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1.
Trials ; 25(1): 315, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38741174

RESUMO

BACKGROUND: The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. METHODS: The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15-35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12-14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth. DISCUSSION: This study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.


Assuntos
Proteínas Alimentares , Suplementos Nutricionais , Ganho de Peso na Gestação , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Feminino , Gravidez , Bangladesh/epidemiologia , Adulto , Adulto Jovem , Adolescente , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Estado Nutricional , Recém-Nascido , Fenômenos Fisiológicos da Nutrição Materna , Peso ao Nascer , Complicações na Gravidez/prevenção & controle , Micronutrientes/administração & dosagem , Resultado do Tratamento , Idade Gestacional , Fatores de Tempo
2.
PLoS One ; 19(5): e0302968, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38709803

RESUMO

INTRODUCTION: Micronutrient deficiencies are prevalent in West Africa, particularly among women of reproductive age (WRA) and young children. Bouillon is a promising food fortification vehicle due to its widespread consumption. This study aims to evaluate the impact of multiple micronutrient-fortified bouillon cubes, compared to control bouillon cubes (fortified with iodine only), on micronutrient status and hemoglobin concentrations among lactating and non-lactating WRA and young children in northern Ghana. METHODS: This randomized, controlled doubly-masked trial will be conducted in the Kumbungu and Tolon districts in the Northern Region of Ghana, where prior data indicate multiple micronutrient deficiencies are common. Participants will be: 1) non-pregnant non-lactating WRA (15-49 y), 2) children 2-5 y, and 3) non-pregnant lactating women 4-18 months postpartum. Eligible participants will be randomly assigned to receive household rations of one of two types of bouillon cubes: 1) a multiple micronutrient-fortified bouillon cube containing vitamin A, folic acid, vitamin B12, iron, zinc, and iodine, or 2) a control cube containing iodine only. Each participant's household will receive a ration of bouillon cubes every 2 weeks, and households will be advised to prepare meals as usual, using the study-provided cubes. The trial duration will be 9 months for non-pregnant non-lactating WRA and children, and 3 months for lactating women. The primary outcomes will be changes in biomarkers of micronutrient status and hemoglobin among WRA and children and milk micronutrient concentrations among lactating women. Secondary outcomes will include change in prevalence of micronutrient deficiency and anemia; dietary intake of bouillon and micronutrients; inflammation, malaria, and morbidity symptoms; and child growth and development. DISCUSSION: Evidence from this study will inform discussions about bouillon fortification in Ghana and West Africa. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov (NCT05178407) and the Pan-African Clinical Trial Registry (PACTR202206868437931). This manuscript reflects protocol version 4 (August 29, 2022).


Assuntos
Alimentos Fortificados , Micronutrientes , Estado Nutricional , Humanos , Feminino , Gana/epidemiologia , Micronutrientes/deficiência , Micronutrientes/administração & dosagem , Micronutrientes/análise , Adulto , Adolescente , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Lactação , Masculino , Hemoglobinas/análise , Iodo/deficiência , Iodo/administração & dosagem , Iodo/análise
3.
Food Res Int ; 186: 114324, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38729692

RESUMO

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.


Assuntos
Necessidades Nutricionais , Humanos , Idoso , Envelhecimento/fisiologia , Valor Nutritivo , Dieta , Idoso de 80 Anos ou mais , Fenômenos Fisiológicos da Nutrição do Idoso/fisiologia , Estado Nutricional , Micronutrientes
4.
Eat Weight Disord ; 29(1): 34, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714632

