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2.
Molecules ; 26(8)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33917113

RESUMO

Active women or women of reproductive age (15-49 years old) have a high risk of suffering from anaemia. Anaemia is not solely caused by iron deficiency, however, the approaches to improve iron status in both cases are greatly related. Improving the iron status of active women can be done by dietary intervention with functional food. This review aims to provide insights about the functional food role to increase iron absorption in active women and the potency of pulse probiotic superfood development in dry matrices. Results showed that the beneficial effect of iron status is significantly improved by the synergic work between probiotic and prebiotic. Furthermore, chickpeas and lentils are good sources of prebiotic and the consumption of pulses are related with 21st century people's intention to eat healthy food. There are wide possibilities to develop functional food products incorporated with probiotics to improve iron status in active woman.


Assuntos
Alimento Funcional , Ferro/metabolismo , Probióticos , Adolescente , Adulto , Fatores Etários , Anemia/epidemiologia , Anemia/etiologia , Anemia/metabolismo , Anemia/prevenção & controle , Biomarcadores , Dieta , Comportamento Alimentar , Feminino , Humanos , Ferro/sangue , Pessoa de Meia-Idade , Avaliação Nutricional , Adulto Jovem
3.
Nutrients ; 13(4)2021 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-33920345

RESUMO

Numerous disorders can alter the physiological mechanisms that guarantee proper digestion and absorption of nutrients (macro- and micronutrients), leading to a wide variety of symptoms and nutritional consequences. Malabsorption can be caused by many diseases of the small intestine, as well as by diseases of the pancreas, liver, biliary tract, and stomach. This article provides an overview of pathophysiologic mechanisms that lead to symptoms or complications of maldigestion (defined as the defective intraluminal hydrolysis of nutrients) or malabsorption (defined as defective mucosal absorption), as well as its clinical consequences, including both gastrointestinal symptoms and extraintestinal manifestations and/or laboratory abnormalities. The normal uptake of nutrients, vitamins, and minerals by the gastrointestinal tract (GI) requires several steps, each of which can be compromised in disease. This article will first describe the mechanisms that lead to poor assimilation of nutrients, and secondly discuss the symptoms and nutritional consequences of each specific disorder. The clinician must be aware that many malabsorptive disorders are manifested by subtle disorders, even without gastrointestinal symptoms (for example, anemia, osteoporosis, or infertility in celiac disease), so the index of suspicion must be high to recognize the underlying diseases in time.


Assuntos
Mucosa Intestinal/fisiopatologia , Intestino Grosso/fisiopatologia , Intestino Delgado/fisiopatologia , Síndromes de Malabsorção/fisiopatologia , Nutrientes/metabolismo , Anemia/diagnóstico , Anemia/etiologia , Anemia/prevenção & controle , Humanos , Infertilidade/diagnóstico , Infertilidade/etiologia , Infertilidade/prevenção & controle , Absorção Intestinal/fisiologia , Mucosa Intestinal/diagnóstico por imagem , Intestino Grosso/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/terapia , Osteoporose/diagnóstico , Osteoporose/etiologia , Osteoporose/prevenção & controle
5.
Niger Postgrad Med J ; 28(1): 44-50, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33642324

RESUMO

Context: Adolescents constitutes 21% of total Indian population. Iron deficiency anaemia has remained as a major nutritional problem amongst adolescents. To overcome this problem, Government of India started weekly iron-folic acid supplementation (WIFS) in 2012. Aims: Amongst adolescents in selected schools of urban Puducherry, to determine the prevalence of anaemia, proportion of those compliant to WIFS and to assess the sociodemographic and clinical factors associated with anaemia and compliance to WIFS. Subjects and Methods: A cross-sectional analytical study was conducted amongst school-going adolescents (10-18 years) in selected schools of Urban Puducherry. Data were collected using semi-structured, self-administered and pretested questionnaire. Haemoglobin estimation was done using a digital haemoglobinometer. Details regarding intake of iron and albendazole tablets were recorded. The anaemia status was evaluated as per World Health Organization guidelines. Results: The prevalence of anaemia was found to be 62.7% (95% confidence interval [CI]: 58.2-67.0). Proportion having mild, moderate and severe anaemia were 27.3%, 32.5% and 2.8% respectively. The proportion of adolescents compliant to WIFS was 67.7%. Late adolescents were significantly more associated with anaemia (adjusted prevalence ratio [aPR]: 1.7 95% CI: 1.0-3.0) as compared to early adolescents. Males were more compliant to iron-folic acid (IFA) tablets (aPR 1.4 95% CI: 1.0-1.8). Conclusions: More than half of adolescents were anaemic. This study emphasises on the fact that stricter supervision by teachers will result in better compliance to WIFS program. Strategies to improve WIFS compliance, imparting knowledge regarding IFA intake and involvement of school teachers will help to tackle anaemia amongst adolescents.


