Nutrition education alone improves dietary practices but not hematologic indices of adolescent girls in Iran

BACKGROUND: Iron-deficiency anemia is the most prevalent nutritional deficiency worldwide. Iron-deficiency anemia has particular negative consequences on women in their childbearing years, and its prevention is a high priority in most health systems. OBJECTIVE: This interventional study assessed the effect of nutrition education on hematologic indices, iron status, nutritional knowledge, and nutritional practices of high-school girls in Iran. METHODS: Sixty healthy 16- to 18-year-old girls were randomly selected from two high schools in the city of Ahvaz and divided into two equally matched groups, one that received nutrition education, and one that did not. The education group received instruction in face-to-face sessions, group discussions, and pamphlets for 2 months. The control group did not receive any information during the study. Hematologic tests, corpuscular indices, and serum ferritin levels were measured at baseline and after 2 months. Food-frequency questionnaires were administered and histories taken, clinical signs of nutritional deficiencies observed, anthropometric measurements taken, nutritional knowledge tested, practices determined, and lifestyle questionnaires administered to all subjects. RESULTS: There were no statistically significant differences in any baseline characteristics between the two groups. Scores for nutritional knowledge and practices of the education group were significantly higher after two months compared with the baseline (31.4 +/- 6 vs. 24.3 +/- 5.9 points, p < .001, and 31.2 +/- 5 vs. 28.4 +/- 5.7 points, p < .05, respectively). The scores in the control group showed no significant changes from baseline to 2 months. Mean corpuscular volume values were elevated in the education group (p < .001) but not in the control group. However, in the control group, serum ferritin concentrations showed about a 17% drop at the end of the study (p < .004). There were no changes in other hematologic, lifestyle, clinical, or anthropometric data compared with baseline after completion of the study in both groups. CONCLUSION: These findings indicate that nutritional education can improve knowledge of healthy nutrition and lifestyle choices. Focused nutritional education using available resources and correcting current dietary habits in a vulnerable group of young women may result in dietary changes that can ultimately improve iron intake.     

Effectiveness of intermittent iron treatment of two- to six-year-old Jordanian children with iron-deficiency anemia

BACKGROUND: Iron deficiency is a common nutritional problem in young children among vulnerable populations in Jordan. Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status. Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting. OBJECTIVE: To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia. METHODS: About 4400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa, Jordan, from August 2000 to June 2001 were screened for age, general health, and birthweight. About 10% of these children were screened for anemia, using complete blood count (defined as a hemoglobin level < or = 10.5 g/dL, and a mean corpuscular volume < or =75 ft). Anemic children underwent further screening for iron deficiency, defined as serum ferritin level < or =12 microg/L. Children with iron-deficiency anemia, as indicated by hemoglobin < or = 10.5 g/dL, mean corpuscular volume < or =75 fL, and serum ferritin < or =12 microg/L, or as indicated by mean corpuscular volume < or =75 fL and hemoglobin < or = 10.5 g/dL, were enrolled in the study after informed oral consent by their parents. Study children (n=134) were assigned randomly to one of three groups. Subjects in group 1 (n=45), group 2 (n=45), and group 3 (n=44) received iron treatment daily, weekly, and twice weekly, respectively. Out of 134 children recruited for the study, only 63 (39 boys and 24 girls) completed the 3-month treatment period. All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight. The parents also received nutritional counseling. RESULTS: At the end of treatment, hemoglobin, serum ferritin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups. The increases in hemoglobin in groups 1, 2, and 3 were 2.47 +/- 0.17, 2.12 +/- 0.18, and 2.18 +/- 0.18 g/dL, respectively. Measurements of final serum ferritin concentration were available for only 12, 12, and 10 children in groups 1, 2, and 3, respectively. In all children who completed the study, except for one in group 1, hemoglobin, mean corpuscular volume, and serum ferritin reached normal values in response to iron treatment. CONCLUSIONS: Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study.     

