scholarly journals Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Julia L Finkelstein ◽  
Heather S Herman ◽  
Albert Plenty ◽  
Saurabh Mehta ◽  
Paul Natureeba ◽  
...  
Keyword(s):  
Vitamin D ◽  
Antiretroviral Therapy ◽  
Placental Malaria ◽  
Health Concern ◽  
Vitamin B ◽  
Micronutrient Deficiencies ◽  
Multivariate Models ◽  
Infant Outcomes ◽  
Micronutrient Status ◽  
Vitamin B 12

ABSTRACT Background Women living with HIV (WLHIV) are at higher risk of micronutrient deficiencies and adverse health outcomes. There are limited data on the burden or sequelae of micronutrient deficiencies among pregnant WLHIV receiving antiretroviral therapy (ART). Objectives We aimed to examine anemia and vitamin B-12, folate, and vitamin D deficiencies, and their associations with obstetric and infant outcomes, among pregnant WLHIV initiating combination antiretroviral therapy (cART) in rural Uganda. Methods This was a prospective analysis among pregnant WLHIV (12–28 weeks of gestation) in PROMOTE-Pregnant Women and Infants (PIs), a randomized trial comparing the effects of protease inhibitor (PI)-based ART with those of a non-PI-based ART on placental malaria risk. We conducted a substudy on the burden of anemia [trimester 1/3: hemoglobin (Hb) <11.0 g/dL; trimester 2: Hb <10.5 g/dL; n = 367] and micronutrient deficiencies (n = 127) in pregnant WLHIV and their associations with obstetric and infant outcomes. Hb was measured by cyanmethemoglobin, vitamin B-12 and folate were measured via electrochemiluminescence, and vitamin D was measured by ELISA. Linear and binomial regression were used to evaluate associations between micronutrient status during pregnancy and perinatal outcomes. Results 26.8% women were anemic, 30.2% were vitamin B-12 insufficient (<221.0 pmol/L), 66.1% were folate insufficient (<13.5 nmol/L), and 65.4% were vitamin D insufficient (<30.0 ng/mL) at enrollment. Anemia during pregnancy was associated with a greater risk of small for gestational age (SGA) (RR: 1.88; 95% CI: 1.28, 2.77; P = 0.001); each 1-g/dL decrease in Hb was associated with greater risk of SGA (RR: 0.76; 95% CI: 0.65, 0.90; P = 0.001). Multivariate models showed that increased vitamin D concentrations predicted lower risk of infant wasting (WLZ < −2; RR: 0.94; 95% CI: 0.89, 0.99; P = 0.04). Multivariate models also indicated that maternal vitamin B-12 and folate concentrations at enrollment predicted maternal (P < 0.001) and infant (P = 0.02) concentrations postpartum. Conclusions Anemia and micronutrient deficiencies are associated with a variety of adverse obstetric and infant outcomes and are an important public health concern in perinatal WLHIV on cART and their children. This trial was registered at clinicaltrials.gov as NCT00993031.

scholarly journals Nutrition and the psychoneuroimmunology of postpartum depression

2012 ◽  
Vol 25 (1) ◽  
pp. 180-192 ◽  
Author(s):  
E. R. Ellsworth-Bowers ◽  
E. J. Corwin
Keyword(s):  
Vitamin D ◽  
Postpartum Depression ◽  
B Vitamins ◽  
Trace Minerals ◽  
Future Research ◽  
Potential Contribution ◽  
Micronutrient Deficiencies ◽  
Vitamin Status ◽  
Micronutrient Status ◽  
B Vitamin

Postpartum depression (PPD) is a relatively common and often severe mood disorder that develops in women after childbirth. The aetiology of PPD is unclear, although there is emerging evidence to suggest a psychoneuroimmune connection. Additionally, deficiencies in n-3 PUFA, B vitamins, vitamin D and trace minerals have been implicated. This paper reviews evidence for a link between micronutrient status and PPD, analysing the potential contribution of each micronutrient to psychoneuroimmunological mechanisms of PPD. Articles related to PPD and women's levels of n-3 PUFA, B vitamins, vitamin D and the trace minerals Zn and Se were reviewed. Findings suggest that while n-3 PUFA levels have been shown to vary inversely with PPD and link with psychoneuroimmunology, there is mixed evidence regarding the ability of n-3 PUFA to prevent or treat PPD. B vitamin status is not clearly linked to PPD, even though it seems to vary inversely with depression in non-perinatal populations and may have an impact on immunity. Vitamin D and the trace minerals Zn and Se are linked to PPD and psychoneuroimmunology by intriguing, but small, studies. Overall, evidence suggests that certain micronutrient deficiencies contribute to the development of PPD, possibly through psychoneuroimmunological mechanisms. Developing a better understanding of these mechanisms is important for guiding future research, clinical practice and health education regarding PPD.

