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1.
Asia Pac J Clin Nutr ; 28(3): 577-583, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464404

RESUMO

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) is the most common micronutrient deficiency worldwide and usually leads to impaired neurodevelopment. Appropriate introduction of complementary foods is mandatory for all infants to prevent iron insufficiency. We aimed to demonstrate feeding behaviors in relation to infant iron status and also identify potential concomitant nutrient inadequacies. METHODS AND STUDY DESIGN: A cross-sectional descriptive study of infants 6-12 months old was performed at the Well Baby Clinic at Thammasat University Hospital, Pathumthani. Demographic data, feeding practices and nutritional status were obtained. Dietary intake was evaluated using general and food frequency questionnaires. Blood samples for complete blood count and iron studies were investigated. RESULTS: We enrolled 206 infants (mean age 8.552.1 months). Prevalence of ID and iron deficiency anemia (IDA) was 34.0% and 25.7%, respectively. In multivariable ordinal continuation ratio logistic regression analysis for risk of iron depletion severity among the 3 groups (normal, ID and IDA infants), we found a stepwise increase in odds ratios for iron depletion with lower family income, longer duration of breastfeeding, delayed introduction of meat, and lower dietary iron intake. IDA infants had significantly lower intakes of energy, protein, fat and various micronutrients, compared to those with normal iron status. CONCLUSIONS: Infants with ID may have low intakes of other nutrients due to reduced complementary food intake. Nutritional education for appropriate feeding practices should be provided to prevent ID and other possible micronutrient deficiencies.


Assuntos
Deficiências Nutricionais/epidemiologia , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Ferro/administração & dosagem , Ferro/deficiência , Aleitamento Materno , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Micronutrientes/deficiência , Estado Nutricional , Tailândia/epidemiologia
2.
Nutrients ; 11(7)2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31284450

RESUMO

This review discusses the personalised dietary approach with respect to inflammatory bowel disease (IBD). It identifies gene-nutrient interactions associated with the nutritional deficiencies that people with IBD commonly experience, and the role of the Western diet in influencing these. It also discusses food intolerances and how particular genotypes can affect these. It is well established that with respect to food there is no "one size fits all" diet for those with IBD. Gene-nutrient interactions may help explain this variability in response to food that is associated with IBD. Nutrigenomic research, which examines the effects of food and its constituents on gene expression, shows that-like a number of pharmaceutical products-food can have beneficial effects or have adverse (side) effects depending on a person's genotype. Pharmacogenetic research is identifying gene variants with adverse reactions to drugs, and this is modifying clinical practice and allowing individualised treatment. Nutrigenomic research could enable individualised treatment in persons with IBD and enable more accurate tailoring of food intake, to avoid exacerbating malnutrition and to counter some of the adverse effects of the Western diet. It may also help to establish the dietary pattern that is most protective against IBD.


Assuntos
Deficiências Nutricionais/dietoterapia , Dieta Ocidental/efeitos adversos , Hipersensibilidade Alimentar/dietoterapia , Doenças Inflamatórias Intestinais/dietoterapia , Nutrigenômica/métodos , Estado Nutricional , Medicina de Precisão/métodos , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Adulto , Animais , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/genética , Deficiências Nutricionais/fisiopatologia , Comportamento Alimentar , Feminino , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/genética , Hipersensibilidade Alimentar/fisiopatologia , Interação Gene-Ambiente , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional/genética , Valor Nutritivo , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
J Perinat Med ; 47(7): 724-731, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31318696

RESUMO

Background Pregnancy is associated with biochemical changes leading to increased nutritional demands for the developing fetus that result in altered micronutrient status. The Indian dietary pattern is highly diversified and the data about dietary intake patterns, blood micronutrient profiles and their relation to low birthweight (LBW) is scarce. Methods Healthy pregnant women (HPW) were enrolled and followed-up to their assess dietary intake of nutrients, micronutrient profiles and birthweight using a dietary recall method, serum analysis and infant weight measurements, respectively. Results At enrolment, more than 90% of HPW had a dietary intake below the recommended dietary allowance (RDA). A significant change in the dietary intake pattern of energy, protein, fat, vitamin A and vitamin C (P < 0.001) was seen except for iron (Fe) [chi-squared (χ2) = 3.16, P = 0.177]. Zinc (Zn) deficiency, magnesium deficiency (MgDef) and anemia ranged between 54-67%, 18-43% and 33-93% which was aggravated at each follow-up visit (P ≤ 0.05). MgDef was significantly associated with LBW [odds ratio (OR): 4.21; P = 0.01] and the risk exacerbate with the persistence of deficiency along with gestation (OR: 7.34; P = 0.04). Pre-delivery (OR: 0.57; P = 0.04) and postpartum (OR: 0.37; P = 0.05) anemia, and a vitamin A-deficient diet (OR: 3.78; P = 0.04) were significantly associated with LBW. LBW risk was much higher in women consuming a vitamin A-deficient diet throughout gestation compared to vitamin A-sufficient dietary intake (OR: 10.00; P = 0.05). Conclusion The studied population had a dietary intake well below the RDA. MgDef, anemia and a vitamin A-deficient diet were found to be associated with an increased likelihood of LBW. Nutrient enrichment strategies should be used to combat prevalent micronutrient deficiencies and LBW.