Assuntos
Anemia , Adolescente , Anemia/epidemiologia , Anemia/prevenção & controle , Estudos Transversais , Suplementos Nutricionais , Feminino , Ácido Fólico , Hemoglobinas , Humanos , Índia/epidemiologia , Ferro , Masculino , Nigéria , Prevalência , Instituições Acadêmicas
6.
Eur J Pharmacol ; 897: 173958, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33610598

RESUMO

Hepcidin is the only known hormone negatively regulates systemic iron availability, its excess contributes to anemia of chronic disease (ACD).Heparin has been shown to be an efficient hepcidin inhibitor both in vitro and in vivo, but its powerful anticoagulant activity limits this therapeutic application. To this end, heparin-iron complex was prepared by electrostatic interaction and/or coordination between heparin and dihydroxy iron solution ([Fe(OH)2]+) under the condition of ultrasonic assisted. We assessed the anticoagulant activity of heparin-iron in vitro and vivo by sheep plasma, chromogenic substrate method and tail-bleeding in mice, respectively. Anti-hepcidin effect of heparin-iron was detected in HepG2 cell and LPS induced acute inflammation mice by qRT-PCR and ELISA. Turpentine-induced anemia mice were established to evaluate the effect of heparin-iron in ACD. Mice were treated with heparin-iron for 4 weeks. The results indicated that heparin-iron has significantly reduced anticoagulant activity in vitro and in vivo, strongly decreases hepcidin mRNA and IL-6 induced high level of secreted hepcidin in HepG2 cell. Heparin-iron was also found to cause a reduction on hepcidin expression through BMP/SMAD and JAK/STAT3 pathways in LPS induced acute inflammation model in mice. In ACD mice, heparin-iron could lower elevated serum hepcidin and improve anemia. These findings demonstrated low anticoagulant heparin-iron has potential applications for the treatment of ACD with high hepcidin levels.


Assuntos
Anemia/prevenção & controle , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Heparina/farmacologia , Hepcidinas/antagonistas & inibidores , Compostos de Ferro/farmacologia , Fígado/efeitos dos fármacos , Anemia/etiologia , Anemia/metabolismo , Animais , Proteínas Morfogenéticas Ósseas/metabolismo , Modelos Animais de Doenças , Feminino , Células Hep G2 , Heparina/análogos & derivados , Hepcidinas/genética , Hepcidinas/metabolismo , Humanos , Inflamação/complicações , Compostos de Ferro/análogos & derivados , Janus Quinases/metabolismo , Fígado/metabolismo , Camundongos Endogâmicos BALB C , Fator de Transcrição STAT3/metabolismo , Carneiro Doméstico , Transdução de Sinais , Proteínas Smad/metabolismo , Terebintina
7.
Blood ; 137(5): 610-623, 2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33538795

RESUMO

This study was conducted to determine the dosage effect of c-Myc on hematopoiesis and its distinct role in mediating the Wnt/ß-catenin pathway in hematopoietic stem cell (HSC) and bone marrow niche cells. c-Myc haploinsufficiency led to ineffective hematopoiesis by inhibiting HSC self-renewal and quiescence and by promoting apoptosis. We have identified Nr4a1, Nr4a2, and Jmjd3, which are critical for the maintenance of HSC functions, as previously unrecognized downstream targets of c-Myc in HSCs. c-Myc directly binds to the promoter regions of Nr4a1, Nr4a2, and Jmjd3 and regulates their expression. Our results revealed that Nr4a1 and Nr4a2 mediates the function of c-Myc in regulating HSC quiescence, whereas all 3 genes contribute to the function of c-Myc in the maintenance of HSC survival. Adenomatous polyposis coli (Apc) is a negative regulator of the Wnt/ß-catenin pathway. We have provided the first evidence that Apc haploinsufficiency induces a blockage of erythroid lineage differentiation through promoting secretion of IL6 in bone marrow endothelial cells. We found that c-Myc haploinsufficiency failed to rescue defective function of Apc-deficient HSCs in vivo but it was sufficient to prevent the development of severe anemia in Apc-heterozygous mice and to significantly prolong the survival of those mice. Furthermore, we showed that c-Myc-mediated Apc loss induced IL6 secretion in endothelial cells, and c-Myc haploinsufficiency reversed the negative effect of Apc-deficient endothelial cells on erythroid cell differentiation. Our studies indicate that c-Myc has a context-dependent role in mediating the function of Apc in hematopoiesis.


