren. Methods: The children included in this study (aged 11-13 years) were a part of the schoolchildren recruited in the second nationwide survey (period 2015-2019) conducted in Italy to monitor by law (Atto di Intesa Stato-Regioni February 26, 2009) the nationwide iodine prophylaxis program. Specifically, 1281 schoolchildren residing in iodine-sufficient areas (IS group) and 384 children residing in a still mildly iodine-deficient area (ID group) were recruited between January and March 2015 in the first-degree secondary state schools. In all the children, spot UIC was measured, thyroid ultrasound was performed to evaluate TV, and hypoechogenicity was assessed to indirectly evaluate iodine-associated thyroid autoimmunity. Results: The frequency of OW, OB, and adequate weight (AW) children was similar in the IS and ID groups at any age. After adjusting for sex and age, the regression analysis showed lower UIC values in OB children than in AW children of the IS group (beta coefficient = -34.09 [95% confidence interval -65.3 to -2.8]), whereas no significant differences were observed in the ID group. In both the IS and ID groups, the distribution of TV in AW children was significantly shifted toward lower values in comparison to the distribution of OB children (p < 0.001 in the IS group; p = 0.012 in the ID group). Furthermore, the frequency of thyroid hypoechogenicity was higher in the ID group than in the IS group (10.9% vs. 6.6%, p = 0.005); however, in both groups, it was significantly lower in AW children than in OB children (p < 0.01). Conclusions: This study for the first time demonstrates that BMI may be a confounding factor in monitoring iodine nutritional status in schoolchildren. Since in Italy as in other Western countries the number of OW and OB children is high, BMI is a factor to consider in monitoring salt iodization programs worldwide.

Urine metabolome alterations in malnutrition and the impact of glycerol or rumen-protected choline chloride supplementation in advanced pregnant ewes.

The objective of this study was to explore the metabolic profiles of pregnancy malnutrition induced by feed restriction (FR) and the counteracting effects of glycerol and rumen-protected choline chloride supplementation. Two feeding trials were conducted. In the first experiment, twenty pregnant Hu sheep carrying multiple fetuses with a gestation period of 108 d were randomly divided into two groups. The ewes in the control (CON) group were offered 100 % of their nutritional requirements as recommended by the National Research Council (NRC), while the FR group was offered 30 % of feed intake of CON for 15 d. In the second experiment, eighteen pregnant Hu sheep were offered a feed intake comprising 30 % of the NRC-recommended nutritional requirements twice daily. The sheep were randomly divided into three groups: the FR group in the second experiment (FR2), with no supplementation, the glycerol (GLY) group, which received 40 ml of glycerol per d, and the rumen-protected choline chloride (RPC) group, which received 10 g of rumen-protected choline chloride per d for 9 d. In the first experiment, the urine metabolome of sixteen ewes showed significant difference between the CON group and FR group. Compared with the CON group, FR decreased the level of d-glucose, lactic acid, levoglucosan, α-ketoglutarate, phosphohydroxypyruvic acid, glucose 6-phosphate and the methyl donors, while increasing the level of pyruvate, fumaric acid and carnitines in urine. Both the GLY and RPC treatments counteracted some of these changes and modulated the urine metabolome in advanced pregnant ewes suffering from malnutrition.

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China.