Assuntos
Deficiências Nutricionais , Dieta/métodos , Recém-Nascido de Baixo Peso/metabolismo , Micronutrientes , Complicações na Gravidez , Adulto , Peso ao Nascer/fisiologia , Deficiências Nutricionais/sangue , Deficiências Nutricionais/diagnóstico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/etiologia , Comportamento Alimentar/fisiologia , Feminino , Humanos , Índia/epidemiologia , Micronutrientes/sangue , Micronutrientes/classificação , Micronutrientes/deficiência , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Serviços Preventivos de Saúde , Recomendações Nutricionais , Fatores de Risco
4.
Indian Pediatr ; 56(7): 577-586, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333213

RESUMO

JUSTIFICATION: Micronutrient deficiencies have significant impact on the overall health and well-being of society and potential targets for supplementations. It is important to formulate a consensus statement in view of current evidence, and put in place strategies to meet targets. OBJECTIVE: To formulate by endorsement or adoption and disseminate a consensus statement for prevention of micronutrients deficiencies in young children for office practices from an Indian perspective. PROCESS: A National Consultative Meeting was convened by Infant and Young Child Feeding Chapter (IYCF) of Indian Academy of Pediatrics (IAP) on 17 December, 2016 at Mumbai. IYCF chapter, IAP, United Nations Children Fund, National Institute of Nutrition and Government of India were the participating agencies; and participants representing different parts of India were included. CONCLUSIONS: Micronutrient deficiencies are widespread. For its prevention proper maternal and infant-young child feeding strategies need to be practiced. Encourage delayed cord clamping, dietary diversification, germinated foods, soaking and fermentation processes. Existing Iron, Vitamin A, Zinc supplementation and universal salt iodization programs need to be scaled up, especially in high risk groups. Universal vitamin D supplementation need to be in place; though, the dose needs more research. Vitamin B12 deficiency screening and supplementation should be practiced only in high-risk groups. Availability of appropriately fortified foods needs to be addressed urgently.


Assuntos
Deficiências Nutricionais , Suplementos Nutricionais , Alimentos Fortificados/provisão & distribução , Micronutrientes , Necessidades Nutricionais , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Consenso , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais/normas , Suplementos Nutricionais/provisão & distribução , Feminino , Humanos , Índia/epidemiologia , Lactente , Micronutrientes/classificação , Micronutrientes/deficiência , Estado Nutricional , Medição de Risco/métodos
5.
Am J Clin Nutr ; 109(5): 1484-1492, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30976780

RESUMO

BACKGROUND: Cross-sectional (CS) surveys indicate that individuals with acute inflammation have higher plasma ferritin (pF), and lower retinol-binding protein (RBP) and zinc (pZn) concentrations than those without. In populations with a high burden of infection, correction factors (CFs) or regression corrections (RCs) are applied to biomarkers to estimate the prevalence of micronutrient (MN) deficiencies adjusted for inflammation. This assumes that individuals with and without inflammation have the same nutritional status, which may not be the case. OBJECTIVES: The aim of this study was to investigate relations between short-term, longitudinal within-individual changes in acute phase proteins (C-reactive protein [CRP], α-1-acid glycoprotein [AGP]) and biomarkers of MN status (pF, soluble transferrin receptor [sTfR], RBP, and pZn), and compare them to CS differences. METHODS: Two blood samples were obtained 21 d apart from 451 asymptomatic Burkinabé children aged 6-23 mo. To calculate CFs, inflammation was defined as CRP >5 mg/L or AGP >1 g/L, or both. The RC approach adjusted MN biomarkers to a presumably healthy reference point within the study population (10th percentile CRP or AGP concentration). CS CFs and RCs were estimated from a naive regression model, treating observations from the same children as independent. Longitudinal CFs and RCs, to estimate effects of within-individual changes in CRP and/or AGP, were estimated from general linear models, accounting for repeated measures. RESULTS: In CS models, geometric mean pF and sTfR concentrations were 8-340% greater, and RBP and pZn 2-18% lower, in children with inflammation than those without. Except for sTfR, biomarker concentrations differed in the same direction and by similar magnitude within individuals whose inflammation status changed during the observation period. Although geometric mean MN concentrations differed significantly when adjusted with CS compared with longitudinal models, the estimated prevalence of MN deficiencies in CS and longitudinally adjusted models was similar. CONCLUSIONS: The CF and RC approaches to adjust MN biomarkers for inflammation between individuals in CS surveys are valid approaches for data collection and programmatic decisions in comparable populations. This study was registered at clinicaltrials.gov as NCT00944853.


