ArticleLiterature Review

Iron Deficiency: Causes, Consequences, and Strategies to Overcome This Nutritional Problem

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Abstract

Iron deficiency and anemia affect a substantial portion of the world's population, provoking severe health problems to the people suffering these conditions, as well as important economic losses to the regions in which this nutritional deficiency is significant. In this work, the principal causes and consequences produced by this deficiency are discussed, as well as the different strategies that can be applied in order to prevent and solve this nutritional problem.

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... The main causes of this insufficiency are the lack of iron-rich foods in the diet or the body's inability to absorb ingested iron owing to acquired or genetic causes. Iron deficiency affects about 40% of the population in developing countries and around 10% of the inhabitants of developed countries [1]. Iron can be obtained through food products, supplements, or medical procedures such as blood transfusion and/or transfusion of red cell concentrates [2]. ...
... The most common causes of iron deficiency are low solubility of iron, low bioavailability, and loss of blood due to hemorrhage [6]. The explanatory factor for these conditions is that most of the iron from ingested food has low solubility and, consequently, low bioavailability [1]. Once absorbed, iron enters into the systemic circulation and becomes available either for storage or for the physiological functioning of the body [36]. ...
... The main foods used for iron fortification are cereals and dairy products and, to a smaller extent, salt, sugar, and condiments. Using cereals, their flours, and derived food products as iron carriers is disadvantageous because of their high phytic acid content, which can diminish iron absorption [1]. Unabsorbed iron destroys the gut microbiota and causes changes in the ratio of protective and pathogenic bacteria. ...
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Iron deficiency in the human body is a global issue with an impact on more than two billion individuals worldwide. The most important functions ensured by adequate amounts of iron in the body are related to transport and storage of oxygen, electron transfer, mediation of oxidation-reduction reactions, synthesis of hormones, the replication of DNA, cell cycle restoration and control, fixation of nitrogen, and antioxidant effects. In the case of iron deficiency, even marginal insufficiencies may impair the proper functionality of the human body. On the other hand, an excess in iron concentration has a major impact on the gut microbiota composition. There are several non-genetic causes that lead to iron deficiencies, and thus, several approaches in their treatment. The most common methods are related to food fortifications and supplements. In this review, following a summary of iron metabolism and its health implications, we analyzed the scientific literature for the influence of iron fortification and supplementation on the gut microbiome and the effect of probiotics, prebiotics, and/or synbiotics in iron absorption and availability for the organism.
... Micronutrient deficiencies (e.g., iron, folic acid), parasitic infections (malaria and hookworm), and hemoglobinopathies are the most common causes of anemia worldwide (Boccio and Iyengar 2003). Chronic disease and infections (e.g., Tuberculosis, HIV/AIDS) also interfere with hemoglobin concentration. ...
... Potential consequences of anemia are reduced work capacity, increased morbidity from infections, greater risk of death associated with pregnancy and childbirth, low birth weight and prematurity, and diminished learning ability (Boccio and Iyengar 2003). From an evolutionary perspective, anemia influences maternal and infant survival and RS. ...
... Two analyses were run: one for all 315 women Table 7.16 Multilinear regression model for hemoglobin (transformed, Hb 2.5 ) by reproductive status, BMI, SES, family planning, community of residence, meat consumption (n=215) Statistical analysis suggests that young women (under age 20), pregnant women, and lactating women have significantly lower hemoglobin levels and higher rates of anemia than older and non-pregnant women. Young women are likely to enter their reproductive years with low nutrient reserves because of recent investment of nutrients in their own growth (Boccio and Iyengar 2003). Increased iron and folic acid requirements during pregnancy and lactation may also be stressful. ...
... Maternal hemoglobin below 8 g/dl has been associated with a 2.7-fold increase in the risk of preterm birth and with a 3.1-fold increase in low birth weight due to increased prematurity and intrauterine growth retardation (2,3) . Severe anemia is associated with an increased risk of motor and cognitive impairments, reduced amniotic fluid volume, fetal cerebral vasodilation and fetal death (2,4,5) , and with death in approximately 30% of infants hospitalized with anemia without immediate blood transfusion (6) . Perinatal mortality rates increase significantly when maternal Hb values are below 11 g/dL, increase 2-3-fold at values below 8 pediatru g/dL and 8-10-fold at values below 5 g/dL (7) . ...
... However, at 3 months of age, serum ferritin levels were significantly higher in infants of non-anemic mothers, and also the anthropometric parameters were normal. Significantly decreased immune response, growth retardation, impaired tooth integrity and salivary gland dysfunction can occur in prenatally iron-deficient infants (6,8) . ...
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Cite: Atomei O, Monor PP, Stana BA. Consequences of anemia in pregnancy upon the newborn – a cross-sectional study. Pediatru.ro. 2022;XVIII.65(1):36-40. (ISSN 1841-5164, e-ISSN 2066-8252, ISSN-L 1841-5164) DOI: 10.26416/Pedi.65.1.2022.6335 Background. Anemia in pregnant women is still an im­por­tant public health problem. The consequences on the newborn, immediate or late, can range from mild to se­vere pathologies. Aims. The main objective of the study was to identify the correlations that might occur between iron deficiency ane­mia in pregnant women from Suceava county, Romania, and its consequences on the newborn. Materials and method. Data collection for the cross-sectional study was performed using a questionnaire given to pregnant wo­­men admitted to the “Sf. Ioan cel Nou” County Emer­gen­cy Clinical Hospital, in Suceava, Romania, in 2017. The questionnaire completed by the interviewer provided both general data about the patients and data on ges­ta­tio­nal age, hemoglobin and hematocrit values, birth weight of the newborn, APGAR score and neonatal path­o­logies. Results. The prevalence of iron deficiency ane­mia in pregnant women was 48% (Hb<11.5 g/dl). No cor­re­la­tion was found between hemoglobin value and new­born weight (p=0.353), even though it ranged from 1360 g to 4510 g (mean weight = 3020 g), nor between the presence of anemia and gestational age (p=0.155), although there were 30% preterm and 70% term births. In con­trast, anemia during pregnancy was associated with a lower APGAR score (p=0.024), with the occurrence of pe­ri­na­tal pathologies in the newborn, some of them of sig­ni­fi­cant severity (p<0.0009), and with the occurrence of neonatal pathologies in 50% of newborns. Conclusions. This study has shown the major practical importance of prophylaxis of iron deficiency anemia in pregnant wo­men, with a positive impact on conception product.
... Maternal hemoglobin below 8 g/dl has been associated with a 2.7-fold increase in the risk of preterm birth and with a 3.1-fold increase in low birth weight due to increased prematurity and intrauterine growth retardation (2,3) . Severe anemia is associated with an increased risk of motor and cognitive impairments, reduced amniotic fluid volume, fetal cerebral vasodilation and fetal death (2,4,5) , and with death in approximately 30% of infants hospitalized with anemia without immediate blood transfusion (6) . Perinatal mortality rates increase significantly when maternal Hb values are below 11 g/dL, increase 2-3-fold at values below 8 pediatru g/dL and 8-10-fold at values below 5 g/dL (7) . ...
... However, at 3 months of age, serum ferritin levels were significantly higher in infants of non-anemic mothers, and also the anthropometric parameters were normal. Significantly decreased immune response, growth retardation, impaired tooth integrity and salivary gland dysfunction can occur in prenatally iron-deficient infants (6,8) . ...
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Cite: Atomei O, Monor PP, Stana BA. Consequences of anemia in pregnancy upon the newborn – a cross-sectional study. Pediatru.ro. 2022;XVIII.65(1):36-40. (ISSN 1841-5164, e-ISSN 2066-8252, ISSN-L 1841-5164) DOI: 10.26416/Pedi.65.1.2022.6335 Date generale. Anemia la gravide este încă o problemă im­por­tantă de sănătate publică. Consecinţele asupra nou-născutului, imediate sau tardive, pot varia de la pa­to­lo­gii uşoare la boli se­ve­re. Scop. Obiectivul principal al stu­diu­lui a fost de a iden­ti­fica corelaţiile care pot apărea în­tre ane­mia feriprivă în sar­­ci­nă la gravidele din judeţul Su­cea­­va şi con­se­cinţele acesteia asu­­pra nou-născutului. Materiale şi metodă. Colectarea datelor pentru stu­­diul transversal s-a realizat prin intermediul unui chestionar ad­mi­nis­trat fe­mei­lor gravide internate la Spitalul Judeţean de Ur­genţă „Sfântul Ioan cel Nou” din Suceava, România, în anul 2017. Ches­tio­na­rul completat a furnizat atât date generale de­­spre pa­cien­te, cât şi date privind vârsta gestaţională, va­lo­ri­le he­mo­glo­bi­nei şi hematocritului, greutatea la naştere a nou-năs­cu­tului, scorul APGAR şi patologiile neonatale. Re­zul­ta­te. Prevalenţa anemiei feriprive la gravide a fost de 48% (Hb<11,5 g/dl). Nu s-a constatat nicio corelaţie între valoarea he­mo­glo­bi­nei şi greutatea nou-născutului (p=0,353), deşi aceasta a variat între 1360 g şi 4510 g (greutate medie = 3020 g), şi nici între prezenţa anemiei şi vârsta gestaţională (p=0,155), deşi au existat 30% naşteri premature şi 70% naş­teri la termen. În schimb, anemia din timpul sarcinii a fost asociată cu un scor APGAR mai mic (p=0,024), cu apa­ri­ţia unor patologii perinatale la nou-născut, unele dintre ele de gravitate semnificativă (p<0,0009), şi cu apariţia unor patologii neonatale la 50% din­tre nou-născuţi. Concluzii. Acest studiu a demonstrat im­por­tan­ţa practică majoră a profilaxiei anemiei feriprive la gravide, cu impact pozitiv asupra produsului de concepţie.
... Excessive consumption of Fe supplements is the most common cause of overdose mortality among children up to 6 years (Cheney, et al., 2008;Spanierman, 2016). Fe deficiency, on the other hand, will result in ferropenic anemia, which induces reduced physical aptitude and cognitive ability (Boccio & Iyengar, 2003). Zn is less toxic than Fe, but cases of toxicity have occurred after long-term, high-level ingestion. ...
... Fe deficiency induced ferropenic anemia causes reduced physical aptitude, reduced cognitive ability, complications at birth, and decreased labor productivity, all of which in turn have proven links to economic stagnation (Boccio & Iyengar, 2003). Fe fortification is frequently used in children's breakfast cereals and other processed foods to supplement the diets of at-risk groups (Gibso, 1999). ...
Thesis
DEFINING GENETIC AND ENVIRONMENTAL DETERMINANTS OF ELEMENTAL HOMEOSTASIS IN MAIZE (Zea mays L.): A GENOME-WIDE ASSOCIATION STUDY OF ELEMENTAL COMPOSITION OF MAIZE GRAIN Philip J Kear, Ph.D Cornell University 2018 Dissolved minerals are absorbed by plants from the soil or other sources, incorporated into seeds, leaves and other tissues that are then consumed by animals and humans, which carry those nutrients up the food chain. Plant-absorbed minerals form the source of 22 elements required by the human body for proper functionality, whether eaten directly or through meat consumption. The proportion of a plant or other organism that forms the inorganic mineral and trace elements is defined as the ionome. Study of the ionome has the potential to affect a wide range of agronomically pertinent areas affecting agriculture and society, including nutrient-use efficiency, toxicology, bio-fortification, bio-availability, bio-remediation and mitigation of toxic metals in the crops we consume. Maize is a model species, well suited to ionomic studies because of the high diversity in genic regions, but is also the most widely grown staple food crop on the planet with significant cultivation on every continent except Antarctica. Maize also provides a diverse collection of germplasm with the feasibility of creating segregating progenies and immortal genotypes through self-fertilization. This dissertation investigates the dynamic nature of field-based maize kernel concentrations of 20 elements in order to simulate ‘real-world’ situations experienced by plants grown as food, but also to reflect a plant’s necessarily complex genetic adaptation to environments. This study utilized both linkage and association mapping on multiple populations, benefiting from advantageous population design and genetic architecture. PREVIEW Analysis across different populations discovered significant genomic regions that co-localized with known and novel candidate genes. For all 20 elements, significant regions were most frequently found in single field locations, ranging between 219 and 7240 regions per element across locations collectively. Nevertheless, some of these regions were discovered in two or more field environments. The occurrence of significant regions found in two or more locations ranged between 19 and 25. Two additional populations provided nearly isogenic backgrounds to investigate regions found to be significant in previous studies. Specifically, these populations provide evidence for the discovery of a cadmium regulator explaining about 23mg/kg difference between haplotypes, localized to a region of chromosome 2. The results from these studies are anticipated to contribute to the understanding of gene action across environments and provide a rich resource for the identification of genes driving elemental accumulation in maize grain, which can be used to create new varieties better suited to feed our changing world.
