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1.
BMJ Glob Health ; 6(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33472840

RESUMO

Acute respiratory tract infections (ARIs) are a leading cause of ill-health and death globally. Individual or multiple micronutrients have been shown to modulate immune function and affect the risk and severity of a number of infectious diseases. We systematically reviewed the evidence on the impact of micronutrient supplements to reduce the occurrence of ARIs and shorten the duration of ARI symptoms among adults. Random effects meta-analyses were conducted to estimate the pooled effects of vitamin D, vitamin C, zinc and multiple micronutrient supplementation (MMS) on the occurrence of ARIs and the duration of ARI symptoms. Vitamin D supplementation reduced the risk of ARI (risk ratio (RR)=0.97; 95% CI 0.94 to 1.00; p=0.028) and shortened the duration of symptoms (per cent difference: -6% (95% CI -9% to -2%; p=0.003)). The RR of vitamin D to prevent ARI was farther from the null when diagnosis was based on clinical diagnosis or laboratory testing, compared with self-report and when the loading dose was <60 000 IU. Vitamin C supplementation reduced the risk of ARIs (RR=0.96; 95% CI 0.93 to 0.99; p=0.01) and shortened the duration of symptoms (per cent difference: -9% (95% CI -16% to -2%; p=0.014)). The effect of vitamin C on preventing ARI was stronger among men and in middle-income countries, compared with women and high-income countries, respectively. Zinc supplementation did not reduce the risk of ARIs but shortened the duration of symptoms substantially (per cent difference: -47% (95% CI -73% to -21%; p=0.0004)). Our synthesis of global evidence from randomised controlled trials indicates that micronutrient supplements including zinc, vitamins C and D, and multiple micronutrient supplements may be modestly effective in preventing ARIs and improving their clinical course. Further research is warranted to better understand the effectiveness that individual or multiple micronutrients have on SARS-CoV-2 infection and treatment outcomes.


Assuntos
Suplementos Nutricionais , Micronutrientes/uso terapêutico , Infecções Respiratórias/prevenção & controle , /prevenção & controle , Humanos , Influenza Humana/prevenção & controle
2.
Nutrition ; 81: 110989, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33049573

RESUMO

Coronavirus disease 2019 (COVID-19) is a global pandemic causing one of the biggest challenges for critical care medicine. Mortality from COVID-19 is much greater in elderly men, many of whom succumb to acute respiratory distress syndrome (ARDS) triggered by the viral infection. Because there is no specific antiviral treatment against COVID-19, new strategies are urgently needed. Selenium is an essential trace element with antioxidant and immunomodulatory effects. Poor nutritional status increases the pathogenicity of viruses and low selenium in particular can be a determinant of viral virulence. In the past decade, selenium pharmaconutrition studies have demonstrated some reduction in overall mortality, including how reduced incidence of ventilator-associated pneumonia and infectious complications such as ARDS in the critically ill. Consequently, we postulate that intravenous selenium therapy, could be part of the therapeutic fight against COVID-19 in intensive care unit patients with ARDS and that outcomes could be affected by age, sex, and body weight. Our working hypothesis addresses the question: Could high-dose selenite pharmaconutrition, as an early pharmacologic intervention, be effective at reducing the incidence and the progression from type 1 respiratory failure (non-ARDS) to severe ARDS, multiorgan failure, and new infectious complications in patients with COVID-19 patients?


Assuntos
/dietoterapia , Selênio/uso terapêutico , /complicações , Estado Terminal , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Inflamação/etiologia , Masculino , Micronutrientes/administração & dosagem , Micronutrientes/farmacocinética , Micronutrientes/uso terapêutico , Modelos Biológicos , Fenômenos Fisiológicos da Nutrição , Obesidade/complicações , Pandemias , Guias de Prática Clínica como Assunto , Selênio/administração & dosagem , Selênio/farmacocinética
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 643-649, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197676