RESUMO

PURPOSE: Bariatric surgery (BS), an effective treatment for severe obesity and its comorbidities, may result in micronutrient and vitamin deficiencies. This monocentric prospective observational study aimed at evaluating the efficacy of a specifically designed vitamin/mineral formula (Bariatrifast, BIOITALIA S.r.l., Italy) for preventing and treating micronutrient deficiencies in patients submitted to BS. METHODS: Twenty patients with severe obesity (mean weight and BMI: 123.5 kg (range 88-174) and 43.3 kg/m2 (range 37-54) respectively) underwent BS (10 vertical sleeve gastrectomy VSG, 10 Roux-en-Y gastric bypass, RYGB). The mean age was 49.9 years (range 27-68). After a presurgical visit (V0), follow-up visits were performed at 1, 3, 6 and 12 months after surgery (V1-V4). Recorded data included weight, height and BMI. A complete blood count, measurement of ferritin, folic acid, vitamin B12, ionized calcium, 25 OH vitamin D, parathyroid hormone (PTH) were obtained. Following BS, patients started the daily oral multivitamin and mineral supplement. RESULTS: All patients achieved a significant weight loss (mean - 34.7 ± 11.8 kg). No deficiencies of various vitamins/micronutrients were detected during the entire study period. The serum concentrations of vitamin B12, 25-OH Vitamin D and folic acid increased over the follow-up period compared with V0 (mean increase 243 ng/L, 23 µg /L, 8 µg/L, respectively). Compared to RYGB, patients who underwent sleeve gastrectomy showed higher levels of 25-OH vitamin D at V2, V3 and V4 (all p < 0.05), and higher levels of Vitamin B12 and folic acid at V4 (p < 0.05 and p < 0.005, respectively). No adverse events were reported. CONCLUSION: Following VSG or RYGB, Bariatrifast administration was associated with normal values of essential micronutrients, and it was well-tolerated without evidence of gastrointestinal side effects. Clinical Trial Registration ClinicalTrials.gov, identifiers NCT06152965.


Assuntos
Cirurgia Bariátrica , Vitaminas , Humanos , Pessoa de Meia-Idade , Feminino , Adulto , Masculino , Vitaminas/uso terapêutico , Vitaminas/administração & dosagem , Estudos Prospectivos , Idoso , Resultado do Tratamento , Obesidade Mórbida/cirurgia , Suplementos Nutricionais , Redução de Peso , Micronutrientes/administração & dosagem , Micronutrientes/uso terapêutico
5.
Clin Nutr ESPEN ; 61: 369-376, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38777456

RESUMO

BACKGROUND: Trace elements are an essential component of metabolism and medical nutrition therapy, with key roles in metabolic pathways, antioxidation, and immunity, which the present course aims at summarizing. RESULTS: Medical nutrition therapy includes the provision of all essential trace elements. The clinical essential issues are summarized for Copper, Iron, Selenium, Zinc, Iodine, Chromium, Molybdenum, and Manganese: the optimal analytical techniques are presented. The delivery of all these elements occurs nearly automatically when the patient is fed with enteral nutrition, but always requires separate prescription in case of parenteral nutrition. Isolated deficiencies may occur, and some patients have increased requirements, therefore a regular monitoring is required. The clinicians should always consider the impact of inflammation on blood levels, mostly lowering them even in absence of deficiency. CONCLUSION: This text summarises the most relevant clinical manifestations of trace element depletion and deficiency, the difficulties in assessing status, and makes practical recommendations for provision for enteral and parenteral nutrition.


Assuntos
Nutrição Enteral , Micronutrientes , Nutrição Parenteral , Oligoelementos , Humanos , Oligoelementos/deficiência , Oligoelementos/administração & dosagem , Oligoelementos/sangue , Micronutrientes/deficiência , Selênio/deficiência , Selênio/sangue , Estado Nutricional , Zinco/deficiência , Zinco/sangue , Necessidades Nutricionais , Cobre/deficiência , Cobre/sangue , Molibdênio , Ferro/sangue
6.
Clin Nutr ESPEN ; 61: 427-436, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38777465

RESUMO

Vitamins are essential organic molecules, which are required in the diet in relatively small amounts in any form of nutrition (oral, enteral, parenteral). Despite the small amounts that are required, the vitamins are essential both for maintenance of health, growth, and treatment of disease. After reminding about the principal function of all the vitamins, their needs and the clinical consequences of their deficit, the text present some common clinical problems: the impact of inflammation on the assessment of status. The reasons and diseases which cause increased requirements are presented, with the indications to monitoring of blood levels which remain the classical way to assess status in clinical settings. The text summarises the most relevant clinical manifestations of vitamins depletion and deficiency, the difficulties in assessing status, and makes recommendations for provision for medical nutrition therapy.