... In healthy people, taking high doses of iron supplements (especially on an empty stomach) can cause stomach upset, constipation, nausea, vomiting, and diarrhoea. Large amounts of iron may also cause more serious effects, including inflammation of the stomach lining and ulcers (Boccio and Iyengar 2003). Mohammadi et al. (2016) reported that various iron salts are used; among these salts, FeSO 4 is more beneficial for fortification because it is rapidly absorbed, low in price, and has a high bioavailability characteristic. ...
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Article
Fortification is one of the most important processes for the improvement of nutrients in food. This process can be a very cost-effective public health intervention. Due to the high consumption rate of fruit products, fortification of these products will effectively reduce and prevent diseases associated with nutritional deficiencies. This paper offers an overview of the fortification of fruit products with minerals (calcium, iron), vitamins, and dietary fibre. Fortification is defined, and the main reasons behind carrying out this process are discussed. This review studied the different types of products and their fortification model.
... It is essential for optimum growth and functioning of immune system, enzyme catalyzed biochemical reactions, neurobehavioral development, protein and DNA synthesis [15] and its deficiency results in adverse health conditions such as diarrhea, stunted physical and mental growth, loss of appetite, etc. Iron deficiency results into anemia, which globally has affected 40.0 and 42.0% of pregnant women and children, respectively, and even resulted to 20.0% of maternal deaths [16,17]. Inadequate Fe intake causes the increased mortality of pregnant women and newborns and compromises the immune system [18]. ...
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Biofortification of pulse crops with Zn and Fe is a viable approach to combat their widespread deficiencies in humans. Lentil (Lens culinaris Medik.) is a widely consumed edible crop possessing a high level of Zn and Fe micronutrients. Thus, the present study was conducted to examine the influence of foliar application of Zn and Fe on productivity, concentration, uptake and the economics of lentil cultivation (LL 931). For this, different treatment combinations of ZnSO4·7H2O (0.5%) and FeSO4·7H2O (0.5%), along with the recommended dose of fertilizer (RDF), were applied to the lentil. The results of study reported that the combined foliar application of ZnSO4·7H2O (0.5%) + FeSO4·7H2O (0.5%) at pre-flowering (S1) and pod formation (S2) stages was most effective in enhancing grain and straw yield, Zn and Fe concentration, and uptake. However, the outcome of this treatment was statistically on par with the results obtained under the treatment ZnSO4·7H2O (0.5%) + FeSO4·7H2O (0.5%) at S1 stage. A single spray of ZnSO4·7H2O (0.5%) + FeSO4·7H2O (0.5%) at S1 stage enhanced the grain and straw yield up to 39.6% and 51.8%, respectively. Similarly, Zn and Fe concentrations showed enhancement in grain (10.9% and 20.4%, respectively) and straw (27.5% and 27.6% respectively) of the lentil. The increase in Zn and Fe uptake by grain was 54.8% and 68.0%, respectively, whereas uptake by straw was 93.6% and 93.7%, respectively. Also the benefit:cost was the highest (1.96) with application of ZnSO4·7H2O (0.5%) + FeSO4·7H2O (0.5%) at S1 stage. Conclusively, the combined use of ZnSO4·7H2O (0.5%) + FeSO4·7H2O (0.5%) at S1 stage can contribute significantly towards yield, Zn and Fe concentration, as well as uptake and the economic returns of lentil to remediate the Zn and Fe deficiency.
... Iron deficiency is one of the most common human nutritional deficiencies prevalent across the globe and a leading factor for disabilities and deaths [6]. Iron deficiency leads to anemia in humans [7]. Anemia is a condition in which our blood lacks enough red blood cells (RBCs) and, thus, fails to carry adequate oxygen to the body tissues. ...
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The effectiveness of nanoscale zero-valent iron (NZVI) and microscale zero-valent iron (MZVI) in fortifying spinach (Spinacia oleracea) with iron was examined. The changes in uptake of some macro- and microelements essential for plants and humans were also investigated in the presence of NZVI and MZVI. Spinach was grown hydroponically until maturity using three doses of iron (11, 55, 110 mg/L) using NZVI, MZVI, and ferrous sulfate (FeSO4). Spinach produced most biomass when exposed to 55 mg/L NZVI and 110 mg/L MZVI. With the application of 55 mg/L NZVI, the biomass increase in the edible part (the aboveground biomass) was ~ 1.10-fold compared to 110 mg/L MZVI, and ~ 1.57-fold compared to 55 mg/L FeSO4 treatments. There was a 1.15-fold increase in iron content in spinach treated with 55 mg/L NZVI compared to 110 mg/L MZVI and a 1.70-fold increase was seen with 55 mg/L NZVI compared to 55 mg/L FeSO4. NZVI and MZVI also enhanced the plant uptake of some macronutrients (P, K, S, Ca, Mg, Na) and micronutrients (Zn, Mn, Cu, B). Both NZVI and MZVI have the potential for use as nutrient fortifiers in crops.
... The possible mechanism for the association of dietary pattern and anemia, particularly iron deficiency anemia, could be correlated with the effects of dietary components on the absorption or bioavailability of iron [47]. The bioavailability of iron depends on several factors, including the form of iron (heme vs. non-heme iron), the amount of iron in the diet, the presence of iron enhancers or inhibitors in the diet, and iron status in the individual [48]. Eggs inhibits non-heme iron absorption [49], and rice high in phytate (1.85-9.63 ...
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Inadequate dietary intake, poor nutritional status, heavy smoking, and alcohol consumption are associated with the risk of anemia. The objective of this study was to investigate the associations between dietary patterns, lifestyle, nutritional status, and anemia-related biomarkers among adults using a multivariable regression model. Taiwanese adults aged 20–45 years (n = 118,924, 43,055 men and 75,869 women) were obtained from the Mei Jau Health Management Institution database, between 2001 and 2015, for data analysis. The anemia–inflammation-related dietary pattern was derived by reduced rank regression analysis. Dietary patterns with high intakes of eggs, meat, organ meats, rice or flour products, fried foods, sugary beverages, and processed foods significantly increased the risk of anemia, and was associated with decreased hemoglobin, hematocrit, and red blood cells, but increased white blood cells and C-reactive protein levels. Moreover, current alcohol drinkers, as well as people who were underweight, overweight, obese, and central obese, were more likely to increase their risk of anemia by 46%, 20%, 23%, 34%, and 28%, respectively. Interestingly, participants who are current or past smokers were inversely associated with risk of anemia. In conclusion, adherence to the anemia–inflammation dietary pattern was associated with an increased risk of anemia in Taiwanese adults. Furthermore, abnormal weight status and alcohol drinking were correlated with an increased risk of anemia.
... It is well known that the deficiency of micronutrients such as zinc and iron can cause some negative effects such as the anemia and low immunity, which is one of the devastating public health problems, especially in the developing countries [1,2]. Generally, the micronutrient deficiency is caused by the inadequate dietary intake, uneven food distribution and increased requirements. ...
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Micronutrient (such as zinc and iron) deficiency can cause the mental retardation, anemia and low immunity. For this purpose, large quantity of zinc-containing and iron-containing food additives and drugs such as gluconates are produced in large scale. However, the imbalance between the production and the consumption also results in the expiration of the gluconates as well as the environment pollution. Herein, for the first time, expired zinc/ferrous gluconates were synchronously recycled by a facile solvothermal method and subsequent calcination in air for the different times of 1 h, 2 h and 3 h, and the resultant ZnFe2O4/C composites were marked as ZnFe2O4/C-1 h, ZnFe2O4/C-2 h and ZnFe2O4/C-3 h, respectively. The results showed that three ZnFe2O4/C composites manifested a uniform dumbbell-like morphology with about 300–400 nm in diameter and 1–2 μm in length. With the elongation of the calcination time from 1 h to 2 h and to 3 h, the carbon content of ZnFe2O4/C composite decreased from 10.4% to 6.5% and to 3.6%, while the graphitization degree and crystallinity gradually increased. Furthermore, the dumbbell-like ZnFe2O4/C-2 h composite anode exhibited the reversible specific capacity of 909 mA hg⁻¹ at 0.5 Ag⁻¹ after 50 cycles, higher than those of ZnFe2O4/C-1 h, ZnFe2O4/C-3 h as well as the result in literatures possibly attributed to the synergistic effect of the optimal carbon content, graphitization degree and crystallinity. Graphic Abstract
... Globally, 40 and 42% of pregnant women and children, respectively, are anemic, and 20% of maternal deaths are attributed to anemia, mostly due to Fe deficiency (2,3). Inadequate Fe intake causes the inability to maintain body temperature, increases mortality of pregnant women and newborns, decreases workability and fitness, and increases susceptibility to infectious diseases (4). Zn deficiency is also widespread, especially in lower-income countries. ...
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Lentil (Lens culinaris Medik.) is a quick-cooking, rapidly expanding protein-rich crop with high iron (Fe) and zinc (Zn), but low bioavailability due to the presence of phytate, similar to other grains. Lentils dual fortified with Fe and Zn can significantly improve the bioavailable Fe and Zn content. Three milled lentil product types (LPTs) were fortified with Fe using NaFeEDTA [ethylenediaminetetraacetic acid iron (III) sodium salt] (Fe fortified) or Zn from ZnSO4·H2O (Zn fortified), or both (dual fortified). Fe, Zn, phytic acid (PA) concentration, and relative Fe bioavailability (RFeB%) were assessed for samples from two fortified batches (initial and for 1 year stored). Fe, Zn, and RFeB% increased significantly in two batches of samples from the three LPTs, and decreased by 5–15% after 1 year of storage. PA concentration decreased from 8 to 15% after fortification of all samples from two batches of the three LPTs but showed different patterns of influence after storage. Dual-fortified lentil fortified with 24 mg Fe and 12 mg Zn 100 g−1 lentil had the highest amount of Fe and Zn, and the lowest PA concentration, and RFeB% was increased from 91.3 to 519.5%. Significant (p ≤ 0.01) Pearson correlations were observed between Fe concentration vs. PA:Fe molar ratio (MR), Fe concentration vs. RFeB%, RFeB% vs. PA:Fe MR, and Zn concentration vs. PA:Zn MR in all samples from two batches of the three LPTs. In conclusion, dual-fortified lentil can contribute significant bioavailable Fe and Zn to populations at risk of Fe and Zn deficiency.
... Imbalance in iron homeostasis, both excess and deficiency, are deleterious to human health and have been associated with medical conditions; these include neurodegenerative disorders (i.e., Parkinson and Alzheimer diseases), type II diabetes, and anemia [1][2][3]. Paradoxically, although iron is one of the most abundant elements on the planet, iron deficiency (ID) is the most common nutritional deficiency [4]. The World Health Organization estimates that more individuals have ID anemia than any other health problem [5]. ...
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Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.
... Children have a higher risk of suffering from iron deficiency (ID), defined as serum ferritin <1.5 µg/dL [33]. Two larger South African national surveys have shown that the prevalence of ID among children below five years old increased from 10% in 1994 [25] to 11% in 2013 [26]. ...
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In many poorer parts of the world, biofortification is a strategy that increases the concentration of target nutrients in staple food crops, mainly by genetic manipulation, to alleviate prevalent nutrient deficiencies. We reviewed the (i) prevalence of vitamin A, iron (Fe) and zinc (Zn) deficiencies; (ii) availability of vitamin A, iron and Zn biofortified crops, and their acceptability in South Africa. The incidence of vitamin A and iron deficiency among children below five years old is 43.6% and 11%, respectively, while the risk of Zn deficiency is 45.3% among children aged 1 to 9 years. Despite several strategies being implemented to address the problem, including supplementation and commercial fortification, the prevalence of micronutrient deficiencies is still high. Biofortification has resulted in the large-scale availability of βcarotene-rich orange-fleshed sweet potatoes (OFSP), while provitamin A biofortified maize and Zn and/or iron biofortified common beans are at development stages. Agronomic biofortification is being investigated to enhance yields and concentrations of target nutrients in crops grown in agriculturally marginal environments. The consumer acceptability of OFSP and provitamin A biofortified maize were higher among children compared to adults. Accelerating the development of other biofortified staple crops to increase their availability, especially to the target population groups, is essential. Nutrition education should be integrated with community health programmes to improve the consumption of the biofortified crops, coupled with further research to develop suitable recipes/formulations for biofortified foods.
... Iron deficiency is very common all over the world and affects approximately 20% of the world population (Martinez-Navarretea et al., 2002). Fortification of beverages with iron is an easy and cheaper alternative for preventing and treating iron deficiency anemia (Boccio and Iyengar, 2003). Organic acids (i.e., lactic acid) can enhance the absorbtion of iron in foods and hence fermented milks and milk products may be suitable choices for iron fortification (Branca and Rossi, 2002;Silva et al., 2008). ...