RESUMO

INTRODUCCIÓN: La ingesta adecuada de yodo es esencial durante el embarazo. Sin embargo, una parte de la población gestante de nuestro país persiste en una situación de yododeficiencia. Un estudio previo realizado en embarazadas del área sanitaria de Pamplona mostró una yoduria insuficiente (125 mcg/l) y un bajo consumo de sal yodada. El objetivo del presente trabajo es conocer la ingesta de yodo y analizar la evolución del estado de yodación en gestantes de nuestro medio en los últimos años. MÉTODOS: Estudio observacional de 400 gestantes de primer trimestre sin antecedentes conocidos de enfermedad tiroidea. Se cumplimentó un cuestionario de consumo de yodo. Como marcadores del estado de yodación se analizaron la yoduria en una muestra simple de orina y la tiroglobulina sérica, y se calculó el volumen tiroideo mediante ecografía cervical. RESULTADOS: El 70,5% de las participantes consumía sal yodada (55,3% pregestacional) y el 98,5% suplementos farmacológicos con yodo (dosis 202,6±30,1 mcg/día). La mediana de la yoduria fue 242 mcg/l (138,5-415,5 mcg/l) y de la tiroglobulina 12,3 mcg/l (8,39 mcg/l). El consumo de sal yodada se asoció a mayor yoduria y a un menor volumen tiroideo. No se encontraron diferencias en los parámetros estudiados en función del consumo de lácteos, pescado o huevos. CONCLUSIONES: La ingesta de yodo en gestantes de Pamplona ha aumentado, tanto a expensas del empleo de sal yodada como de la dosis de la suplementación farmacológica. Esto ha permitido alcanzar un estado de yodación adecuado


INTRODUCTION: Adequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. METHODS: An observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. RESULTS: Iodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. CONCLUSIONS: Iodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade


Assuntos
Humanos , Feminino , Gravidez , Adulto , Estado Nutricional , Iodo/administração & dosagem , Evolução Clínica/métodos , Deficiência de Iodo/diagnóstico , Complicações na Gravidez/dietoterapia , Iodo/metabolismo , Inquéritos e Questionários , Complicações na Gravidez/sangue , Tireoglobulina/urina , Micronutrientes/uso terapêutico , Estudos Transversais
4.
Molecules ; 25(22)2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33207753

RESUMO

Low levels of micronutrients have been associated with adverse clinical outcomes during viral infections. Therefore, to maximize the nutritional defense against infections, a daily allowance of vitamins and trace elements for malnourished patients at risk of or diagnosed with coronavirus disease 2019 (COVID-19) may be beneficial. Recent studies on COVID-19 patients have shown that vitamin D and selenium deficiencies are evident in patients with acute respiratory tract infections. Vitamin D improves the physical barrier against viruses and stimulates the production of antimicrobial peptides. It may prevent cytokine storms by decreasing the production of inflammatory cytokines. Selenium enhances the function of cytotoxic effector cells. Furthermore, selenium is important for maintaining T cell maturation and functions, as well as for T cell-dependent antibody production. Vitamin C is considered an antiviral agent as it increases immunity. Administration of vitamin C increased the survival rate of COVID-19 patients by attenuating excessive activation of the immune response. Vitamin C increases antiviral cytokines and free radical formation, decreasing viral yield. It also attenuates excessive inflammatory responses and hyperactivation of immune cells. In this mini-review, the roles of vitamin C, vitamin D, and selenium in the immune system are discussed in relation to COVID-19.


Assuntos
Ácido Ascórbico/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Síndrome da Liberação de Citocina/prevenção & controle , Suplementos Nutricionais , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Selênio/uso terapêutico , Vitamina D/uso terapêutico , Anticorpos Antivirais/biossíntese , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/dietoterapia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/dietoterapia , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/virologia , Citocinas/antagonistas & inibidores , Citocinas/biossíntese , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Interações Hospedeiro-Patógeno/imunologia , Humanos , Sistema Imunitário/efeitos dos fármacos , Fatores Imunológicos/uso terapêutico , Micronutrientes/uso terapêutico , Pneumonia Viral/dietoterapia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Linfócitos T Citotóxicos/efeitos dos fármacos , Linfócitos T Citotóxicos/imunologia , Linfócitos T Citotóxicos/virologia
5.
Nutrients ; 12(10)2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33092041