BACKGROUND: Pregnant women, neonates, and school-age children are vulnerable to iodine deficiency. The iodine contents in the environment (drinking water and household salt for cooking) vary by geographical location in China. The aim of this study was to assess the iodine status in vulnerable groups from different geographical zones and analyze the iodine content in household salt and drinking water from these zones. METHODS: In coastal and inland regions of Zhejiang Province, China, samples of spot urine, drinking water, and household salt for cooking from both pregnant women and school-age children were determined for iodine concentration between 2017 and 2018. Thyroid-stimulating hormone (TSH) levels from neonates born between 2014 and 2015 were acquired from the Newborns Screening Information System. The iodine status of the vulnerable populations was assessed according to the criteria recommended by the World Health Organization. RESULTS: The median UIC of pregnant women was significantly lower in the coastal region (113.0 µg/L) than the inland region (134.9 µg/L; p < 0.001). The median UICs of pregnant women from these two regions were below the lower optimal iodine cutoff level of 150 µg/L. The percentage of neonates with elevated TSH (> 5 mIU/L) was significantly higher in the coastal region (15.8%) than the inland region (10.5%; p < 0.001). The percentage of neonates with elevated TSH from each region decreased within the range of mild iodine deficiency of 3-19.9%. The median UIC of the coastal school-age children was 156.0 µg/L, and the median UIC of inland children was 181.5 µg/L. Both medians fell within the recommended optimal iodine range of 100-299 µg/L. The iodine concentrations in drinking water varied from 1.0 µg/L in the inland region to 2.0 µg/L in the coastal region. The proportion of households that consumed iodized salt was lower in the coastal region (nearly 65%) than the inland region (approximately 95%). CONCLUSIONS: In these two regions with low iodine contents in drinking water, both pregnant women and neonates were iodine-deficient, although school-age children were iodine-sufficient. Urgent efforts are needed to improve the iodine status of pregnant women and neonates.

IODINE NUTRITION IN THE REPUBLIC OF ARTSAKH (NAGORNO KARABAKH).

OBJECTIVE: Iodine is a required nutrient for thyroid function. The mountainous terrain in the Republic of Artsakh (Nagorno Karabakh) in the south Caucasus suggests that it is likely to be endogenously deficient in iodine. The region is heavily dependent on neighboring Armenia for food imports including iodized salt. Since 2005, iodine is a government-sanctioned compulsory supplemental ingredient in salt in Armenia. However, there has never been a study of iodine nutrition in Artsakh. We sought to determine the level of iodine nutrition in Artsakh and the iodine content of table salt in the region. METHODS: Using a cross-sectional modified cluster model, we measured urine and salt iodine concentrations from a representative sample of children living in Artsakh. From 30 schools throughout the territory, we obtained 772 urine samples from children aged 8 to 10, and 323 samples of table salt. Repeat urine samples from 18.6% of participants were obtained. RESULTS: The median adjusted urinary iodine content was 203 µg/L (mean 206 µg/L, 95% confidence interval 202-210), within the range indicating sufficient iodine nutrition. There were small but statistically significant differences between the 8 administrative regions; however, there were no differences between individual sites. We found that 97.2% of table salt samples tested had iodine concentrations within the standard of 25 to 55 mg/kg. CONCLUSION: Among school-age children in Artsakh, iodine nutrition is adequate, and the salt is appropriately iodized. These results illustrate the remarkable success of the Armenian salt iodization program in providing sufficient but not excessive iodine to the mountainous territory of Artsakh. Abbreviation: UIC = urinary iodine concentration.

Undernutrition, Vitamin A and Iron Deficiency Are Associated with Impaired Intestinal Mucosal Permeability in Young Bangladeshi Children Assessed by Lactulose/Mannitol Test.

BACKGROUND: Lactulose/mannitol (L:M) test has been used as a non-invasive marker of intestinal mucosal -integrity and -permeability (enteropathy). We investigated the association of enteropathy with anthropometrics, micronutrient- status, and morbidity in children. METHODS: The urine and blood samples were collected from 925 children aged 6-24 months residing in Mirpur slum of Dhaka, Bangladesh during November 2009 to April 2013. L:M test and micronutrient status were assessed in the laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) following standard procedure. RESULTS: Mean±SD age of the children was 13.2±5.2 months and 47.8% were female. Urinary- lactulose recovery was 0.264±0.236, mannitol recovery was 3.423±3.952, and L:M was 0.109±0.158. An overall negative correlation (Spearman's-rho) of L:M was found with age (rs = -0.087; p = 0.004), weight-for-age (rs = -0.077; p = 0.010), weight-for-length (rs = -0.060; p = 0.034), mid-upper-arm-circumference (rs = -0.098; p = 0.001) and plasma-retinol (rs = -0.105; p = 0.002); and a positive correlation with plasma α-1-acid glycoprotein (rs = 0.066; p = 0.027). However, most of the correlations were not very strong. Approximately 44% of children had enteropathy as reflected by L:M of ≥0.09. Logistic regression analysis revealed that younger age (infancy) (adjusted odds ratio (AOR) = 1.35; p = 0.027), diarrhea (AOR = 4.00; p = 0.039) or fever (AOR = 2.18; p = 0.003) within previous three days of L:M test were the risk factors of enteropathy (L:M of ≥0.09). CONCLUSIONS: Enteropathy (high L:M) is associated with younger age, undernutrition, low vitamin A and iron status, and infection particularly diarrhea and fever.

