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Effect of a beverage fortified with evaporated sugarcane juice on hemoglobin levels in preschool children

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Abstract

The study objective was to measure the effect of consumption of a beverage mixed with a high-iron sweetener (evaporated sugarcane juice known as rapadura) on hemoglobin levels in preschool children, and to compare it with the effect of consuming the same beverage sweetened with refined sugar. Research consisted of a 12-week randomized, controlled double-blind trial conducted in 2007 at a state-run school in Sobral, Brazil, among children aged 2-3 years. The study sample was divided into two groups-one consuming cashew juice mixed with 25 g of rapadura and 40 mg of ascorbic acid (per 200-mL serving), and another consuming the same quantity of juice and ascorbic acid sweetened with 25 g of standard refined sugar. A significant statistical increase in hemoglobin was observed in the group consuming the rapadura-fortified beverage. It was therefore concluded that consumption of rapadura increased hemoglobin and thus reduced iron deficiency anemia in preschool children.

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... According to Jaffé (2012), NCS can be considered a bio-compound, due to the presence of phenolic, iron, chromium, and phosphates. Studies in animals and humans have demonstrated the increased formation of hemoglobin and red blood cells due to consumption of a NCS fortified beverage (Arcanjo, Pinto, Arcanjo, Amici, & Amâncio, 2009). Furthermore, results obtained from Arcanjo, Amancio, and Braga (2013) consider NCS a food fortification compound. ...
Article
Background Non-centrifugal sugar cane (NCS) is currently considered a marginal natural sweetener. The nutritional and functional compound found in NCS allows it to be considered a superfood. Research on this product has been evolving from the improvement of sugar cane varieties and their energy efficiency process assessment. In this decade, the research topics have focused on NCS as a bioactive ingredient for the food, nutraceutical, and medicinal industries. However, no comprehensive analysis of research trends has been carried out. Scope and approach The aim of this research was to analyze the leading research, development, and innovation thematic lines, topics, and trends, using scientometrics, bibliometrics, and scientific landscape methods. These tools allowed the identification of networks of researchers, strategic publications, research networks of countries, trend clusters, and key performance indicators. Key findings and conclusions A comprehensive construction of research evolution on NCS in the last two decades was carried out; a keyword co-occurrence network, a thematic map, and a multicriteria analysis map were synthetized. Further, four future trend lines were constructed. Finally, the methodology applied contributed to building a broader and more specific “big picture” of NCS research for future project focalization. The results confirmed the interest in NCS as a source on bioactive compounds that could lead to promoting the research lines proposed in this article. https://www.sciencedirect.com/science/article/pii/S0924224420306828?dgcid=author
... It effect is similar to that of molasses in constituents as it only involves the evaporation of water from sugarcane juice. A Brazilian study on pre-school children aged 2-3 years done by Arcanjo et al. (2009) showed an increase in hemoglobin level in children fed with jaggery and ascorbic acid. In the study, jaggery-and ascorbic acid-fortified cashew juice (juice made from cashew apple) showed higher increase in Hb level in children as compared with refined sugar-and ascorbic acid-fortified cashew juice (p < 0.05), although the baseline Hb levels of the group fed with jaggery and ascorbic acid-fortified cashew juice were higher (11.1 g/dL) as compared with the baseline Hb levels (10.2 g/dL) of the group fed with refined sugar-and ascorbic acid-fortified cashew juice. ...
Article
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Iron deficiency anemia (IDA) is a serious public health problem that debilitates ∼1.6 billion people globally every year, the majority being pregnant women and children from developing countries. In India, for example, in spite of several operational programs at the national level using iron–folic acid and other allopathic interventions, IDA is still prevalent. Traditional medicines, such as Ayurveda, prescribe herbal formulations containing sugarcane derivatives for the management of pandu, a condition similar to IDA. This article reviews molasses, a sugar industry by-product, as a potential raw material to develop nutraceutical products for IDA. Molasses contains iron and its absorption enhancers, such as sulfur, fructose, and copper, which make it a potential dietary supplement for IDA. More research, product development, and evidence of safety and efficacy of molasses in IDA management can provide a tasty and cost-effective dietary supplement, particularly for children. However, there are challenges, such as competition for raw material from refined sugar manufacturers, quality control, etc., that need to be overcome.
... Guerra and Mujica (2010) found results in the concentration range from 1,60 to 3.87 mg 100 g -1 of Fe. The use of rapadura for improved child nutrition, especially to meet the needs of Fe, was the result of a study by Arcanjo, Pinto, Arcanjo, Amici, and Amâncio (2009) who reported on the importance of using rapadura in children's school meals to prompt a reduction in anemia due to increased hemoglobin levels. ...