A multicenter community study on the efficacy of double-fortified salt

BACKGROUND: Iron and iodine deficiencies affect more than 30% of the world's population. Typical Indian diets contain adequate amounts of iron, but the bioavailability is poor. This serious limiting factor is caused by low intake of meat products rich in heme iron and intake of phytates in staple foods in the Indian diet, which inhibits iron absorption. OBJECTIVE: To test the stability of double-fortified salt (DFS) during storage and to assess its efficacy in improving the iron and iodine status of the communities. METHODS: The stability of both iodized salt and DFS during storage for a 2-year period was determined. The bioefficacy of DFS was assessed in communities covering three states of the country for a period of 1 year. This was a multicenter, single-blind trial covering seven clusters. The experimental group used DFS and the control group used iodized salt. The salts were used in all meals prepared for family members, but determination of hemoglobin by the cyanmethemoglobin method was performed in only two or three members per family, and not in children under 10 years of age (n = 393 and 436 in the experimental and control groups, respectively). The family size was usually four or five, with a male: female ratio of 1:1, consisting of two parents with two or three children. Hemoglobin was measured at baseline, 6 months (midpoint), and 12 months (endpoint). Urinary iodine was measured in only one cluster at baseline and endpoint. All the participants were dewormed at baseline, 6 months, and 12 months. RESULTS: The iron and iodine in the DFS were stable during storage for 2 years. Over a period of 1 year, there was an increase of 1.98 g/dL of hemoglobin in the experimental group and 0.77 g/dL of hemoglobin in the control group; the latter increase may have been due to deworming. The median urinary iodine changed from 200 microg/dL at baseline to 205 microg/dL at the end of the study in the experimental group and from 225 microg/dL to 220 microg/dL in the control group. There was a statistically significant (p < .05) improvement in the median urinary iodine status of subjects who were iodine deficient (urinary iodine < 100 microg/L) in both the experimental and the control groups, a result showing that DFS was as efficient as iodized salt in increasing urinary iodine from a deficient to sufficient status. There was a statistically significant increase (p < .05) in hemoglobin in all seven clusters in the experimental group compared with the control. CONCLUSIONS: The iron and iodine in the DFS are stable in storage for 2 years. The DFS has proved beneficial in the delivery of bioavailable iron and iodine.     

Bioavailability of a Heme-Iron Concentrate Product Added to Chocolate Biscuit Filling in Adolescent Girls Living in a Rural Area of Mexico

ABSTRACT: A heme-iron concentrate product derived from swine hemoglobin was used to enrich the chocolate-flavored filling of biscuits and the bioavailability of this source of heme-iron was assessed in adolescent girls. The placebo control (PC) group consisted of 35 teenagers with the highest baseline hemoglobin concentrations. The supplemented groups were randomized to receive biscuits fortified with iron sulfate (IS, n = 37) or heme-iron concentrate (HIC, n = 40). Both groups were supplemented with 10.3 mg Fe/d for 7 wk. Blood chemistry and hematology analyses were performed at baseline and at the end of the study. The baseline prevalence of anemia (hemoglobin <12g/dl) in the entire group was 3.9% and by the end of the study it had fallen to 2.3%. The hemoglobin levels in both supplemented groups increased (P < 0.05) during the study period from 13.6 and 13.5 g/dl for HIC and IS, respectively, at baseline to 14 g/dl at the end of the study. Serum ferritin concentrations decreased by the end of the study in both the PC and IS groups (P < 0.05), but not in the heme group. In conclusion, iron bioavailability from HIC-fortified biscuits was calculated to be 23.7% higher than that observed for IS, as shown by the differences observed in serum ferritin levels during the study. The iron contained in the heme-iron concentrate was well absorbed and tolerated by the adolescents included in the study.     

Impact of a multiple-micronutrient food supplement on the nutritional status of schoolchildren

BACKGROUND:. Multiple-micronutrient deficiencies exist in many developing nations. A system to deliver multiple micronutrients effectively would be of value in these countries. OBJECTIVE:. To evaluate the delivery of multiple micronutrients through the food route. The goal was to test the stability of the supplement during cooking and storage and then to test its bioefficacy and bioavailability in residential schoolchildren 5 to 15 years of age. METHODS: A pre- and post-test design was used to study children 5 to 15 years of age, with an experimental and a control group. The experimental group (n=211) consisted of children from two residential schools, and the control group (n=202) consisted of children from three residential schools. The experimental group received a micronutrient supplement containing vitamin A, vitamin B2, vitamin B6 vitamin B12, folic acid, niacin, calcium pantothenate, vitamin C, vitamin E, iron, lysine, and calcium daily for 9 months. There was no nutritional intervention in the control group. Children in the experimental and control groups were matched by socioeconomic status, age, and eating habits at baseline. All of the children in the experimental and control schools were dewormed at baseline, after 4 months, and at the endpoint. Biochemical measurements (hemoglobin, serum vitamin A, serum vitamin E, serum vitamin B12, and serum folic acid) were measured at baseline, after 4 months, and at the endpoint (after 9 months). The heights and weights of the children were also measured at baseline and endpoint. Serum vitamins A and E were measured in a subsample of 50% and vitamin B12 and serum folic acid measured in a subsample of 25% of the children. RESULTS: In the experimental group, the mean gains in hemoglobin, serum vitamin A, serum vitamin E, serum vitamin B12, and serum folic acid over 9 months were 0.393 g/dL, 6.0375 microg/dL, 1037.45 microg/dL, 687.604 pg/mL, and 1.864 ng/mL, respectively. In the control group, the mean losses in hemoglobin and serum vitamin A over 9 months were 0.9556 g/dL and 10.0641 microg/dL, respectively, and the mean gains in serum vitamin E, vitamin B12, and folic acid were 903.52 microg/dL, 233.283 pg/mL, and 0.0279 ng/mL. The mean gain in all biochemical measurements was significantly higher (p < .05) in the experimental group than in the control group. CONCLUSIONS: Vitamin A, vitamin E, vitamin B12, folic acid, and iron are bioavailable from the multiple-micronutrient food supplement used in this study. This method of micronutrient delivery has been beneficial. We believe the study intervention was beneficial because of small doses of the micronutrients added but delivered many times through meals throughout the day, over a period of 9 months.     