Chapter
Increasing consumers’ demand for healthy foods has triggered the efforts to develop novel foods with defined health effects. Today, a great number of novel functional foods are available in the markets, and dairy foods and beverages have a distinct place in this market. The first commercial functional dairy products were kefir, probiotic/synbiotic milks and yogurts, and vitamin/mineral-enriched milks. These product categories were followed by milks enriched with conjugated linoleic acids, peptides, sterols/stanols, etc. and whey-based functional products. Since 1990s, nutritional properties of cheese whey have been well documented. Whey is also a suitable medium for fermentation and/or tailor-made modifications (i.e., membrane separations) for development of health-specific nonalcoholic beverages. These factors have made cheese whey popular for beverage industry. The market share of whey-based beverages is increasing year by year. Although intensive efforts have been made to develop novel functional dairy- and whey-based products (especially beverages) during the last 10 years or so, the proper scientific validation of functional claims still remains the critical issue for the functional foods field. Especially safety, biocompatibility, and health claim issues of functional dairy- and/or whey-based beverages are often ignored or evaluated with improper/insufficient methodologies. An interdisciplinary approach should be followed to build up a strong scientific background for functionality of beverages under question. This chapter deals with the recent scientific, technological, and commercial developments in the dairy −/whey-based beverage sector as well as models for interdisciplinary approaches for justification of health claims and biocompatibility of such products.
... Indeed, there are many factors that regulate iron status, including dietary intake. 20,21 Our data suggest that smaller bodyweights are a risk factor of IDA, which may further interact with the pathophysiology of depression. 8,9,22,23 Alternatively, it is also possible that loss of appetite due to depression might be involved in IDA. ...
Article
Aim This web‐based survey aimed to examine the relationship between iron deficiency anemia and depression in 11,876 Japanese participants. Methods Participants consisted of 1,000 individuals with self‐reported history of depression (mean age, 41.4 ± 12.3 years; 499 women) and 10,876 population‐based controls (mean age, 45.1 ± 13.6 years; 5,185 women). The 6‐item Kessler scale test score was used as a psychological distress scale. The design of the study was cross‐sectional. Results The rate of self‐reported life‐time history of iron deficiency anemia was higher in depression group in both men (depression, 7.2%; control, 4.0%; p < 0.001; odds ratio, 1.86; 95% confidence interval, 1.30–2.68) and women (depression, 33.4%; control, 25.8%; p < 0.001; odds ratio, 1.45; 95% confidence interval, 1.19–1.76). The 6‐item Kessler scale test score in participants with self‐reported history of iron deficiency anemia was higher in both depression (p = 0.004) and control (p < 0.001) groups. In addition, the rate of individuals who showed the 6‐item Kessler scale test cut‐off score of 13 or more was higher in iron deficiency anemia group of all participants (p < 0.001; odds ratio, 1.47; 95% confidence interval 1.31–1.65). Logistic regression analyses revealed self‐reported history of depression and the 6‐item Kessler scale test score were positively associated with the self‐reported history of iron deficiency anemia (all p < 0.01). Conclusions Self‐reported history of iron deficiency anemia was associated with self‐reported history of depression. Furthermore, self‐reported history of iron deficiency anemia was associated with higher psychological distress.
... The most vulnerable segments for Fe and Zn deficiencies in developing countries are women, pregnant and nursing women, and infants and pre-school children (Black et al. 2008;Gibson 2006;Zimmermann and Hurrell 2007). Fe deficiency in humans can result in mental impairment, high morbidity rates, and physical incapacitation (Boccio and Iyengar 2003;Caballero 2002). Insufficient levels of Zn in the human body impairs growth, reduces mental/ cognitive abilities, limits the body's ability to resist infection, as well as the ability to effectively utilize other nutrients from the food matrix (Rodgers et al. 2004). ...
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Seed nutrients in legumes are important for human health, particularly in developing countries with heavy reliance on plant-based diets, and among vegetarians in developed nations. Here, we report on our efforts to uncover the genetic basis underlying the phenotypic variation for protein, zinc, calcium concentrations, and iron bioavailability present in 206 accessions of dry bean (Phaseolus vulgaris L.) from the Andean Diversity Panel (ADP). We used 8111 single nucleotide polymorphisms (SNPs) generated with genotyping-by-sequencing (GBS) to examine the allelic variants’ associations with seed protein, zinc, and calcium concentrations, and iron bioavailability in the 206 ADP accessions grown over 2 years in Michigan. These efforts identified phenotypic variation among the ADP genotypes for each of the traits, with the highest variation (5.4-fold) found for cooked seed iron bioavailability. In addition, significant SNP-trait associations were found and explained from 6.3 to 13.2% of the phenotypic variation. These results expand the current understanding of the genetic architecture underlying these complex nutritional quality traits and iron bioavailability in dry beans. Furthermore, they have utility for future nutritional quality breeding efforts to better biofortify dry bean through genomics-assisted breeding.
... This deficiency has become a major nutritional disorder, widespread in both developing and developed countries [11]. The major consequences of Fe deficiency are reduction of physical activity, fitness and work capability, a reduced ability to maintain body temperature, a lowered resistance to infection, and an increase in mortality during pregnancy and in newborns [12]. According to Food and Agriculture Organization (FAO) and World Health Organization (WHO) recommendations, the estimated daily average Fe requirements for females and males 19-50 years of age are 29.4 mg and 10.8 mg, respectively, based on 10% bioavailability [13]. ...
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Iron (Fe) deficiency is a major human health concern in areas of the world in which diets are often Fe deficient. In the current study, we aimed to identify appropriate methods and optimal dosage for Fe fortification of lentil (Lens culinaris Medik.) dal with FeSO4·7H2O (ferrous sulphate hepta-hydrate), NaFeEDTA (ethylenediaminetetraacetic acid iron (III) sodium salt) and FeSO4·H2O (ferrous sulphate mono-hydrate). We used a colorimetric method to determine the appearance of the dal fortified with fortificants at different Fe concentrations and under different storage conditions. Relative Fe bioavailability was assessed using an in vitro cell culture bioassay. We found that NaFeEDTA was the most suitable fortificant for red lentil dal, and at 1600 ppm, NaFeEDTA provides 13–14 mg of additional Fe per 100 g of dal. Lentil dal sprayed with fortificant solutions, followed by shaking and drying at 75◦C, performed best with respect to drying time and color change. Total Fe and phytic acid concentrations differed significantly between cooked unfortified and fortified lentil, ranging from 68.7 to 238.5 ppm and 7.2 to 8.0 mg g⁻¹, respectively. The relative Fe bioavailability of cooked fortified lentil was increased by 32.2–36.6% compared to unfortified cooked lentil. We conclude that fortification of lentil dal is effective and could provide significant health benefits to dal-consuming populations vulnerable to Fe deficiency.
... Iron (Fe) deficiency is a worldwide problem that is directly correlated with poverty and food insecurity. Approximately one third of the world's population suffers from Fe deficiency-induced anemia, 80 % of which are in developing countries (Boccio and Iyengar 2003;Miethke and Marahiel 2007). Total Fe content in soil is relatively high, but its availability to soil microorganisms is low in aerated soils because the prevalent form (Fe 3+ ) is poorly soluble. ...
Chapter
One major challenge for the twenty-first century will be the production of sufficient food for the global human population. The negative impacts on soil–plant–microbes–environmental sustainability due to injudicious use of chemical fertilizer, pesticide, insecticide, etc. by the unaware farmers deteriorate soil and environment quality. One possible way to use efficient soil microorganisms to remediate nutrient deficiency in agricultural soils and other plant growth-promoting (PGP) activities that can be of help for plant growth and development. The Bacillus species is one the most dominant rhizospheric bacterial/rhizobacteria species like Bacillus subtilis, B. cereus, B. thuringiensis, B. pumilus, B. megaterium, etc. that can help enhance the plant growth and development by different mechanisms, which PGPR can inhibit phytopathogens is the production of hydrogen cyanide (HCN) and/or fungal cell wall degrading enzymes, e.g., chitinase and ß-1,3-glucanase. Direct plant growth promotion includes symbiotic and non-symbiotic PGPR which function through production of plant hormones such as auxins, cytokinins, gibberellins, ethylene, and abscisic acid. Mitigate the challenge by adopting eco-friendly crop production practices. Some Bacillus species function as a sink for 1-aminocyclopropane-1-carboxylate (ACC), the immediate precursor of ethylene in higher plants, by hydrolyzing it into α-ketobutyrate and ammonia and in this way promote root growth by lowering indigenous ethylene levels in the micro-rhizo environment. Bacillus species also help in solubilization of mineral phosphates, potassium, zinc, and other nutrients; rhizobacteria retain more soil organic N and other nutrients in the soil–plant system, thus reducing the need for fertilizers and enhancing release of the nutrients from indigenous or mineral sources, enhancing the economic and environmental sustainability.
... La anemia por deficiencia de hierro es una de las deficiencias nutricionales más críticas en todo el mundo, especialmente en los países subdesarrollados y en vías de desarrollo, de-bido a sus efectos negativos sobre la salud humana. Debido a ello, una de las estrategias para prevenir y tratar la deficiencia de hierro es la fortificación de alimentos que representa un bajo costo, como alternativa de amplio alcance, además que supone una fácil incorporación a los hábitos alimentarios de la población (Boccio e Iyengar, 2003). Estudios en humanos mostraron que la leche de consumo adicionada con hierro ayuda regularmente a reducir los problemas asociados con la deficiencia de hierro (Silva, Dias, Ferreira, Franceschinib y Costa, 2008). ...
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RESUMEN Durante la última década, el enfoque de los consumidores de alimentos saludables ha cambia-do drásticamente, ya que anteriormente se desconocían los beneficios que otorgan algunos ingredientes; por ejemplo, el empleo de bacterias probióticas adicionadas a los alimentos, causaba desconfianza en los consumidores por falta de información. Por otro lado, el aumento de enfermedades y las deficiencias nutricionales ha obligado a la gente a encontrar medios preventivos y eficientes, como el consumo de productos lácteos fortificados para proteger su salud. Este hecho ha dado lugar a un aumento en el interés de los consumidores sobre los alimentos con un valor agregado. Debido a esto los productos lácteos ocupan un espacio sig-nificativo y creciente del mercado de los alimentos funcionales y fortificados. En esta revisión se presenta una visión general del desarrollo de alimentos de origen lácteo tanto funcionales como fortificados y enriquecidos que representan un beneficio para la salud del consumidor. ABSTRACT During the last decade, the focus of health food consumers has changed dramatically since the benefits previously granted of some ingredients were unknown; for example, the use of probiotic bacteria added to food, caused distrust from the consumers by lack of information. On the other hand, increased diseases and nutritional deficiencies have forced people to find preventive and efficient ways, as the consumption of fortified dairy products to protect their health. This has led to an increase in consumer interest on foods with added value. Dairy products occupy a significant and growing market space as functional and fortified foods. An overview of the development of functional, fortified and enriched dairy foods is presented in this review, as well as the benefit for consumers health.
... According to WHO, globally 1.6 billion people are in serious risk of iodine deficiency as some regions are identified under low soil native iodine category (Bruno et al. 2008;Hetzel et al. 2004). Worldwide, deficiency of iron in human increases the risk of disability as well as death (Boccio and Iyengar 2003). The World Health Organization estimated that out of 3.7 billion iron-deficient individuals, 2 billion people are severely affected and considered as anaemic (Yang et al. 2007). ...
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A large share of global population is affected by mineral and vitamin deficiency, particularly in the developing countries. Recent estimates exposed the problem will be more disappointing in the near future. Biofortification is emerging as a potential crop-based approach to deal with the mineral malnutrition problem by enriching the density of bio-available micronutrients and vitamins in food products. In recent years, significant advancement has been made in the fundamental understanding of micronutrient acquisition and translocation in soil-plant system. However , the current knowledge base in this area needs significant advancement to accelerate the pace of biofortification programme. Apart from the conventional breeding techniques, possible transgenic and agronomic approaches have also been identified for increasing the zinc, iron, sele-nium and iodine concentrations in the edible parts of food crops. Although these approaches are useful to address the mineral malnutrition problems worldwide, the effectiveness of the biofortification programme essentially relies on the farmers' and consumers' acceptance and future policy interventions. Therefore, strategic research and appropriate policy can lead to biofortification's grand success in the near future. In this chapter, we discussed the current knowledge and future prospects of crop biofortification.
... Elemental dietary deficiencies affect approximately 3 billion people, where multiple deficiencies are possible in the same person or popu- lation (Welch and Graham 2004). Approximately one-third of the world's population suffers from iron deficiency or anemia ( Boccio and Iyengar 2003). Zinc deficiency affects a similar number of people as iron deficiency, although without an inexpensive and effective clinical assay this problem is perhaps harder to track (Welch and Graham 2004). ...
Article
Dietary deficiencies affect nearly half of the people on the planet, who simply do not receive sufficient nutrition from the food they buy or grow. Inadequate calcium, iron, and zinc consumption create short and long term health problems, which in turn can magnify and stagnate national development. Dietary diversity, use of industrially fortified foods, and medical interventions are all effective solutions to this suite of related problems. However, each of these solutions requires infrastructure, economic support, and either education or access to markets, and thus are more suitable for the urban than rural poor. Biofortification, or the nutritional enhancement of staple and specialty crops, represents a low cost, sustainable, and potentially effective solution to addressing dietary deficiency and malnutrition in the rural poor. Recent progress on calcium, iron, and zinc biofortification using quantitative genetics, mutational genetics, and genetic engineering technologies will be discussed. © 2014 Springer Science+Business Media Dordrecht. All rights are reserved.