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The aim of this work was the physicochemical, microbiological and microscopic evaluation of artisanal rapaduras produced in Cuiabá, Mato Grosso State, Brazil. The determination of the proximal composition, pH and the microscopic analyses were made according to the Association of Official Analytical Chemists (AOAC). The concentrations of minerals and toxic metals were quantified by flame atomic absorption spectrometry. The Coliforms at 45°C and Salmonella sp. were determined according to the American Public Health Association (APHA). The results obtained were: moisture (6.09 to 16.34%), ash (0.07 to 1.88%), insoluble solids (0.11 to 11.3%), pH (4.73 to 5.61), proteins (0.21 to 0.47%), sucrose (13.15 to 43.89%), and reducing sugars (10.96 to 26.28%). Significant differences were found between the samples (p ≤ 0.05) as well as nonconformities in relation to national regulations. The mineral contents showed significant differences between lots of samples (p ≤ 0.05) and some lots presented Cd and Pb concentrations above the maximum values allowed by Brazilian legislation. High quantities of unwanted materials were detected and none of the samples presented microbiological contamination. The results suggest the creation of technical standards for quality control for the production of rapaduras to ensure food safety. © 2016 Eduem - Editora da Universidade Estadual de Maringa. All rights reserved.
... The cause and effect relationship between iron consumption and hemoglobin and red blood cells increase has been accepted by the European Food Safety Agency and therefore claims in this sense are permitted in Europe (EFSA, 2014). The statistically significant increase in hemoglobin in preschool children after consumption of a NCS fortified beverage has been demonstrated by a Brazilian group (Arcanjo et al., 2009) leading them to propose to consider NCS a food fortificant (Arcanjo et al., 2013). ...
... One in Ecuador found that iron adsorption from wheat noodle soup was significantly higher consumed with lemonade sweetened with panela (11%), compared with the same meal without lemonade, in 13 women and measured by a double isotopic method (Olivares et al. 2007). A statistical significant increase in hemoglobin in pre-school children was demonstrated in a 12 weeks randomized, controlled double blind trial, with the consumption of a beverage of panela with ascorbic acid, in Brazil (Arcanjo et al. 2009). These are still few evidences for this potentially very important health effect of NCS. ...
Article
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Non-centrifugal sugar (NCS), the technical name of the product obtained by evaporating the water in sugar cane juice, is known by many different names in the world, the most important being un-refined muscovado, whole cane sugar, panela (Latin America), jaggery (South Asia) and kokuto (Japan). Scientific research has been confirming that NCS has multiple health effects but it is still practically outside the current focus on functional foods and nutriceuticals. 46 academic publications have been identified which reports them. The highest frequency is immunological effects (26%), followed by anti-toxicity and cytoprotective effects (22%), anticariogenic effects (15%) and diabetes and hypertension effects (11%). Some of these effects can be traced to the presence of Fe and Cr, and others are suggested to be caused by antioxidants.
... Several studies have sought to tackle the problem of iron deficiency or iron deficiency anemia using different approaches [11][12][13][14][15]. All of which had one basic goal, which was to reduce anemia as quickly as possible, with low cost and without adverse outcomes. ...
Article
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This study analyses the impact of weekly iron supplementation with ferrous sulphate heptahydrate (FeSO4) in 5-year-olds compared with placebo, on hemoglobin (Hb) and hematocrit (Ht) values and anemia. The study concerns a cluster-randomized, placebo-controlled double-blind trial. Intervention participants received 50 mg elemental iron for 14 weeks. The study population comprised pre-school children (n = 135) from one randomly chosen public school in the northeast of Brazil. Participants were 5-year-old students from a public school. Mean Hb and Ht values increased after iron supplementation, with p < 0.0001. There was no statistically significant increase in the placebo group. After intervention, anemia prevalence reduced only in the intervention group, from 48.0% to 26.0%. Weekly iron supplementation was effective in reducing anemia in 5-year-olds.
Article
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Anemia is one of the most widespread nutritional deficiencies of blood which affect the populations of all ages throughout the world, children and adolescents being at a significantly higher risk for the condition. Medicinal plants have been a source of succor in the control of many diseases in developing countries and anemia is no exception. Treatment of anemia involves an iron-rich diet, iron and vitamin supplements. Iron supplements that are commercially available, if consumed too much of which can lead to circumstances like Hemochromatosis, Neurogenic Disorders and sometimes even cancer. In this study, extracts of different plants (Moringa oleifera, Psidium guajava, Cymbopogon citratus, and Trigonella foenum-graecum) were examined for their iron content to formulate some natural iron product to put forth as a solution to iron deficiency. The total iron content in the standard solution and samples of selected plant were obtained by phenanthroline method modified using analysis by absorption spectrophotometer. The spectrophotometric studies reveal the amount of iron content and hence the efficiency of the species in combatting anemia. Since these are natural sources, the food supplements designed from their extracts are expected to provide a solution to the disease without causing the harmful effects of the commercial iron supplements and also alongside provide other nutritional benefits to the individual.