[Iodine supply of pregnant women in the Czech Republic]. / Zásobení jodem u tehotných zen v Ceské republice.

INTRODUCTION: Iodine deficiency is a global public health problem which is particularly noticeable in pregnant or breastfeeding women and their children. Even mild iodine deficiency during pregnancy can lead to damage to the developing brain and thus affecting the fetus intelligence, his cognitive and neurological function, embryogenesis and growth. PATIENTS: In the period 2010-2015 was determined by spectrophotometry at the Institute of Endocrinology the basal urinary iodine in 532 pregnant women at the age of 32 ± 5 (18-44) years, which came from Prague, Hradec Kralove and Mlada Boleslav. It was located 349 women in the first trimester, 112 in the second trimester, and 71 women in the third trimester. In the monitoring of pregnant women in the first trimester 218 basal urine samples of women were determined by mass spectrometry with inductively coupled plasma (ICP MS) in The National Institute of Public Health (NIPH). Women came from the 6 areas in the Czech Republic. Development of urinary iodine in the general population in the period 1994-2015 was observed in patients who underwent Institute of Endocrinology and from population studies conducted in 7 regions of the Czech Republic. It performed 52 648 spectrophotometric analysis of urinary iodine in the general population. METHODS: Urinary iodine was determined by alkali melting of urine samples, followed by spectrophotometric determination of iodine in the form of iodide using the Sandell-Kolthoff reaction in the Institute of Endocrinology or determination was performed by ICP-MS in the laboratory of NIPH. RESULTS: On average, only 21.8 % of pregnant women had urinary iodine values determined by spectrophotometry higher than 150 µg/L. The results of iodine nutrition of pregnant women in the first trimester analyzed using ICP-MS are better, but even so, only 50.5 % of pregnant women have urinary iodine higher than 150 µg/L. CONCLUSION: The results of iodine nutrition of pregnant women are alarming, on average, only 30 % of the total of 750 examined women have urinary iodine values greater than 150 µg/L and therefore meet the requirements of the WHO for pregnant women. Our results, however, show that iodine deficiency is not major public health problem in the general population.Key words: ICP-MS - pregnant women - Sandell-Kolthoff reaction - urinary iodine.

[Iodine supply and iodinuria among the Czech population between the years 1995 and 2016]. / Zásobení jodem a jodurie obyvatel v Ceské republice v letech 1995-2016.

Monitoring of Ioduria and Iodine saturation are essential tools for evaluation of effectivness of measures aimed at elimination of diseases caused by iodine deficiency. Between 1995 and 2016 monitoring of ioduria was udertaken in various population groups in Czech Republic. The most recent study (2015) found only 37 % of pregnant women in optimal range of ioduria (150-300 mcg/l), in iodopenic range 27 %, while 6 % of these had severe iodopenia below 50 mcg/l. In a group of 3y old children investigated in the same year, 57 % were found to have Ioduria within the recommended range (90-299 mcg/l), 24 % had higher than recommended Ioduria (300-499 mcg/l) and 8 % excessive saturation (over 500 mcg/l). Observed group of seniors (60-75 years) satisfied criteria for maintenance of elimination of iodine deficit of International Council for Control of Iodine Deficiency Disorders (ICCIDD), the advisory institution to World Health Organisation (WHO), as only 9 % of participants were found to have Ioduria less than 100 mcg/l and no participant had Ioduria below 50 mcg/l. Main challenges are currently stabilisation of Iodine content in milk and ensuring optimal saturation of pregnant and breast feeding women with Iodine. On-going ambition of the Inter-resort Commission for Solution of Iodine Deficit (MKJD) affiliated to the National Health Institute in Prague is to reduce and eventually eliminate diseases caused by Iodine deficiency or excess. Also, to achieve Ioduria between 100-300 mcg/l in majority of population, which would indicate adequate Iodine supply, while median of Iodurias should remain below 300 mcg/l.Key words: iodine deficiency - iodine supply - ioduria.