Assuntos
Ferritinas/sangue , Inflamação/sangue , Micronutrientes/sangue , Estado Nutricional , Projetos de Pesquisa/normas , Proteínas de Ligação ao Retinol/metabolismo , Zinco/sangue , Proteína C-Reativa/metabolismo , Estudos Transversais , Deficiências Nutricionais/sangue , Deficiências Nutricionais/epidemiologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Micronutrientes/deficiência , Avaliação Nutricional , Orosomucoide/metabolismo , Prevalência , Reprodutibilidade dos Testes
6.
J Coll Physicians Surg Pak ; 29(3): 253-257, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823953

RESUMO

OBJECTIVE: To assess the level of zinc in type 2 diabetes mellitus and its relation to glycemic control. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Medicine, Dallah Hospital, Riyadh, KSA, from May 2014 to June 2015. METHODOLOGY: This study employed 200 diabetic and 192 control subjects. The demographic data was taken from all 392 subjects; and laboratory investigations like, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1C), and serum zinc level were done. The groups were divided into diabetic and control, normal zinc group (>70 mcg/dL) and low zinc group (<70 mcg/dL) levels. RESULTS: The mean age for low zinc group was 51.99 +10.51 years and for normal zinc group 52.87 +10.29 years (p=0.408). The male to female ratio was 0.93:1 in low zinc group and 1.3:1 in normal zinc group (p=0.082). The mean serum zinc was significantly lower in diabetic patients (66.54 +11.328 mcg/dL) than in healthy subjects (82.63 +12.194 mcg/dL, p<0.001). The mean FBS was 139.84 +30.68 mg/dL in low zinc level group in contrast to 104.88 +26.12 mg/dL in normal zinc level group (p<0.001). The mean HbA1c was 8.91 +2.16% in low zinc level group in contrast to 5.696 +2.3 in normal zinc level group (p<0.001). The serum zinc level was negatively associated with FBS and HbA1c. CONCLUSION: This study concluded that low zinc level was associated with Type 2 DM, and serum zinc level was negatively associated with poor glycemic control.


Assuntos
Glicemia/análise , Deficiências Nutricionais/sangue , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/análise , Zinco/sangue , Adulto , Estudos Transversais , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/fisiopatologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Medição de Risco , Arábia Saudita
7.
Ann Agric Environ Med ; 26(1): 73-77, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30922033

RESUMO

INTRODUCTION: Iodine deficiency is one of the most important public health problems in the world. It mostly affects pregnant women and children. The lack of iodine leads to an increase in the numbers of perinatal mortality and mental retardation. MATERIAL AND METHODS: In 2012-2014, a survey was carried out of 2,342 women, of whom 2284 were analyzed for salt to measure the content of iodine, and 2,242 women of reproductive age had their urine samples analyzed by the cerium-arsenite method based on the Sandell-Kolthoff reaction. Determination of the medical and social effectiveness of biological monitoring of IDS was carried out in 3 stages. RESULTS: The study revealed that in the eastern Kazakhstan region the relative risk (RR) of overall prevalence of iodine deficiency among women was 1.1 times higher (95% ID: 0.35-3.61; Z statistic = 0.192) among household respondents (≤15mkg/kg). In the Pavlodar region, the RR of the prevalence of total iodine deficiency is 0.5 times higher in households where the salt was not sufficiently iodized. In the Zhambyl region the RR of the iodine deficiency prevalence was about twice as high due to insufficient iodized salt. CONCLUSIONS: The introduction of biological monitoring of IDS among women, especially pregnant women, may positively affect the detection of the risk limits for the birth of infants with reduced mental abilities or other diseases during pregnancy, using timely targeted preventive measures to exclude factors that affect the spread of IDS.


Assuntos
Deficiências Nutricionais/epidemiologia , Iodo/deficiência , Cloreto de Sódio na Dieta/provisão & distribução , Adulto , Estudos Transversais , Monitoramento Ambiental/métodos , Características da Família , Feminino , Humanos , Iodo/provisão & distribução , Iodo/urina , Cazaquistão , Gravidez , Cloreto de Sódio na Dieta/análise , Inquéritos e Questionários
8.
Med J Aust ; 210(3): 121-125, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30772938