Assuntos
Genes myc , Hematopoese/fisiologia , Proteínas Proto-Oncogênicas c-myb/fisiologia , Proteína da Polipose Adenomatosa do Colo/fisiologia , Anemia/genética , Anemia/prevenção & controle , Animais , Apoptose/fisiologia , Transplante de Medula Óssea , Autorrenovação Celular/fisiologia , Ensaio de Unidades Formadoras de Colônias , Células Endoteliais/patologia , Células Eritroides/patologia , Deleção de Genes , Genes APC , Haploinsuficiência , Hematopoese/genética , Células-Tronco Hematopoéticas , Interleucina-6/fisiologia , Histona Desmetilases com o Domínio Jumonji/fisiologia , Camundongos Mutantes , Membro 1 do Grupo A da Subfamília 4 de Receptores Nucleares/fisiologia , Membro 2 do Grupo A da Subfamília 4 de Receptores Nucleares/fisiologia , Poli I-C/farmacologia , Quimera por Radiação , Via de Sinalização Wnt/fisiologia
8.
Curr Opin Anaesthesiol ; 34(2): 125-130, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33577206

RESUMO

PURPOSE OF REVIEW: More than 8.5 million people in the world observe the Jehovah's Witness faith, and require unique consideration for perioperative blood management as they generally refuse transfusion of blood and blood products. This review addresses a collaborative approach to each patient throughout the perioperative arena. The principles of this approach include optimization of hemoglobin levels preoperatively, attention to blood-salvaging methods intraoperatively, and minimization of blood draws postoperatively. In addition, we review the technologies currently in development as transfusion alternatives, including hemoglobin-based oxygen carriers. RECENT FINDINGS: Progress has been made recently in the field of synthetic blood alternatives and hemoglobin-based oxygen carriers, which may lead to improved outcomes in this patient population. SUMMARY: Utilization of multiple prevention and mitigation strategies to optimize oxygen supply and decrease oxygen demand will lead to decreased incidence of critical anemia and subsequent improved mortality in Jehovah's Witness patients.


Assuntos
Transfusão de Sangue , Testemunhas de Jeová , Anemia/prevenção & controle , Hemoglobinas , Humanos
9.
Adv Nutr ; 12(2): 334-342, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33439978

RESUMO

Weekly iron and folic acid supplementation (WIFAS) is among the 8 key effective actions for improving adolescent nutrition included by the WHO in the 2018 guidelines. However, at present WIFAS in the WHO-recommended formulation is not included in the Model Essential Medicines List (MEML), limiting the potential for countries to import, produce, and prioritize this formulation as part of their national supply management and procurement plans for medicines. The WHO WIFAS guideline presents evidence that the formulation reduces anemia, but not that folic acid reduces neural tube defects (NTDs), because sufficient evidence was unavailable at the time of the last review. Recently, a 3-arm, parallel-group, randomized, double-blind, placebo-controlled folic acid efficacy trial on WIFAS was conducted to address this evidence gap. The study population included 331 women (18-45 y old), randomly assigned to 3 treatment groups, including a supplement with 60 mg Fe as ferrous fumarate and either 0 mg, 0.4 mg, or 2.8 mg of folic acid, to be consumed once weekly for 16 wk, followed by a 4-wk washout period. In this article we critically review how the outcomes of this folic acid efficacy trial, and how the evidence generated, could potentially be used to inform WHO WIFAS guidelines for the potential inclusion of this formulation on the MEML, and how this, in turn, may affect product availability. If the new evidence on weekly folic acid is assessed as adequately reducing the risk of NTDs, a guideline revision could be warranted and WIFAS could be presented to the MEML for the dual benefits of anemia reduction and NTD prevention. This inclusion could enable acceleration of implementing policies and programs to contribute to global anemia and NTD reduction efforts.