Assuntos
Micronutrientes , Vitaminas , Humanos , Estado Nutricional , Necessidades Nutricionais , Deficiência de Vitaminas , Inflamação
7.
Clin Nutr ESPEN ; 61: 437-446, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38777466

RESUMO

Micronutrients (MN), i.e. trace elements and vitamins, are essential components of the diet in relatively small amounts in any form of nutrition, with special needs in critically ill patients. Critical illness is characterised by the presence of inflammation and oxidative stress. MNs are tightly involved in antioxidant and immune defences. In addition, some conditions, and treatments result in large losses of biological fluids containing MNs: therefore, acute renal injury requiring renal replacement therapy, acute intestinal failure, and major burns and trauma are at high risk of acute depletion of body stores, and of deficiency. MN requirements are increased above standard DRI. Blood level interpretation is complicated by inflammation: some biomarkers assist the status determination. Due to the acute challenges of critical illness, it of utmost importance to cover the needs to maintain the organism's endogenous immune and antioxidant defences, and capacity to repair tissues. Practical strategies are proposed.


Assuntos
Estado Terminal , Micronutrientes , Estresse Oxidativo , Humanos , Micronutrientes/sangue , Antioxidantes/metabolismo , Doença Aguda , Necessidades Nutricionais , Oligoelementos/sangue , Inflamação , Estado Nutricional , Vitaminas/sangue , Biomarcadores/sangue
8.
Cells ; 13(10)2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38786092

RESUMO

The early stages of life, especially the period from conception to two years, are crucial for shaping metabolic health and the risk of obesity in adulthood. Adipose tissue (AT) plays a crucial role in regulating energy homeostasis and metabolism, and brown AT (BAT) and the browning of white AT (WAT) are promising targets for combating weight gain. Nutritional factors during prenatal and early postnatal stages can influence the development of AT, affecting the likelihood of obesity later on. This narrative review focuses on the nutritional programming of AT features. Research conducted across various animal models with diverse interventions has provided insights into the effects of specific compounds on AT development and function, influencing the development of crucial structures and neuroendocrine circuits responsible for energy balance. The hormone leptin has been identified as an essential nutrient during lactation for healthy metabolic programming against obesity development in adults. Studies have also highlighted that maternal supplementation with polyunsaturated fatty acids (PUFAs), vitamin A, nicotinamide riboside, and polyphenols during pregnancy and lactation, as well as offspring supplementation with myo-inositol, vitamin A, nicotinamide riboside, and resveratrol during the suckling period, can impact AT features and long-term health outcomes and help understand predisposition to obesity later in life.


Assuntos
Micronutrientes , Obesidade , Humanos , Animais , Obesidade/metabolismo , Micronutrientes/farmacologia , Micronutrientes/metabolismo , Tecido Adiposo Marrom/efeitos dos fármacos , Tecido Adiposo Marrom/metabolismo , Feminino , Gravidez , Tecido Adiposo/metabolismo , Tecido Adiposo/efeitos dos fármacos , Fármacos Antiobesidade/farmacologia , Fármacos Antiobesidade/uso terapêutico
9.
Int J Mol Sci ; 25(9)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38732128

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is a condition in which the pathological cumulation of fat with coexisting inflammation and damage of hepatic cells leads to progressive dysfunctions of the liver. Except for the commonly well-known major causes of NAFLD such as obesity, dyslipidemia, insulin resistance, or diabetes, an unbalanced diet and imbalanced nutritional status should also be taken into consideration. In this narrative review, we summarized the current knowledge regarding the micro- and macronutrient status of patients suffering from NAFLD considering various diets and supplementation of chosen supplements. We aimed to summarize the knowledge indicating which nutritional impairments may be associated with the onset and progression of NAFLD at the same time evaluating the potential therapy targets that could facilitate the healing process. Except for the above-mentioned objectives, one of the most important aspects of this review was to highlight the possible strategies for taking care of NAFLD patients taking into account the challenges and opportunities associated with the micronutrient status of the patients. The current research indicates that a supplementation of chosen vitamins (e.g., vitamin A, B complex, C, or D) as well as chosen elements such as zinc may alleviate the symptoms of NAFLD. However, there is still a lack of sufficient data regarding healthy ranges of dosages; thus, further research is of high importance in this matter.