RESUMO

OBJECTIVE: To assess the median urine iodine concentration (UIC) of young adults in the Top End of Northern Territory, before and after fortification of bread with iodised salt became mandatory. DESIGN, SETTING: Analysis of cross-sectional data from two longitudinal studies, the Aboriginal Birth Cohort and the non-Indigenous Top End Cohort, pre- (Indigenous participants: 2006-2007; non-Indigenous participants: 2007-2009) and post-fortification (2013-15). PARTICIPANTS: Indigenous and non-Indigenous Australian young adults (mean age: pre-fortification, 17.9 years (standard deviation [SD], 1.20 years); post-fortification, 24.9 years (SD, 1.34 years). MAIN OUTCOME MEASURE: Median UIC (spot urine samples analysed by a reference laboratory), by Indigenous status, remoteness of residence, and sex. RESULTS: Among the 368 participants assessed both pre- and post-fortification, the median UIC increased from 58 µg/L (interquartile range [IQR], 35-83 µg/L) pre-fortification to 101 µg/L (IQR, 66-163 µg/L) post-fortification (P < 0.001). Urban Indigenous (median IUC, 127 µg/L; IQR, 94-203 µg/L) and non-Indigenous adults (117 µg/L; IQR, 65-160 µg/L) were both iodine-replete post-fortification. The median UIC of remote Indigenous residents increased from 53 µg/L (IQR, 28-75 µg/L) to 94 µg/L (IQR, 63-152 µg/L; p < 0.001); that is, still mildly iodine-deficient. The pre-fortification median UIC for 22 pregnant women was 48 µg/L (IQR, 36-67 µg/L), the post-fortification median UIC for 24 pregnant women 93 µg/L (IQR, 62-171 µg/L); both values were considerably lower than the recommended minimum of 150 µg/L for pregnant women. CONCLUSIONS: The median UIC of young NT adults increased following mandatory fortification of bread with iodised salt. The median UIC of pregnant Indigenous women in remote locations, however, remains low, and targeted interventions are needed to ensure healthy fetal development.


Assuntos
Alimentos Fortificados , Iodo , Política Nutricional , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Deficiências Nutricionais/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Iodo/deficiência , Iodo/urina , Masculino , Northern Territory , Adulto Jovem
9.
Obes Surg ; 29(1): 166-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30191504

RESUMO

BACKGROUND: Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies. METHODS: This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed. RESULTS: Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m2. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L. Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients. CONCLUSION: Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.


Assuntos
Grupo com Ancestrais do Continente Asiático , Deficiências Nutricionais/epidemiologia , Obesidade Mórbida/epidemiologia , Adulto , Ásia/etnologia , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/estatística & dados numéricos , Estudos de Coortes , Deficiências Nutricionais/etnologia , Deficiências Nutricionais/etiologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Obesidade Mórbida/cirurgia , Prevalência , Estudos Prospectivos , Singapura/epidemiologia
10.
Obes Surg ; 29(1): 178-182, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30218196

RESUMO

PURPOSE: Most patients undergoing bariatric surgery (BS) are fertile women whose postoperative (post-op) hormonal balance and weight loss increases fertility, frequently leading to pregnancy. This study aims to analyze supplementation adherence of pregnant women after BS and perinatal outcomes. MATERIALS AND METHODS: This retrospective study analyzed records from women after BS who consulted nutritionists at least twice during pregnancy. Each patient received nutritional guidance about vitamin and mineral supplementation and protein intake. Demographic data, body mass index (BMI), percentage of weight loss (%WL) at conception, maximum post-op BMI and %WL, post-op time at conception, supplementation adherence, biochemical data, possible gestational complications, and infant's birth weight were collected. RESULTS: Data was obtained from 23 women (mean age 33 ± 4 years). On average, patients became pregnant 43 months after surgery. The mean preoperative BMI was 40.2 kg/m2, the maximum post-op %WL was 36.6%, and the mean %WL at conception was 32.0%. No gestational intercurrence was related to biochemical data. Supplementation adherence was 34.7% for one multivitamin and 34.7% for two multivitamins; 43.5% for iron, 43.5% for omega 3, 39.1% for folic acid, 17.4% for B complex, and 60.8% for calcium. Mean infant birth weight was 3.0 kg, and it was not associated with maximum %WL, % WL at conception, and time since BS at conception. CONCLUSION: Our data indicate satisfactory adherence to post-op micronutrient supplementation and few gestational complications following BS. Moreover, child's birth weight was not associated with maximum %WL, %WL at conception, or time since BS.


Assuntos
Cirurgia Bariátrica , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Obesidade Mórbida/dietoterapia , Obesidade Mórbida/cirurgia , Cooperação do Paciente/estatística & dados numéricos , Complicações na Gravidez , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/reabilitação , Deficiências Nutricionais/epidemiologia , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Ácido Fólico/administração & dosagem , Humanos , Ferro/administração & dosagem , Obesidade Mórbida/epidemiologia , Período Pós-Operatório , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Vitaminas/administração & dosagem
11.
J Gastrointestin Liver Dis ; 27(3): 233-239, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30240466