Assuntos
Anemia , Defeitos do Tubo Neural , Adolescente , Anemia/tratamento farmacológico , Anemia/prevenção & controle , Suplementos Nutricionais , Feminino , Ácido Fólico , Humanos , Ferro , Defeitos do Tubo Neural/tratamento farmacológico , Defeitos do Tubo Neural/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Ecotoxicol Environ Saf ; 208: 111620, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33396140

RESUMO

Di(2-ethylhexyl) adipate (DEHA) is a widely used plasticizer and prevalent environmental contaminant. In this study, DEHA concentrations in the milk, cheese, and butter samples wrapped with food-grade commercial polyethylene films and stored at 4 °C for 30 days were detected using gas chromatographic analysis. Also, the effects of exposure to a high dose of DEHA for a long duration on the liver, brain, and heart of Wistar rats were assessed. Besides, the possible beneficial effect of Peganum harmala oil (PGO), in relieving DEHA induced adverse effects was explored. For this purpose, four groups (8 rats/group) were orally given physiological saline, PGO (320 mg/kg bwt), DEHA (2000 mg/kg bwt), or PGO + DEHA for 60 days. The results revealed that the DEHA concentrations in the tested dairy products were ordered as follows: (butter > cheese > milk). Notably, the detected levels in butter were higher than the specific migration limit in foods. DEHA induced a significant increase in the serum levels of glucose, alanine transaminase, aspartate transaminase, acetylcholine esterase, creatine kinase-myocardium bound, malondialdehyde, tumor necrosis factor-α, and interleukin-1ß. But, significant hypoproteinemia, hypoalbuminemia, hypoglobulinemia, and hypocholesterolemia were evident following DEHA exposure. A significant reduction in the serum level of superoxide dismutase, reduced glutathione, and brain-derived neurotrophic factor was recorded. Besides, a significant downregulation in hepatic CYP2E1, brain glial fibrillary acidic protein, and cardiac troponin I gene expression was noticed. Moreover, DEHA exposure induced a significant decrease in Bcl-2 immunolabeling, but Caspase-3 immunoexpression was increased. On the contrary, PGO significantly recused DEHA injurious impacts. Therefore, PGO could represent a promising agent for preventing DEHA-induced hepatotoxicity, neurotoxicity, and cardiotoxicity.


Assuntos
Adipatos/toxicidade , Encéfalo/efeitos dos fármacos , Coração/efeitos dos fármacos , Fígado/efeitos dos fármacos , Peganum/química , Óleos Vegetais/farmacologia , Plastificantes/toxicidade , Adipatos/análise , Anemia/sangue , Anemia/prevenção & controle , Animais , Glicemia/análise , Encéfalo/metabolismo , Encéfalo/patologia , Laticínios/análise , Embalagem de Alimentos , Fígado/metabolismo , Fígado/patologia , Testes de Função Hepática , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Estresse Oxidativo/efeitos dos fármacos , Plastificantes/análise , Ratos , Ratos Wistar , Fatores de Tempo
11.
Life Sci ; 269: 119075, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33465391

RESUMO

BACKGROUND: Erythropoietin (EPO) is an essential growth factor for erythroid cells and is mainly secreted from the kidneys and subsidiarily from the livers of adult mammals in an anemia/hypoxia-inducible manner. AIM AND METHOD: To elucidate the regulatory mechanisms of stress-inducible and cell type-specific Epo gene transcription, the rate-limiting step of EPO production, we investigated the sufficiency of a 180-kb genomic fragment flanking the mouse Epo gene locus for recapitulating endogenous Epo gene function by a transgene complementation strategy. KEY FINDINGS: While Epo gene-deficient mice exhibited lethal anemia in utero with defects in erythroblast proliferation and maturation, Epo-knockout mice integrated with the 180-kb Epo transgene showed normal erythropoiesis throughout life. In the transgene-rescued mice, liver-specific deletion of the transgene by the Cre-loxP recombination system caused neonatal anemia with erythropoietic defects in the liver but not in the spleen, indicating the essential function of hepatic EPO on normal erythropoiesis in the liver, which is the major erythropoietic site in late embryonic and neonatal stages. SIGNIFICANCE: These results demonstrate that the 180 kb Epo gene flanking region contains the fully functional Epo gene unit and that EPO from the liver dominantly stimulates hepatic erythropoiesis but contributes less to erythropoiesis in other organs.


Assuntos
Anemia/prevenção & controle , Eritropoese , Eritropoetina/metabolismo , Fígado/metabolismo , Sequências Reguladoras de Ácido Nucleico , Transgenes/fisiologia , Anemia/genética , Anemia/patologia , Animais , Eritropoetina/genética , Camundongos , Camundongos Knockout , Camundongos Transgênicos
12.
J Ethnopharmacol ; 266: 113448, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33022342