Chapter
Iron deficiency anemia (IDA) is the most widespread preventable nutritional problem in the world, despite continuous efforts for its control. The World Health Organization (WHO) estimates more than two billion people suffer from this condition worldwide [1]. The prevalence estimate of global anemia in preschoolers is 293.1 million cases, or 47.4 % of the total population in this age range [2]. More recent evidence from studies in animals and humans associates anemia in the first years of life to impaired cognitive development in later stages [3]. Estimates report that in developing countries annual losses due to reduction in physical productivity through anemia are US$ 3.54 per person or 0.81 % gross domestic product (GDP), and that median total losses (physical and cognitive) are US$ 16.78 per person or 4.05 % GDP [4]. To combat anemia WHO advocates three main methods: dietary diversification, to include foodstuffs rich in iron, with high bioavailability; fortification of staple food items; and iron supplements for at-risk populations [5]. Dietary diversification is probably the most sustainable means of addressing the problem of IDA. According to WHO, the most promising diversification strategies are those that include the use of locally consumed foodstuffs [5]. Popular locally consumed foodstuffs with high iron content and bioavailability are of key interest, as they can be used to tackle anemia in populations with low iron stocks and/or high iron requirements such as growing children and women of childbearing age [5, 6].
Article
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The utility of iron fortification of food to improve iron deficiency, anemia, and biological outcomes is not proven unequivocally. The objectives were to evaluate 1) the effect of iron fortification on hemoglobin and serum ferritin and the prevalence of iron deficiency and anemia, 2) the possible predictors of a positive hemoglobin response, 3) the effect of iron fortification on zinc and iron status, and 4) the effect of iron-fortified foods on mental and motor development, anthropometric measures, and infections. Randomized and pseudorandomized controlled trials that included food fortification or biofortification with iron were included. Data from 60 trials showed that iron fortification of foods resulted in a significant increase in hemoglobin (0.42 g/dL; 95% CI: 0.28, 0.56; P < 0.001) and serum ferritin (1.36 μg/L; 95% CI: 1.23, 1.52; P < 0.001), a reduced risk of anemia (RR: 0.59; 95% CI: 0.48, 0.71; P < 0.001) and iron deficiency (RR: 0.48; 95% CI: 0.38, 0.62; P < 0.001), improvement in other indicators of iron nutriture, and no effect on serum zinc concentrations, infections, physical growth, and mental and motor development. Significant heterogeneity was observed for most of the evaluated outcomes. Sensitivity analyses and meta-regression for hemoglobin suggested a higher response with lower trial quality (suboptimal allocation concealment and blinding), use of condiments, and sodium iron edetate and a lower response when adults were included. Consumption of iron-fortified foods results in an improvement in hemoglobin, serum ferritin, and iron nutriture and a reduced risk of remaining anemic and iron deficient.
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Because industrial workers in dusty or smoky environments seemed to experience no discomfort if they consumed the sugar cane product jaggery, experimental studies were undertaken to observe the effects of jaggery on dust-exposed rats. Rats with and without a single intratracheal instillation of coal dust (50 mg/rat) were orally gavaged with jaggery (0.5 g/rat, 5 days/week for 90 days). The enhanced translocation of coal particles from lungs to tracheobronchial lymph nodes was observed in jaggery-treated rats. Moreover, the jaggery reduced the coal-induced histological lesions and hydroxyproline contents of lungs. The lesions induced in omental tissue and regional lymph nodes by a single intraperitoneal injection of 50 mg each of coal and silica dust were modified by jaggery (0.5 g/rat, 5 days/week for 30 days). These findings along with the preventive action of jaggery on smoke-induced lung lesions suggest the potential of jaggery as protective agent for workers in dusty and smoky environments.