[Urinary iodine concentration in adult patients with type 1 diabetes mellitus]. / Jodurie u nemocných s diabetes mellitus 1. typu Vztahy k vybraným parametrum charakterizujícím diabetický syndrom.

INTRODUCTION: In patients with type 1 and 2 diabetes mellitus only rare data concerning the status of iodine supplementation and impact of possible iodine deficiency is available. AIM: To get basic information about (a) state of supply with iodine in patients with type 1 diabetes mellitus (DM1T), (b) the difference from non-diabetic population, (c) possible association of iodine saturation with some clinical and laboratory features of the diabetic syndrome, including the state of thyroid gland. SUBJECTS AND METHODS: We examined 54 men and 51 women treated with DM1T in a cross-sectional study. Age: median 42 years (25th quartil 31, 75th quartil 55), DM1T duration: 18 years (13, 23), BMI: 25.9 (23.3, 29.7), HbA1c: 61 mmol/mol (51, 71), creatinine: 71 µmol/l (61, 83), micro-albuminuria 4.3 µg/min (1.9, 11.8), TSH: 1.77 mIU/l (1.12, 2.80). The iodine saturation was evaluated using iodine concentration in a sample of first morning urine. RESULTS: Urinary iodine concentration in the whole group: median 152 µg/l, 25th quartile 117 µg/l, 75th quartile 219 µg/l. More than 50 % of the urinary iodine samples fell within range of optimal saturation (100-200 µg/l), 13 % within insufficient saturation (< 100 µg/l), 35 % of the samples showed increased saturation (> 200 µg/l), in which 2/3 were men. Using multiple regression analysis we found significant positive association of urinary iodine concentration and male gender, body weight, stature, and serum creatinine. No relation between urinary iodine and clinical and laboratory features of the diabetic syndrome was found. CONCLUSIONS: Iodine saturation in examined patients with DM1T was in accordance with ICCIDD (WHO) requirements for optimal/good saturation in non-diabetic population. With respect to the chosen normal urinary iodine concentration, eg. 100, resp. 150 µg/l the features of diabetic syndrome were not different. The question whether other factors than general measures taken in the past for solution of the iodine deficiency in the Czech Republic are involved in good level of iodine saturation in patients with DM1T should be addressed in further investigations comprising larger cohorts of patients.Key words: diabetes mellitus - urinary iodine concentration.

Estimation of the Prevalence of Inadequate and Excessive Iodine Intakes in School-Age Children from the Adjusted Distribution of Urinary Iodine Concentrations from Population Surveys.

BACKGROUND: The urinary iodine concentration (UIC), a biomarker of iodine intake, is used to assess population iodine status by deriving the median UIC, but this does not quantify the percentage of individuals with habitually deficient or excess iodine intakes. Individuals with a UIC <100 µg/L or ≥300 µg/L are often incorrectly classified as having deficient or excess intakes, but this likely overestimates the true prevalence. OBJECTIVE: Our aim was to estimate the prevalence of inadequate and excess iodine intake in children (aged 4-14 y) with the distribution of spot UIC from iodine surveys. METHODS: With the use of data from national iodine studies (Kuwait, Oman, Thailand, and Qatar) and a regional study (China) in children (n = 6117) in which a repeat UIC was obtained in a subsample (n = 1060), we calculated daily iodine intake from spot UICs from the relation between body weight and 24-h urine volume and within-person variation by using the repeat UIC. We also estimated pooled external within-person proportion of total variances by region. We used within-person variance proportions to obtain the prevalence of inadequate or excess usual iodine intake by using the Estimated Average Requirement (EAR)/Tolerable Upper Intake Level (UL) cutoff method. RESULTS: Median UICs in Kuwait, Oman, China, Thailand, and Qatar were 132, 192, 199, 262, and 333 µg/L, respectively. Internal within-person variance proportions ranged from 25.0% to 80.0%, and pooled regional external estimates ranged from 40.4% to 77.5%. The prevalence of inadequate and excess intakes as defined by the adjusted EAR/UL cutoff method was ∼45-99% lower than those defined by a spot UIC <100 µg/L or ≥300 µg/L (P < 0.01). CONCLUSIONS: Applying the EAR/UL cutoff method to iodine intakes from adjusted UIC distributions is a promising approach to estimate the number of individuals with deficient or excess iodine intakes.

