Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh.

BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

Carotenoid, flavonoid profiles and dietary fiber contents of fruits commonly consumed in Thailand.

Soluble and insoluble dietary fiber and flavonoid contents in 21 varieties of Thai fruits, as well as carotenoids in five varieties of ripe durians were determined. Fresh fruits were purchased from five local markets in Bangkok during July 2008-May 2009. Dietary fiber content ranged from 0.71 to 3.58 g/100 g edible portion, with all five varieties of durian, guava, ripe banana and papaya being good sources of dietary fiber. Durian (Chanee, Kradom, and Puang manee variety) having yellow to deep-yellow color pulp had the highest carotenoid content. Durian, pomelo, guava and ripe banana were good sources of flavonoids; especially pomelo (Thong dee and Tuptimsayam variety) showed the greatest total flavonoid content (13,994.21 and 15,094.99 microg/100 g edible portion). Data in this study demonstrated that Thai fruits are not only a good source of dietary fiber but also a good source of carotenoids and flavonoids.

Newborn micronutrient status biomarkers in a cluster-randomized trial of antenatal multiple micronutrient compared with iron folic acid supplementation in rural Bangladesh.

BACKGROUND: Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown. OBJECTIVE: We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA supplementation and maternal gestational micronutrient status in rural Bangladeshi newborns. DESIGN: In a double-blinded, cluster-randomized trial of antenatal IFA or MM (with the same IFA content), we analyzed cord blood plasma from 333 singleton births, and corresponding maternal plasma at 32.5 ± 2.6 wk of gestation, for ferritin (iron stores), folate, cobalamin (vitamin B-12), retinol (vitamin A), 25-hydroxyvitamin D [25(OH)D, vitamin D status], α-tocopherol (vitamin E), zinc, thyroglobulin, and free thyroxine (iodine status). Intervention effects and associations were determined using linear regression, exploring maternal status as a mediator of intervention effects on cord biomarkers. RESULTS: The MM intervention increased cord ferritin (mean: +12.4%; 95% CI: 1.3, 24.6%), 25(OH)D (mean: +14.7%; 95% CI: 4.8, 25.6%), and zinc (mean: +5.8%; 95% CI: 1.0, 10.8%). Cord folate (mean: +26.8%; 95% CI: 19.6, 34.5%), cobalamin (mean: +31.3%; 95% CI: 24.6, 38.3%), 25(OH)D (mean: +26.7%; 95% CI: 23.2, 30.3%), α-tocopherol (mean: +8.7%; 95% CI: 3.6, 13.7%), zinc (mean: +2.3%; 95% CI: 0.5, 4.2%), thyroglobulin (mean: +20.1%; 95% CI: 9.0, 32.2%) and thyroxine (mean: +1.5%; 95% CI: 0.0, 3.0%) increased per 1-SD increment in maternal status (all P < 0.05); ferritin and retinol changed by +2.0%; 95% CI: -8.9, 14.3%; P = 0.72; and +3.5%; 95% CI: -0.4, 7.3%; P = 0.07, respectively. Ferritin, folate, cobalamin, zinc, and thyroglobulin averaged 1.57-6.75 times higher and retinol, α-tocopherol, and 25(OH)D 0.30-0.84 times lower in cord than maternal plasma, suggesting preferential maternal-fetal transfer of iron, folate, cobalamin, and zinc; limited transfer of fat-soluble vitamins; and high fetal iodine demand. CONCLUSIONS: Antenatal MM supplementation increased newborn ferritin, 25(OH)D, and zinc, while maternal and newborn folate, vitamins B-12, D, and E, zinc, and iodine biomarkers were positively related. Despite limited effects of MM, better maternal micronutrient status was associated with improved micronutrient status of Bangladeshi newborns. This trial was registered at clinicaltrials.gov as NCT00860470.

Effect of processing on the flavonoid content and antioxidant capacity of Citrus hystrix leaf.

The objective of the present study was to compare fresh (F) use and the effects of boiling (B) and deep-fat frying (DF) on the leaf of Citrus hystrix on total phenolic content, the types and amounts of flavonoids and their total antioxidant capacities (TAC), as measured by three different assays: oxygen radical absorption capacity, ferric reducing/antioxidant power, and scavenging effect on the 2,2-diphenyl-1-picrylhydrazyl free radical. Boiling decreased TAC values on the three assays. The amount of total flavonoids calculated as aglycone equivalents of eight identified flavonoids (cyanidin, myricetin, peonidin, quercetin, luteolin, hesperetin, apigenin and isorhamnetin) determined by high-performance liquid chromatography was 1,129 (DF), 1,104 (F) and 549 (B) mg/100 g freeze-dried weight (dry matter exclude fat). Hesperetin was the predominant flavonoid. The total phenolic content expressed as grams of gallic acid equivalents/100 grams fresh weight (excluding fat) was 2.0, 1.9 and 1.8 in F, DF and B samples, respectively. These results suggest that method of processing can significantly affect the content of flavonoids and their TAC values.