RESUMO

Viral infections are a leading cause of morbidity and mortality worldwide, and the importance of public health practices including handwashing and vaccinations in reducing their spread is well established. Furthermore, it is well known that proper nutrition can help support optimal immune function, reducing the impact of infections. Several vitamins and trace elements play an important role in supporting the cells of the immune system, thus increasing the resistance to infections. Other nutrients, such as omega-3 fatty acids, help sustain optimal function of the immune system. The main aim of this manuscript is to discuss of the potential role of micronutrients supplementation in supporting immunity, particularly against respiratory virus infections. Literature analysis showed that in vitro and observational studies, and clinical trials, highlight the important role of vitamins A, C, and D, omega-3 fatty acids, and zinc in modulating the immune response. Supplementation with vitamins, omega 3 fatty acids and zinc appears to be a safe and low-cost way to support optimal function of the immune system, with the potential to reduce the risk and consequences of infection, including viral respiratory infections. Supplementation should be in addition to a healthy diet and fall within recommended upper safety limits set by scientific expert bodies. Therefore, implementing an optimal nutrition, with micronutrients and omega-3 fatty acids supplementation, might be a cost-effective, underestimated strategy to help reduce the burden of infectious diseases worldwide, including coronavirus disease 2019 (COVID-19).


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Suplementos Nutricionais , Ácidos Graxos Ômega-3/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Oligoelementos/uso terapêutico , Viroses/tratamento farmacológico , Vitaminas/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Ácidos Graxos Ômega-3/farmacologia , Humanos , Imunidade/efeitos dos fármacos , Micronutrientes/uso terapêutico , Estado Nutricional , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Infecções Respiratórias/imunologia , Infecções Respiratórias/virologia , Oligoelementos/farmacologia , Viroses/imunologia , Viroses/virologia , Vitaminas/farmacologia , Zinco/farmacologia , Zinco/uso terapêutico
6.
PLoS One ; 15(8): e0237491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841256

RESUMO

PURPOSE: Viral upper respiratory infections are associated with significant health and economic impact. This study sought to determine the efficacy of routine immune system micronutrient supplementation on the incidence, duration and severity of common cold symptoms. METHODS: This pilot study was a randomized, double-blinded, placebo-controlled trial of N = 259 with asymptomatic participants aged 18 to 65 in two cold seasons of 2016 and 2017. The treatment group received an immune system targeted micronutrient caplet, while the placebo group received a micronized cellulose caplet externally identical to the treatment caplet. Weekly surveys were sent electronically to participants to document common cold incidence, duration and severity. Primary statistical results were obtained using mixed-effects logistic regressions to account for longitudinal measurements for participants. RESULTS: The odds of acquiring an upper respiratory infection, adjusted for potential confounders, was estimated to be 0.74 times lower in the treatment group (p = 0.14). The odds of reporting specific symptoms were statistically lower in the treatment arm compared to the placebo arm for runny nose (OR = 0.53, p = 0.01) and cough (OR = 0.51, p = 0.04). Shorter durations of runny nose and cough were also observed in the treatment arm compared to placebo (both p < 0.05). There was no significant difference in severity of symptoms in either group. The observed proportion of reported cold symptoms in the treatment group was lower compared to the placebo group between late January and February in two consecutive cold seasons. Given the physical, workplace and economic impact of upper respiratory infections, this low cost and low risk intervention should be further studied with more robust investigation and meticulous experimental design.


Assuntos
Resfriado Comum/tratamento farmacológico , Micronutrientes/uso terapêutico , Adolescente , Adulto , Idoso , Resfriado Comum/complicações , Resfriado Comum/epidemiologia , Resfriado Comum/patologia , Tosse/patologia , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Faringite/patologia , Projetos Piloto , Efeito Placebo , Índice de Gravidade de Doença , Adulto Jovem
7.
Nutrients ; 12(8)2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32784601