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Silkworm faeces are the dry faeces of the insect Bombyx mori (Linnaeus) and have historically been used in traditional Chinese medicine to treat blood deficiency and rheumatic pain. Silkworm faeces extract (SFE) is derived from silkworm faeces. AIM OF THE STUDY: Clinical observations of patients in the Department of Nephrology have shown that SFE effectively improves renal anaemia. However, the molecular mechanism remains unclear. This article mainly explores the regulatory effects of SFE on erythropoietin (EPO) and hepcidin to identify the molecular mechanism of SFE. MATERIALS AND METHODS: A rat model of renal anaemia was established by feeding rats food containing 0.75% adenine. SFE was orally administered to the rats, while recombinant human erythropoietin (rhEPO) was used as a positive control drug. Haematological parameters and inflammation levels were compared between rats from each group, and pathological kidney sections from each rat were observed. The serum EPO and hepcidin levels were detected using enzyme-linked immunosorbent assay (ELISA) kits, while Western blot analyses were performed to detect the levels of proteins involved in the EPO-related hypoxia-inducible factor 2α (HIF-2α)/prolyl hydroxylase 2 (PHD2) signalling pathway and hepcidin-related BMP6/SMAD4 and interleukin-6 (IL-6)/STAT3 signalling pathways. RESULTS: SFE significantly ameliorated haematological parameters, renal function, and inflammation levels in the rats. A mechanistic study showed that SFE promoted EPO expression by upregulating HIF-2α expression and inhibiting the expression of NF-κB and GATA2 both in vivo and in vitro. In particular, SFE inhibited PHD2 expression, resulting in a decrease in the enzymatic reaction of HIF-2α to increase EPO expression. Furthermore, SFE inhibited hepcidin expression by blocking the BMP6/SMAD4 and IL-6/STAT3 pathways. CONCLUSIONS: SFE regulated iron metabolism by inhibiting hepcidin and simultaneously promoted EPO synthesis to improve renal anaemia in rats.


Assuntos
Anemia/prevenção & controle , Bombyx/metabolismo , Fezes/química , Nefropatias/complicações , Adenina , Anemia/etiologia , Animais , Modelos Animais de Doenças , Eritropoetina/administração & dosagem , Eritropoetina/metabolismo , Hepcidinas/antagonistas & inibidores , Hepcidinas/metabolismo , Humanos , Ferro/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley
13.
Nutrients ; 12(12)2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33339415

RESUMO

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project's effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2-5.5) and 2.79 (95% CI: 1.7-4.4) for DDS and 3.49 (95% CI: 2.2-5.5) and 2.74 (95% CI: 1.8-5.2) for MAD in the 9-11 month and 16-18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age.


Assuntos
Terapia Comportamental/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Desenvolvimento Infantil/fisiologia , Dieta Saudável/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Adulto , Anemia/epidemiologia , Anemia/prevenção & controle , Antropometria , Terapia Comportamental/métodos , Estatura , Peso Corporal , Análise por Conglomerados , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Masculino , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Prevalência
14.
J Pregnancy ; 2020: 2139892, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802508

RESUMO

Background: Anaemia in pregnancy is a major problem in both developed and developing countries. The commonest source of anaemia is nutritional deficiency of iron with evidence suggesting that up to 90% of maternal anaemia may be due to inadequate consumption of dietary iron; however, there are other causes which include worm infestation, HIV infection, and genetic disorders. There are some implemented approaches in Ghana including education and awareness creation, nutritional supplements, and control and prevention of parasitic infections among others to prevent and control anaemia in pregnancy. This study assessed pregnant women adherence to Ghana's anaemia prevention strategies being implemented in the Juaboso District. Method: A descriptive cross-sectional data on knowledge of and adherence to anaemia prevention strategies among pregnant women was collected. Pearson's chi-square and logistic regression models were used to assessed associations between predictor and outcome variables. A p value <0.05 was considered as statistically significant. Findings. About 13.5% of the pregnant women had high knowledge on anaemia, while 58.4% and 28.1% had moderate and low knowledge, respectively. Less than half (39.1%) of the women adhered to anaemia prevention strategies. There were significant associations between knowledge of anaemia and where pregnant woman resides in the district (AOR: 2.04, 95% CI: 2.16-9.83, p = 0.003), woman's educational (AOR: 10.43, 95% CI: 6.14-51.63, p = 0.002), and occupational status (AOR: 15.14, 95% CI: 13.57-18.43, p < 0.001). Again, there were significant associations between adherence to anaemia prevention strategies and the woman's ethnicity (AOR: 0.61, 95% CI: 0.04-0.92, p = 0.001) and her knowledge of anaemia (AOR: 3.88, 95% CI: 1.32-7.93, p = 0.001). Conclusions: Pregnant women's knowledge of anaemia and adherence to anaemia prevention strategies are not encouraging. However, anaemia in pregnancy and its consequences could be devastating to all stakeholders if actions are not taken to reduce the phenomenon. Therefore, we recommend that more education and sensitisation programs including good nutritional practices in the diet of pregnant women be promoted to increase awareness and adherence to anaemia prevention strategies among pregnant women in the Juaboso District.