... White and Broadley (2009) reported that over three billion people suffered from micronutrient malnutrition worldwide. Zinc and Iron deficiencies cause severe health problems including losses in the immune system, growth, mental and cognitive development and increased incidence of anemia, mortality and morbidity (Black, 2003;Boccio and Iyenger, 2003;Holtz and Brown, 2004;Sanchez and Swaminathan, 2005;Cakmak, 2008). Micronutrients deficiency is linked to reduced work efficiency and decreased in gross national product in developing countries (Bouis, 2003). ...
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The population of world is accelerating fast with increased number of malnourished people having deficiency of micronutrients, particularly in developing countries. Mineral malnutrition is considered to be the most serious among the global challenges for humans. Biofortification of wheat grain through genetics is a powerful methodology for altering the balance of nutrients in the human food on a large scale. In this study, concentration of mineral nutrients, protein and grain yield were studied to find out potential source of minerals in historical and present spring wheat varieties of Pakistan with the objective to strengthen the hybridization programme and to develop high nutritive wheat. Fifty eight genotypes were sown according to randomized complete block design with three replications. Total nitrogen in wheat grain samples was determined by the Kjeldahl method and grain nitrogen value in percentage was multiplied by 6.25 to get grain protein concentration. Potassium was measured with the help of Jenway Flame Photometer and phosphorus was determined colorimetrically using spectrophotometer. Zn2+, Fe2+, Cu2+ and Mn2+ were determined using an atomic absorption spectrophotometer. A wide range of diversity was observed among the studied varieties for grain yield, protein and seven mineral in wheat grain. The grain yield was increased and nitrogen concentration in the endosperm diluted over time of green revolution. While mineral concentration of Zn2+, Fe2+, Cu2+, NO3- and protein was significantly low in present local varieties as compared to the mean of pre-green revolution local varieties. Fe2+ concentration was significantly increased in present local varieties than the local varieties of green revolution period. The mean of grain yield, Zn2+, Mn2+ and H2 PO4- concentration of present International Maize and Wheat Improvement Center (CIMMYT) varieties (GA-2002, Seher-2006, Chakwal-50 and FSD-2008) were significantly increased (33.8%, 22.8%, 60% and 30.8 %, respectively) than CIMMYT varieties of green revolution era (Mexipak-65, Blue Silver, Arz, Sandal, Lyallpur-73, Pari-73, Pothowar-73, Noori, Pavon, WL-711 and Bahawalpur-79). The present (local&CIMMYT) varieties have a significant edge for yield, Zn2+, Fe2+, Mn2+, H2 PO4- and K+ over varieties of all other groups. Grain yield had positive and significant phenotypic correlation with Mn2+, H2 PO4- and K+ (0.247, 0.364 and 0.140, respectively). Nitrogen had negative genotypic/ phenotypic correlations with the minerals (Zn2+, Fe2+, Mn2+, H2 PO4- and K+) and the yield. Therefore, variation of mineral concentration and grain yield present in studied genotypes can be utilized to develop high yielding wheat varieties without affecting the nutritional quality of grain.
... According to the World Health Organization (2002), zinc and iron deficiencies are the top-ranked health risk factors in developing countries [2]. It is estimated that about 30% and 60% of the world's population suffers from diseases that are caused by zinc deficiency and iron deficiency, respectively [3][4][5]. Biofortification is the improvement of the concentration of essential minerals and vitamins in major staple crops through conventional plant breeding and modern biotechnology. This, combined with increasing the daily intake of such crops, has proven to be the most economical and sustainable approach for relieving micronutrient deficiency in the last decade worldwide [6][7][8]. ...
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Background Grain zinc and iron concentration is a complex trait that is controlled by quantitative trait loci (QTL) and is important for maintaining body health. Despite the substantial effort that has been put into identifying QTL for grain zinc and iron concentration, the integration of independent QTL is useful for understanding the genetic foundation of traits. The number of QTL for grain zinc and iron concentration is relatively low in a single species. Therefore, combined analysis of different genomes may help overcome this challenge. Results As a continuation of our work on maize, meta-analysis of QTL for grain zinc and iron concentration in rice was performed to identify meta-QTL (MQTL). Based on MQTL in rice and maize, comparative mapping combined with homology-based cloning was performed to identify candidate genes for grain zinc and iron concentration in maize. In total, 22 MQTL in rice, 4 syntenic MQTL-related regions, and 3 MQTL-containing candidate genes in maize (ortho-mMQTL) were detected. Two maize orthologs of rice, GRMZM2G366919 and GRMZM2G178190, were characterized as natural resistance-associated macrophage protein (NRAMP) genes and considered to be candidate genes. Phylogenetic analysis of NRAMP genes among maize, rice, and Arabidopsis thaliana further demonstrated that they are likely responsible for the natural variation of maize grain zinc and iron concentration. Conclusions Syntenic MQTL-related regions and ortho-mMQTL are prime areas for future investigation as well as for marker-assisted selection breeding programs. Furthermore, the combined method using the rice genome that was used in this study can shed light on other species and help direct future quantitative trait research. In conclusion, these results help elucidate the molecular mechanism that underlies grain zinc and iron concentration in maize.
... Thus, if the natural iron depots are depleted, iron absorption will increase, and if the depots are saturated, iron absorption will decrease. There are different physiological states (e.g., growth and pregnancy) that produce a substantial increase in the absorption of this metal because of an increase in the synthesis of new biomolecules that have iron in their structure (19)(20)(21)(22)(23). ...
Article
Abstract: In this work dissolution profiles of furosemide tablets of nine commercial products marketed in Argentine were evaluated. All brands fulfill the specifications of dissolution test of USP. Comparison of dissolution profiles were carried out by model-dependent and model independent approaches. Results obtained via model-dependent approach show a first order drug release mechanism especially for Brand I (reference) and Brand IV. Results obtained via modelindependent approach show that there was not significant difference in Dissolution efficiency between the reference product and Brands II, III and IV and in Mean dissolution time between the reference product and Brands II, III, IV and V. Using fit factors, only Brands I and III were similar.
... Elemental dietary deficiencies affect approximately three billion people, where multiple deficiencies are possible in the same person or population (Welch and Graham, 2004). Approximately one-third of the world's population suffers from Fe deficiency or anemia (Boccio and Iyengar, 2003). Zinc deficiency affects a similar number of people as Fe deficiency, although without an inexpensive and effective clinical assay this problem is harder to track (Welch and Graham, 2004). ...
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Dietary mineral deficiencies affect nearly half of the people on our planet, largely due to poverty. Enhancing nutritional quality-or biofortification-represents an efficient and sustainable potential solution to this massive public health problem. To create biofortified crops, one must understand the genetic and environmental factors that influence the ionome, or collection of mineral nutrients, in the target organism and tissue. We describe the use of quantitative trait loci (QTL) mapping to characterize the maize (Zea mays L.) grain ionome illustrated by the intermated B73 x Mo17 (IBM) recombinant inbred population. Ionomic profiling was applied to field grown materials from Florida, North Carolina, and New York. Twenty-seven QTL were detected for 10 traits derived from the North Carolina and New York grown maize explaining between 4 and 46% of the variance observed. For biofortification to succeed, QTL effective in multiple environments need to be the targets for improvement efforts. Florida grown maize were sampled shallowly to provide a low cost dataset to evaluate the models based on the combined North Carolina and New York traits. Twenty-five QTL were detected as significant in two or more locations using ANOVA on the original single location and/or site data; 12 QTL were found to be significant in Florida. While this strategy may have not detected every potential QTL from our data, we suggest these QTL effective in multiple environments represent a starting position for the biofortification of maize grain.
... The intake of foods that can enhance iron absorption such as fruits and vegetables containing vitamin C or meat is often limited in these countries (Hurrell 1997;Hurrell 2002;Zimmermann, Chaouki et al. 2005). Of the 2.15 billion individuals affected by anemia, it is believed that approximately 85% suffer from an inadequate dietary intake of iron or low iron dietary bioavailability (Boccio and Iyengar 2003). ...
... Thus, if the natural iron depots are depleted, iron absorption will increase, and if the depots are saturated, iron absorption will decrease. There are different physiological states (e.g., growth and pregnancy) that produce a substantial increase in the absorption of this metal because of an increase in the synthesis of new biomolecules that have iron in their structure (19)(20)(21)(22)(23). ...
Article
The aim of the present study was to evaluate and compare the dissolution profile of seven commercial tablets containing Ferrous sulfate and fumarate marketed in Argentina. Accordingly the second objective of this study was to assess the interchangeability of the available iron products on the basis of their in vitro dissolution characteristics using USP Apparatus 2.
... It also affects performance in school-age children, which when carried into adulthood, leads to generalized fatigue and reduced work capacity. 7,8 Several strategies have been implemented to prevent and control micronutrient deficiencies; however, the problem still persists. 9 Mass fortification has been the most efficient, cost-effective strategy to reduce micronutrient deficiency in industrialized countries. ...
Article
Background Micronutrient deficiencies continue to afflict children rural populations around the world. A Micronutrient Delivery Vehicle (MDV) was developed as a point-of-use technology for fortification of meals for school age children beneficiaries of the Healthy Schools Program (HSP) in Honduras. RESULTS: MDV combines micronutrient powder through traditional dough making process, using staple flours (wheat and nixtamalized corn), oil and water as ingredients. After mixing ingredients and kneading, dough is extruded through a specially designed hand press into noodles. After drying (overnight; 23°C), noodles are broken into small pieces, mixed (1:100 w/w) with rice and cooked as customary. Dispersion studies with NaFeEDTA showed adequate distribution (<10% RSD) and recovery (>90%) in white rice. Color changes in MDV due to addition of vitamin A and iron (NaFeEDTA) carried forward into cooked rice. In Honduras, children from two rural schools (N=47, 6–12 y) were not able to differentiate (triangle test) between control and unfortified MDV mixed (1:100 w/w) with white rice. Children from four schools (N=83, 7–12 y) accepted control and iron fortified rice (3 mg Fe per serving) based on color and flavor similarly.Conclusion This is a feasible point-of-use fortification technology for improvement of meals provided by the HSP in Honduras.
... Iron deficiency is the third greatest global health risk after obesity and unsafe sex [1]. Anemia resulting from iron deficiency affects approximately 2 billion people or 34% of the world population [2]. Iron deficiency anemia most severe stage of iron deficiency (defined as a low hemoglobin concentration with iron deficiency) was found in 3% of the adolescent females in the United State of America [3]. ...
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Iron deficiency anemia is most common nutritional deficiency disorder in India and remains a formidable health challenge. Girls in the period of later school age and early adolescence are prone to develop iron deficiency. Iron deficiency leads to many non-hematological disturbances which include growth and development, depressed immune function in infants; reduces physical work capacity; decreases the cognitive function in both infants and adolescents. Present study was done to know the prevalence of iron deficiency in both the anemic and non anemic school going adolescent girls, to assess the effect of iron deficiency on cognitive functions in anemic iron deficient and non-anemic iron deficient school girls in a village school situated in central India. Methods. A secondary school having girl students in the age group of 12-15 years studying in sixth to ninth standard was selected. Serum ferritin concentration was estimated by ELISA. For assessing the cognitive function mathematics score, one multi-component test for memory, attention and verbal learning and Intelligent Quotient scores of the students were used. Results. Scholastic Performance, IQ and Scores of Mental balance, Attention & Concentration, Verbal Memory and Recognition were decreased in iron deficient girls, both anemic and non anemic as compared to the non iron deficient girls.
... Iron (Fe) deficiency is a worldwide problem that is directly correlated with poverty and food insecurity. Approximately, one-third of the world's population suffer from Fe deficiency-induced anaemia, 80% of which are in developing countries (Boccio and Iyengar, 2003). The consequences of Fe deficiency include increased mortality and morbidity rates, diminished cognitive abilities of children and reduced labour productivity that in turn stagnates national development (Caballero, 2002). ...
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Mineral nutrient deficiencies are a worldwide problem that is directly correlated with poverty and food insecurity. The most common of these is iron deficiency; more than one-third of the world's population suffer from iron deficiency-induced anaemia, 80% of which are in developing countries. The consequences of iron deficiency include increased mortality and morbidity rates, diminished cognitive abilities in children and reduced labour productivity, which in turn stagnates national development. The developed world has made tremendous success in alleviating nutrient deficiencies through dietary diversification, food product fortification, improved public health care and supplementation. In developing countries, these strategies are often expensive and difficult to sustain, especially in rural areas. The rural poor typically consume what they grow and are dependent upon a small number of staple crops for the vast majority of their nutrition. Therefore, genetic improvement of staple crops (biofortification) is the most cost-effective and sustainable solution to this global health problem. In this study, we describe a strategy to enhance iron nutritional quality in maize using a human cell culture (Caco-2)-based bioassay as a phenotyping tool to guide genetic analysis of the trait. We also report validation of this approach using an animal feeding study.