RESUMO

OBJECTIVES: The novel coronavirus infection (COVID-19) conveys a serious threat globally to health and economy because of a lack of vaccines and specific treatments. A common factor for conditions that predispose for serious progress is a low-grade inflammation, e.g., as seen in metabolic syndrome, diabetes, and heart failure, to which micronutrient deficiencies may contribute. The aim of the present article was to explore the usefulness of early micronutrient intervention, with focus on zinc, selenium, and vitamin D, to relieve escalation of COVID-19. METHODS: We conducted an online search for articles published in the period 2010-2020 on zinc, selenium, and vitamin D, and corona and related virus infections. RESULTS: There were a few studies providing direct evidence on associations between zinc, selenium, and vitamin D, and COVID-19. Adequate supply of zinc, selenium, and vitamin D is essential for resistance to other viral infections, immune function, and reduced inflammation. Hence, it is suggested that nutrition intervention securing an adequate status might protect against the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - coronavirus-2) and mitigate the course of COVID-19. CONCLUSION: We recommended initiation of adequate supplementation in high-risk areas and/or soon after the time of suspected infection with SARS-CoV-2. Subjects in high-risk groups should have high priority as regards this nutritive adjuvant therapy, which should be started prior to administration of specific and supportive medical measures.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Micronutrientes/uso terapêutico , Estado Nutricional , Pneumonia Viral/tratamento farmacológico , Selênio/uso terapêutico , Vitamina D/uso terapêutico , Zinco/uso terapêutico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Deficiências Nutricionais/complicações , Progressão da Doença , Feminino , Humanos , Inflamação/prevenção & controle , Masculino , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/virologia
8.
PLoS One ; 15(8): e0237112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790693

RESUMO

BACKGROUND: The effect of nutritional supplements on the re-infection rate of species-specific soil-transmitted helminth infections in school-aged children remains complex and available evidence on the subject matter has not been synthesized. METHODS: The review included randomised controlled trials (RCTs) and cluster RCTs investigating food supplements on school-aged children between the age of 4-17 years. A search for RCTs was conducted on eight databases from inception to 12th June 2019. Cochrane Risk of Bias tool was used to assess the risk of bias in all included studies. Meta-analysis and narrative synthesis were conducted to describe and analyze the results of the review. Outcomes were summarized using the mean difference or standardized mean difference where appropriate. RESULTS: The search produced 1,816 records. Six studies met the inclusion criteria (five individually RCTs and one cluster RCT). Four studies reported data on all three STH species, while one study only reported data on Ascaris lumbricoides infections and the last study reported data on only hookworm infections. Overall, the risk of bias in four individual studies was low across most domains. Nutritional supplementation failed to statistically reduce the re-infection rates of the three STH species. The effect of nutritional supplements on measures of physical wellbeing in school-aged children could not be determined. CONCLUSIONS: The findings from this systematic review suggest that nutritional supplements for treatment of STH in children should not be encouraged unless better evidence emerges. Conclusion of earlier reviews on general populations may not necessarily apply to children since children possibly have a higher re-infection rate.


Assuntos
Ascaríase/prevenção & controle , Suplementos Nutricionais , Micronutrientes/uso terapêutico , Tricuríase/prevenção & controle , Vitaminas/uso terapêutico , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Ascaríase/parasitologia , Criança , Humanos , Micronutrientes/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Solo/parasitologia , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , Tricuríase/parasitologia , Vitaminas/administração & dosagem
9.
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
10.
Clin Immunol ; 220: 108545, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32710937

