Maternal trace elements, vitamin B12, vitamin A, folic acid, and fetal malformations

Abstract Objectives We modeled the potential impacts of bouillon fortification with different levels of vitamin A, folic acid, vitamin B12, iron, and zinc on dietary micronutrient adequacy to inform multi-stakeholder discussions around bouillon fortification programs. Methods We used individual dietary intake data in Cameroon from women of reproductive age (WRA) and children 1–5 y (n = 902 and 872), and household (HH) survey data in Cameroon (n = 11,384 HH), Ghana (n = 11,870 HH), and Haiti (n = 4,951 HH) to estimate micronutrient (MN) intake. The Adult Male Equivalent method was applied to estimate “apparent intake” of WRA, children, and men from HH surveys. We examined intake of bouillon and calculated prevalence of inadequate (below the estimated average requirement) and high (above the tolerable upper intake level, UL) micronutrient intake. Analyses included the contributions of mandatory fortification of oil or wheat flour at estimated current micronutrient levels. We simulated the impacts of bouillon fortification with varying levels of vitamin A, folic acid, vitamin B12, iron, and zinc on inadequate and high intakes of each nutrient. Results Bouillon was commonly consumed in all countries, with any reported consumption ranging from 67–81% in Ghana to over 90% in Cameroon and Haiti. Median (apparent) bouillon consumption ranged from 1.6–2.1 g/d for women, 0.7–1.0 g/d for children, and 1.8–2.2 g/d for men. Bouillon fortification with vitamins was predicted to reduce dietary inadequacy (120 μg/g vitamin A: 15–33 percentage points, pp, depending on the country and target group; 80 μg/g folate: 11–33 pp; 1.2 μg/g B12: 12–67 pp) with minimal risk of high intake. In contrast, predicted effects on dietary iron inadequacy were modest (5–12 pp reduction at 5 mg iron/g, assuming 2% absorption). Simulated zinc fortification showed reductions in inadequate absorbable zinc intake (14–42 pp at 3 mg/g), but children's intakes commonly exceeded the UL. Conclusions Modeling suggests that bouillon fortification could reduce inadequate MN intakes in these countries. Further work is needed to identify fortification levels that will meet criteria for nutritional benefits, technical feasibility, and cost-effectiveness. Funding Sources This analysis was supported by a grant to UC Davis from Helen Keller International.

Download Full-text

The relationship between serum trace elements, vitamin B12, folic acid and clinical parameters in patients with myofascial pain syndrome

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-2010-0264 ◽

2010 ◽

Vol 23 (4) ◽

pp. 187-191 ◽

Cited By ~ 10

Author(s):

M. Okumus ◽

E. Ceceli ◽

F. Tuncay ◽

S. Kocaoglu ◽

N. Palulu ◽

...

Keyword(s):

Trace Elements ◽

Folic Acid ◽

Vitamin B12 ◽

Myofascial Pain ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Clinical Parameters ◽

Serum Trace Elements ◽

The Relationship

Download Full-text

National Wheat and Maize Flour Fortification Standards and Their Comparison with International Guidelines in Countries with Mandatory Fortification (P22-001-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz042.p22-001-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Katya Bobrek ◽

Britt Broersen ◽

Nancy Aburto ◽

Aashima Garg ◽

Mary Serdula ◽

...

Keyword(s):