Assuntos
Suplementos Nutricionais , Micronutrientes , Hepatopatia Gordurosa não Alcoólica , Nutrientes , Estado Nutricional , Humanos , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/dietoterapia , Nutrientes/metabolismo , Micronutrientes/metabolismo , Vitaminas/metabolismo , Vitaminas/administração & dosagem
10.
Nutrients ; 16(9)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38732620

RESUMO

Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes.


Assuntos
Diabetes Gestacional , Micronutrientes , Humanos , Feminino , Gravidez , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Grécia/epidemiologia , Micronutrientes/administração & dosagem , Estudos Prospectivos , Adulto , Fenômenos Fisiológicos da Nutrição Materna , Fatores de Risco , Teste de Tolerância a Glucose , Estado Nutricional , Índice de Massa Corporal , Comportamento Alimentar
11.
Int J Mol Sci ; 25(9)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38732186

RESUMO

Breast cancer is one of the most common cancers worldwide, at the same time being one of the most prevalent causes of women's death. Many factors such as alcohol, weight fluctuations, or hormonal replacement therapy can potentially contribute to breast cancer development and progression. Another important factor in breast cancer onset includes micronutrient status. In this narrative review, we analyzed 23 micronutrients and their possible influence on breast cancer onset and progression. Further, the aim of this study was to investigate the impact of micronutrient status on the prevention of breast cancer and its possible influence on various therapeutic pathways. We researched meta-analyses, systemic and narrative reviews, retrospective studies, as well as original studies on human and animal models. The results of these studies indicate a possible correlation between the different levels of micronutrients and a decreased risk of breast cancer as well as a better survival rate. However, further studies are necessary to establish adequate doses of supplementation of the chosen micronutrients and the exact mechanisms of micronutrient impact on breast cancer therapy.


Assuntos
Neoplasias da Mama , Micronutrientes , Humanos , Neoplasias da Mama/metabolismo , Feminino , Animais , Suplementos Nutricionais
12.
BMC Public Health ; 24(1): 1317, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750483

RESUMO

BACKGROUND: Despite the positive impact of trade liberalization on food availability in India, severe inequality in nutrition consumption at the district level persists. Empirical evidence on the relationship between trade liberalization and nutrition consumption inequality often offers a country-level perspective and generates disputed outcomes. The study aimed to explore the effects of trade liberalization on inequality in nutrition consumption at the district level in India and to examine the heterogeneity of the impact on different nutrition consumption. METHODS: Our study employed the Gini Index to measure nutrition consumption inequality of 2 macronutrients and 5 micronutrients at the district level in India during 2009-2011, utilizing the comprehensive FAO/WHO individual food consumption data. The import tariff was adopted as a proxy for trade liberalization, as its externally imposed nature facilitates a causal interpretation. We further identified the direct causal relationship between food trade liberalization and inequality in nutrition consumption using a fixed effects model. RESULTS: The results show that more than 50% of the individuals in the survey districts did not meet the dietary standards for both macronutrients and micronutrients. Food trade liberalization hindered the improvement of inequality in nutrition consumption. As import tariffs were reduced by 1%, the inequality in intake of calories, zinc, vitamin B1, and vitamin B2 increased significantly by 0.45, 0.56, 0.48, and 0.66, respectively, which might be related to food market performance. The results also highlight the positive role of the gender gap, female-headed households, and caste culture on inequality in nutrition consumption in India. CONCLUSIONS: To ease the shock of liberalization and minimize its inequality effects, complementary measures should be adopted, such as improving food logistic conditions in poor areas, and nutrition relief schemes.


Assuntos
Comércio , Humanos , Índia , Feminino , Masculino , Adulto , Comércio/estatística & dados numéricos , Micronutrientes , Adolescente , Abastecimento de Alimentos/estatística & dados numéricos , Adulto Jovem , Dieta/estatística & dados numéricos , Política , Fatores Socioeconômicos , Pessoa de Meia-Idade , Criança , Estado Nutricional
13.
J Nutr Sci Vitaminol (Tokyo) ; 70(2): 131-138, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38684383