... Fe is also an important micronutrient required by all organisms and plays an essential role in several metabolic pathways including photosynthesis, respiration, chlorophyll synthesis and other fundamental redox reactions (Briat et al. 1995, Briat andLobréaux 1997). Fe deficiency-induced anemia has been reported to affect approximately 1/3 of world population, especially children and women (Boccio and Iyengar 2003, FAO 2006, Stein 2010. ...
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Micronutrient malnutrition, especially zinc (Zn) and iron (Fe) deficiency in diets, has aroused worldwide attention. Biofortification of food crops has been considered as a promising approach for alleviating this deficiency. Quantitative trait locus (QTL) analysis was performed to dissect the genetic mechanism of Zn and Fe content in maize grains using a total of 218 F2:3 families derived from a cross between inbred lines 178 and P53. Meta-analysis was used to integrate genetic maps and detect Meta-QTL (MQTL) across several independent QTL researches for traits related to Zn or Fe content. Five significant QTLs and 10 MQTLs were detected. Two informative genomic regions, bins 2.07 and 2.08, showed a great importance for Zn and Fe content QTLs. The correlation between Zn and Fe level in maize grains was proposed by MQTLs as 8 of the 10 involved both traits. The results of this study suggest that QTL mapping and meta-analysis is an effective approach to understand the genetic basis of Zn and Fe accumulation in maize grains.
... Iron deficiency is still an unsolved nutritional problem all over the world. It affects developing as well as industrialized countries [1], producing physical and psychological diseases, reducing productivity, and affecting the health budget [2]. In industrialized countries, iron deficiency is associated with low intake of absorbable iron, while in developing countries, it may respond to a poor availability of the dietary iron because of the presence of iron absorption inhibitors in the diet. ...
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The purpose of the present work is to evaluate the iron bioavailability of stabilized iron (II) sulphate in industrialized fortified infant dessert. The prophylactic–preventive test in rats, using ferrous sulphate as the reference standard, was applied as the evaluating methodology. Thirty female Sprague–Dawley rats weaned, were randomized into three different groups (group 1: FeSO 4 + IDF; group 2: FeSO 4 stabilized + IDF and group 3: control). The iron bioavailability (BioFe) of each compound was calculated using the formula proposed by Dutra-de-Oliveira et al where BioFe = (HbFef-HbFei) / ToFeIn. Finally the iron bioavailability results of each iron source were also given as relative biological value (RBV) using ferrous sulfate as the reference standard. The results showed that both BioFe and RBV % were not different among the groups assayed (FeSO 4 + D 0.38±0.01 and 100%; FeSO 4 stabilized + D 0.39±0.02 and 102%).
Article
Potato fries, a relatively an untapped food matrix for fortification, was fortified with iron using vacuum impregnation technique and impact of this fortification on quality attributes (structure, color, texture, flavor, acrylamide, sensory characteristics) of the product was assessed. Further, to reduce the dietary restraints of consumers for fried fries, fat reduction was achieved using vacuum frying. Ferrous ammonium sulphate hexahydrate was used as a fortificant to yield 3.15 mg iron from 30 g fries (RACC for snacks- Recommended Amount Customarily Consumed). Effect of iron fortificant level, blanching, vacuum and restoration time (independent variable) were evaluated on responses (iron impregnation level and firmness) of fries using box-behnken design of response surface methodology. Results showed that blanching time was the most significant variable affecting iron impregnation followed by iron concentration and vacuum time. Ferrous ammonium sulphate hexahydrate was found to be the most appropriate fortificant since reflecting the least colour and sensory changes in fries. A fortified raw potato fries when fried under vacuum, provided better retention of colour and reduced fat absorption (by 17.72%) with comparable crispiness (0.37 kg/sec vs 0.35 kg/sec), firmness (0.39 kg/sec vs 0.38 kg/sec), color (ΔE = 1.39) and sensory score (7.9 vs 8.1 on 9-point scale) with control fries.
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Common bean (Phaseolus vulgaris L.) has two major origins of domestication, Andean and Mesoamerican, which contribute to the high diversity of growth type, pod and seed characteristics. The climbing growth habit is associated with increased days to flowering (DF), seed iron concentration (SdFe), nitrogen fixation, and yield. However, breeding efforts in climbing beans have been limited and independent from bush type beans. To advance climbing bean breeding, we carried out genome-wide association studies and genomic predictions using 1,869 common bean lines belonging to five breeding panels representing both gene pools and all growth types. The phenotypic data were collected from 17 field trials and were complemented with 16 previously published trials. Overall, 38 significant marker-trait associations were identified for growth habit, 14 for DF, 13 for 100 seed weight, three for SdFe, and one for yield. Except for DF, the results suggest a common genetic basis for traits across all panels and growth types. Seven QTL associated with growth habits were confirmed from earlier studies and four plausible candidate genes for SdFe and 100 seed weight were newly identified. Furthermore, the genomic prediction accuracy for SdFe and yield in climbing beans improved up to 8.8% when bush-type bean lines were included in the training population. In conclusion, a large population from different gene pools and growth types across multiple breeding panels increased the power of genomic analyses and provides a solid and diverse germplasm base for genetic improvement of common bean.
Chapter
Heavy menstrual bleeding is a very common complaint among adolescents with prevalence rates as high as 37% in this population. Although mortality rates are very low in developed countries where blood products and medications are readily available to manage severe cases, there is significant morbidity, healthcare utilization, and decreased health-related quality of life among adolescents that present with heavy menstrual bleeding. This chapter explores the most common complications of heavy menstrual bleeding including anemia, complications of medical and surgical treatments, as well as the psychosocial and financial impacts of heavy menstrual bleeding.
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Biofortification is an economical and sustainable process of delivering essential micronutrients through staple crops. The biofortified crops developed by HarvestPlus through conventional breeding continue to reach the target populations of Asia and Africa in order to reduce the burden of iron, zinc and vitamin A deficiency. Pearl millet, a dryland crop of the arid and semi-arid tropics is a suitable crop for iron biofortification as it harbours sufficient genetic variability for grain iron (Fe) and zinc (Zn) in the existing germplasm. Zn is highly correlated with grain Fe and therefore enhanced as an associated trait during the breeding for high-iron pearl millet. ICTP 8203 Fe-10-2, an iron-biofortified pearl millet (Fe-PM) variety developed via intra-population improvement of iniadi germplasm, was commercially released for cultivation in Maharashtra, India, by 2014. Efficacy trials undertaken in women and children feeding on Fe-PM meals revealed an enhancement in their micronutrient status as well as their functional outcomes. Disbursement of Fe-PM through public–private seed markets worked out to be cost-effective. Farmers readily adopted Fe-PM for cultivation based on its superior agronomic performance rather than the preference for consumer attributes. On the other hand, consumers expressed their willingness to pay for Fe-PM over regular pearl millet because of its favourable sensory characteristics. Therefore, investment on high-Fe hybrids would bridge the gap between the farmers and consumers acceptance of biofortified millets. Iron biofortification is also limited by the presence of antinutrients like phytates and polyphenols as they hinder the Fe bioavailability. The development of biofortified crops with reduced antinutrients needs careful evaluation as they have a significant role in protection against diseases and seedling growth. This review paper deliberately describes the success of high-Fe pearl millet in India and the lessons to be learnt for expanding the biofortification efforts to other small millets.
Article
Poly(sodium-p-styrenesulfonate)-enhanced and D-penicillamine stabilized Ag nanoclusters (PSS-DPA-AgNCs) were prepared using one-step ultraviolet irradiation combined with microwave heating method, and the effects of the AgNCs photo-luminescence performance based on different types of polyelectrolytes and energy suppliers were studied detailedly. The as-prepared AgNCs can be used as a viable fluorescent probe for monitoring indirectly iron(II) lactate hydrate (ILH) and ammonium ferric citrate (AFC), respectively. The fluorescence (FL) quenching of PSS-DPA-AgNCs by Fe3+ (it is obtained from oxidized ILH/ionized AFC) mainly derives from a dynamic quenching process. Excellent linear relationships exist between the FL quenching degree of the AgNCs and the concentrations of ILH/AFC in the range of 0.17-6.00/0.067-3.33 μmol·L-1, and corresponding limit of detection (at 3σ/slope) is 12.4/6.04 nmol·L-1. Moreover, the AgNCs probe was extended to the assays of ILH in tablets, solid beverage or ILH additive and AFC in two kinds of edible salts or syrup with satisfactory results compared with the standard 1, 10-phenanthroline method. In addition, the AgNCs probe reveals a good temperature sensing capability.
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Iron is a fundamental metal ion for living organisms as it facilitates various biological processes. The ferric uptake regulator (Fur) protein controls iron homeostasis in various bacterial species. It is believed that Fur’s iron-dependent regulatory action is sufficient for it to function as an iron sensor. However, we now establish that the bacterial pathogen Salmonella enables Fur to properly reflect changes in surrounding iron availability by fine-tuning its responsiveness to iron. This process requires a protein that hampers Fur DNA binding at low iron concentrations. In this way, Salmonella broadens the range of iron concentrations that Fur responds to. Our findings reveal a potentially widespread control mechanism of bacterial iron homeostasis.
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Nanotechnology applications in food-related fields have dramatically increased over the past few years. From nanoscale food components designed to exhibit unique functionalities to self assembled nanostructures capable of delivering flavors, drugs, or specific nutrients to the site of action, nanotechnology represents a new approach for developing added-value food products according to current consumer trends. As diseases related to nutritional deficiencies have escalated globally forcing health-conscious consumers to find efficient ways to prevent them, nanotechnology may provide a new array of tools for creating fortified or enriched products with improved digestibility and higher quality from the nutritional, sensory and functional standpoints. Arguably, dairy foods constitute the most important food category in terms of nutritional claims and occupy a significant and growing market space among functional and fortified foods. In this chapter, both the use of nanomaterials in milk by-products (cheese, yogurt, among others) and the application of emergent technologies, which may be scaled for industrial production, in dairy matrices for creating nanostructures are reviewed and discussed, stressing their potential benefits while addressing the concerns of consumers about the lack of information regarding long term use.
Chapter
Micronutrients are essential minerals and vitamins required by humans in tiny amounts which play a vital role in human health and development. Over three billion people in the world are malnourished, particularly in the developing countries. Current food systems cannot provide sufficiently balanced micronutrients required to meet daily needs and to sustain the wellbeing of people in developing countries. Heavy and monotonous consumption of cereal-based foods which contain limited amounts of micronutrients is one of the major reasons for the significantly high prevalence of micronutrient deficiencies in many of the developing countries. The development of crops with enhanced micronutrient concentration is one of the most sustainable and cost-effective approaches to alleviate micronutrient malnutrition globally. In this chapter we focus on the research to improve mineral element concentration in crops through plant breeding strategies, especially in major cereal crops and a legume which are most widely cultivated and preferred in Africa and Asia. Biofortification is an appropriate strategy to increase the bioavailable concentrations of an element in edible portions of crop plants through traditional breeding practices or modern biotechnology to overcome the problem of micronutrient deficiencies. Therefore, conventional breeding with modern genetic engineering approaches are important for developing crop cultivars with enhanced micronutrient concentrations to improve human health. This chapter reports on biofortification research on rice, pearl millet, sorghum, maize, wheat and common bean.
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This study aimed to perform a systematic literature review about food fortifi cation and the main challenges in achieving success in fortifi cation programs. This article has discussed the recommended levels of the main micronutrients used as agents of fortifi cation and reviewed aspects related to the addition of iron, zinc, vitamin A and folic acid to foods. New technologies in controlling micronutrients defi ciencies and the use of rice as a vehicle for fortifi cation were also approached, summarizing the major studies conducted about this subject. It was concluded that the correct choice of the fortifying micronutrients, the establishment of fortifi cation levels and the selection of suitable vehicle are some of the key issues for achieving success on food fortifi cation programs.
Article
Micronutrients like vitamins and minerals are an important element of food safety, however are often not available in sufficient amounts in the diet. Fortification of food is not always possible or appropriate. Biofortification is a method which improves the content of vitamins and minerals directly in the crop plant. Breeding for accumulation of micronutrients is often difficult. Recent developments added gene technology as a supplementary technique to breeding. in combination with functional genomics gene technology could contribute in the future significantly to these traits. We review recent developments of biofortification with vitamin A, vitamin E and folate, and with the minerals iron, zinc and selenium.
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Este trabalho teve como objetivo realizar uma revisão sistemática da literatura a respeito da fortificação de alimentos e os principais desafios na obtenção de sucesso em programas de fortificação. Foram abordados os níveis recomendados dos principais micronutrientes utilizados como agentes de fortificação e revisados os aspectos relacionados à adição de ferro, zinco, vitamina A e ácido fólico aos alimentos. Também foram abordadas as novas tecnologias para o controle das deficiências de micronutrientes e a utilização do arroz como veículo de fortificação, sumarizando-se os principais estudos desenvolvidos sobre o tema. Concluiu-se que a escolha correta dos micronutrientes fortificantes, o estabelecimento dos níveis de fortificação e a seleção do veículo adequado são algumas das questões fundamentais para a obtenção de sucesso nos programas de fortificação.
