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ABSTRACT: Corn tortilla is the staple food of Mexico and its fortification with zinc, iron, and other micronutrients is intended to reduce micronutrient deficiencies. However, no studies have been performed to determine the relative amount of zinc absorbed from the fortified product and whether zinc absorption is affected by the simultaneous addition of iron.
To compare zinc absorption from corn tortilla fortified with zinc oxide versus zinc sulfate and to determine the effect of simultaneous addition of two doses of iron on zinc bioavailability.
A randomized, double-blind, crossover design was carried out in two phases. In the first phase, 10 adult women received corn tortillas with either 20 mg/kg of zinc oxide added, 20 mg/kg of zinc sulfate added, or no zinc added. In the second phase, 10 adult women received corn tortilla with 20 mg/kg of zinc oxide added and either with no iron added or with iron added at one of two different levels. Zinc absorption was measured by the stable isotope method.
The mean (+/- SEM) fractional zinc absorption from unfortified tortilla, tortilla fortified with zinc oxide, and tortilla fortified with zinc sulfate did not differ among treatments: 0.35 +/- 0.07, 0.36 +/- 0.05, and 0.37 +/- 0.07, respectively. The three treatment groups with 0, 30, and 60 mg/kg of added iron had similar fractional zinc absorption (0.32 +/- 0.04, 0.33 +/- 0.02, and 0.32 +/- 0.05, respectively) and similar amounts of zinc absorbed (4.8 +/- 0.7, 4.5 +/- 0.3, and 4.8 +/- 0.7 mg/day, respectively).
Since zinc oxide is more stable and less expensive and was absorbed equally as well as zinc sulfate, we suggest its use for corn tortilla fortification. Simultaneous addition of zinc and iron to corn tortilla does not modify zinc bioavailability at iron doses of 30 and 60 mg/kg of corn flour.
Food and nutrition bulletin 12/2012; 33(4):261-6. · 1.92 Impact Factor
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ABSTRACT: BACKGROUND: Fecal calprotectin (FC) is an established simple biomarker of gut inflammation. To examine a possible relationship between linear growth and gut inflammation, we compared fecal calprotectin levels in 6 month old infants from poor rural vs affluent urban families. METHODS: The project was a cross-sectional comparison of FC from rural and urban populations in China. The relationship between length-for-age Z-score (LAZ) and FC concentrations were also compared. Single fecal samples were assayed for FC using EK-CAL ELISA kits. RESULTS: The age of subjects for both locations was 6.1 [PLUS-MINUS SIGN] 0.2 mo; all were apparently healthy. The mean [PLUS-MINUS SIGN] SD of the LAZ for the rural and urban infants were [MINUS SIGN]0.6 [PLUS-MINUS SIGN] 0.9 and 0.4 [PLUS-MINUS SIGN] 0.9, respectively. FC had a non-normal distribution. The median FC of 420.9 and 140.1 mug/g for rural and urban infants, respectively, were significantly different (P < 0.0001). For the rural group, linear regression analysis showed that an increase in FC of 100 mug/g was associated with a decrease of 0.06 in LAZ. CONCLUSION: FC levels were significantly elevated in the rural infants and high concentrations accounted for approximately one-third of the low LAZ scores of these infants.
BMC Pediatrics 08/2012; 12(1):129. · 1.88 Impact Factor
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ABSTRACT: To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes.
Population-based, prospective, interventional pre-post design study.
11 rural clusters in Chimaltenango, Guatemala.
Health care providers.
This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006.
The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g.
Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57).
Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability.
Acta Obstetricia Et Gynecologica Scandinavica 02/2012; 91(5):593-7. · 1.77 Impact Factor
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ABSTRACT: Male and female infants from rural Ethiopia were tested to investigate relations among hemoglobin (Hb), anthropometry, and attention. A longitudinal design was used to examine differences in attention performance from 6 (M = 24.9 weeks, n = 89) to 9 months of age (M = 40.6 weeks, n = 85), differences hypothesized to be related to changes in iron status and growth delays. Stunting (length-for-age z scores < -2.0) and attention performance, t(30) = -2.42, p = .022, worsened over time. Growth and Hb predicted attention at 9 months, R(2) = .15, p < .05, but not at 6. The study contributes to the knowledge base concerning the relations among Hb, early growth, and attention.
Child Development 05/2011; 82(4):1238-51. · 4.72 Impact Factor
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Waldemar A Carlo,
Shivaprasad S Goudar,
Imtiaz Jehan,
Elwyn Chomba,
Antoinette Tshefu,
Ana Garces,
Sailajanandan Parida,
Fernando Althabe,
Elizabeth M McClure,
Richard J Derman,
Robert L Goldenberg,
Carl Bose, Michael Hambidge,
Pinaki Panigrahi,
Pierre Buekens,
Hrishikesh Chakraborty,
Tyler D Hartwell,
Janet Moore,
Linda L Wright
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ABSTRACT: The goal was to determine the effect of training in newborn care and resuscitation on 7-day (early) neonatal mortality rates for very low birth weight (VLBW) infants. The study was designed to test the hypothesis that these training programs would reduce neonatal mortality rates for VLBW infants.