RESUMO

COVID-19 rapidly turned to a global pandemic posing lethal threats to overwhelming health care capabilities, despite its relatively low mortality rate. The clinical respiratory symptoms include dry cough, fever, anosmia, breathing difficulties, and subsequent respiratory failure. No known cure is available for COVID-19. Apart from the anti-viral strategy, the supports of immune effectors and modulation of immunosuppressive mechanisms is the rationale immunomodulation approach in COVID-19 management. Diet and nutrition are essential for healthy immunity. However, a group of micronutrients plays a dominant role in immunomodulation. The deficiency of most nutrients increases the individual susceptibility to virus infection with a tendency for severe clinical presentation. Despite a shred of evidence, the supplementation of a single nutrient is not promising in the general population. Individuals at high-risk for specific nutrient deficiencies likely benefit from supplementation. The individual dietary and nutritional status assessments are critical for determining the comprehensive actions in COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/dietoterapia , Tosse/dietoterapia , Fatores Imunológicos/uso terapêutico , Micronutrientes/uso terapêutico , Pandemias , Pneumonia Viral/dietoterapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Tosse/diagnóstico , Tosse/imunologia , Tosse/patologia , Gerenciamento Clínico , Febre/diagnóstico , Febre/dietoterapia , Febre/imunologia , Febre/patologia , Humanos , Imunidade Celular/efeitos dos fármacos , Imunidade Inata/efeitos dos fármacos , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/dietoterapia , Transtornos do Olfato/imunologia , Transtornos do Olfato/patologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/dietoterapia , Insuficiência Respiratória/imunologia , Insuficiência Respiratória/patologia , Índice de Gravidade de Doença , Oligoelementos/uso terapêutico , Vitaminas/uso terapêutico
11.
Am J Trop Med Hyg ; 103(4): 1416-1426, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618258

RESUMO

The objective of this study was to assess the impact of different strategies for delivering supplemental zinc on fecal myeloperoxidase (MPO), neopterin (NEO), and calprotectin (CAL) among young Laotian children. In a double-blind controlled trial, children aged 6-23 months were randomized to receive either daily preventive zinc (PZ) tablets (7 mg/day), daily micronutrient powder (MNP; containing 10 mg zinc and 14 other micronutrients), therapeutic zinc (TZ) supplements for diarrhea treatment (20 mg/day for 10 days), or daily placebo powder and followed for ∼36 weeks. Stool samples were collected at baseline and endline. Fecal MPO, NEO, and CAL concentrations were determined in a randomly selected subsample of 720 children using commercially available ELISA kits. At baseline, the mean age was 14.1 ± 4.9 months and prevalence of stunting was 39%. The endline prevalence of stunting was 43%; there was no overall treatment effect on physical growth in the parent trial. At endline, the mean (95% CI) MPO in the PZ group was 1,590 [1,396; 1,811] ng/mL and did not differ from that in the MNP (1,633 [1,434; 1,859] ng/mL), TZ (1,749 [1,535; 1,992] ng/mL), and control (1,612 [1,415; 1,836] ng/mL) groups (P = 0.749). Similarly, there was no overall treatment effect on NEO and CAL concentrations (P = 0.226 and 0.229, respectively). In this population, the provision of PZ or TZ supplements or MNP had no impact on growth or environmental enteric dysfunction (EED) as assessed by fecal MPO, NEO, and CAL. Additional research is needed to better understand the etiology and proposed mechanisms of EED pathogenesis.


Assuntos
Biomarcadores/análise , Diarreia/tratamento farmacológico , Fezes/química , Zinco/administração & dosagem , Desenvolvimento Infantil/efeitos dos fármacos , Saúde da Criança , Diarreia/epidemiologia , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Lactente , Laos/epidemiologia , Complexo Antígeno L1 Leucocitário/análise , Masculino , Micronutrientes/administração & dosagem , Micronutrientes/efeitos adversos , Micronutrientes/uso terapêutico , Neopterina/análise , Peroxidase/análise , Zinco/efeitos adversos , Zinco/uso terapêutico
12.
Medicine (Baltimore) ; 99(24): e20310, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541454

RESUMO

RATIONALE: Mitochondrial encephalomyopathy with lactic acidosis and stroke- like episodes (MELAS) syndrome is caused by mitochondrial respiratory chain dysfunction and oxidative phosphorylation disorder. It is a rare clinical metabolic disease involved with multiple systems. PATIENT CONCERNS: A 22-year-old patient presented with limb convulsion accompanied by loss of consciousness, headache, partial blindness, blurred vision, and so on. DIAGNOSES: Brain magnetic resonance imaging showed a high-intensity area in bilateral occipital cortex, left parietal lobe and cerebellum on diffusion-weighted imaging. These focus did not distribute as vascular territory. The pathological examination of skeletal muscle revealed several succinate dehydrogenase reactive vessels with overreaction and increased content of lipid droplets in some muscle fibers. Genetic testing showed that the patient carried m.10158T>C mutation. INTERVENTIONS: She was provided with traditional arginine hydrochloride therapy and orally medication of coenzyme Q (10 mg). OUTCOMES: Mitochondrial DNA of blood and hair follicle of patient carried m.10158T>C mutation LESSONS:: For the suspected patients of MELAS syndrome, if the hot-spot mutation test is negative, more detection sites should be selected.