Assuntos
Anemia/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente , Complicações Hematológicas na Gravidez/prevenção & controle , Gravidez/psicologia , Fenômenos Fisiológicos da Nutrição Pré-Natal , Anemia/etiologia , Feminino , Gana , Instalações de Saúde , Humanos , Educação de Pacientes como Assunto , Complicações Hematológicas na Gravidez/etiologia , Cuidado Pré-Natal
15.
Am J Clin Nutr ; 112(3): 683-694, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32710737

RESUMO

BACKGROUND: Small-quantity lipid-based nutrient supplements (SQ-LNS) are efficacious in controlled settings; data are scarce on the effectiveness utilizing health care delivery platforms. OBJECTIVE: We evaluated the impact of an infant young child feeding (IYCF)-SQ-LNS intervention on anemia and growth in children aged 6-18 mo in the Democratic Republic of Congo following a quasi-experimental effectiveness design. METHODS: An intervention health zone (HZ) received enhanced IYCF including improved counseling on IYCF during pregnancy until 12 mo after birth and daily use of SQ-LNS for infants 6-12 mo; the control HZ received the standard IYCF package. We analyzed data from 2995 children, collected in repeated cross-sectional surveys. We used adjusted difference-in-difference analyses to calculate changes in anemia, iron and vitamin A deficiencies, stunting, wasting, and underweight. RESULTS: Of mothers, 70.5% received SQ-LNS at least once in the intervention HZ, with 99.6% of their children consuming SQ-LNS at least once. The mean number of batches of SQ-LNS (28 sachets per batch, 6 batches total) received was 2.3 ± 0.8 (i.e., 64.4 ± 22.4 d of SQ-LNS). The enhanced program was associated with an 11.0% point (95% CI: -18.1, -3.8; P < 0.01) adjusted relative reduction in anemia prevalence and a mean +0.26-g/dL (95% CI: 0.04, 0.48; P = 0.02) increase in hemoglobin but no effect on anthropometry or iron or vitamin A deficiencies. At endline in the intervention HZ, children aged 8-13 mo who received ≥3 monthly SQ-LNS batch distributions had higher anthropometry z scores [length-for-age z score (LAZ): +0.40, P = 0.04; weight-for-age z score (WAZ): +0.37, P = 0.04] and hemoglobin (+0.65 g/dL, P = 0.007) and a lower adjusted prevalence difference of stunting (-16.7%, P = 0.03) compared with those who received none. CONCLUSIONS: The enhanced IYCF-SQ-LNS intervention using the existing health care delivery platform was associated with a reduction in prevalence of anemia and improvement in mean hemoglobin. At endline among the subpopulation receiving ≥3 mo of SQ-LNS, their LAZ, WAZ, and hemoglobin improved. Future research could explore contextual tools to maximize coverage and intake adherence in programs using SQ-LNS.


Assuntos
Anemia/epidemiologia , Anemia/prevenção & controle , Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Lipídeos/química , República Democrática do Congo/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Lipídeos/administração & dosagem
16.
Lancet Glob Health ; 8(8): e1071-e1080, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710863

RESUMO

BACKGROUND: Universal home fortification of complementary foods with iron-containing multiple micronutrient powders (MNPs) is a key intervention to prevent anaemia in young children in low-income and middle-income countries. However, evidence that MNPs might promote infection raises uncertainty about whether MNPs give net health benefits and are cost-effective. We aimed to determined country-specific net benefit or harm and cost-effectiveness of universal provision of MNPs to children aged 6 months. METHODS: We developed a microsimulation model to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months, compared with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Programme and health-care costs were modelled to determine cost per DALY averted (US$). Additionally, we explored the effects of reduced MNP coverage in a sensitivity analysis. FINDINGS: 78 countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, and we simulated 5 million children per country. 6 months of universal distribution of daily MNPs, assuming 100% coverage, produced a net benefit (DALYs averted) in 54 countries (24 in Africa, 19 in Asia and the Middle East, 11 in Latin America) and net harm in 24 countries (22 in Africa, one in Asia, and one in Latin America). MNP intervention provided a benefit on YLDs associated with anaemia, but these gains were attenuated and sometimes reversed by increases in YLLs associated with malaria and diarrhoea, reducing the benefits seen for DALYs. In the 54 countries where MNP provision was beneficial, the median benefit was 28·1 DALYs averted per 10 000 children receiving MNPs (IQR 20·6-40·4), and median cost per DALY averted was $3576 (IQR 2474-4918). DALY effects positively correlated with moderate and severe anaemia prevalence in Asia, the Middle East, and Latin America, but correlated inversely in Africa. Suboptimal coverage markedly reduced DALYs averted and cost-effectiveness. INTERPRETATION: Net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest, and are ameliorated when coverage of the intervention is poor. Our data provide country-specific guidance to national policy makers. FUNDING: International Union of Nutrition Sciences.