Efficacy of iron-fortified Ultra Rice in improving the iron status of women in Mexico

BACKGROUND: Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country populations. Nonetheless, relatively few efficacy trials have been reported to date to demonstrate impact on iron status. The Ultra Rice technology provides a means of delivering fortificant iron via rice. OBJECTIVE: The objective of this study was to test the efficacy of rice fortified with microencapsulated, micronized iron pyrophosphate to improve the iron status of women in Mexico in a randomized, controlled intervention trial. METHODS: Nonpregnant, nonlactating women 18 to 49 years of age were recruited from six factories. The women received a daily portion of cooked rice 5 days per week for a period of 6 months, before and after which iron status indicators were determined in venous blood samples. RESULTS: The average intake of iron from the fortificant was 13 mg/day. Mean plasma ferritin concentration and estimated body iron stores were significantly higher, and transferrin receptors were lower, in the iron-fortified rice group following the intervention. Mean hemoglobin concentration also increased in the treatment group, but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points, respectively. Total iron intake from fortificant was a significant covariate of change in body iron stores. The overall prevalence of anemia was reduced by 80%. CONCLUSIONS: Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency.     

Effect of vitamin A supplementation on iron status in humans: A systematic review and meta-analysis

Anemia is a worldwide public health problem that can be related to many causes, including vitamin A deficiency. The aim of this study was to assess and estimate the effect of vitamin A supplementation (VAS) on iron status biomarkers and anemia in humans. Six databases, including Cochrane, EMBASE, LILACS, Pubmed, Scopus and Web of Science, were searched for clinical trials and cohort studies that investigated the effect of vitamin A supplementation alone on iron status and anemia, without time-restriction. The search yielded 23 eligible studies, 21 clinical trials and 2 cohort studies, with children, teenagers, pregnant or lactating women. The meta-analysis of the clinical trials showed that VAS reduces the risk of anemia by 26% and raises hemoglobin levels, compared to non-treated group, independent of the life stage. VAS did not alter the prevalence of iron deficiency among the clinical trials conducted with children and teenagers (RR 0.82, 95% CI 0.60 to 1.12, p = 0.204), whereas a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women (WMD 6.61 μg/L; 95% CI 6.00 to 7.21 μg/L; p < 0.001). Therefore, vitamin A supplementation alone may reduce the risk of anemia, by improving hemoglobin and ferritin levels in individuals with low serum retinol levels.     

Studies on the effectiveness of NaFeEDTA-fortified soy sauce in controlling iron deficiency: a population-based intervention trial

The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population. This was an 18-month, randomized, placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City, Guizhou Province, China, using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce (29.6 mg Fe/100 ml). The study data included measurements of food consumption, hemoglobin, serum ferritin, and serum retinol. The results showed that the diet consisted primarily of cereals, fruits, and vegetables, with very little meat. Food consumption remained unchanged during the study period and was similar in the fortified and control groups. The average daily soy sauce consumption of the group consuming the fortified product was 16.4 ml per person, which provided 4.9 mg of iron from NaFeEDTA. At the end of the trial, all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels, a lower prevalence of anemia, and higher plasma ferritin levels than the controls. The effects became statistically significant after six months of intervention and were maintained throughout the study period. We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men, women, and children. NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population.     