Local instructors trained birth attendants from 96 rural communities in 6 developing countries in protocol and data collection, the World Health Organization Essential Newborn Care (ENC) course, and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP), by using a train-the-trainer model. To test the impact of ENC training, data on infants of 500 to 1499 g were collected by using a before/after, active baseline, controlled study design. A cluster-randomized, controlled trial design was used to test the impact of the NRP.
A total of 1096 VLBW (500-1499 g) infants were enrolled, and 98.5% of live-born infants were monitored to 7 days. All-cause, 7-day neonatal mortality, stillbirth, and perinatal mortality rates were not affected by ENC or NRP training.
Neither ENC nor NRP training of birth attendants decreased 7-day neonatal, stillbirth, or perinatal mortality rates for VLBW infants born at home or at first-level facilities. Encouragement of delivery in a facility where a higher level of care is available may be preferable when delivery of a VLBW infant is expected.
PEDIATRICS 10/2010; 126(5):e1072-80. · 4.47 Impact Factor
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Elizabeth M McClure,
Linda L Wright,
Robert L Goldenberg,
Shivaprasad S Goudar,
Sailajanandan N Parida,
Imtiaz Jehan,
Antoinette Tshefu,
Elwyn Chomba,
Fernando Althabe,
Ana Garces,
Hillary Harris,
Richard J Derman,
Pinaki Panigrahi,
Cyril Engmann,
Pierre Buekens, Michael Hambidge,
Waldemar A Carlo
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ABSTRACT: Our goal was to determine stillbirth rates in a multisite population-based study in community settings in the developing world.
Outcomes of all community deliveries in 5 resource-poor countries (Democratic Republic of Congo, Guatemala, India, Zambia, and Pakistan) and in 1 mid-level country (Argentina) were evaluated prospectively over an 18-month period. Births of > 1000 g with no signs of life were defined as stillbirth.
Outcomes of 60,324 deliveries were included. Stillbirth rates ranged from 34 per 1000 in Pakistan to 9 per 1000 births in Argentina. Increased stillbirth rates were associated significantly with lower skilled providers, out-of-hospital births, and low cesarean section rates. Maceration was present in 17.2% of stillbirths.
The stillbirth rates among births of > or = 1000 g in these developing countries were substantially higher than reported stillbirth rates in developed countries (3-5/1000 births). Because most developed countries define stillbirth as > or = 20 weeks of gestation or > or = 500 g and because almost one-half of all stillbirths are < 1000 g, the developing/developed country difference is actually larger than apparent from this study. Maceration was uncommon, which indicates that most of the deaths probably occurred during labor. The low rates of physician attendance, hospital delivery, and cesarean section deliveries suggest that stillbirth rates could be reduced by access to higher quality institutional deliveries.
American journal of obstetrics and gynecology 09/2007; 197(3):247.e1-5. · 3.28 Impact Factor
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Sue Fairweather-Tait,
Sean Lynch,
Christine Hotz,
Richard Hurrell,
Leo Abrahamse,
Steve Beebe,
Stine Bering,
Klaus Bukhave,
Ray Glahn, Michael Hambidge,
Janet Hunt,
Bo Lonnerdal,
Denis Miller,
Najat Mohktar,
Penelope Nestel,
Manju Reddy,
Ann-Sofie Sandber,
Paul Sharp,
Birgit Teucher,
Trinidad P Trinidad
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ABSTRACT: A combination of dietary and host-related factors determines iron and zinc absorption, and several in vitro methods have been developed as preliminary screening tools for assessing bioavailability. An expert committee has reviewed evidence for their usefulness and reached a consensus. Dialyzability (with and without simulated digestion) gives some useful information but cannot predict the correct magnitude of response and may sometimes predict the wrong direction of response. Caco-2 cell systems (with and without simulated digestion) have been developed for iron availability, but the magnitude of different effects does not always agree with results obtained in human volunteers, and the data for zinc are too limited to draw conclusions about the validity of the method. Caco-2 methodologies vary significantly between laboratories and require experienced technicians and good quality cell culture facilities to obtain reproducible results. Algorithms can provide semi-quantitative information enabling diets to be classified as high, moderate, or low bioavailability. While in vitro methods can be used to generate ideas and develop hypotheses, they cannot be used alone for important decisions concerning food fortification policy, selection of varieties for plant breeding programs, or for new product development in the food industry. Ultimately human studies are required for such determinations.