Assuntos
Acidose Láctica/complicações , DNA Mitocondrial/genética , Síndrome MELAS/genética , Acidente Vascular Cerebral/etiologia , Administração Oral , Arginina/administração & dosagem , Arginina/uso terapêutico , Conscientização , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Síndrome MELAS/diagnóstico por imagem , Síndrome MELAS/tratamento farmacológico , Síndrome MELAS/patologia , Imagem por Ressonância Magnética/métodos , Micronutrientes/administração & dosagem , Micronutrientes/uso terapêutico , Encefalomiopatias Mitocondriais/diagnóstico , Encefalomiopatias Mitocondriais/etiologia , Encefalomiopatias Mitocondriais/patologia , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Mutação , Acidente Vascular Cerebral/diagnóstico , Succinato Desidrogenase/metabolismo , Ubiquinona/administração & dosagem , Ubiquinona/uso terapêutico , Adulto Jovem
13.
Nutr. hosp ; 37(3): 549-558, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193863

RESUMO

OBJECTIVE: studies have been published in Europe comparing the mean macronutrient and micronutrient intake values of the general population with those of the vegan population, but none has been conducted in a country that mainly follows the Mediterranean diet. Therefore, the aim of this study was to carry out this comparison in Spain. METHODS: a cross-sectional study of a sample of Spanish vegans was designed in 2015. To compare the distribution of nutrients with those of the general population, we used data from the Spanish Agency for Food Safety and Nutrition, which was considered to be normally distributed as it was a large population with biological parameters. All participants were asked about their dietary intake for the previous day (24 hour reminder) and the nutrients were calculated using specialized software. The distributions were compared using the Kolmogorov-Smirnov test. RESULTS: the sample comprised 102 vegans, 67 of whom were women. The vegan population consumed more carbohydrates and fiber, less total fat (women only), fewer saturated fatty acids, and more polyunsaturated fatty acids. They had much lower cholesterol intake, lower calcium and iodine intake, higher iron and folic acid intake, and much lower intake of vitamins B12 and D. CONCLUSIONS: Spanish vegans had nutritional deficiencies compared to the general population and should therefore ensure their diet includes the necessary supplements


ANTECEDENTES: se han publicado en Europa estudios que comparan los valores medios de ingesta de macronutrientes y micronutrientes de la población general con los de la población vegana, pero ninguno se ha llevado a cabo en un país que sigue principalmente la dieta mediterránea. Por lo tanto, el objetivo de este estudio fue llevar a cabo esta comparación en España. MÉTODOS: se diseñó un estudio transversal de una muestra de veganos españoles en 2015. Para comparar la distribución de nutrientes con los de la población general, utilizamos datos de la Agencia Española de Seguridad Alimentaria y Nutrición, considerando dichos datos como una distribución normal de parámetros biológicos al constituir una gran muestra. A todos los participantes se les preguntó sobre su ingesta dietética en el día anterior y los nutrientes se calcularon utilizando un software especializado. Las distribuciones se compararon mediante la prueba de Kolmogorov-Smirnov. RESULTADOS: la muestra comprendió 102 veganos, 67 de los cuales eran mujeres. La población vegana consumió más carbohidratos y fibra, menos grasa total (solo mujeres), menos ácidos grasos saturados y más ácidos grasos poliinsaturados. Tenían una ingesta mucho más baja de colesterol, una ingesta más baja de calcio y yodo, una mayor ingesta de hierro y ácido fólico, y una ingesta mucho más baja de vitaminas B12 y D. CONCLUSIÓN: los veganos españoles tenían deficiencias nutricionales en comparación con la población general y, por lo tanto, deben asegurarse de que su dieta incluya los suplementos necesarios