An analysis of the etiology of anemia and iron deficiency in young women of low socioeconomic status in Bangalore, India

BACKGROUND: Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. OBJECTIVES: Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. METHODS: A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. RESULTS: The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. CONCLUSIONS: An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.     

The connection between vitamin and iron status indexes of school-age children

The analysis of vitamin and iron indexes of 95 children sufficiently supplied with vitamin C and vitamin B2 and carotenoids deficiency has been carried out. Vitamin E deficit takes place among anemic children (with decreased hemoglobin blood level) 2 fold more often than among healthy children. From another side, decreased hemoglobin blood level, erythrocyte quantity and erythrocyte indexes have been determined 1.7-2.4 fold more often in insufficiently supplied with vitamin E children. Tocopherols serum level had tendency to the decrease and vitamin E deficit took place 2 fold more frequently in children suffering from iron deficiency anemia that is with decreased hemoglobin and serum ferritin concentrations. Marked positive linear correlation between these iron indexes and vitamin E serum level has been revealed. These results give evidence concerning significant role of this vitamin in the body iron supplying. The results obtained give evidence for multi-deficient anemia presence among children, which are not always caused by iron deficit. High frequency of vitamin E and B group vitamins deficiency proves expediency of these vitamins inclusion in complex therapy of iron deficiency.     

Infection and anemia in Canadian aboriginal infants.

The prevalence of anemia in Aboriginal children is high, but, given the high burden of infection in these children, the extent to which anemia is due to iron deficiency and/or infection is unclear. To determine the contribution of iron deficiency to anemia, we screened 144 Aboriginal infants (70 boys, 74 girls) who were free from infection. The prevalence of anemia (hemoglobin <105 g/L) was 18.8%; caregivers reported that 53.5% of infants had had an infection in the two weeks before screening. Anemic infants were more likely than non-anemic infants to have had an infection before screening (74.1% versus 48.7%, p = 0.02), and anemic infants had a higher prevalence of iron deficiency revealed by low serum iron concentrations (<7 micromol/L) (73.7% versus 38.3%, p <0.01). Iron deficiency measured using serum ferritin concentration tended to be less marked in infants who had had an infection (13% versus 30.3%, p = 0.06); this is probably because serum ferritin is a positive acute-phase protein. This study indicates the difficulty of isolating the contribution of infection to anemia from the separate effects of dietary iron deficiency.     

苏氨酸铁对缺铁性贫血大鼠铁营养状况的改善

目的:探讨苏氨酸铁(Thr-Fe)对缺铁性贫血(IDA)大鼠铁营养状况的改善作用。方法:以低铁饲料饲喂雄性初断乳斯泼累格·多雷(SD)大鼠建立IDA模型,设置3个不同Thr-Fe剂量组和阳性对照组、低铁对照组、空白对照组,每组6只,每天灌胃1次,连续给药21 d,Thr-Fe剂量组分别给予8、16、32 mg/kg·bw的Thr-Fe,阳性对照组给予32 mg/kg·bw硫酸亚铁。结果:较低铁对照组,Thr-Fe高剂量组大鼠体重及血红蛋白、血清铁蛋白等血液指标显著提高(p<0.01),血清转铁蛋白(p<0.01)和总铁结合力(p<0.05)显著降低,各Thr-Fe剂量组大鼠游离原卟啉显著降低(p<0.01)。Thr-Fe高剂量组IDA大鼠各项指标改善优于阳性对照组。结论:低铁膳食补充Thr-Fe可以改善IDA大鼠的铁营养状况,提高功能铁及贮存铁含量,促进机体铁转运。Thr-Fe对IDA大鼠体重及血红蛋白等的影响呈剂量相关性,Thr-Fe对IDA大鼠铁营养状况的改善效果优于硫酸亚铁。     