Urinary N-methylnicotinamide and ß-aminoisobutyric acid predict catch-up growth in undernourished Brazilian children.

Enteric infections, enteropathy and undernutrition in early childhood are preventable risk factors for child deaths, impaired neurodevelopment, and later life metabolic diseases. However, the mechanisms linking these exposures and outcomes remain to be elucidated, as do biomarkers for identifying children at risk. By examining the urinary metabolic phenotypes of nourished and undernourished children participating in a case-control study in Semi-Arid Brazil, we identified key differences with potential relevance to mechanisms, biomarkers and outcomes. Undernutrition was found to perturb several biochemical pathways, including choline and tryptophan metabolism, while also increasing the proteolytic activity of the gut microbiome. Furthermore, a metabolic adaptation was observed in the undernourished children to reduce energy expenditure, reflected by increased N-methylnicotinamide and reduced ß-aminoisobutyric acid excretion. Interestingly, accelerated catch-up growth was observed in those undernourished children displaying a more robust metabolic adaptation several months earlier. Hence, urinary N-methylnicotinamide and ß-aminoisobutyric acid represent promising biomarkers for predicting short-term growth outcomes in undernourished children and for identifying children destined for further growth shortfalls. These findings have important implications for understanding contributors to long-term sequelae of early undernutrition, including cognitive, growth, and metabolic functions.

Lipid-based nutrient supplements containing vitamins and minerals attenuate renal electrolyte loss in HIV/AIDS patients starting antiretroviral therapy: A randomized controlled trial in Zambia.

BACKGROUND & AIMS: Advanced HIV infection combined with undernutrition and antiretroviral therapy (ART) places HIV/AIDS patients at high risk of electrolyte abnormalities and increased morbidity and mortality. Here, in a sub-study of a large published randomized trial, we evaluated if nutritional supplements will help curtail renal electrolyte loss in HIV/AIDS patients starting ART. METHODS: 130 malnourished HIV-positive patients referred for ART received lipid-based nutrient supplements alone (LNS, n = 63) or together with vitamins and minerals (LNS-VM, n = 67). Serum and spot urine samples were collected and assayed for creatinine, potassium, magnesium and phosphate concentrations at baseline and after 12 weeks of ART, and fractional excretion and reabsorption were calculated using standard equations. RESULTS: Eighteen (28.6%) patients from the LNS and 16 (23.9%) from LNS-VM groups died, most during the referral interval before starting ART. Phosphate excretion at baseline, was high in both LNS (mean ± SD: 1.2 ± 0.6 mg/mg creatinine) and LNS-VM (1.1 ± 0.8 mg/mg creatinine) groups relative to normal physiological ranges. Phosphate excretion remained high in the LNS group (1.1 ± 0.41 mg/mg creatinine) but significantly decreased in the LNS-VM group (0.6 ± 0.28 mg/mg creatinine; p < 0.001) after 12 weeks of ART. This difference is probably explained by increased renal tubular reabsorption of phosphate in the LNS-VM group (88.3 ± 5.7%) compared to the LNS group (76.6 ± 8.9%). The fractional excretion of potassium (FEK) was not significantly different at baseline between the two groups (p = 0.69) but the values were above normal physiological ranges (i.e. >6.4%) reflecting renal potassium wasting. However, FEK was significantly lowered in the LNS-VM group (6.2 ± 3.4%) but not in the LNS group (12.8 ± 4.7%) after 12 weeks of ART (p < 0.001). Finally, the fractional excretion of magnesium was not significantly different between the two groups at baseline (p = 0.68) and remained unchanged within normal physiological ranges at 12 weeks of ART (p = 0.82) in both groups. CONCLUSIONS: The LNS-VM regimen appeared to offer protection against phosphate and potassium loss during HIV/AIDS treatment. This offers potential opportunities to improve care and support of poorly nourished HIV-infected patients in resource-limited settings. TRIAL REGISTRATION: www.pactr.org ID number: PACTR201106000300631.