RESUMO

AIM: To evaluate the yield of routine laboratory tests and Dual Energy X-ray Absorptiometry (DEXA) scans in coeliac disease. METHODS: A retrospective analysis of medical files of all followed-up patients with coeliac disease attending Rijnstate Hospital in 2016 was conducted with respect to blood tests of hemoglobin, vitamin B12, folate acid, iron status, calcium, vitamin D, glucose, thyroid function, DEXA-scans and related symptoms or signs of abnormalities. All patients had positive coeliac serology and/or biopsy-proven coeliac disease and attended regular visits after diagnosis. The chi-square test for trend was used for statistical analysis: a two-tailed probability of p < 0.05 was considered significant. RESULTS: We analyzed 250 patients with a median follow-up of 7.8 (1-22) years. At diagnosis, we found anemia in 24.4%, iron deficiency in 38%, folic acid deficiency in 22.6% and vitamin B12 deficiency in 15.9%. All deficiencies recovered within 1-2 years with or without supplements. Deficiencies or autoimmune diseases occurred in 50 patients (37 possibly coeliac-related) during follow-up. Twelve cases of coeliac-related deficiencies or autoimmune diseases occurred in patients with normal values at diagnosis of whom 10 were asymptomatic (incidence 10/1000 patient years). Osteoporosis and osteopenia were present in 23.3% and 35% at diagnosis. In most patients bone mineral density (BMD) improved or stabilized during follow up (p < 0.05), 8% deteriorated. CONCLUSIONS: The incidence of asymptomatic coeliac-related deficiencies or autoimmune diseases is low in patients with normal values at diagnosis. Therefore, routine laboratory screening is not necessary in this group: attending regular follow-up visits should be sufficient. DEXA scans are recommended.


Assuntos
Absorciometria de Fóton , Doenças Autoimunes/sangue , Análise Química do Sangue , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doença Celíaca/dietoterapia , Deficiências Nutricionais/sangue , Dieta Livre de Glúten , Osteoporose/diagnóstico por imagem , Doenças Autoimunes/epidemiologia , Biomarcadores/sangue , Doenças Ósseas Metabólicas/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Deficiências Nutricionais/epidemiologia , Humanos , Incidência , Países Baixos/epidemiologia , Osteoporose/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
12.
Nutr Res ; 57: 12-27, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30122192

RESUMO

The Eastern Mediterranean Region (EMR) is undergoing social and economic changes that may impact the nutritional status of children living in its countries. The objective of this review is to evaluate the nutritional status and dietary intakes of children (0-12 years) in selected EMR countries, namely, Jordan, Lebanon, Kingdom of Saudi Arabia (KSA), and the United Arab Emirates. MedLine, PubMed, Scopus, and Google Scholar were searched for relevant articles published between 1990 and 2016; international organizations and governmental websites were also searched. Stunting in the region was estimated at 7.3% to 9.3%, wasting at 1.1% to 11.8%, and underweight at 1.6% to 5.3%. In contrast, overweight and obesity affected 19% to 21% of school-aged children from Lebanon and KSA. Available biochemical data showed that pediatric anemia, vitamin A, and vitamin D deficiencies remain a challenge in the region. Dietary intake studies have identified inadequate intakes of iron, calcium, zinc, folic acid, vitamin A, and vitamin D, concurrently with high intakes of fat, saturated fat, and sugar. This review provides valuable insight into the nutrition situation of children in 2 major areas of the EMR, the Levant and the Gulf, and identified several gaps and challenges in existing nutritional assessment studies. Key issues include the triple burden of malnutrition in this age group (underweight, nutrient inadequacies, and overweight/obesity), while calling for integrated action to improve the nutritional status of children in countries of the region. Opportunities for future research include nationwide nutritional and dietary surveys in countries where the largest data gaps remain such as the United Arab Emirates and KSA.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Deficiências Nutricionais/epidemiologia , Dieta , Transtornos do Crescimento/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Magreza/epidemiologia , Anemia/epidemiologia , Criança , Feminino , Humanos , Lactente , Masculino , Região do Mediterrâneo/epidemiologia , Oriente Médio/epidemiologia , Síndrome de Emaciação/epidemiologia
13.
PLoS One ; 13(8): e0201230, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30070992