饮食中添加L-赖氨酸对儿童发育和营养指标的影响

目的对儿童发育过程中应用L-赖氨酸对儿童的各项营养指标的影响以及对儿童饮食、保健品食用的指导价值进行研究分析。方法选择2016年3月~2017年3月间在某三甲医院进行体检的饮食正常儿童共66例作为本次研究分析对象,根据在儿童饮食中是否添加L-赖氨酸以及添加时间进行随机分组,分为A、B、C 3组,其中A组为添加L-赖氨酸3个月、B组为添加L-赖氨酸1个月、C组未添加L-赖氨酸,将3组儿童的胸围、头围、臂围、体重、身高进行对比,同时抽取儿童股静脉中的血液进行检测,比较3组儿童的总蛋白、血红蛋白、红细胞数、白蛋白、镁离子、铜离子、铁离子、锌离子、钙离子的浓度。同期选择22例食欲减退症患儿作为对照组,对食欲减退症患儿在饮食中添加L-赖氨酸3个月,对比患儿前后的各项指标。结果在血红蛋白、白蛋白、总蛋白方面,A、B、C 3组无明显差异(P0.05);在身高、体重、臂围、胸围、头围中,A、B两组的身高、体重明显高于C组(P0.05);A、B两组血清中铜、铁、锌、钙、镁浓度明显高于C组(P0.05);在对照组中患有食欲减退症患者中,经过添加L-赖氨酸3个月后,患儿的蛋白质、脂肪、碳水化合物摄入量均明显高于添加前(P0.05),在体重方面明显高于添加前(P0.05)。添加L-赖氨酸3个月后,血清中白蛋白、血红蛋白以及总蛋白明显高于添加前(P0.05),差异均有统计学意义。结论在儿童的饮食中通过对L-赖氨酸的添加,能够显著提高儿童的体重、身高、血清中铜、铁、锌、钙浓度,同时针对食欲减退症患儿使用L-赖氨酸后能够明显的改善患儿的营养状况,对儿童的饮食以及对保健品的使用提供指导作用,具有重要的价值。     

Evaluation of the effects of specialized therapeutic canned food on the course of iron-deficiency anemia in young children

A total of 25 normal children and 131 children with iron-deficiency anemia (IDA) were investigated, 53 out of 131 IDA patients served as controls and received a standard food ration for children suffering from IDA, the rest received nutrition containing medicinal canned food. The following paraclinical parameters were evaluated in all the children investigated: red blood cell and hemoglobin content, calcium concentration, the content of ascorbic acid and vitamin B1, iron metabolism indices (serum iron, general and latent iron-binding capacity of the blood serum, coefficient of transferrin saturation with iron, serum ferritin). The results of the study have shown a favourable effect of the special-purpose medicinal canned food on IDA course in young children that necessitates their wide production and practical use.     

Is iron status associated with highly unsaturated fatty acid status among Canadian Arctic Inuit?

Impaired fatty acid synthesis was noted in iron deficient animal models. Human data, however, are scarce. Although Canadian Inuit have a traditional diet rich in heme iron and long chain n-3 fatty acids, recent literature has also indicated the presence of prevalent iron deficiency. We aimed to explore whether the presence of iron deficiency would affect fatty acid status and an estimate of the activity of desaturase 5 (Δ5), which is crucial in the biosynthesis of highly unsaturated n-3 fatty acids among Canadian Inuit. Erythrocyte membrane fatty acid composition was utilized as an indicator of fatty acid status and serum ferritin and circulating hemoglobin level were measured as the indicators of iron status. Data analyzed were collected among 1511 Canadian Inuit adult participants in the International Polar Year Inuit Health Survey, 2007-2008. Only 13.7% of survey participants had iron deficiency; however, serum ferritin showed a moderate positive association with highly unsaturated n-3 fatty acids after adjusting for age, waist and C-reactive protein (r = 0.172, P < .0001). Serum ferritin correlated significantly with Δ5 after further adjusting for highly unsaturated n-3 fatty acids (r = 0.126, P < .0001). Although the current study only demonstrated a weak link between ferritin and Δ5, the latter association underscores a possible health risk caused by a nutrient interaction related to reduced iron intake and decreased highly unsaturated n-3 fatty acid biosynthesis. Future studies are recommended to evaluate iron status in relation to highly unsaturated n-3 fatty acid biosynthesis and status among indigenous people undergoing rapid dietary transitions.     

A multinutrient package of iron,vitamin A,and iodine improved the productivity and earnings of women tea pickers in south India

Tea-picking is a highly skilled activity that is usually performed by women. This study, conducted on the Balanoor Plantations, India, from 1996 to 1998, was successful in empowering 339 women pickers and their families to take iron (60 mg of elemental iron two times a week) and vitamin A (1,600 IU) once a week, and to purchase subsidized iodized salt (30 ppm) from the plantation ration shop. The average hemoglobin level of the pickers rose significantly (p < .001) from 11.0 g/dl at baseline to 11.9 g/dl at the end of the nine months of intervention. The average amount of tea per picker increased significantly (p < .001) from 22.9 to 25.6 kg. There was a significant decrease in the number of "moderate pickers," who picked between 14 and 25 kg per day, and a significant increase in the number of "good pickers," who picked more than 25 kg per day, and the earnings of the majority of the pickers increased. The management of the estate where the intervention occurred benefited from a decrease in the number of pickers needed during the supplement period from 2,857 to 2,763, with no significant change in the yield per hectare in the two years. The yield per hectare on the control estate was not significantly different from that on the intervention estate, and the average amount of tea picked per worker was the same for the two periods (20.8 and 20.7 kg).     