Assuntos
Anemia/prevenção & controle , Países em Desenvolvimento , Suplementos Nutricionais , Ferro na Dieta/economia , Ferro na Dieta/uso terapêutico , Micronutrientes/economia , Micronutrientes/uso terapêutico , Análise Custo-Benefício , Suplementos Nutricionais/economia , Humanos , Lactente , Pós , Resultado do Tratamento
17.
s.l; Anaesthesia Critical Care & Pain Medicine; July 23, 2020. 10 p.
Não convencional em Inglês | BIGG - guias GRADE | ID: biblio-1117192

RESUMO

Anemia is very common in critical care patients, on admission (affecting about two thirds ofpatients), but also during and after their stay, due to repeated blood loss, the effects of inflammation onerythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated withseverity of illness and length of stay.Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT,evaluated three fields: (1) anaemia prevention, (2) transfusion strategies and (3) non-transfusiontreatment of anaemia. Population, Intervention, Comparison, and Outcome (PICO) questions werereviewed and updated as needed, and evidence profiles were generated. Analysis of the literature andformulation of recommendations were then conducted according to the GRADE1methodology.Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemiain adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope ofthese recommendations. After two rounds of discussion and various amendments, a strong consensuswas reached for ten recommendations. Three of these recommendations had a high level of evidence(GRADE 1) and four had a low level of evidence (GRADE 2). No GRADE recommendation could be providedfor two questions in the absence of strong consensus.Conclusions: The experts reached a substantial consensus for several strong recommendations foroptimal patient management. The experts recommended phlebotomy reduction strategies, restrictivered blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless ofstorage time, treatment of anemic patients with erythropoietin, especially after trauma, in the absence ofcontraindications and avoidance of iron therapy (except in the context of erythropoietin therapy). C2020 The Author(s). Published by Elsevier Masson SAS on behalf of Socie ́te ́franc ̧aise d'anesthe ́sie et dere ́animation (Sfar).


Assuntos
Humanos , Adulto , Transfusão de Sangue/instrumentação , Eritropoetina/análise , Anemia/prevenção & controle , Anemia/sangue , Ferro/uso terapêutico
18.
PLoS One ; 15(6): e0234541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584835

RESUMO

Erythropoisis stimulating agent (ESA) use was addressed in Food and Drug Administration (FDA) Oncology Drug Advisory Committee (ODAC) meetings between 2004 and 2008. FDA safety-focused regulatory actions occurred in 2007 and 2008. In 2007, black box warnings advised of early death and venous thromboembolism (VTE) risks with ESAs in oncology. In 2010, a Risk Evaluation Strategies (REMS) was initiated, with cancer patient consent that mortality and VTE risks were noted with ESAs. We report warnings and REMS impacts on ESA utilization among Veterans Administration (VA) cancer patients with chemotherapy-induced anemia (CIA). Data were from Veterans Affairs database (2003-2012). Epoetin and darbepoetin use were primary outcomes. Segmented linear regression was used to estimate changes in ESA use levels and trends, clinical appropriateness, and adverse events (VTEs) among chemotherapy-treated cancer patients. To estimate changes in level of drug prescription rate after policy actions, model-specific indicator variables as covariates based on specific actions were included. ESA use fell by 95% and 90% from 2005, for epoetin and darbepoetin, from 22% and 11%, respectively, to 1% and 1%, respectively, among cancer patients with CIA, respectively (p<0.01). Following REMS in 2010, mean hematocrit levels at ESA initiation decreased from 30% to 21% (p<0.01). Black box warnings preceded decreased ESA use among VA cancer patients with CIA. REMS was followed by reduced hematocrit levels at ESA initiation. Our findings contrast with privately- insured and Medicaid insured cancer patient data on chemotherapy-induced anemia where ESA use decreased to 3% to 7% by 2010-2012. By 2012, the era of ESA administration to VA to cancer patients had ended but the warnings remain relevant and significant. In 2019, oncology/hematology national guidelines (ASCO/ASH) recommend that cancer patients with chemotherapy-induced anemia should receive ESAs or red blood cell transfusions after risk-benefit evaluation.