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The objective of this study is to examine the factors that influence the occurrence of childhood anaemia in North-East India by exploring dataset of the Reproductive and Child Health-II Survey (RCH-II). The study population consisted of 10,137 children in the age-group of 0-6 year(s) from North-East India to explore the predictors of childhood anaemia by means of different background characteristics, such as place of residence, religion, household standard of living, literacy of mother, total children ever born to a mother, age of mother at marriage. Prevalence of anaemia among children was taken as a polytomous variable. The predicted probabilities of anaemia were established via multinomial logistic regression model. These probabilities provided the degree of assessment of the contribution of predictors in the prevalence of childhood anaemia. The mean haemoglobin concentration in children aged 0-6 year(s) was found to be 11.85 g/dL, with a standard deviation of 5.61 g/dL. The multiple logistic regression analysis showed that rural children were at greater risk of severe (OR = 2.035; p = 0.003) and moderate (OR = 1.23; p = 0.003) anaemia. All types of anaemia (severe, moderate, and mild) were more prevalent among Hindu children (OR = 2.971; p = 0.000), (OR = 1.195; p = 0.010), and (OR = 1.201; p = 0.011) than among children of other religions whereas moderate (OR = 1.406; p = 0.001) and mild (OR = 1.857; p=0.000) anaemia were more prevalent among Muslim children. The fecundity of the mother was found to have significant effect on anaemia. Women with multiple children were prone to greater risk of anaemia. The multiple logistic regression analysis also confirmed that children of literate mothers were comparatively at lesser risk of severe anaemia. Mother's age at marriage had a significant effect on anaemia of their children as well.
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To provide nationally representative data on the prevalence of anaemia, vitamin A and Fe deficiencies among pre-school age children (pre-SAC) and non-pregnant women of reproductive age (WRA), and on vitamin B12 and folate deficiencies in WRA, and the influence of inflammation on their interpretation. A cross-sectional survey to measure anthropometry, malaria parasitaemia and micronutrient status. Specifically, blood samples were analysed for Hb, plasma ferritin, soluble transferrin receptors, C-reactive protein, α1-acid glycoprotein, retinol-binding protein, vitamin B12 and folate. Côte d'Ivoire in 2007. Nine hundred and twenty-eight WRA and 879 pre-SAC. In WRA, prevalence of Plasmodium parasitaemia (5 %) was low, but inflammation (34 %) was higher. Anaemia was a severe public health problem and prevalence differed by residency and eco-region. Inflammation-adjusted Fe deficiency was highest in urban areas (20 %). Nationally, folate deficiency was 86 %, higher in urban areas and varied by eco-region. Prevalence of vitamin B12 deficiency was low but higher in the rural areas and the north. Inflammation-adjusted vitamin A deficiency was very low (1 %). In pre-SAC, prevalence of inflammation (67 %) and Plasmodium parasites (25 %) was high; the latter was associated with poverty, rural residency and higher ferritin concentrations. Anaemia was classified as a severe public health problem (72 %), and was higher in rural areas (76 %) and the north (87 %). A quarter of pre-SAC suffered from vitamin A deficiency (inflammation-adjusted) and prevalence of undernutrition was high. Prevalence of inflammation, Plasmodium parasitaemia and micronutrient deficiencies were high in Côte d'Ivoire, particularly in pre-SAC. Nutritional interventions should be accompanied by strategies to reduce exposure to infections.
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Conference Paper
Global food system is failing to deliver adequate quantities of healthy, nutritionally balanced food, especially to the resource‐poor underprivileged people leading to micronutrient malnutrition. The malnutrition of minerals (Fe, Zn) and vitamin A are major food‐related primary health problem among populations of the developing world including India where there is a heavy dependence on cereal‐based diets and limited access to meat, fruits and vegetables. Vitamin A deficiency (VAD) alone is significant from the public health point of view resulting in over 330,000 child deaths every year, and about 57% of preschoolers and their mothers having subclinical VAD leading to increased morbidity and risk of mortality. While therapeutic supplementation of vitamin A is currently being addressed through sponsored nutrition programmes, they are not sufficient in covering the affected populations. Biofortification of important crop plants through biotechnological applications is a cost‐effective and sustainable solution for alleviating VAD. Genetic engineering is the obvious alternative to enhance the β‐carotene levels in crop plants. The development of the ‘golden rice’ proved that, it is possible to redirect a complete biosynthetic pathway of carotenoids by genetic engineering of multiple genes encoding key enzymes of the pathway. Recently, there have been several reports on the development of transgenic crops for enhanced levels provitamin A content in crops like maize, tomato, cassava, potato and mustered. At ICRISAT, transgenic events of groundnut and pigeonpea carrying either a single maize phytoene synthase 1 (psy1) gene or both psy1 and tomato β‐lycopene cyclase (β‐lyc) have been developed through Agrobacterium‐mediated genetic transformation. Preliminary results showed a significant increase in the total carotenoids and β‐carotene levels in the transgenic events. Provitamin A enrichment of these crops could have a significant impact on the nourishment and nutrient interactions by playing a major role in the bioavailability and metabolic efficiency in the affected populations.
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The effect of Fe fortification on the absorption of Zn was studied by radioisotopic labelling of single meals, followed by measurements of whole-body retention of 65Zn at 14 d after intake. Healthy adult volunteers participated in the study. Weaning cereal, wheat bread and infant formula, foods that are all frequently Fe-fortified, were evaluated in the study. The amounts of Fe added as FeSO4 were similar to the levels in commercial products in Europe and the USA, and were 200 or 500 mg Fe/kg (weaning cereal), 65 mg Fe/kg (white wheat flour) and 12 mg Fe/l (infant formula). For comparison, Zn absorption was measured in the same subjects, from identical test meals containing no added Fe. No statistically significant differences were found when Zn absorption from the Fe-fortified test meals was compared with that from non-Fe-fortified test meals. Fractional Zn-absorption values from Fe-fortified v. non-fortified meals were 31.1 (SD 11.9) v. 30.7 (SD 7.0)% (weaning cereal; 200 mg Fe/kg), 37.7 (SD 16.6) v. 30.2 (SD 9.9)% (weaning cereal; 500 mg Fe/kg), 36.5 (SD 14.4) v. 38.2 (SD 18.1)% (bread; 65 mg Fe/kg flour) and 41.6 (SD 8.1) v. 38.9 (SD 14.5)% (infant formula; 12 mg Fe/l). The addition of Fe to foods at the currently used fortification levels was thus not associated with impaired absorption of Zn and the consumption of these Fe-fortified foods would not be expected to have a negative effect on Zn nutrition.
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The data on the relationship between iron deficiency and infection are conflicting. Some researchers conclude that mild iron deficiency is beneficial for immunity, whereas others contend that any deficit is not good for immunity. Additionally, infection or inflammation generate anemia and profound changes in iron metabolism mediated by cytokines. These changes are important confounders to consider in assessments of iron status.
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The bioavailability of iron glycine added to a vegetable infant weaning food was compared with ferrous sulfate. Stable, isotopically labeled compounds (57Fe or 58Fe) were mixed into the midday meal (1.4 mg added Fe/serving) and fed to 9-mo-old infants on alternate days for 8 d. Bioavailability, expressed as a percentage of the dose consumed, was measured from isotopic enrichment of hemoglobin 14 d after the last test meal. There was no difference between iron glycine and ferrous sulfate (x+/-SEM): 9.0+/-0.7% and 9.9+/-0.8%, respectively. The effect of chelation was examined by measuring iron bioavailability of iron glycine and ferrous sulfate added to a high-phytate (310 mg/100 g) whole-grain cereal weaning food and comparing it with a lower-phytate (147 mg/100 g) vegetable food, as used in the first study. Both iron compounds had lower bioavailability from the high-phytate food, 5.2+/-0.5% for iron glycine and 3.8+/-0.9% for ferrous sulfate, than the lower-phytate food, 9.8+/-1.5% for iron glycine and 9.1+/-1.3% for ferrous sulfate. The results showed no significant difference in bioavailability between the two forms of iron when added to infant weaning foods, suggesting that the glycine complex was fully or partially dissociated in the gastrointestinal tract. It is concluded that chelation does not improve the bioavailability of iron in the presence of dietary inhibitors.
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Eighty iron-deficient, nonpregnant female workers were randomly assigned to ferrous sulphate (60 or 120 mg Fe/d) or placebo treatment for 12 wk. Energy expenditure was estimated during 3 d by heart rate (HR) recording. Production efficiency (PE) was calculated as the ratio of productivity to energy expenditure. In the iron-treated group mean hemoglobin (Hb) increased from 114 to 127 g/L (P < 0.001), mean serum ferritin increased from 9.7 to 30.0 micrograms/L (P < 0.001), and mean free erythrocyte protoporphyrin decreased from 1.01 to 0.49 mumol/L (P < 0.001). Mean HR at work decreased from 95.5 to 91.1 beats/min (P < 0.001), which was inversely correlated with the change in Hb (r = -0.60, P < 0.001). PE increased significantly in the iron-treated group (P < 0.001) and its change paralleled the change in Hb (r = 0.58, P < 0.001). The results show that iron supplementation enabled these women to do the same work at a lower energy cost.
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La anemia por deficiencia de hierro es uno de los problemas nutricionales de mayor magnitud en el mundo. A pesar de conocer su etiología y tener a disposición el conocimiento de cómo enfrentarla y de saber que las intervenciones son de bajo costo, aún no se ha podido superar este problema. Este documento parte de una estimación de la magnitud del problema y plantea los elementos necesarios para el diseño, la ejecución y la medición del impacto de la suplementación con hierro y la fortificación, como las intervenciones más efectivas para disminuir considerablemente la dimensión de la anemia por falta de hierro. Propone una lista de pasos a seguir previos a la elaboración de un proyecto y recomienda una serie de elementos a considerar en ello. Define, asimismo, los aspectos que se deben incluir en una propuesta de fortificación y en otra de suplementación. El documento concluye con un listado de actividades complementarias que la Organización Panamericana de la Salud/Organización Mundial de la Salud ofrece dentro de su paquete de cooperación técnica.
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Observou-se a eficácia da fortificação do leite fluido com 3 mg de ferro aminoácido quelato no combate à carência de ferro em crianças menores de quatro anos. Foram acompanhadas 269 crianças que receberam, durante 12 meses, um litro de leite fortificado por dia, e que foram avaliadas a cada 6 meses de acompanhamento. Antes de se iniciar a intervenção, a anemia estava presente em 62,3% das crianças. Após 6 meses, este percentual reduziu-se a 41,8% e, ao final de um ano, a 26,4%. As maiores reduções foram detectadas nas faixas etárias de 12 a 23 meses e em menores de um ano. Das crianças que apresentavam hemoglobinas iniciais inferiores a 9,5 g/dl, 59,3% recuperaram-se da anemia ao final de um ano de acompanhamento. Naquelas com hemoglobinas iniciais entre 9,5 e 10,9 g/dl, o percentual de recuperação da anemia foi de 66,7%. Encontrou-se, ainda, melhores evoluções hematológicas em crianças que ingeriam quantidades superiores a 750 ml/dia de leite fortificado, pertencentes a famílias que não dividiam o suplemento recebido com outros membros e naquelas com apenas uma criança com menos de 5 anos no núcleo familiar. Concluiu-se pela viabilidade e eficácia da fortificação do leite fluido como medida de intervenção no combate à carência de ferro em pré-escolares.
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Fortification of salt with iron has been suggested as a practical method of iron supplementation. In an effort to identify a suitable method for fortifying salt with iron two approaches were investigated. In one the possibility of fortifying salt with ferrous sulfate and a stabilizing agent was tried. Of the several stabilizing agents studied orthophosphoric acid was found to be the most promising one. Salt fortified with ferrous sulfate and orthophosphoric acid was found to keep well on storage without color development. Bioavailability of iron from this fortified salt, although satisfactory at the beginning, deteriorated on storage. An alternative approach in which salt was fortified with ferric orthophosphate, a stable iron compound and an absorption promoter like sodium acid sulfate was found to be more satisfactory. Salt fortified with ferric orthophosphate (3,500 ppm) and sodium acid sulfate (5,000 ppm) kept well without any color development for several months. The bioavailability of iron from this formula was comparable to that from ferrous sulfate and bioavailability did not decrease even after storage for 4-5 months. This fortified salt was also acceptable. This formula offers a practical solution to fortification of salt with iron.
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1. The feasibility of improving iron nutrition by fortifying cane sugar with Fe and ascorbic acid was studied. 2. It was found to be possible to add a number of Fe salts together with ascorbic acid to sugar without affecting its appearance or storage properties. 3. The absorption of Fe from fortified sugar eaten with maize-meal porridge or made into jam or biscuits was measured in ninety-four volunteer multiparous Indian women using the 59-Fe erythrocyte utlization method. 4. The absorption of Fe from sugar fortified with ascorbic acid and ferrous sulphate and eaten with maize-meal porridge was increased about twofold in the ratio, ascorbic acid:Fe was 10:1 by weight. If the ratio was increased to 20:2, Fe absorption was increased a further threefold. 5. Sugar fortified with soluble Fe salts, including FeSO4.7H2O, discoloured both tea and coffee; sugar fortified with ferric orthophosphate did not have this effect. 6. Fe from FePO4.H2O was poorly absorbed when added with sugar to maize-meal porridge, and also when added with adequate quantities of ascorbic acid. This form of Fe was absorbed much less well than was the intrinsic Fe present in the maize. 7. When sugar fortified with FePO4.H2O and ascorbic acid was added to maize-meal porridge before cooling or was made into jam there was a several-fold increase in the amount of Fe absorbed.