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Koko, a fermented maize porridge used as the primary complementary food in Ghana, has been implicated in the high prevalence of child malnutrition. Weanimix, a cereal-legume blend developed by the United Nations Children's Fund and the Ghanaian government, has been promoted as an alternative. We evaluated the effect of feeding Weanimix and 3 other locally formulated, centrally processed complementary foods on the nutritional status of 208 breast-fed infants. Infants were randomly assigned to receive 1 of 4 foods from 6 to 12 mo of age: Weanimix (W), Weanimix plus vitamins and minerals (WM), Weanimix plus fish powder (WF), and koko plus fish powder (KF). Dietary and anthropometric data were collected regularly. Blood was collected at 6 and 12 mo of age to assess iron, zinc, vitamin A, and riboflavin status. Before and after the intervention, cross-sectional data on the anthropometric status of infants not included in the intervention (NI; n = 464) were collected. There were no significant differences between intervention groups in weight or length gain or in hemoglobin, hematocrit, transferrin saturation, plasma zinc, or erythrocyte riboflavin values between 6 and 12 mo of age. From 9 to 12 mo of age, z scores were lower in NI infants than in the combined intervention groups [at 12 mo: -1.71 +/- 0.90 compared with -1.19 +/- 0.93 for weight and -1.27 +/- 1.02 compared with -0.63 +/- 0.84 for length (P < 0.001 for both), respectively]. The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W, WF, and KF but not in group WM. Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined (0.14 +/- 0.3 compared with -0.04 +/- 0.3 micromol/L, P = 0. 003). All 4 foods improved growth relative to the NI group. Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods.
Article
This paper examines the evidence for a causal relationship between iron deficiency and a variety of functional consequences with economic implications (motor and mental impairment in children and low work productivity in adults). To the extent that we can be confident that iron deficiency does cause a consequence with economic implications, this effect is quantified in economic terms. Illustrative calculations for 10 developing countries suggest that the median value of annual physical productivity losses due to iron deficiency is around $2.32 per capita, or 0.57% of GDP. Median total losses (physical and cognitive combined) are $16.78 per capita, 4.05% of GDP. Using a cost of $1.33 per case of anemia prevented, from one of the few effectiveness studies of national fortification, allows us to calculate the benefit-cost ratio for long-term iron fortification programs. The median value is 6:1 for the 10 countries examined and rises to 36:1 including the discounted future benefits attributable to cognitive improvements. This paper improves on previous work by including a much more thorough survey of the quantitative magnitudes involved, and by incorporating effects of iron deficiency on cognition. However, more research is needed to verify the accuracy of the assumptions needed for this type of analysis.
Article
This study, undertaken to investigate the social customs and beliefs surrounding breast feeding in Western Rajasthan, India, was conducted at the Umaid Hospital for Women and Children in Jodhpur. 300 women attending the pediatric outpatient and impatient departments and underfive clinics at the hospital constituted the study subjects. The women ranged in age from 15-42 years. They were interviewed to collect information on social and family variables and on breast feeding. Of the 300 women, 65.3% were residents of urban areas. 92.7% of the respondents believed in inaugural feeding with 32.3% preferring honey, followed by, among others, animal milk (17.6%), and janam ghutti (11.7%). Honey and janam ghutti were preferred by rural respondents; jaggery (13.8%), water (9.7%), and tea (7.7%) were preferred by urban women. Ceremonial ritual prior to beginning breast feeding was observed by 47.9% of the urban women (despite better education in urban areas) and 57.7% of the rural women. Colostrum feeding was denied by 32.6% women, but it was favored by 65.8% urban and 46.1% rural women. Nearly 33% urban and 40.9% rural mothers favored the restriction of breast feeding during maternal illness. During illness of the child, 48.4% urban and 51.9% rural women favored breast feeding restriction. The breast-feeding practices reflect a strong interlocking influence with social customs and beliefs as do the preference of women for inaugural feeds. The use of these feeds depends upon local customs and beliefs and the socioeducational level of the population. This is strongly supported by the observation that 79.7% of the women gave inaugural feed because of advice of an elderly family member or family tradition.
Article
Studies on the effect of iron deficiency on children's cognition and behavior are selectively reviewed, looking for evidence of a causal relationship. Most correlational studies have found associations between iron-deficiency anemia and poor cognitive and motor development and behavioral problems. Longitudinal studies consistently indicate that children anemic in infancy continue to have poorer cognition, school achievement, and more behavior problems into middle childhood. However, the possible confounding effects of poor socioeconomic backgrounds prevent causal inferences from being made. In anemic children <2 y old, short-term trials of iron treatment have generally failed to benefit development. Most longer trials lacked randomized placebo groups and failed to produce benefits. Only one small randomized controlled trial (RCT) has shown clear benefits. It therefore remains uncertain whether the poor development of iron-deficient infants is due to poor social backgrounds or irreversible damage or is remediable with iron treatment. Similarly, the few preventive trials have had design problems or produced no or questionable benefits only. For children >2 y old, the evidence from RCT is reasonably convincing but not conclusive. RCT of iron treatment are warranted especially in younger children.