Reduced cholesterol levels in renal membranes of undernourished rats may account for urinary Na⁺ loss.

PURPOSE: It has been demonstrated that reabsorption of Na⁺ in the thick ascending limb is reduced and the ability to concentrate urine can be compromised in undernourished individuals. Alterations in phospholipid and cholesterol content in renal membranes, leading to Na⁺ loss and the inability to concentrate urine, were investigated in undernourished rats. METHODS: Sixty-day-old male Wistar rats were utilized to evaluate (1) phospholipid and cholesterol content in the membrane fraction of whole kidneys, (2) cholesterol content and the levels of active Na⁺ transporters, (Na⁺ + K⁺)ATPase and Na⁺-ATPase, in basolateral membranes of kidney proximal tubules, and (3) functional indicators of medullary urine concentration. RESULTS: Body weight in the undernourished group was 73 % lower than in control. Undernourishment did not affect the levels of cholesterol in serum or in renal homogenates. However, membranes of whole kidneys revealed 56 and 66 % reduction in the levels of total phospholipids and cholesterol, respectively. Furthermore, cholesterol and (Na⁺ + K⁺)ATPase activity in proximal tubule membranes were reduced by 55 and 68 %, respectively. Oxidative stress remained unaltered in the kidneys of undernourished rats. In contrast, Na⁺-ATPase activity, an enzyme with all regulatory components in membrane, was increased in the proximal tubules of undernourished rats. Free water clearance and fractional Na⁺ excretion were increased by 86 and 24 %, respectively, and urinary osmolal concentration was 21 % lower in undernourished rats than controls. CONCLUSION: Life-long undernutrition reduces the levels of total phospholipids and cholesterol in membranes of renal tubular cells. This alteration in membrane integrity could diminish (Na⁺ + K⁺)ATPase activity resulting in reduced Na⁺ reabsorption and urinary concentrating ability.

Effects of periconceptional undernutrition on maternal taurine concentrations in sheep.

Taurine has an important role in numerous physiological processes, including many aspects of fetal development such as development of the pancreas and brain, and requirements increase during pregnancy. Periconceptional undernutrition has long-term effects on pancreas and brain function of the offspring, but the effects on maternal taurine economy are unknown. We, therefore, studied the effects of different periods of periconceptional undernutrition on maternal plasma and urine taurine concentrations before and during pregnancy. Four groups of singleton-bearing ewes were studied (n 10-11): controls fed ad libitum, and groups undernourished from 60 d before until mating (PreC), from 2 d before mating until 30 d after mating (PostC) or from 60 d before until 30 d after mating (Pre+PostC). In PreC ewes, plasma taurine concentrations remained at control levels for the first 30 d, and then decreased through the remainder of undernutrition, but recovered by 30 d after mating; urinary taurine excretion was low at mating, but recovered similarly. In PostC ewes, plasma taurine concentrations recovered after 2 weeks despite ongoing undernutrition; urinary taurine excretion had recovered by 30 d after mating. Pre+PostC ewes followed the same pattern as PreC for the first 60 d, but plasma taurine concentrations and urinary excretion recovered slowly, and did not reach the control levels until 97 d. These data suggest that different periods of mild periconceptional undernutrition in sheep have different but substantial effects on maternal taurine homoeostasis. These effects may be one mechanism by which maternal periconceptional undernutrition alters development of the offspring with implications for adult health.