Food frequency questionnaire for assessing infant iron nutrition.

A food frequency questionnaire (FFQ) was developed and tested for assessing iron nutrition in infants through comparison with a three-day food record (3d-FR) and measures of iron status. Parents of 148 infants aged eight to 26 months completed a 3d-FR and an FFQ. Blood was collected for measures of hemoglobin (Hgb), ferritin, and transferrin receptor (sTfR). Iron deficiency anemia and iron depletion (ferritin < or =12 microg/L) were found in 9% and 26% of infants, respectively. The intakes of energy, total iron, heme and non-heme iron, vitamin C, and dietary fibre determined by the FFQ were associated with the intakes of the same nutrient determined by the 3d-FR (p<0.05). The intakes of energy, total iron, non-heme and heme iron, vitamin C, and fibre were significantly higher when estimated by the FFQ than by the 3d-FR. Total and heme iron intakes determined by the FFQ were significantly associated with serum ferritin, sTfR, and the sTfR:ferritin ratio (p<0.05). However, iron intakes explained <10% of the variability in iron status. Despite relative validity of the FFQ for evaluating differences in energy, iron, vitamin C, and fibre intake compared with a 3d-FR, FFQs need further development before they can be used to advance assessment of iron intake and status in infants.     

Effect of fortification of drinking water with iron plus ascorbic acid or with ascorbic acid alone on hemoglobin values and anthropometric indicators in preschool children in day-care centers in Southeast Brazil

BACKGROUND: Iron-deficiency anemia currently is the most frequently occurring nutritional disorder world-wide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. OBJECTIVE: The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. METHODS: A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. RESULTS: The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. CONCLUSIONS: Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of non-heme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.     

Effects of iron supplementation versus dietary iron on the nutritional iron status: Systematic review with meta-analysis of randomized controlled trials

ABSTRACT

This meta-analysis compared the effects of dietary intervention versus iron supplementation on biochemical parameters related to the iron nutritional status in humans. The PubMed, CENTRAL, LILACS, SCIELO, OPENGREY.EU and ClinicalTrials.gov databases were searched for randomized clinical trials that assigned individuals to a dietary intervention or to an iron supplementation regimen, for 12 weeks or more. The primary outcome was the hemoglobin concentration, and secondary outcomes were ferritin, RDW, mean corpuscular volume, soluble transferrin receptor, total iron binding capacity, serum iron, and transferrin saturation. From the 6095 records identified, twelve studies were included, six with children, five with adolescents/adults, and one with pregnant women. In the subgroup of studies that included anemic/iron deficient children, supplementation significantly increased the hemoglobin concentration (weighted mean difference (WMD): 3.19 g/L [95% CI: 1.31, 5.07]) and induced a significantly greater reduction of the soluble transferrin receptor (WMD: ?0.46 mg/L [95% CI: ?0.70, ?0, 21]), when compared to dietary intervention. It also induced a greater reduction of the total binding capacity of iron in adolescents/adults (WMD: ?6.96 μmol/L [95% CI: ?12.70, ?1.21]). Supplementation showed a better effect on hemoglobin recovery in anemic/iron deficient children, while no differences were observed between supplementation and dietary intervention in treating adolescents/adults.     

缺铁性贫血对青少年体力能力影响的研究

本文对15例缺铁性贫血和15例正常男生的有氧能力和日常体力活动状况进行研究. 根据铁营养状况进行分组,铁营养指标包括血红蛋白、血清铁蛋白、血清铁和血清转铁蛋白受体,研究两组学生的最大耗氧量、相对体重最大耗氧量、相对瘦体重最大耗氧量、最大作功时间、最大心率以及在工作(学习)和休闲时的净心率、能量消耗和有氧活动时间等指标. 结果表明,缺铁性贫血学生的最大耗氧量,相对体重最大耗氧量、相对瘦体重最大耗氧童、最大作功时间显著下降;休闲时的净心率和能量消耗较正常对照组明显降低,有氧活动时问显著少于正常对照组. 结果提示,缺铁性贫血男性青少年的有氧能力受到损伤,日常体力活动减少.