RESUMO

Industrial fortification of wheat flour is a potentially effective strategy for addressing micronutrient deficiencies in Mongolia, given its ubiquitous consumption and centralized production. However, Mongolia has not mandated fortification of any foods except for salt with iodine. This study modeled the effectiveness and safety of mandatory industrial fortification of wheat flour alone and in combination with edible oil and milk in reducing the prevalence of multiple micronutrient intake deficiencies among healthy non-pregnant adults in Mongolia. Six days of diet records (3 summer, 3 winter) were collected from 320 urban and rural adults across the country and analyzed for food and nutrient consumption using a purpose-built food composition table, and the Intake Monitoring and Planning Program (IMAPP) was used to project the effects of fortification on summer and winter bioavailable micronutrient intake and intake deficiency under different fortification guidelines within population subgroups defined by urban or rural locality and sex. Projections showed that flour fortification would be effective in reducing intake deficiencies of thiamin and folate, while marginal benefits of fortification with iron and riboflavin would be smaller given these nutrients' higher baseline consumption, and fortification with zinc, niacin, and vitamin B12 may be unnecessary. Fortification of flour, oil, and milk with vitamins A, D, and E at levels suggested by international guidelines would substantially reduce vitamin A intake deficiency and would increase vitamin D intake considerably, with the greatest benefits elicited by flour fortification and smaller benefits by additionally fortifying oil and milk. These results support mandatory industrial fortification of wheat flour, edible oil, and milk with iron, thiamin, riboflavin, folate, and vitamins A, D, and E in Mongolia. Considerations will be necessary to ensure the fortification of these nutrients is also effective for children, for whom the potential benefit of zinc, niacin, and vitamin B12 fortification should be assessed.


Assuntos
Deficiências Nutricionais/prevenção & controle , Farinha , Alimentos Fortificados , Leite , Óleos , Triticum , Adulto , Animais , Deficiências Nutricionais/epidemiologia , Dieta , Feminino , Humanos , Masculino , Micronutrientes/administração & dosagem , Micronutrientes/deficiência , Pessoa de Meia-Idade , Mongólia , Prevalência , População Rural , Estações do Ano , Fatores Sexuais , População Urbana , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 18(1): 313, 2018 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-30075759

RESUMO

BACKGROUND: Zhejiang has achieved the goal of elimination of iodine deficiency disorders (IDD) via the implementation of universal salt iodization (USI) since 2011. Iodine content in household table salt decreased from the national standard (35 ppm) to the Zhejiang provincial standard (25 ppm) in 2012. It is crucial to periodically monitor iodine status in pregnant women because IDD in pregnancy have adverse effects on fetal neurodevelopment. METHODS: We carried out a cross-sectional study between April 2014 and September 2015 in the eight sentinel surveillance counties across Zhejiang Province, where IDD was previously known to be endemic. A total of 1304 pregnant women participated and provided a random spot urine sample and a household table salt sample. Urinary iodine concentration (UIC) was determined using arsenic-cerium catalytic spectrophotometry. Iodine content in salt was measured using a titration method with sodium thiosulphate. RESULTS: Overall, the median UIC of the total study population of pregnant women was 129.3 µg/L, with a higher UIC in inland (152.54 µg/L) and a lower UIC in coastal counties (107.54 µg/L). Household coverage of iodized salt was 94.6% and the rate of adequately iodized salt was 89.9%. CONCLUSIONS: Our results indicate deficient iodine status in the pregnant population of Zhejiang, according to the lower cut-off value of optimal iodine nutrition (150 µg/L) recommended by the World Health Organization. In addition to sustaining USI, more efforts are urgently needed to improve iodine intake in women during pregnancy, especially those residing in the coastal counties.


Assuntos
Deficiências Nutricionais , Desenvolvimento Fetal/efeitos dos fármacos , Iodo/deficiência , Transtornos do Neurodesenvolvimento , Complicações na Gravidez , Cloreto de Sódio na Dieta/normas , Adulto , China/epidemiologia , Estudos Transversais , Deficiências Nutricionais/diagnóstico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/prevenção & controle , Feminino , Humanos , Recém-Nascido , Iodo/normas , Iodo/urina , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/prevenção & controle , Política Nutricional , Necessidades Nutricionais , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cloreto de Sódio na Dieta/análise , Urinálise/métodos
15.
PLoS Med ; 15(7): e1002586, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29969442