Folic Acid ◽

Vitamin A ◽

Vitamin B12 ◽

Pantothenic Acid ◽

World Health ◽

Maize Flour ◽

Nutrient Levels ◽

Fortified Food ◽

Iron Folic Acid ◽

Health Organization

Abstract Objectives Compare national wheat and maize flour standards to World Health Organization (WHO) fortification guidelines in countries with mandatory fortification. Methods Seventy-three countries’ grain availability, flour extraction rate, flour standards (with fortification compounds and nutrient levels) and mass fortification of other foods were obtained from databases and country contacts. For each nutrient, standards were compared with recommendations, specifically, presence of a compound that is in guidelines was noted (yes/no), and nutrient levels in standards were classified as lower than, equal to, or higher than those suggested by WHO. When a nutrient in flour was categorized as “lower than” in a particular standard and if another food (e.g., rice, oil, milk) was mass fortified with the same nutrient, the classification was changed to “less than recommendation and included in other mass fortified food”. Results At least 63% of standards included one or more recommended compounds for all nutrients in standards for wheat flour alone (iron, folic acid, vitamin A, zinc, vitamin B12, ), wheat and maize flour together (iron, folic acid, vitamin A, zinc, vitamin B12) and maize flour alone (thiamin, riboflavin, niacin, pyridoxine); no country included pantothenic acid in its maize flour standard. For folic acid, vitamin A, thiamin, riboflavin, niacin and pyridoxine, >50% of standards (1) met or exceeded WHO suggested levels, or (2) were lower than suggested levels and another food was mass fortified with the specific nutrient in the country. For iron, zinc and vitamin B12, <50% of standards met (1) or (2). Conclusions Iron, zinc and vitamin B12 may require the most attention in national wheat and maize flour fortification standards. Funding Sources No external funding received for conduct of this study.

Download Full-text

Prevalence of Micronutrient Deficiency after Bariatric Surgery

Obesity Facts ◽

10.1159/000514847 ◽

2021 ◽

pp. 1-8

Author(s):

Eva-Christina Krzizek ◽

Johanna Maria Brix ◽

Alexander Stöckl ◽

Verena Parzer ◽

Bernhard Ludvik

Keyword(s):

Bariatric Surgery ◽

Vitamin D ◽

Folic Acid ◽

Vitamin E ◽

Vitamin A ◽

Vitamin B12 ◽

Micronutrient Deficiency ◽

Micronutrient Status ◽

25 Oh Vitamin D

Introduction: While vitamin deficiency after bariatric surgery has been repeatedly described, few studies have focused on adequate micronutrient status. In this study, we examine the prevalence of vitamin and micronutrient deficiency for the first 3 years after surgery. Methods: Out of 1,216 patients undergoing surgery, 485 who underwent postoperative follow-up in an outpatient clinic between 2010 and 2019 were included in this evaluation (76.9% women, mean age 42 ± 12 years, mean BMI: year 1, 33.9 ± 19.2; year 2, 29.7 ± 8.7; year 3, 26.2 ± 4.0). Weight and cardiovascular risk factors as well as ferritin, vitamin B12, folic acid, 25-OH-vitamin D, vitamin A, vitamin E, zinc, copper, and selenium were evaluated. Deficits were defined as follows: ferritin <15 µg/L, vitamin B12 <197 pg/mL, folic acid <4.4 ng/mL, 25-OH-vitamin D <75 nmol/L, vitamin A <1.05 µmol/L, vitamin E <12 µmol/L, zinc <0.54 mg/L, copper <0.81 mg/L, and selenium <50 µg/L. All patients underwent dietary counselling and substitution of the respective deficits as appropriate. Results: One year after bariatric surgery, 485 patients completed follow-up. This number decreased to 114 patients in year 2, and 80 patients in year 3. Overall, 42.7% (n = 207) underwent sleeve gastrectomy, 43.7% (n = 211) Roux-en-Y-gastric bypass, and 13.9% (n = 67) gastric banding. The following deficits were found (year 1/2/3): ferritin, 21.6/35.0/32.5%; vitamin B12, 14.3/1.8/6.3%; folic acid, 29.7/21.6/15.3%; 25-OH-vitamin D, 70.8/67.0/57.4%; vitamin A, 13.2/8.9/12.8%; vitamin E, 0%; zinc, 1.7/0/1.5%; copper, 10.4/12.2/11.9%; selenium, 11.1/4.3/0%. Conclusion: As seen in other studies, the follow-up frequency decreased over the years. Despite intensive substitution, the extent of some deficiencies increased or did not improve. These results suggest reinforcing measures to motivate patients for regular follow-up visits, considering closer monitoring schedules, and improving supplementation strategies.

Download Full-text