Assuntos
Humanos , Masculino , Feminino , Adulto , Nutrientes/uso terapêutico , Micronutrientes/uso terapêutico , Veganos/estatística & dados numéricos , Dieta Vegana/métodos , Dietoterapia/métodos , Dieta Mediterrânea , Ácidos Graxos Insaturados/uso terapêutico , Suplementos Nutricionais
16.
Complement Ther Med ; 48: 102268, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31987251

RESUMO

BACKGROUND: Multiple researchers have suggested the influence of micronutrients in the cure and survival of tuberculosis. OBJECTIVE: To determine the effectiveness of micronutrients in the cure and treatment of pulmonary tuberculosis. METHODS: Systematic search of randomized controlled trials (RCTs) in databases of people under treatment for active pulmonary tuberculosis, that must have received oral micronutrients for at least four weeks compared with placebo. The synthesis of the variables was shown in standardized mean difference (MD) and/or risk difference (RD). The random effects model was used and was reported in forest plot of the estimates of the effect with a 95 % CI. RESULTS: Sixteen of 246 studies were included, in total 4398 people. Zinc showed (RD, 0.04; 95 % CI, 0.00-0.08) in mortality, increases muscle mass index (MD, 1.20; 95 % CI, 0.04-2.36) and gains weight (MD, 3.10; 95 % CI, 0.66-5.54). Zinc plus vitamin A increases the weight (MD, 3.10; 95 % CI, 2.78-3.42), improving karnofsky scale (MD, 2.50; 95 % CI, 2.22-2.78). Additionally, vitamin D accelerate the sputum conversión time (RD, 0.38; 95 % CI, 0.03-0.73). Hemoglobin (Hb) with vitamin A and zinc achieves statistically significant changes (MD, 0.69; 95 % CI, 0.28-1.09) and (MD, 0.52; 95 % CI, 0.21-0.83) and reduces area of cavitations in chest X-ray (MD, -0.33; 95 % CI, -0.60--0.06). CONCLUSIONS: The consumption of micronutrients could achieve weight gain, hemoglobin, accelerated sputum conversion and improvement in quality of life. There are no changes in mortality that may be attributable to the suboptimal dose, larger studies are suggested with adequate doses.


Assuntos
Suplementos Nutricionais , Micronutrientes/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Altern Complement Med ; 26(2): 88-97, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31928364

RESUMO

Objective: Premenstrual syndrome (PMS) affects 20%-30% of women but current medical treatments are limited in their efficacy. The objective of this study was to compare efficacy of a broad-spectrum micronutrient formula (consisting mainly of minerals and vitamins) to a single vitamin (B6) for treatment of PMS, for which B6 has already been shown to be efficacious. Methods: This double-blind, randomized, treatment-controlled trial allocated 78 (72 completed) regularly menstruating women with PMS to consume micronutrients or vitamin B6 (80 mg/day) daily following a two-cycle baseline period, for three menstrual cycles. The primary outcome measure, Daily Record of Severity of Problems (DRSP), established PMS as well as tracked change in five PMS symptoms: psychological, somatic, total symptoms, impact ratings, and worst day ratings. Results: Linear-mixed model analyses indicated both treatments produced comparable reduction in PMS symptoms with medium effect sizes (ES) across all PMS variables as measured by the DRSP (micronutrient ES = 0.50-0.56; B6 ES = 0.43-0.56), with 72% of the micronutrient and 60% of the vitamin B6 group identified as in full remission in PMS symptoms after three cycles. The micronutrient-treated participants showed greater improvement than the B6 group (between group d = 0.51, p < 0.05) in health-related quality of life. For those women (n = 28) who met criteria for premenstrual dysphoric disorder (PMDD), the DRSP ES were larger for those who had been in the micronutrient condition (ES = 1.28-1.67) as compared with those on B6 (ES = 0.50-0.75), although the group differences were not statistically reliable. There were no group differences in side effects, nor any serious adverse effects reported. Conclusions: Both treatments provided similar benefit for reducing PMS symptoms, with greater effect of micronutrients on quality of life as well as potential clinical benefit of micronutrients for PMDD. This study provides further efficacy data on B6 and also identifies the nutritionally broader spectrum intervention as possibly having specific advantages for those whose symptoms are more severe. As this is the first study to investigate these treatments for PMDD, systematic replication is required.