[Proteinuria in urinary infection and acute pyelonephritis in paediatric patients: can it replace scintigraphic studies in diagnostic localisation?]. / Estudio de proteinuria en infección urinaria y pielonefritis aguda en Pediatría: ¿puede sustituir en el diagnóstico de localización al estudio gammagráfico?

UNLABELLED: ANTECEDENTS AND OBJECTIVES: The location of the urinary tract infection in children has serious implications both in therapy and prognosis. Affectation in gammagraphic studies is considered the "gold standard" for the diagnosis of acute pyelonephritis. Several studies with biomarkers have been made with controverted results. The objective of this study is to set the utility of beta2-microglobuline, alfa1-microglobuline, Cistatine C, IgG and albumin in the location of the infection, through the analysis of the relation among their urinary excretion, clinical and laboratory parameters and the renal scintigraphy findings. PATIENTS AND METHODS: Prospective observational study made in 40 patients, aged from 1 month to 11 years, after their Hospital admission with suspicion for acute pyelonephritis. Exclusion criteria were: decrease in the glomerular filtration rate, malnutrition, massive albuminuria and history or findings of nephrourologic disease. Clinical and laboratory variables were analyzed, and renal ultrasonography and scintigraphy were performed within the first seven days after admission. Once the fever dropped, the urinary creatinine-protein ratio was analyzed. After the acute process, a renal scintigraphy was performed in order to detect renal scars. The non-parametric Mann-Whitney U test has been used as the statistical hypothesis test, and Chi-square and Fisher s exact tests have been used to compare the qualitative variables. RESULTS: The glomerular filtration rate, as well as the ultrasonography scan, was normal in all patients. 45% of the children (24/80 kidneys) had scintigraphic alterations that were compatible with acute pyelonephritis, and there were not differences in proteinuria between these and those with normal scintigraphy. To greater age greater probability of scintigraphic affectation. The sensitivity and specificity of leukocytes and CRP to predict pyelonephritis were 77-65% and 94-52%, r = 0.70 (CI 95% 0.54-0.87) y 0.75 (CI 95% 0.60-0.90) respectively. An apparent relation between the maximum temperature or duration of the symptoms and the renal affectation does not exist. In all the children, the normality of urinary markers of renal function was confirmed once the acute phase had passed, even in those 3 patients with renal scars (7.5%). CONCLUSIONS: Renal scintigraphy is still being the reference pattern for the diagnosis of acute pyelonephritis in Pediatrics. The combined use of different urinary markers of renal function does not increase its sensitivity. It is necessary to do research in order to confirm the utility of new biomarkers.

Serum lipids and neopterin in urine as new biomarkers of malnutrition and inflammation in the elderly.

OBJECTIVE: Levels of serum lipids are influenced by malnutrition and inflammation. The study aimed to find the relation of the lipidogram to positive and negative markers of inflammation in geriatric patients. Attention was paid to neopterin in urine as a non-protein positive bioindicator of inflammation. METHODS: It was a local, monocentric, prospective clinical study in hospitalized patients older than 80 y. The study included 101 patients (54 women, 47 men). The average age of the entire group was 85.37 +/- 4.88 y. The dependence of the values of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triacylglycerols (TAGs) on C-reactive protein (CRP), neopterin in urine, and prealbumin was examined. RESULTS: When we compared CRP and serum lipids, we found a statistically significant negative correlation between levels of CRP and total cholesterol (P < 0.05), HDL (P < 0.01), and LDL (P < 0.05). Also the level of neopterin in urine was negatively correlated with levels of total cholesterol (P < 0.05) and HDL (P < 0.01). A statistically highly significant interaction was demonstrated between levels of prealbumin and total cholesterol (P < 0.001), HDL (P < 0.001), LDL (P < 0.001), and TAG (P < 0.05). CONCLUSION: A significant negative correlation between levels of inflammation markers (neopterin in urine, CRP) and total cholesterol and HDL was found. LDL was influenced to a lesser extent. A close relation between serum lipids and prealbumin was also demonstrated. Total cholesterol, HDL, and LDL can be considered novel biomarkers of malnutrition and inflammation in geriatric patients.