RESUMO

This randomized controlled clinical study aimed to assess the effectiveness of a nutrition intervention program for non-pregnant female workers in Vietnam. A total of 500 female workers were randomly assigned to the intervention and control groups. Participants in the intervention group were provided nutrition education, personalized specific dietary, and received oral nutrition supplements (ONS)-which contained multi-minerals and vitamins according to recommendations for adults for a duration of 12 wk, while participants in the control group received only nutrition education. The result shows the percentage of malnutrition by BMI in the control group rose from 15.6% to 21.3% after 12 wk; the figure for counterpart experienced a remain unchanged (p<0.05). Additionally, the mean of serum zinc in the intervention group significantly increased from 49.0±21.2 µg/dL to 53.6±19.5 µg/dL after 12 wk. Moreover, the intervention group demonstrated significant increases in serum iron and total serum calcium levels (p<0.05), with from 13.9±5.6 µmol/L to 15.3±5.8 µmol/L, and from 2.36±0.15 mmol/L to 2.4±0.09 mmol/L, respectively. The participants of the intervention group were more likely to have higher total serum calcium (Coef=0.04, p<0.05), serum iron (Coef=1.99, p<0.05), and serum zinc (Coef=18.9, p<0.05), which presents a reduce micronutrient deficiency. In conclusion, workplace nutrition interventions effectively mitigate micronutrient deficiencies and improve the nutritional status of female workers.


Assuntos
Suplementos Nutricionais , Desnutrição , Micronutrientes , Estado Nutricional , Local de Trabalho , Zinco , Humanos , Feminino , Vietnã , Micronutrientes/deficiência , Micronutrientes/administração & dosagem , Micronutrientes/sangue , Adulto , Zinco/deficiência , Zinco/sangue , Zinco/administração & dosagem , Desnutrição/prevenção & controle , Desnutrição/epidemiologia , Ferro/sangue , Pessoa de Meia-Idade , Cálcio/sangue , Cálcio/deficiência , Índice de Massa Corporal , Dieta/métodos , Vitaminas/administração & dosagem , Vitaminas/sangue , Educação em Saúde/métodos
14.
FP Essent ; 539: 13-17, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38648170

RESUMO

Micronutrients are nutrients the body needs in small quantities, such as vitamins and minerals. Micronutrient deficiencies can occur when an individual is restricting calorie intake for weight loss or management, not consuming an adequate amount of food to meet energy requirements due to poor appetite or illness, eliminating one or more food groups from the diet on a regular basis, or consuming a diet low in micronutrient-rich foods despite adequate or excessive energy intake. Patient groups at risk include older adults, pregnant patients, patients with alcohol use disorder, patients with vegetarian or vegan diets, and patients with increased requirements secondary to medical conditions or long-term drug use that alters nutrient absorption, metabolism, or excretion. The micronutrients that most commonly require supplementation are vitamin D, iron, vitamin A, zinc, folate, and iodine. Results of large-scale randomized trials have shown no overall benefit of multivitamins for the majority of patients. However, a daily multivitamin may be beneficial, particularly for patients who do not consistently consume a well-balanced diet. Although dietary supplements can be helpful in correcting deficiencies, higher than recommended doses can cause adverse effects. Patients should be advised to take recommended dosages of supplements and consult their physician if they notice any adverse effects. Physicians should advise patients to consult drug labels and/or pharmacists about potential supplement interactions with drugs or other supplements.


Assuntos
Suplementos Nutricionais , Micronutrientes , Humanos , Micronutrientes/uso terapêutico , Vitaminas/uso terapêutico , Vitaminas/administração & dosagem , Feminino , Necessidades Nutricionais , Gravidez , Zinco/administração & dosagem , Zinco/uso terapêutico , Zinco/deficiência
15.
Trials ; 25(1): 289, 2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38685109