Assuntos
Micronutrientes , Síndrome Pré-Menstrual/tratamento farmacológico , Vitamina B 6 , Adulto , Feminino , Humanos , Micronutrientes/efeitos adversos , Micronutrientes/uso terapêutico , Projetos Piloto , Síndrome Pré-Menstrual/fisiopatologia , Síndrome Pré-Menstrual/psicologia , Resultado do Tratamento , Vitamina B 6/administração & dosagem , Vitamina B 6/uso terapêutico , Adulto Jovem
19.
Ann N Y Acad Sci ; 1465(1): 161-180, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31797386

RESUMO

Meeting children's vitamin A (VA) needs remains a policy priority. Doing so efficiently is a fiscal imperative and protecting at-risk children during policy transitions is a moral imperative. Using the Micronutrient Intervention Modeling tool and data for Cameroon, we predict the impacts and costs of alternative VA intervention programs, identify the least-cost strategy for meeting targets nationally, and compare it to a business-as-usual (BAU) strategy over 10 years. BAU programs effectively cover ∼12.8 million (m) child-years (CY) and cost ∼$30.1 m; ∼US$2.34 per CY effectively covered. Improving the VA-fortified oil program, implementing a VA-fortified bouillon cube program, and periodic VA supplements (VAS) in the North macroregion for 3 years effectively cover ∼13.1 m CY at a cost of ∼US$9.5 m, or ∼US$0.71 per CY effectively covered. The tool then identifies a sequence of subnational policy choices leading from the BAU toward the more efficient strategy, while addressing VA-attributable mortality concerns. By year 4, fortification programs are predicted to eliminate inadequate VA intake in the South and Cities macroregions, but not the North, where VAS should continue until additional delivery platforms are implemented. This modeling approach offers a concrete example of the strategic use of data to follow the Global Alliance for VA framework and do so efficiently.


Assuntos
Suplementos Nutricionais , Micronutrientes/uso terapêutico , Deficiência de Vitamina A/dietoterapia , Vitamina A/uso terapêutico , Camarões/epidemiologia , Pré-Escolar , Feminino , Alimentos Fortificados , Humanos , Lactente , Masculino , Micronutrientes/metabolismo , Programas Nacionais de Saúde , Estado Nutricional/genética , Vitamina A/genética , Vitamina A/metabolismo , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/prevenção & controle
20.
Ann N Y Acad Sci ; 1465(1): 76-88, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31696532

RESUMO

Prenatal micronutrient deficiencies are associated with negative maternal and birth outcomes. Multiple micronutrient supplementation (MMS) during pregnancy is a cost-effective intervention to reduce these adverse outcomes. However, important knowledge gaps remain in the implementation of MMS interventions. The Child Health and Nutrition Research Initiative (CHNRI) methodology was applied to inform the direction of research and investments needed to support the implementation of MMS interventions for pregnant women in low- and middle-income countries (LMIC). Following CHNRI methodology guidelines, a group of international experts in nutrition and maternal health provided and ranked the research questions that most urgently need to be resolved for prenatal MMS interventions to be successfully implemented. Seventy-three research questions were received, analyzed, and reorganized, resulting in 35 consolidated research questions. These were scored against four criteria, yielding a priority ranking where the top 10 research options focused on strategies to increase antenatal care attendance and MMS adherence, methods needed to identify populations more likely to benefit from MMS interventions and some discovery issues (e.g., potential benefit of extending MMS through lactation). This exercise prioritized 35 discrete research questions that merit serious consideration for the potential of MMS during pregnancy to be optimized in LMIC.


Assuntos
Suplementos Nutricionais , Micronutrientes/uso terapêutico , Cuidado Pré-Natal , Análise Custo-Benefício , Feminino , Humanos , Política Nutricional/tendências , Ciências da Nutrição/tendências , Pobreza , Gravidez
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