International Journal for Vitamin and Nutrition Research 12/2005; 75(6):371-4. · 0.88 Impact Factor
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Journal of Nutrition 01/2004; 133(12):4071-3. · 3.92 Impact Factor
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Michael Hambidge
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ABSTRACT: Three selected aspects of human zinc homeostasis and requirements are reviewed with special reference to studies undertaken by the author and his colleagues: 1) the implications for the calculation of physiologic requirements for zinc of the interrelationship between two key variables of zinc homeostasis, intestinal excretion of endogenous zinc and total absorbed zinc, are examined at levels of absorption below those necessary to meet physiologic requirements; 2) a method for deriving average dietary zinc requirements from zinc-stable isotope tracer/metabolic studies is illustrated with examples of studies being conducted in developing countries; and 3) the effect of reduction of high intakes of phytic acid on zinc bioavailability is examined with test meals prepared from low-phytic-acid maize or isohybrid wild-type control maize.
Journal of Nutrition 06/2003; 133(5 Suppl 1):1438S-42S. · 3.92 Impact Factor
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Michael Hambidge
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ABSTRACT: The emerging public health importance of zinc and selenium and the continuing public health challenges of iron and iodine draw attention to the unmet need for improved biomarkers of trace element status. Currently available biomarkers of these four trace elements are critiqued including the outstanding lack of satisfactory biomarkers for the assessment of zinc intake and status. Other trace elements are reviewed briefly including copper, for which human dietary deficiencies and excesses have been documented, and chromium, which is of possible but unconfirmed public health significance. Evolving strategies of considerable potential include molecular techniques such as the measurement of metallothionein mRNA in lymphocytes as a biomarker of zinc status, an assay that can now be performed with a dried blood spot. The judicious application of tracer techniques also has a role in advancing the quality of zinc biomarkers. Also of special current interest is full definition of the potential of plasma-soluble transferrin receptor concentrations as the biomarker of choice for the detection of early functional iron deficiency.
Journal of Nutrition 04/2003; 133 Suppl 3:948S-955S. · 3.92 Impact Factor
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ABSTRACT: Phytic acid reduction in cereal grains has been accomplished with plant genetic techniques. These low-phytic acid grains provide a strategy for improving the mineral (eg, zinc) status in populations that are dependent on grains, including maize (Zea mays L.), as major dietary staples.
The objective was to compare the fractional absorption of zinc from polenta prepared from maize low in phytic acid with that prepared from a wild-type isohybrid maize (control) after short-term consumption by adults whose habitual diet is low in phytic acid.
Healthy adults served as their own control subjects in a crossover design. All meals on 1 d consisted of polenta prepared from a low-phytic acid maize homozygous for the recessive low phytic acid 1-1 (lpa1-1). On the preceding or following day, all meals consisted of polenta prepared from a sibling isohybrid homozygous wild-type maize with a "normal" phytic acid content. The low-phytic acid maize contained approximately 60% less phytic acid than did the wild-type maize. All test meals were extrinsically labeled with zinc stable-isotope tracers. The fractional absorption of zinc was determined on the basis of fecal enrichment.
The molar ratios of phytic acid to zinc in the polenta prepared from lpa1-1 maize and the wild-type maize were 17:1 and 36:1, respectively. The corresponding fractional absorptions of zinc were 0.30 +/- 0.13 and 0.17 +/- 0.11, respectively (P < 0.005).
Substitution of a low-phytic acid grain in a maize-based diet is associated with a substantial increase in zinc absorption.
American Journal of Clinical Nutrition 09/2002; 76(3):556-9. · 6.67 Impact Factor
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Journal of Nutrition 03/2002; 132(2):322-3. · 3.92 Impact Factor
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ABSTRACT: There is a major increase in endogenous zinc excretion, specifically via the mammary gland, in early human lactation. Whereas fractional absorption of dietary zinc has been reported to increase in early human lactation, it is not known to what extent adaptive mechanisms may maintain zinc homeostasis, especially when dietary zinc intake is relatively low.
The objective of this study was to quantitate major variables of zinc homeostasis during early lactation in subjects from a population whose habitual dietary zinc intake is low.
We studied 18 free-living lactating women from a rural community of northeast China whose infants were exclusively breast-fed. The subjects were studied at approximately 2 mo of lactation with use of stable isotopes of zinc and metabolic collection techniques. Milk volume was measured with use of a deuterium enrichment method.
The mean (+/-SD) secretion of zinc in milk was 2.01 +/- 0.97 mg/d, the intake of zinc was 7.64 +/- 1.61 mg/d, and the fractional absorption of zinc was 0.53 +/- 0.09, for a total daily zinc absorption of 4.00 +/- 0.71 mg/d. Endogenous zinc excretion in urine and feces was 0.30 +/- 0.10 and 1.66 +/- 0.97 mg/d, respectively.
Zinc balance, including zinc secreted in breast milk, was maintained at approximately 2 mo of lactation in women whose habitual diet was low in zinc. Homeostasis was achieved by high fractional absorption of zinc and intestinal conservation of endogenous fecal zinc.
American Journal of Clinical Nutrition 02/2002; 75(1):99-103. · 6.67 Impact Factor