Assuntos
Anemia/epidemiologia , Antineoplásicos/efeitos adversos , Hematínicos/efeitos adversos , Neoplasias/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/induzido quimicamente , Anemia/patologia , Anemia/prevenção & controle , Antineoplásicos/uso terapêutico , Rotulagem de Medicamentos , Feminino , Hematínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Tromboembolia Venosa , Adulto Jovem
19.
J Pregnancy ; 2020: 2789536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566297

RESUMO

Background: The objective of this study was to estimate and identify the determinants of hemoglobin concentration before pregnancy, during pregnancy, and after labor and delivery. Methods: A prospective cohort study design was implemented. Data were collected from May 2015 to September 2018. A simple random sampling technique was used to select the participants. An interview technique was used to collect the data. Blood samples were collected before pregnancy, during each trimester, during labor and delivery, after third stage of labor, and at the 6-week postpartum period. Descriptive statistics were used to describe the profile of study participants. Generalized estimating equations were used to identify the determinants of hemoglobin concentration during each phase of pregnancy. Results: The mean hemoglobin concentrations of primigravida and multigravida before pregnancy were 12.41 g/dl and 10.78 g/dl, respectively. The hemoglobin concentration decreases with consecutive trimester reaching the lowest level at 42 days after delivery. The hemoglobin concentrations of pregnant women were decreased by hookworm 0.24 g/dl [95% CI:0.18-0.29], multiple pregnancy 0.16 g/dl [95% CI: 0.07-0.24], episiotomy 0.05 g/dl [95% CI: 0.01-0.09], gravidity 0.15 g/dl [95% CI: 0.09-0.21], age 0.03 g/dl [95% CI: 0.03-0.04], and gestational age 0.1 g/dl [95% CI: 0.09-0.11]. The hemoglobin concentration increased by iron supplementation 1.02 g/dl [95% CI: 0.97-1.07] and birth weight 0.14 g/dl [95% CI: 0.02-0.11]. Conclusion: Pregnancy significantly decreases the hemoglobin concentration of pregnant women reaching the lowest point during labor and delivery. Recommendation. Regular anemia screening intervention should be implemented after delivery.


Assuntos
Anemia/prevenção & controle , Hemoglobinas/análise , Complicações Hematológicas na Gravidez/prevenção & controle , Gravidez/sangue , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento , Estudos Prospectivos , Adulto Jovem
20.
Arch. argent. pediatr ; 118(3): 160-165, jun. 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1102717

RESUMO

Introducción. La fortificación y suplementación son estrategias para la prevención de carencias de micronutrientes. El objetivo fue describir la procedencia de la ingesta del hierro y ácido fólico a lo largo del ciclo vital de la población de la Ciudad Autónoma de Buenos Aires. Población y métodos. Análisis de la información de la Primera Encuesta Alimentaria y Nutricional de la Ciudad Autónoma de Buenos Aires 2011, que tomó una muestra probabilística por conglomerados. El consumo se recabó con recordatorio de 24 horas. Se calculó el aporte de hierro y ácido fólico, y se categorizó en contenido natural, harina de trigo enriquecida, leche del Plan Materno Infantil, alimentos fortificados y suplementos. Resultados. De los 5369 individuos evaluados, prácticamente, la totalidad obtenía hierro y ácido fólico de contenido natural (el 58 % y el 29 % del consumo, respectivamente). Más del 90 % consumía harina de trigo enriquecida, que aportaba el 28 % del hierro y el 54 % del ácido fólico. Los alimentos fortificados mostraron consumo y aporte muy variable. La leche del Plan Materno Infantil mostró muy baja participación, inclusive en grupos específicos. El aporte de suplementos fue bajo, excepto en < 2 años (el 30 % consumía suplementos de hierro, que aportaban el 38 % de este).Conclusión. Además del aporte natural de los alimentos, la harina de trigo enriquecida representó una importante contribución en el consumo de ácido fólico y hierro de esta población; los alimentos fortificados y los suplementos tuvieron una participación diferente según el grupo etario.


Introduction. Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires.Population and methods. Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements.Results. Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron).Conclusion. In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Alimentos Fortificados , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Ingestão de Alimentos , Epidemiologia Descritiva , Estudos Transversais , Inquéritos e Questionários , Suplementos Nutricionais , Farinha , Anemia/prevenção & controle
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