scholarly journals Complementary feeding and micronutrient status: a systematic review

2019 ◽  
Vol 109 (Supplement_1) ◽  
pp. 852S-871S ◽  
Author(s):  
Julie E Obbagy ◽  
Laural K English ◽  
Tricia L Psota ◽  
Yat Ping Wong ◽  
Nancy F Butte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Iron Status ◽  
First Year ◽  
Vitamin B ◽  
Fatty Acid Status ◽  
Micronutrient Status ◽  
Acid Status ◽  
Vitamin B 12 ◽  
Fortified Cereal

ABSTRACTBackgroundProper nutrition during early life is critical for growth and development.ObjectivesThe aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)?MethodsA literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.ResultsNine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status.ConclusionsSeveral conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.

Association of vitamin D and vitamin B 12 with cognitive impairment in elderly aged 80 years or older: a cross‐sectional study

2019 ◽  
Vol 32 (4) ◽  
pp. 518-524
Author(s):  
M. I. da Rosa ◽  
W. O. Beck ◽  
T. Colonetti ◽  
J. Budni ◽  
A. C. B. Falchetti ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cognitive Impairment ◽  
Cross Sectional Study ◽  
Vitamin B ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vitamin B 12

scholarly journals Antenatal Multiple Micronutrient Supplementation Compared to Iron–Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh

2019 ◽  
Vol 149 (7) ◽  
pp. 1260-1270 ◽  
Author(s):  
Kerry J Schulze ◽  
Sucheta Mehra ◽  
Saijuddin Shaikh ◽  
Hasmot Ali ◽  
Abu Ahmed Shamim ◽  
...  
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Late Pregnancy ◽  
Vitamin B ◽  
Rural Bangladesh ◽  
Micronutrient Status ◽  
Baseline Status ◽  
Multiple Micronutrient ◽  
Vitamin B 12 ◽  
Iron Folic Acid

ABSTRACT Background Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron–folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. Objective We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. Methods Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. Results Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7–13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7–16.6% lower, for the MM group compared with the IFA group, with a 15–38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. Conclusions Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

scholarly journals Micronutrient Status of Young Adolescents in Rural Bangladesh: The JiVitA-1 Birth Cohort (FS01-04-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sarah Baker ◽  
Kerry Schulze ◽  
Lee Wu ◽  
Saijuddin Shaikh ◽  
Hasmot Ali ◽  
...  
Keyword(s):  
Vitamin D ◽  
Nutritional Status ◽  
Vitamin D Deficiency ◽  
Birth Cohort ◽  
Controlled Trial ◽  
Micronutrient Deficiencies ◽  
Z Score ◽  
Young Adolescents ◽  
Blood Draw ◽  
Micronutrient Status

Abstract Objectives We assessed micronutrient status in young rural Bangladeshi adolescents to determine prevalence of deficiency by sex, age, season and dietary pattern. Methods In a birth cohort of >30,000 youth in whom data on health, development, and nutritional status was collected in 2015–2017, venous blood was drawn from a ∼3% subsample (n = 991, 9–13 years old). Participants’ mothers had been in a cluster-randomized, placebo-controlled trial of daily antenatal beta-carotene or vitamin A supplementation in 2001–2007. Hemoglobin (Hb) was obtained at blood draw; plasma ferritin, folate, cobalamin (B12), homocysteine (Hcy), thyroglobulin (Tg), and C-reactive protein (CRP) were measured by chemiluminescent immunoassay, 25-hydroxyvitamin D [25(OH)D] by commercial immunoassay, and zinc by atomic absorption spectrometry. Results Participants were short (height-for-age Z-score -1.59 ± 0.93 in boys, -1.65 ± 0.98 in girls) and thin (BMI-for-age Z-score -1.49 ± 1.06 in boys, -1.28 ± 1.08 in girls). Anemia (Hb < 120 g/L, 11.4%) was common but iron deficiency (ferritin < 15 μg/L, 0.5%) was not. Folate (< 6.8 nmol/L, 3.3%) and vitamin B12 (<150 pmol/L, 5.2%) deficiencies, elevated Hcy (>18 μmol/L, 0.8%) and inflammation (CRP >5 mg/L, 3.3%) were uncommon. However, deficiencies of vitamin D (25(OH) D < 50 nmol/L, 43.0%), iodine (Tg > 40 µg/L, 21.9%), and zinc (< 8.6 µmol/L, 18.8%) were prevalent. Only vitamin D deficiency was more prevalent in girls than boys (54.0% versus 31.4%, P < 0.0001), doubling in girls from 32.5% at 10 to 69.7% at 13 years of age. Vitamin D deficiency was highest in winter and zinc deficiency highest during the monsoon. In preliminary analyses, micronutrient deficiencies were not significantly associated with dietary intake patterns derived from three 7-day food frequencies collected over ∼1 year. Conclusions Young adolescents in rural northern Bangladesh experienced anemia and vitamin D, iodine and zinc deficiencies; however, iron, folate, and B12 deficiencies, hyperhomocysteinemia, and inflammation were uncommon. Further resolution of dietary data and exploration of other contextual features may reveal specific risk factors for micronutrient deficiencies, informing our understanding of adolescent nutritional status in this setting. Funding Sources The Bill and Melinda Gates Foundation, Sight and Life.