Article
To develop an iron rich supplement with locally available foods and to test its feasibility in school going children (7-9 Years) belonging to low income families. From the upper primary school in Rajendranagar 7-9 year-old children were screened for hemoglobin (Hb) levels and 36 children having Hb levels below 11 g/dl were selected. Based on their Hb levels, age, and gender, 24 children were grouped as experimental and the rest as control. A supplement food (laddoo) was developed using locally available foods like jaggery, processed rice flakes, graden cress seeds and amaranth seeds (45:40:10.5). In the experimental group, children were given one laddoo per day for a period of 60 days. Effect of supplement on Hb levels, height and weight was assessed. Anthropometric parameters showed that 97% of these children were undernourished, majority (50%) were in grade II malnutrition followed by grade (25%) and grade II (22%). A significant increase in Hb levels was observed in both the boys and girls after 30 days of supplementation only. The increase was comparatively more in the first 30 days than the second 30 days. The overall increase in Hb levels was more in 7-8 years than the 8-9 years age group. In majority of the subjects progression from one Hb level to the next higher level was observed. There was no significant improvement in their height and weight. The product developed contributed around 39-mg% iron. Thus its efficacy as an iron rich supplement in combating iron deficiency anemia is reflected in the results obtained.
Article
Iron deficiency continues to be the most prevalent nutritional deficiency disorder in the world, affecting an estimated two billion people, most of whom live in developing countries. It has far-reaching effects on the health, well-being and productivity of those affected. Iron fortification of food is regarded as the most cost-effective method for reducing the prevalence of nutritional iron deficiency. In industrialized countries this has had an important beneficial effect; however, nutritional anaemia remains very prevalent in developing countries, and iron fortification appears until recently to have had little impact. Two important reasons for the latter situation are inadequate documentation of the magnitude of the iron deficiency component of anaemia in different regions of the world, and the use of iron compounds that are poorly bioavailable in fortification programmes. Several recent interventions using innovative approaches to dietary fortification that ensure the delivery of adequate quantities of bioavailable iron have demonstrated that iron fortification of food can be an effective and implementable strategy for controlling nutritional iron deficiency in non-industrialized countries.
Article
In developing countries there is high prevalence of iron deficiency anemia, which causes negative impact on growth, development and quality of life for infant population. Currently several strategies are being elaborated and tested to tackle this problem. To measure anemia prevalence in preschool children. To evaluate fortification effectiveness with 5 or 10 mg of elemental iron/daily added to school meals by increasing hemoglobin levels in anemic children. Double-blind, cluster randomized intervention study with 728 students from public network. Blood count was taken at beginning of study, to evaluate anemia prevalence, those anemic were selected for intervention, after intervention new blood count was taken to evaluate fortification effectiveness. Ferrous Sulphate was added in individual dosage of 5 or 10 mg of elemental iron/daily to usual school meal. From 35 schools 3 were randomized to receive 5 mg/daily (group A) and 3 to receive 10 mg/daily (group B). Hemoglobin and hematocrit averages before and after intervention were compared in each group and between them. In group A, the anemia prevalence reduced 34.9 to 12.4%, and in group B 39.0 to 18.7%. In both groups a significant increase in hemoglobin was observed: in group A from 10.1 to 11.5 g/dl (p < 0.01) and in group B from 10.0 to 11.0 g/dl (p < 0.01). There was no statistically significant difference in final levels of hemoglobin among groups. Both dosages of elemental iron were equally effective in increasing hemoglobin levels, and reducing anemia prevalence. Fortification of school meals was shown to be an effective, low cost and easy to manage intervention.
Article
Low intake of bioavailable iron from complementary foods is the major cause of the high prevalence of iron-deficiency anemia among children 6 to 24 months of age in developing countries. Increased dietary diversity and traditional food-processing techniques are generally unsuccessful at completely closing the gap between iron intake and needs. Thus, iron-fortified processed complementary foods or home fortification (using powders, crushable tablets, or fat-based products) will be needed in most populations. Several studies have demonstrated that both approaches are efficacious, though there are limited data on effectiveness on a wide scale. The choice of which product to promote may depend on the context, as well as cost constraints. No adverse effects of increasing iron intake through fortification or home fortification of complementary foods have been reported, but large-scale studies that include sufficient numbers of iron-replete children are lacking. Further research is needed to verify the safety of iron-fortification strategies, particularly in malarial areas.
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