RESUMO

BACKGROUND: Rising atmospheric carbon dioxide concentrations are anticipated to decrease the zinc and iron concentrations of crops. The associated disease burden and optimal mitigation strategies remain unknown. We sought to understand where and to what extent increasing carbon dioxide concentrations may increase the global burden of nutritional deficiencies through changes in crop nutrient concentrations, and the effects of potential mitigation strategies. METHODS AND FINDINGS: For each of 137 countries, we incorporated estimates of climate change, crop nutrient concentrations, dietary patterns, and disease risk into a microsimulation model of zinc and iron deficiency. These estimates were obtained from the Intergovernmental Panel on Climate Change, US Department of Agriculture, Statistics Division of the Food and Agriculture Organization of the United Nations, and Global Burden of Disease Project, respectively. In the absence of increasing carbon dioxide concentrations, we estimated that zinc and iron deficiencies would induce 1,072.9 million disability-adjusted life years (DALYs) globally over the period 2015 to 2050 (95% credible interval [CrI]: 971.1-1,167.7). In the presence of increasing carbon dioxide concentrations, we estimated that decreasing zinc and iron concentrations of crops would induce an additional 125.8 million DALYs globally over the same period (95% CrI: 113.6-138.9). This carbon-dioxide-induced disease burden is projected to disproportionately affect nations in the World Health Organization's South-East Asia and African Regions (44.0 and 28.5 million DALYs, respectively), which already have high existing disease burdens from zinc and iron deficiencies (364.3 and 299.5 million DALYs, respectively), increasing global nutritional inequalities. A climate mitigation strategy such as the Paris Agreement (an international agreement to keep global temperatures within 2°C of pre-industrial levels) would be expected to avert 48.2% of this burden (95% CrI: 47.8%-48.5%), while traditional public health interventions including nutrient supplementation and disease control programs would be expected to avert 26.6% of the burden (95% CrI: 23.8%-29.6%). Of the traditional public health interventions, zinc supplementation would be expected to avert 5.5%, iron supplementation 15.7%, malaria mitigation 3.2%, pneumonia mitigation 1.6%, and diarrhea mitigation 0.5%. The primary limitations of the analysis include uncertainty regarding how food consumption patterns may change with climate, how disease mortality rates will change over time, and how crop zinc and iron concentrations will decline from those at present to those in 2050. CONCLUSIONS: Effects of increased carbon dioxide on crop nutrient concentrations are anticipated to exacerbate inequalities in zinc and iron deficiencies by 2050. Proposed Paris Agreement strategies are expected to be more effective than traditional public health measures to avert the increased inequality.


Assuntos
Dióxido de Carbono/efeitos adversos , Simulação por Computador , Produtos Agrícolas/metabolismo , Deficiências Nutricionais/epidemiologia , Abastecimento de Alimentos , Saúde Global , Ferro/deficiência , Zinco/deficiência , Atmosfera , Dióxido de Carbono/metabolismo , Mudança Climática , Comorbidade , Produtos Agrícolas/crescimento & desenvolvimento , Deficiências Nutricionais/diagnóstico , Deficiências Nutricionais/metabolismo , Deficiências Nutricionais/prevenção & controle , Avaliação da Deficiência , Monitoramento Ambiental , Comportamento Alimentar , Humanos , Estado Nutricional , Valor Nutritivo , Medição de Risco , Fatores de Risco , Fatores de Tempo
16.
Nutrients ; 10(7)2018 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-29976875

RESUMO

Zinc is an important mineral for biological and physiological processes. Zinc deficiency (ZD) is one of the most common micronutrient deficiencies worldwide and a crucial determinant of pregnancy outcomes and childhood development. Zinc levels and the zinc supplementation rate among lactating women have not been assessed neither in Ecuador nor in the Andean region. We conducted a pilot study including 64 mothers of infants between eight days to seven months old from a primary care center located in Conocoto, a peri-urban community of Quito, Ecuador. The mothers were interviewed and a fasting blood sample was taken to determine plasma zinc levels. The prevalence of ZD was calculated and compared with the prevalence of ZD among Ecuadorian non-pregnant non-lactating women, and the sample was analysed considering zinc supplementation during pregnancy. The prevalence of ZD among the participants was 81.3% (95% CI: 71.7⁻90.9), higher than the reported among non-pregnant non-lactating women (G² = 18.2; p < 0.05). Zinc supplementation rate was 31.2%. No significant differences were found comparing the groups considering zinc supplementation. The insights obtained from this study encourage extending studies to document zinc levels and its interactions among breastfeeding women in areas with a high prevalence of ZD in order to determine the need of zinc supplementation.


Assuntos
Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Lactação , Saúde Materna , Saúde da População Urbana , Zinco/deficiência , Zinco/uso terapêutico , Adolescente , Adulto , Deficiências Nutricionais/sangue , Equador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Projetos Piloto , Gravidez , Prevalência , Adulto Jovem , Zinco/sangue
17.
Obes Surg ; 28(11): 3439-3445, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30032419

RESUMO

INTRODUCTION: Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB) has been approved as a mainstream metabolic/bariatric procedure by IFSO. Still there are lots of concerns regarding nutritional deficiency after MGB-OAGB. The purpose of this retrospective analysis is to evaluate the effect of biliopancreatic limb (BPL) length on weight loss, comorbidity resolution, and nutritional deficiencies in patients 1 year after MGB-OAGB and to find suitable BPL length. MATERIAL AND METHODS: One hundred and one patients who underwent MGB-OAGB were divided into three groups of 150 cm, 180 cm, and 250 cm depending on the length of BPL bypassed. The nutritional parameters (vitamin D3, vitamin B12, serum iron, serum ferritin, total protein, serum albumin, serum globulin), anthropometric measurements (weight, BMI), and comorbidity resolution (T2DM, hypertension) were compared between the three groups at 1-year follow-up. RESULTS: There was statistically significant difference in number of patients having deficiencies in all the nutritional parameters except globulin between 150 cm and 250 cm groups (P < 0.05). While on comparing 180- and 250-cm group, a statistically significant difference was present in vitamin D3, vitamin B12, and total protein (P < 0.05) only. The difference was statistically insignificant between the three groups on T2DM, hypertension resolution, and %EWL but TWL between 150 cm vs 180 cm and 150 cm vs 250 cm showed significant difference. CONCLUSION: A 150-cm BPL length is adequate with very minimal nutritional complications and good results. A 180-cm BPL can be used in super obese while a 250-cm BPL should be used with utmost care as it results in significant nutritional deficiencies.