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The effect of tea on iron absorption was studied in human volunteers. Absorption from solutions of FeCl3 and FeSO4, bread, a meal of rice with potato and onion soup, and uncooked haemoglobin was inhibited whether ascorbic acid was present or not. No inhibition was noted if the haemoglobin was cooked. The effect on the absorption of non-haem iron was ascribed to the formation of insoluble iron tannate complexes. Drinking tannin-containing beverages such as tea with meals may contribute to the pathogenesis of iron deficiency if the diet consists largely of vegetable foodstuffs.
Article
Purpose: This study assesses the efficacy of an iron-fortified (15 mg Fe, as stabilized ferrous sulfate (SFE-171), per liter) fluid whole cow's milk (IFFWCM) for the treatment of mild iron deficiency in children. Previous studies in healthy adult volunteers showed a mean 10.2 +/- 4.7% iron absorption. Patients and Methods: Seventeen children (12 to 48 months old) with iron deficiency (serum iron (SI) <60 [mu]g/dl, transferrin saturation (TS) <15%, serum ferritin (SF) <15 ng/ml) were included in this study; 11 of them were anemic. As treatment, they received IFFWCM, instead of the customary whole cow's milk, for at least 4 months; medicinal iron was not administered. Hematocrit (Hct), hemoglobin (Hb), SI, TS, and SF were determined monthly. Results: The Hb increased from 10.3 +/- 0.8 to 12.7 +/- 0.6 g/dl in the group with anemia ([DELTA]F_B: 2.4 +/- 1.0 g/dl) and from 12.6 +/- 0.7 to 13.5 +/- 0.3 g/dl in the group without anemia ([DELTA]F_B: 0.9 +/- 0.5 g/dl); the difference between both groups was significant (p < 0.01); the rate for Hct values showed a similar pattern. In the whole group, the SI increased to 84.8 +/- 37.4 +/-g/dl, with no difference between children with anemia and children without anemia; TS showed a similar pattern ([DELTA]F_B: 19.0 +/- 11.0%). The mean SF increased from 12.1 +/- 2.7 ng/ml to 27.9 +/- 25.4 ng/ml. Normal values for Hct, Hb, SI, and TS were reached by 100% of children; the rate for SF was 56.3%. Time required to reach normal Hct in the children with anemia was 59.4 +/- 33.0 days. Acceptance and tolerance were excellent; no treatment had to be discontinued. The group of patients with anemia was compared with an historical group composed of 55 children matched for age, basal Hct, and achieved Hct increase, treated with medicinal FS (4-6 mg/kg/day): time required to reach normal Hct was shorter in the FS-treated group (39.0 +/- 14.5 days) (p = 0.050). Conclusion: The use of IFFWCM alone could be an effective, relatively inexpensive, and well-tolerated treatment of iron deficiency in children.
Article
Iron deficiency is a major nutritional problem in the world today. It affects hundreds of millions of people and is especially prevalent in infants, young children and women of child-bearing age. Although lack of iron remains one of the few nutritional deficiencies in affluent societies, iron deficiency anaemia is most common in poor populations where it has serious public health implications. In children, it can retard psychomotor development and mental performance. In pregnant women, it can result in premature delivery as well as foetal and maternal mortality. In addition, iron deficiency can reduce work capacity, impede body temperature regulation, impair immune response and perhaps lead to a higher incidence of infection.
Article
Iron deficiency anemia is the most prevalent nutritional deficiency in Argentina, particularly among infants under 2 years old. At this age the most efficient way to prevent it is through the daily intake of bioavailable iron in weaning foods. Fluid cow's milk is the most popular weaning food in our country. Nowadays, it is possible to fortify this kind of food with 15 mg of iron per liter by a new technological procedure in which ferrous sulfate is microencapsulated with phospholipids. Therefore we studied the absorption of this novel iron fortification compound called SFE-171TM by means of the classical double-isotopic method. This study was made in fifteen healthy adult men, none of them were anemic and all of them had normal iron stores. Iron absorption from SFE-171TM in milk was 9.2% when it was standardized to 40% absorption of the reference dose of ferrous ascorbate. We conclude that the iron from ferrous sulfate microencapsulated with phospholipids has a good bioavailability and it is an effective alternative for the fortification of fluid cow's milk without affecting its shelf life and its sensorial properties.
Article
This study investigated household income, food program participation, and diet awareness and attitudes of the household meal planner as predictors of dietary iron intake of preschoolers in the United States. Non-breastfeeding children, 1 to 5 years of age, with 3 days of dietary data from the 1989–1991 Continuing Survey of Food Intake of Individuals were included in this sample (N=800). Two measures of intake were analyzed: a nutrient adequacy ratio (NAR), defined as iron intake divided by the RDA; and an index of nutritional quality (INQ), or diet density measure, which is the ratio of iron NAR to energy NAR. Data from the concurrent Diet and Health Knowledge Survey were used to create indicator variables for meal planners who were aware of anemia as a health problem related to iron intake and who felt it was important to choose a diet with plenty of grain products. After controlling for age, gender, ethnicity, household size, region, and urbanization, multi-variate regression analyses revealed that household income and participation in the WIC food program were positively associated with both iron intake measures. Participation in the Food Stamp program was positively associated with the iron NAR, but not the INQ. Although anemia awareness was not a significant predictor of intake, children from households whose main meal planners had a positive attitude about the importance of grains, consumed more iron as measured by either index. The findings suggest that dietary iron intakes of preschoolers continue to be affected by economic factors and that food transfer and/or educational interventions may be useful in improving these intakes.
Article
The general acceptance of NaFe3+EDTA for food Fe fortification has been partly restricted by concern over the influence of EDTA on the metabolism of other nutritionally important trace elements and minerals. We have investigated the influence of NaFe3+EDTA, and of increasing dietary levels of Na2EDTA, on Zn, Cu and Ca metabolism in rats fed on Zn-sufficient and Zn-deficient soya-bean-isolate- based diets. With the Zn-deficient diets, changing the dietary Fe compound from FeSO4 to NaFe3+- EBTA significantly (P < 0·05) increased mean apparent Zn absorption from 50·2 to 67·4%. urinary Zn excretion from 2·0 to 4·0% of intake, and Zn retention from 48·2 to 63·4%. Increasing the dietary EDTA level to 1000 mg/kg further increased Zn absorption to 78·1%, urinary Zn excretion to 15·6% of intake and Zn retention to 62·5%. Increased Zn retention was accompanied by a significant increase in weight gain indicating that the extra Zn was available for normal metabolic processes. With rats fed on the Zn-sufficient diet, NaFe3+EDTA and Na2EDTA similarly increased the absorption, urinary excretion and retention of Zn but to a lesser extent. NaFe3+EDTA, however, had no influence on the absorption, urinary excretion and retention of Cu and Ca, and additional Na2EDTA caused only minor increases in Cu absorption and retention and in the urinary excretion of Ca. We conclude that using NaFe3+EDTA as a food fortificant would have no detrimental effect on the metabolism of Zn, Cu and Ca and, in some situations, could improve Zn absorption and retention from low-bioavailability diets.
Article
Ferric glycinate prooxidant properties were compared with those of ferrous sulfate in a powdered casein-based infant formula. About 60 ppm of either source were added to experimental formulas, and supplemented formulas stored at 20, 37 or 45°C for 7–12 months. The samples were assayed periodically during storage for methionine and available lysine losses, and malonaldehyde formation. Deterioration rate constants for the ferric glycinate-fortified formula dropped to 60–75% of those for the ferrous sulfate-fortified formula. Activation energy values obtained for the glycinate iron source were 15–20% higher than those for ferrous sulfate. Thus, iron had lower prooxidative properties when added to this infant formula as ferric glycinate than when present as ferrous sulfate:
Article
Ferric glycinate prooxidant properties were compared with those of ferrous sulfate in a powdered casein-based infant formula. About 60 ppm of either iron source were added separately to the experimental formula. Fortified formulas were then stored at 20°C, 37°C or 45°C for 12, 9 or 7 months, respectively. The samples were assayed periodically during storage for vitamins A, E, B1, B2 and C evaluation. Ferric glycinate fortification yielded a 30-50% deterioration of the rate constant values of those obtained for ferrous sulfate addition. A 10-30% increase in activation energy values was also observed when ferric glycinate replaced ferrous sulfate as iron source. Results demonstrated lower prooxidant properties of iron when added to this infant formula as ferric glycinate than when ferrous sulfate was present.
Article
Serum ferritin, total plasma ferritin and haematological indices were determined during and for 6 months after normal pregnancy in 45 healthy women, 21 of whom took oral iron supplements. The physiological effect of pregnancy was to markedly depress serum ferritin concentration. During unsupplemented pregnancy median serum ferritin concentration decreased to approx. 6.0 μg/l by 28 weeks gestation, this concentration was maintained until term and was associated with the appearance of erythrocyte microcytosis during the third trimester. At 6 months postpartum, individual and average serum and total plasma ferritin values showed a deficit compared with the values recorded at the beginning of pregnancy. Oral iron supplementation during pregnancy modified the fall in serum ferritin, median serum ferritin concentrations remained about 14.0μg/I after 28 weeks gestation; normocytic erythropoiesis was maintained throughout the third trimester and no deficit in serum and total plasma ferritin occurred as a result of pregnancy. It is concluded that routine oral iron administration should be recommended during pregnancy, certainly after 28 weeks gestation.
Article
The goals of this study were to evaluate the effect of orally administered amino acid-chelated iron (Fe) compared to injected Fe-dextran on haematology and weight gain in two different breeds raised under commercial conditions. Altogether 92 Duroc (D) pigs and 84 Norwegian Landrace (L) pigs from two different herds were included in the study. The day after birth the litters were divided in two groups (split litters). Group (Gr.) 1 was given 4 ml of a 50% solution of Super Fe-MAX® (52 mg glutamic acid-chelated Fe in a water solution) orally, while Gr. 2 was subcutaneously (s.c.) injected with Idofer® (180 mg Fe as ferridextran). Until weaning at 5 weeks, all the piglets had free access to a 3% solution of Super Fe-MAX® (0.78 mg Fe/ml), access to pelleted food being given from 1 week of age. The piglets were weighed and bled before treatment the day after birth (day 1) and on days 4, 7, 14, 21 and 35. All piglets were weighed on days 28 and 49, while 72 of the L pigs were also weighed on days 77, 98 and 119. At weaning D pigs in Gr. 1 and Gr. 2 had a mean body weight of 8.64 kg and 8.30 kg, respectively, the corresponding figures for the L pigs being 10.82 kg and 10.34 kg. As regards the 72 L pigs followed to day 119, the mean weight in Gr. 1 and Gr. 2 was 80.6 kg and 80.2 kg, respectively. A significantly lower weight gain in the piglets with a birth weight below 1.2 kg in Gr. 2 compared with Gr. 1 indicated that excess administration of Fe to small piglets may have a detrimental effect on weight gain. From day 7 (D pigs) and on days 14 and 21 (L pigs), Gr. 2 had a significantly higher haemoglobin concentration (Hb) than Gr. 1. Nevertheless, Hb levels were also adequate in Gr. 1 in both breeds. There was a negative correlation between changes in Hb during the first weeks and the initial value. Though haematological values seemed to show inter-breed differences, with higher average erythrocyte counts (RBC) and Hb and lower mean cell volume (MCV) in the D pigs, the ability to avoid Fe deficiency nevertheless appeared to be the same in both breeds.
Article
One way to prevent iron deficiency anemia in developing countries is through the fortification of food products with iron. In addition to avoiding undesirable color and flavor changes, the main challenge is to protect the fortification iron from potential inhibitors of iron absorption present in commonly fortified foods.
Article
Although there has been a remarkable decline in the proportion of malnourished children in Latin America, micronutrient deficiencies, especially iron deficiency anemia, remain significant public health problems. A substantial reduction in the prevalence of iron deficiency anemia is an important goal for the end of the decade. Interest in fortifying wheat flour and dry-milled maize flour is thus growing, and significant experience in the fortification of flours with iron and the B vitamins, including folate, is emerging. It is necessary to ensure that fortification levels and standards, legislation, and quality assurance and control measures are in place nationally and harmonized regionally.