Hypercholesterolemia in Thai primary school children: relation to maternal and nutritional factors.

BACKGROUND: There is evidence to show that atherosclerosis can occur in young children and that elevated total cholesterol and low density lipoprotein cholesterol concentrations are risk factors for atherosclerosis. The aim of the present cross-sectional study was to investigate the influence of maternal and nutritional factors on blood cholesterol in primary school children. METHODS: One hundred and ninety-five population-based mother-child pairs (obese child-overweight mother pairs, n = 60; obese child-normal-weight mother pairs, n = 48; wasted child-overweight mother pairs, n = 37; normal-weight child-normal-weight mother pairs, n = 50), were enrolled in the study. Various anthropometric parameters were measured and serum lipids of subjects were further determined. Biological data and children's eating behavior were obtained from the mothers through interviews. RESULTS: Hypercholesterolemia was found in 64.6-65% of obese children, 24.3% of wasted children and in 56% of the normal-weight children; whereas the proportion of children in all groups who had normal blood cholesterol levels was in the lower range. Multivariate logistic regression indicated that mother's serum cholesterol (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.12-4.78), child obesity defined by weight-for-height Z-score > +2SD (OR, 2.56; 95%CI: 1.33-4.98), and child's energy intake >/=75th percentile (OR, 2.59; 95%CI: 1.01-6.66) were the significant factors associated with hypercholesterolemia in children. CONCLUSION: Hypercholesterolemia in school children is associated with familial factor, bodyweight and nutrient intake. Elevated blood cholesterol was also found in some of the normal-weight and wasted children. Effective family-based intervention programs are urgently needed to modify risk factors predisposing to coronary heart disease.

Feasibility and use of vitamin A-fortified vegetable oils among consumers of different socioeconomic status in Thailand.

BACKGROUND: Vitamin A losses infortified vegetable oils can differ, depending upon the cooking and distribution conditions of a country. OBJECTIVE: To determine vitamin A losses in different vegetable oils during transportation, cooking, and storage among consumets of different socioeconomic status. METHODS: Soybean, rice bran, and palm oils were fortified with vitamin A palmitate at 267 microg/15 mL. The oils were packaged in 5-L metal cans and 250-mL polyethylene terephthalate (PET) bottles and then stored under light and dark conditions. Unopened and opened bottles were stored for 13 and 4 weeks, respectively. Fortified palm oil also was bulk transported in trucks and packaged in 1-kg polypropylene bags that were closed with rubber bands. Vitamin losses were measured after cooking at 120 degrees and 170 degrees C for 5 and 10 minutes in iron, aluminum, Teflon, and glass pans. RESULTS: Vitamin A losses of oils in PET bottles stored under light conditions were 20% to 25% at the 5th week and became greater than 80% after 13 weeks, whereas losses under dark conditions and in metal containers were less than 15%. Loss during bulk transportation was 25%, with no change in peroxide value. Losses in opened bottles after 4 weeks under light conditions were 50% to 90% based on the degree of oil unsaturation; however, losses under dark conditions were less than 5%. Losses after cooking at 120 degrees and 170 degrees C for 10 minutes were less than 5% and 15%, respectively. The type of pan did not affect the amount of loss. The peroxide values of oils in bottles increased during storage under light conditions. CONCLUSIONS: Fortification of vegetable oils with vitamin A for consumers of different socioeconomic status is feasible; however, light protection is needed for better stability.

First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh.

BACKGROUND: Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. OBJECTIVE: We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh. DESIGN: A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or ß-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 µmol/L) and γ-tocopherol (<0.81 µmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry). RESULTS: In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 µmol/L (8.07-12.35 µmol/L) and 0.66 µmol/L (0.50-0.95 µmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 µg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. CONCLUSIONS: In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822.

Antioxidant capacity, total phenolics and sugar content of selected Thai health beverages.

This study was to determine antioxidant capacity, total phenolics and sugar content of 12 pasteurized and sterilized Thai health beverages, products of The Royal Chitralada Projects. The antioxidant capacities were analyzed using 2,2-diphenyl-l-picrylhydrazyl radical scavenging and the photochemiluminescence (PCL) assay. Folin-Ciocalteu assay and Nelson's reducing sugar test were used to determine total phenolic compounds and sugar contents, respectively. Sacred lotus root drink showed the significantly highest antioxidant capacity in both equivalents to trolox and equivalents to ascorbic acid but not in the PCL test. In contrast, chrysanthemum drink and roselle drink showed the significantly highest values of both the total antioxidant capacity of water and lipid-soluble substances in the PCL assay. Bael fruit drink had the significantly highest total phenolic compounds. There were significant correlations between the total phenolic compounds and the antioxidant capacity values of both assays (r = 0.4-0.5).