RESUMO

BACKGROUND: Iron and folic acid (IFA) supplements are currently provided to Cambodian women during pregnancy. However, recent research has found benefits of a multiple micronutrient supplement (MMS) over just IFA alone on several outcomes of perinatal and infant health. The Ministry of Health in Cambodia has proposed a transition from IFA to MMS but to effectively guide this transition requires implementation research on the acceptability and adherence to MMS (over IFA). METHODS: This non-inferiority trial aims to assess the adherence and acceptability of IFA (60 mg elemental iron and 400 µg folic acid) compared to MMS (standard UNIMMAP formulation including 15 micronutrients) during antenatal care in Cambodia. A prospective cohort of 1545 pregnant women will be assigned to one of three trial arms: (1) IFA for 90 days [IFA-90]; (2) MMS for 180 days with two distributions of 90-count tablet bottles [MMS-90]; or (3) MMS for 180 days with one 180-count tablet bottle [MMS-180]. Each arm will enroll 515 women across 48 health centers (clusters) in Kampong Thom Province in Cambodia. The primary outcome is the non-inferiority of adherence rates of MMS-180 compared to IFA-90, as assessed by tablet counts. Mixed-effects logistic and linear regression models will be used to estimate the difference in the adherence rate between the two groups, with an 'a priori' determined non-inferiority margin of 15%. Acceptability of MMS and IFA will be measured using a quantitative survey conducted with enrolled pregnant women at 30-day, 90-day, and 180-day time-points. DISCUSSION: Findings from this study will guide an effective and feasible MMS scale-up strategy for Cambodia. Additionally, the findings will be shared globally with other stakeholders planning to scale up MMS in other countries. TRIAL REGISTRATION: NCT05867836 ( ClinicalTrials.gov , registered May 18, 2023).


Assuntos
Suplementos Nutricionais , Ácido Fólico , Micronutrientes , Adulto , Feminino , Humanos , Gravidez , Camboja , Estudos de Equivalência como Asunto , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Adesão à Medicação , Micronutrientes/administração & dosagem , Estudos Multicêntricos como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/métodos , Estudos Prospectivos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
BMC Public Health ; 24(1): 960, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38575928

RESUMO

BACKGROUND: Childhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0-18 years old. METHODS: Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist. RESULTS: Seventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0-11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children's growth and eating behaviours, but there is a lack of data on childhood obesity. CONCLUSION: This finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.


Assuntos
Desnutrição , Hipernutrição , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Ferro , Desnutrição/epidemiologia , Desnutrição/complicações , Micronutrientes , Estado Nutricional , Hipernutrição/complicações , Hipernutrição/epidemiologia , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Prevalência , Vietnã/epidemiologia , Zinco
17.
J Med Food ; 27(4): 279-286, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38603555

RESUMO

Amaranth is a pseudocereal rich in macronutrients and micronutrients, with about 60 species cultivated worldwide. It is a high nutritional value food because of its many essential amino acids. Recent investigations demonstrate that the phytochemicals and extracts of amaranth have beneficial effects on health, including antidiabetic potential, a decrease in plasmatic cholesterol and blood pressure, and protection from oxidative stress and inflammation. Nowadays, type 2 diabetes has increased worldwide, becoming a problem of public health that makes it necessary to look for alternative strategies for its prevention and treatment. This review aims to summarize the antidiabetic potential of diverse species of the Amaranth genus. A bibliographical review was updated on the plant's therapeutic potential, including stem, leaves, and seeds, to know the benefits and potential as an adjuvant in treating and managing diabetes and associated pathologies (hypertension, dyslipidemia, and heart disease). This analysis contributes to the generation of knowledge about the therapeutic effects of amaranth, promoting the creation of new products, and the opportunity to conduct clinical trials to assess their safety and efficacy.


Assuntos
Amaranthus , Diabetes Mellitus Tipo 2 , Humanos , Hipoglicemiantes/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Sementes/química , Amaranthus/química , Micronutrientes
18.
PLoS One ; 19(4): e0299515, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38625868