scholarly journals Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data

2014 ◽  
Vol 18 (8) ◽  
pp. 1358-1368 ◽  
Author(s):  
Ziad Abdeen ◽  
Asa’d Ramlawi ◽  
Radwan Qaswari ◽  
Ala’ Abu Alrub ◽  
Omar Dary ◽  
...  
Keyword(s):  
Vitamin D ◽  
Dietary Intake ◽  
Wheat Flour ◽  
Venous Blood ◽  
Health Concern ◽  
Vitamin B ◽  
Palestinian Women ◽  
Women And Children ◽  
The Impact ◽  
Dietary Data

AbstractObjectiveTo utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula.DesignQuantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour.SettingHouseholds in Gaza City and Hebron that were not receiving food aid from social programmes.SubjectsNon-pregnant women (18–49 years) and children aged 36–83 months.ResultsThe micronutrients with highest prevalence of insufficiency were vitamin D in women (84–97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43–82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated.ConclusionsMicronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

scholarly journals Association of maternal diet, micronutrient status, and milk volume with milk micronutrient concentrations in Indonesian mothers at 2 and 5 months postpartum

2020 ◽  
Vol 112 (4) ◽  
pp. 1039-1050
Author(s):  
Rosalind S Gibson ◽  
Sofa Rahmannia ◽  
Aly Diana ◽  
Claudia Leong ◽  
Jillian J Haszard ◽  
...  
Keyword(s):  
Human Milk ◽  
Maternal Diet ◽  
Positive Association ◽  
Retinol Binding Protein ◽  
Vitamin B ◽  
Percentage Difference ◽  
Micronutrient Status ◽  
Milk Volume ◽  
Vitamin B 12 ◽  
Β Carotene

ABSTRACT Background Maternal micronutrient deficits during preconception and pregnancy may persist during lactation and compromise human milk composition. Objective We measured micronutrient concentrations in human milk and investigated their association with maternal micronutrient intakes, status, and milk volume. Methods Infant milk intake (measured via a deuterium dose-to-mother technique), milk micronutrient and fat concentrations, and maternal micronutrient intakes were assessed at 2 and 5 mo postpartum in 212 Indonesian lactating mother–infant pairs. Maternal hemoglobin, ferritin, transferrin receptors, retinol binding protein (RBP), zinc, selenium, and vitamin B-12 were measured at 5 mo (n = 163). Multivariate or mixed effects regression examined associations of milk micronutrient concentrations with maternal micronutrient intakes, status, and milk volume. Results Prevalence of anemia (15%), and iron (15% based on body iron), selenium (2.5%), and vitamin B-12 deficiency (0%) were low compared with deficiencies of zinc (60%) and vitamin A (34%). The prevalence of inadequate intakes was &gt;50% for 7 micronutrients at 2 and 5 mo. Median milk concentrations for most micronutrients were below reference values, and nearly all declined between 2 and 5 mo postpartum and were not associated substantially with milk volume (except for β-carotene, α-carotene, and β-cryptoxanthin). At 5 mo postpartum, associations between maternal micronutrient status and corresponding milk concentrations reported as mean percentage difference in human milk concentration for each unit higher maternal biomarker were significant for hemoglobin (1.9%), iron biomarkers (ranging from 0.4 to 7%), RBP (35%), selenium (70%), and vitamin B-12 (0.1%), yet for maternal intakes only a positive association with β-carotene existed. Conclusions Most milk micronutrient concentrations declined during lactation, independent of changes in human milk production, and few were associated with maternal micronutrient intakes. The significant associations between maternal biomarkers and milk micronutrient concentrations at 5 mo warrant further study to investigate whether the declines in milk micronutrients are linked to shifts in maternal status.