Article
A comparative study with two groups of 25 rats each was undertaken in order to study fluid milk fortified with SFE-171 (stabilized FeSO4 by micro encapsulation with phospholipids) or FeSO4, both labeled with 59Fe. After the administration of either product, its total absorption, biodistribution and incorporation of iron into hemoglobin was determined for both cases. In the first case the total absorption was (28.3 ± 6.0)%, whereas in the second it was (24.1 ± 5.8)%, the difference between both values is statistically significant with a P < 0.01. The biodistribution results show that the iron from SFE-171 follows the same metabolic pathway than that from FeSO4. The highest amount (approximately 80%) was found in blood, followed by the liver with approximately 11% and bones with a proportion somewhat higher than 4%, the activity in intestine was minimal in both cases. The 59Fe in blood was found 18 days after the administration of either product at a 100% in the red blood cells, which implies that the iron administered in the milk fortified with SFE-171 or with FeSO4 was incorporated into hemoglobin. These results indicate with a high degree of significance that the fortification of milk with SFE-171 is a procedure which assures the effective absorption of iron and a physiological behavior of this element.
Article
Ca-supplemented diets (containing 1.0% Ca) were prepared by substituting milk, cheese, yogurt, CaCO3, or Ca citrate-malate (CaCM) into 2 control diets (containing 0.5% Ca and either no lactose or 20% lactose). The diets were labeled with 59Fe and offered to fasted rats aged 21 d, 40 d, and 100 d. Fe absorption was determined by whole-body counting. The effect of Ca supplementation was most pronounced in the 21 d rats where supplementation with yogurt, CaCM, and CaCO3, but not milk or cheese, depressed 59Fe absorption (p<0.05). In 40 d rats, supplementation with CaCM but none of the other sources depressed 59Fe absorption. There was no effect with any of the sources in the 100 d rats. Lactose dramatically increased 59Fe absorption from the milk and control diets in 21 d rats, decreased 59Fe absorption from CaCM in 40 d rats but had no effect in other treatments. These data suggest that Ca in the form of CaCO3 and CaCM, has a more pronounced effect on iron bioavailability than Ca in dairy products (except for yogurt) and that Fe−Ca interactions are influenced by the physiological state of the animal.
Article
A National fortification program instituted in Venezuela in 1993 reduced iron deficiency and anemia by half in only 1 y. The fortification mixture contained ferrous fumarate, vitamin A and other vitamins. We conducted experiments to characterize ferrous fumarate uptake by Caco-2 cells. Increasing amounts of ferrous fumarate, vitamin A, phytate, tannic acid and beta-carotene were added to incubation mixtures using a range of concentrations that included the molar ratios used in the Venezuelan fortification program. Cells were incubated for 1 h at 37 degrees C with 37 kBq (59)Fe and the compound to be evaluated. They were then rinsed, trypsinized and counted to measure uptake. Effects of ascorbic acid, days in culture and use of flasks or inserts were also evaluated. Optimal conditions for uptake experiments were pH 5.5, in the presence of ascorbic acid and at 16 d in culture. Use of flasks or inserts did not affect uptake. Vitamin A did not significantly increase iron uptake under the experimental conditions employed. However, beta-carotene (6 micromol/L) significantly increased iron uptake compared to no beta-carotene addition (114.9 +/- 6.3 and 47.2 +/- 5.9 pmol/mg cell protein, respectively). Moreover, in the presence of phytates or tannic acid, beta-carotene generally overcame the inhibitory effects of both compounds depending on their concentrations. We conclude that beta-carotene improves iron uptake and overcomes the inhibition by potent inhibitors of iron absorption. These experiments also validated the usefulness of Caco-2 cell model system to evaluate iron metabolism.
Article
To determine if repletion of hemoglobin was achievable in young children presenting both severe (< or =9.4 g hemoglobin/dL blood) and less severe iron deficiency anemia (9.5 to 11.0 g hemoglobin/dL blood) through fortification of liquid 3.3% butterfat milk with a bioavailable ferrous iron amino acid chelate (Ferrochel) at 3 mg iron/liter/day. A group of 185 children were selected from Tupã, Brazil who presented the above two stages of iron deficiency anemia plus normalcy. Initially, 54% had severe iron deficiency anemia, 33% were less severely anemic and 13% had normal hemoglobin concentrations. They received iron-fortified milk for a mean of 222+/-2 days. Hemoglobin concentrations were measured initially, at 133+/-13 days, and at 222+/-2 days. By mean 222 days, 57% of the childrens' hemoglobins were normal. Highest rates of repletion were in the initially severe anemic group. Repeated measures ANOVAs demonstrated that hemoglobins at 0, 133 and 222 days for the total group, as well as for the severe and less severe iron deficiency anemic groups, represented statistically different populations at alpha=0.0005. Children with initially normal hemoglobin concentrations showed no change at 0, 133 and 222 days (alpha=0.10), suggesting the possibility of absorptive regulation of this form of iron. Low hemoglobin concentrations in young children can be increased through daily consumption of fluid milk fortified with 3 mg ferrous amino acid chelate (Ferrochel).
Article
The purpose of this review is to examine the need for and appropriate level of Fe fortification of infant formula, and to assess any adverse effects of Fe fortification. The appropriate level of Fe fortification of infant formula has been established through studies of Fe absorption or erythrocyte incorporation of Fe, and through clinical trials of formulas with varying levels of Fe that were aimed at preventing the development of Fe deficiency in participating infants. In addition, the effects of varying levels of Fe fortification on the absorption of other minerals and trace elements, and on the incidence of infection and immune function have been studied, as has the effect of adding bovine lactoferrin to formula. Studies of Fe absorption have shown that increasing the level of Fe fortification in formula does not significantly increase the amount absorbed, and that the addition of bovine lactoferrin is unlikely to further increase absorption of Fe. Quite different recommendations for the level of Fe fortification of formula are made in the USA and in Europe. The higher level (12 mg/l) commonly used in the USA is not well supported by the evidence from clinical trials that suggest that lower levels (4 mg/l or less) may be adequate to prevent the development of Fe deficiency. Higher levels of Fe fortification may also interfere with the absorption of other minerals such as Cu and Se. Concerns about potential adverse effects of Fe fortification on immune function and susceptibility to infections have been disproved as have concerns about associated gastrointestinal symptomatology. There are no clearly demonstrated advantages in using 'follow-on' formula with high Fe content (up to 13 mg/l) instead of the standard UK formulas with Fe fortification in the range 4-7 mg/l after the age of 6 months, although they may provide an important 'safety net' for the prevention of Fe deficiency in communities with weaning diets low in Fe.
Article
Studies were performed in seven children and 98 adults to compare the proportion of iron absorbed when administered as ferric sulfate (Fe2(SO4)3), NaFeEDTA, hemoglobin (Hb), and ferrous ascorbate. Studies in children (mostly iron deficient) showed that when the compounds were given with a milk-rice-sugar formula totalling 5 mg Fe, iron from hemoglobin was absorbed best, followed by NaFeEDTA and by Fe2(SO4)3 (mean percent absorption +/-SD = 34.5 +/- 1.5, 8.6 +/- 1.9 and 3.3 +/- 1.5, respectively). Studies in normal or iron deficient adults also demonstrated a better absorption of iron from NaFeEDTA than from Fe2(SO4)3 whether these compounds were given in an aqueous solution (5 mg Fe) or with a standard meal consisting of beans, tortillas, bread, and coffee providing also a total of 5 mg Fe. Hb iron under the same conditions was absorbed in the same proportion to the reference iron ascorbate, always being higher than iron absorbed from the other compounds. Fe2(SO4)3 and NaFeEDTA mixed in the same meal were absorbed in the same proportion as when NaFeEDTA alone was added to the meal and 2 to 3 times better than when Fe2(SO4)3 alone was added to the meal. Addition of desferrioxamine depressed iron absorption from Fe2(SO4)3 and NaFeEDTA, the latter being less affected. Addition of ascorbic acid increased absorption from both. When the compounds were added to the meal to provide 50 mg of iron, percent absorption was depressed in relation to the smaller iron dose in the case of Fe2(SO4)3 and Hb but remained unaltered in the case of NaFeEDTA. Addition of 45 mg Fe as Fe2(SO4)3 or NaFeEDTA to 0.4 mg Fe from the Hb in the meal did not change Hb iron absorption. Addition of 45 mg Fe as Hb or NaFeEDTA to 0.4 mg Fe from Fe2(SO4)3 in the meal enhanced iron absorption from the latter in the same proportions. Addition of 45 mg Fe as Fe2(SO4)3 and Hb to 0.4 mg Fe as NaFeEDTA in the meal respectively depressed and enhanced iron absorption from NaFeEDTA. These studies indicate that NaFeEDTA, Fe2(SO4)3 and nonheme food iron from a common pool different from the heme pool but which is changed in its characteristics by the presence of NaFeEDTA, resulting in a better absorption of iron.
Article
The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional status, normal body weight and positive nitrogen balance solely by intravenous means. It requires solutions providing calories, amino acids and other nutrients in amounts much greater than those indicated for maintenance of normal body weight. Nutrient solutions have been studied, selected and prepared in our Hospital Pharmacological Service utilizing a sterile closed system, which allows large-volume filtering, sterilizing and bottling devices. For maintenance of weight gain in adults, a basic formula is employed, which provides 1,100 Kcal/1 with pure crystalline amino acids mixed with 50% anhydrous dextrose in water in a ratio of 5.8:1 (160 Kcal:1 g nitrogen). Minerals and vitamins are added to the base solution prior to use and may be increased or decreased by simple addition or omission depending on the patient's condition. This paper is based on 192 surgical patients who received TPN and have been followed in strict cooperation between the Hospital Pharmacological Service and the Surgical Department. The patients, ranging from 23 to 79 years of age, with life threatening diseases and unable to maintain adequate nutrition by the oral route, received TPN through a central catheter inserted via subclavian puncture (146 cases) or through a surgically created internal A-V fistula (46 cases). The condition of the patients generally improved within a few days after starting TPN; and weight gain, wound healing, general improvement and a shorter period of hospitalization were observed. TPN could be efficiently combined with oncologic treatment, and a significant improvement of the patients' performance status and decrease of toxic side-effects due to chemotherapeutic agents were observed. TPN has been successfully applied also in patients with fistulas of the alimentary tract obtaining spontaneous closure and in patients with ulcerative colitis, showing its beneficial effect in allowing complete bowel rest for healing. No major complications or deaths could be attributed to TPN or to the route of administration.
Article
Approximately 88% of adult male workers on a rubber plantation in West Java Indonesia had hookwork infection, and over 45% were anemic as judged by a hemoglobin below 13 g/100 ml. Hemoglobin values and Harvard Step Test (HST) performance for both tappers and weeders were significantly correlated. The rubber tappers were paid by their work output, and their earnings correlated with hemoglobin levels. Morbidity and hemoglobin levels were also correlated. Caloric intakes were not correlated with either work output or HST performance. TReatment with 100 mg of elemental iron for 60 days resulted in a significant improvement in hematological status of the anemic individuals and in their HST performance work output, and morbidity. Both treatment and placebo groups received a daily incentive payment of 15 rupiahs, equivalent to 5 to 7% of minimum daily wages. This sum, spent largely on food, resulted in added intakes of 3 to 5 mg of available iron and 50 mg of vitamin C. This is believed to explain a significant but lesser improvement in hemoglobin. HST performance, work output, and morbidity in the anemic placebo group. In an untreated subsample to whom no payment was given, no change in hemoglobin, hematocrit, work performance, HST score, or disease occurred. After income supplementation was stopped, hemoglobin and hematocrit levels and related changes reverted to initial levels within 30 days in the placebo groups, but were unchanged in the iron-treated groups. The cost of the iron supplementation was small compared with the economic benefits of increased productivity and lowered morbidity.
Article
The data presented confirm the advantages of Fe(III)-EDTA as a salt for iron fortification. This iron compound exchanges completely with intrinsic wheat iron in the lumen of the gut. The iron absorption data from this salt tested with six different food vehicles compared with the absorption of ferrous sulfate administered with the same vehicles indicate that while the mean absorption from ferrous sulfate varies from 2 to 30% according to the food vehicle mixed with the salt, the absorption from Fe(III)-EDTA remains practically the same. Apparently, the iron absorption from Fe(III)-EDTA complex is slightly or not affected by the presence of vegetable foods or milk. All these data suggest that only a small amount of iron from this salt, about 10 mg/day, would be necessary to prevent iron deficiency anemia even in those populations relying for their subsistence on vegetable food only.
Article
The absorption of iron was measured from isotopically tagged salts used in supplementing infant cereals and as the iron supplement in cow's milk and soy-based formulas. Iron as sodium iron pryophosphate and ferric orthophosphate were poorly absorbed from infant cereal (mean, < 1.0%) and thus are not dependable sources of iron to meet the nutritional needs of infants. Reduced iron of very small particle size and ferrous sulfate when added to cereal was absorbed to a greater extent (mean, 4.0% and 2.7% respectively). For technical reasons, these two forms of iron had not been added to commercial cereal products because of discoloration, distribution problems of the iron in the product, and shortened shelf life. Therefore, at the present time, iron supplementation of infant cereals with sodium iron pyrophosphate, ferric orthophosphate, and reduced iron of large particle size does not provide a predictable and available source of iron to meet the needs of infants. Supplemental iron as ferrous sulfate in milk- and soy-based formulas gave a mean absorption of 3.4% to 5.4%. The iron supplements in these formulas can essentially meet the needs for dietary iron of healthy infants.