RESUMO

BACKGROUND AND OBJECTIVE: The adoption of plant-based diets in recent years has increased the need for accurate assessments of dietary intake among vegans, vegetarians, semi-vegetarians, and omnivores. This study aimed at developing and validating a modular web-based food-frequency questionnaire (FFQ), the MY-VEG-FFQ. This FFQ was based on the original FFQ (O-FFQ) designed for the Israeli population and incorporates a skip algorithm tailored for different dietary patterns. METHODS: A convenience sample of 101 participants, recruited via social media, completed the MY-VEG FFQ, as well as a three-day food records, which served as the gold standard for this research. Relative validity of the new FFQ was evaluated by comparing nutrients with those in the three-day food records, using Pearson correlation coefficients, Bland-Altman plots, and cross-classification. The results were compared with 90 O-FFQs that previously had been completed by vegans. RESULTS: The validation analysis showed that nutrient-intake estimates were generally higher for the MY-VEG-FFQ than those of the three-day food records. Pearson correlation coefficients ranged between 0.25-0.63, indicating an acceptable agreement between the two tools. The proportion of participants with exact or adjacent quartile agreement was between 73%-82%. The Bland-Altman analysis revealed overestimation of nutrient intake via the MY-VEG-FFQ. Compared to the O-FFQ, vegans who completed the MY-VEG-FFQ reported consumption of more food items. Additionally, the MY-VEG-FFQ showed a significantly higher intake of most macro- and micronutrients. CONCLUSIONS: The My-VEG-FFQ demonstrated reasonable validity in assessing dietary intake among people who followed a plant-based diet. However, it tended to overestimate nutrient intake compared to the three-day food records. The development of a modular web-based FFQ with a skip algorithm tailored for specific dietary patterns, fills a crucial gap in accurately assessing the dietary intake of these populations. The MY-VEG-FFQ offers a practical and cost-effective tool for evaluating long-term dietary consumption among people who follow different dietary patterns.


Assuntos
Dieta , Veganos , Humanos , Inquéritos e Questionários , Registros de Dieta , Reprodutibilidade dos Testes , Ingestão de Energia , Micronutrientes , Inquéritos sobre Dietas , Internet
19.
BMJ Glob Health ; 9(4)2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38599666

RESUMO

INTRODUCTION: Traditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people. METHODS: Ovid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed. RESULTS: After screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08). CONCLUSIONS: Overnutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition. PROSPERO REGISTRATION NUMBER: CRD42020221523.


Assuntos
Anemia Ferropriva , Hipernutrição , Deficiência de Vitamina A , Criança , Humanos , Adolescente , Ferro , Deficiência de Vitamina A/epidemiologia , Zinco , Sobrepeso/complicações , Anemia Ferropriva/etiologia , Anemia Ferropriva/prevenção & controle , Micronutrientes , Hipernutrição/epidemiologia , Hipernutrição/complicações , Vitamina A , Obesidade/complicações , Fatores de Risco , Biomarcadores
20.
J Matern Fetal Neonatal Med ; 37(1): 2343613, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38637273

RESUMO

INTRODUCTION: The importance of micronutrient intake during the preconceptional and early pregnancy period for both maternal and fetal outcomes is well-known, however, relevant data are not available for Greek pregnant women. The aim of the present study is to delineate the nutritional status preceding conception among a representative cohort of Greek pregnant women. METHODS: This was a prospective study of pregnant women from routine care, recruited at 11+0-13+6 gestational weeks, between December 2020 and October 2022, at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece. Eligible participants for the study included healthy pregnant women aged 20 years or older, possessing a proficient understanding of the Greek language, and not engaged in specific nutritional programs. A validated Food Frequency Questionnaire was applied to gather information regarding nutritional habits in the last 6 months prior to conception. The consumption of nutrients was compared to the reference intake levels suggested by the European Food Safety Authority. Further analyses between different participants' subgroups were performed. RESULTS: Overall, 1100 pregnant women (mean age: 32.4 ± 4.9 years) were enrolled. Almost all examined micronutrients' intake was significantly different from dietary reference values. Furthermore, nutrient adequacy ratio was below 60% in 6 out of 22 micronutrients examined, and Mean Adequacy Ratio was 93%. However, Mean Adequacy Ratio is characterized by extreme variance between the examined values. Iodine, folic acid, potassium, and vitamin D intake levels were significantly lower than the recommended intake levels (p < .001 for all), while vitamin K and niacin (p < .001 for both) were consumed in great extent. Sodium median intake, without calculating extra salt addition also exceeded the reference value levels (p = .03). Notably, magnesium intake exceeded the upper safety limits in 12.4% of the sample. CONCLUSION: Potential inadequacies in important micronutrients for uneventful pregnancy outcomes have been revealed.. Special attention is needed for magnesium to balance possible toxicity with evident benefits.


Assuntos
Micronutrientes , Oligoelementos , Gravidez , Feminino , Humanos , Adulto , Estudos Prospectivos , Grécia/epidemiologia , Magnésio , Dieta , Estudos Epidemiológicos
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