[Fluoride urinary excretion in Mexico City's preschool children]. / Excreción urinaria de flúor por preescolares en la ciudad de México.

OBJECTIVE: The assessment of urinary fluoride excretion during dental developing stage has been reported for different countries with community fluoride programs. Also, one of the factors that could influence on retention and excretion of fluoride is the deficient nutrition so the aim of this study was to determine fluoride urinary excretion by a group of preschool children with and without malnutrition. MATERIALS AND METHODS: Urinary samples from 24 hours were collected from 60 preschool children selected by convenience from Iztapalapa area of Mexico City, 30 with malnutrition and 30 with standard nutritrional status by weight for age. The samples were analyzed by fluoride especific electrode. Orion 720A. RESULTS: The average concentration of fluoride in urine from preschool children with and without malnutrition were 0.89 +/- 0.4 mg/L and 0.80 +/- 0.3 mg/L, respectively. The mean of 24 hours total fluoride excreted were 367 +/- 150 microg/24 hrs. in malnutrition children and 355 +/- 169 microg/24 hrs. for those with standard nutritional status. There were no differences statistically significant between groups. CONCLUSION: The urinary fluoride excretion for children with and without malnutrition were in the optimal range of fluoridation for the prevention of caries decay. Malnutrition was no associated with changes on fluoride orine concentration and excretion rates.

Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, lowland Nepal.

OBJECTIVE: To reveal the inter-relationship between nutritional status and arsenic toxicity. DESIGN: Cross-sectional study. SETTING: A survey in an area of lowland Nepal, where a high prevalence of both skin manifestation and malnutrition was observed. Daily arsenic intake was estimated by measuring the arsenic concentration and daily consumption of the drinking water. PARTICIPANTS: Adult villagers (248 men and 291 women). About half were classified as "underweight" (body mass index <18.5), indicating poor nutritional status. MAIN RESULTS: Arsenic intake was negatively correlated with body mass index and substantially increased the prevalence of underweight individuals, among whom the prevalence of skin manifestations was 1.65-fold higher than normal weight individuals. When exposure level was considered, the prevalence of skin symptoms was consistently higher in the underweight than in the normal group. Although enhanced susceptibility in men was apparent by the increased prevalence of cutaneous symptoms, no sex difference was observed in the prevalence of underweight individuals related with exposure to arsenic. CONCLUSIONS: The present data suggested that exposure to arsenic is associated with an increased prevalence of underweight, a serious health problem in developing countries, which in turn is associated with increased skin manifestation of arsenic poisoning.

Iodine excretion with urine and thyrotrophic hormone concentration in normal and complicated pregnancies in the industrial region of iodine deficiency.

A sufficient amount of iodine in food is necessary for the thyroid gland to produce hormones during pregnancy. The aim of our work was to evaluate iodine and thyrotrophic hormone (TSH) concentration in urine, free triiodothyronine (fT3) and thyroxine (fT4) in complicated pregnancies in Upper Silesia (region of iodine deficiency in Poland) in comparison with normal pregnancies. In both groups the iodine content in urine was evaluated by a quick test and serous concentrations of TSH, fT3 and fT4 were determined by a radioimmunological method. We found the iodine excretion with urine below 100 microg/L in 29.15% of all women under study, i.e. an insufficient supply of this element. The reduced iodine concentration in urine was found to be more often in women with imminent premature delivery. Moreover, it was found that in II trimester the concentration of iodine excreted with urine had been significantly lower comparing to the patients examined in III trimester. We found significantly higher concentration of thyrotrophic hormone in pregnant women with iodine excretion below 100 microg/L of urine. Evaluation of the iodine concentration in urine may be a simple screening test to determine the supply of this element in a diet. Moreover, our studies demonstrate the necessity for the iodine supplementation in pregnant women in the Silesian region--an area of iodine deficiency in Central Europe.