Assuntos
Deficiências Nutricionais/epidemiologia , Derivação Gástrica , Obesidade Mórbida , Perda de Peso/fisiologia , Comorbidade , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Humanos , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia
18.
Nutrients ; 10(7)2018 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-29986492

RESUMO

Micronutrient deficiencies during pregnancy are common in Africa and can cause adverse outcomes. The objective was to measure micronutrient status and change in moderately malnourished pregnant Malawian women randomized to one of three nutritional interventions. Serum vitamin B12, 25-hydroxyvitamin D, folate, retinol, ferritin, zinc, albumin and C-reactive protein were measured in pregnant women with MUAC ≥20.6 cm and ≤23.0 cm at enrollment (n = 343) and after 10 weeks (n = 229) of receiving: (1) ready-to-use supplementary food (RUSF); (2) fortified corn-soy blend (CSB+) with multiple-micronutrient supplement (CSB+UNIMMAP); or (3) CSB+ with iron and folic acid (CSB+IFA). Each provided 100⁻300% Recommended Dietary Allowance of most micronutrients and 900 kcal/day. Birth length was measured in 272 infants. Enrollment measurements indicated deficiencies in vitamin B12 (20.9%) and zinc (22.3%), low values of ferritin (25.1%) and albumin (33.7%), and elevated CRP (46.0%). Vitamin B12 is known to decrease in the third trimester; the RUSF group had the smallest decrease from enrollment to week 10 (3%), compared to 20% decrease in the CSB+IFA group and 8% decrease in the CSB+UNIMMAP group (p = 0.001). Mean serum 25-hydroxyvitamin D increased most in the RUSF group (+6.4 ng/mL), compared to CSB+IFA (+1.7 ng/mL) and CSB+UNIMMAP (+2.7 ng/mL) (p < 0.001). Micronutrient deficiencies and inflammation are common among moderately malnourished pregnant women and had little improvement despite supplementation above the RDA, with the exception of vitamins B12 and D.


Assuntos
Deficiências Nutricionais/dietoterapia , Suplementos Nutricionais , Alimentos Fortificados , Fenômenos Fisiológicos da Nutrição Materna , Micronutrientes/administração & dosagem , Estado Nutricional , Complicações na Gravidez/dietoterapia , Adolescente , Adulto , Biomarcadores/sangue , Desenvolvimento Infantil , Deficiências Nutricionais/sangue , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Malaui/epidemiologia , Micronutrientes/sangue , Valor Nutritivo , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Prevalência , Recomendações Nutricionais , Índice de Gravidade de Doença , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Endocrinol Diabetes Nutr ; 65(8): 458-467, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30030155

RESUMO

Iodine is an essential component of thyroid hormones, and iodine deficit is the leading cause of preventable mental retardation worldwide. Spain was considered iodine-deficient until 2003. Although iodine urinary levels have been in the optimal range in Spain since 2004, the WHO recognizes that our country does not meet the necessary requirements to ensure that the whole population is not at risk of an iodine deficiency disorder. The aim of this article is to review the current iodine status in Spain. Data from several studies emphasize the low consumption of iodized salt at home. Despite the progress made in recent decades, Spanish children are not exempt from suffering an iodine deficiency disorder. Policies that allow for controlling iodine nutrition and promote universal consumption of iodized salt should therefore be implemented.


Assuntos
Iodo/deficiência , Iodo/uso terapêutico , Criança , Deficiências Nutricionais/tratamento farmacológico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/urina , Humanos , Iodo/urina , Estado Nutricional , Espanha/epidemiologia
20.
Nutrients ; 10(7)2018 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-30018262

RESUMO

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks' gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 µg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = -0.311, p < 0.001), but not with calcium intake or serum calcium (r = -0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800⁻1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.


Assuntos
Cálcio na Dieta/administração & dosagem , Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Hormônio Paratireóideo/sangue , Vitamina D/administração & dosagem , 25-Hidroxivitamina D 2/sangue , Adulto , Calcifediol/sangue , Cálcio/sangue , Cálcio/deficiência , Cálcio na Dieta/uso terapêutico , Estudos Transversais , Deficiências Nutricionais/complicações , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/prevenção & controle , Feminino , Humanos , Irlanda/epidemiologia , Hormônio Paratireóideo/metabolismo , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Estudos Prospectivos , Risco , Pigmentação da Pele , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/prevenção & controle
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