scholarly journals Characterizing Micronutrient Status and Risk Factors among Late Adolescent and Young Women in Rural Pakistan: A Cross-Sectional Assessment of the MaPPS Trial

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1237
Author(s):  
Jo-Anna B. Baxter ◽  
Yaqub Wasan ◽  
Amjad Hussain ◽  
Sajid B. Soofi ◽  
Imran Ahmed ◽  
...  
Keyword(s):  
Young Women ◽  
Hierarchical Models ◽  
Vitamin A Deficiency ◽  
Health Concern ◽  
Nutritional Deficiencies ◽  
Deficiency Anemia ◽  
Micronutrient Deficiencies ◽  
Late Adolescent ◽  
Cross Sectional ◽  
Micronutrient Status

Nutritional deficiencies are a leading underlying risk factor contributing to the global burden of disease. In Pakistan, late adolescence is considered a nutritionally vulnerable period, as micronutrient requirements are increased to support maturation, and dietary staples are nutrient poor. However, there has been limited evaluation of micronutrient status beyond anemia and its determinants. Using cross-sectional data from late adolescent and young women (15–23 years) at enrolment in the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial, we aimed to describe the prevalence of key micronutrient deficiencies of public health concern, and generate hierarchical models to examine associations with proxies for social determinants of health (SDoH). The prevalence of micronutrient deficiencies was high: 53.6% (95% confidence interval (CI): 53.0–54.3%) had anemia; 38.0% (95% CI: 36.4–39.6%) iron deficiency anemia; 31.8% (95% CI: 30.2–33.3%) vitamin A deficiency; and 81.1% (95% CI: 79.8–82.4%) vitamin D deficiency. At least one deficiency was experienced by 91.0% (95% CI: 90.1–92.0%). Few SDoH were maintained in the final hierarchical models, although those maintained were often related to socioeconomic status (e.g., education, occupation). To improve the micronutrient status of late adolescent and young women in Pakistan, a direct micronutrient intervention is warranted, and should be paired with broader poverty alleviation methods.

scholarly journals Micronutrient Status of Young Adolescents in Rural Bangladesh: The JiVitA-1 Birth Cohort (FS01-04-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sarah Baker ◽  
Kerry Schulze ◽  
Lee Wu ◽  
Saijuddin Shaikh ◽  
Hasmot Ali ◽  
...  
Keyword(s):  
Vitamin D ◽  
Nutritional Status ◽  
Vitamin D Deficiency ◽  
Birth Cohort ◽  
Controlled Trial ◽  
Micronutrient Deficiencies ◽  
Z Score ◽  
Young Adolescents ◽  
Blood Draw ◽  
Micronutrient Status

Abstract Objectives We assessed micronutrient status in young rural Bangladeshi adolescents to determine prevalence of deficiency by sex, age, season and dietary pattern. Methods In a birth cohort of >30,000 youth in whom data on health, development, and nutritional status was collected in 2015–2017, venous blood was drawn from a ∼3% subsample (n = 991, 9–13 years old). Participants’ mothers had been in a cluster-randomized, placebo-controlled trial of daily antenatal beta-carotene or vitamin A supplementation in 2001–2007. Hemoglobin (Hb) was obtained at blood draw; plasma ferritin, folate, cobalamin (B12), homocysteine (Hcy), thyroglobulin (Tg), and C-reactive protein (CRP) were measured by chemiluminescent immunoassay, 25-hydroxyvitamin D [25(OH)D] by commercial immunoassay, and zinc by atomic absorption spectrometry. Results Participants were short (height-for-age Z-score −1.59 ± 0.93 in boys, −1.65 ± 0.98 in girls) and thin (BMI-for-age Z-score −1.49 ± 1.06 in boys, −1.28 ± 1.08 in girls). Anemia (Hb <120 g/L, 11.4%) was common but iron deficiency (ferritin <15 μg/L, 0.5%) was not. Folate (<6.8 nmol/L, 3.3%) and vitamin B12 (<150 pmol/L, 5.2%) deficiencies, elevated Hcy (>18 μmol/L, 0.8%) and inflammation (CRP >5 mg/L, 3.3%) were uncommon. However, deficiencies of vitamin D (25(OH)D < 50 nmol/L, 43.0%), iodine (Tg > 40 µg/L, 21.9%), and zinc (<8.6 µmol/L, 18.8%) were prevalent. Only vitamin D deficiency was more prevalent in girls than boys (54.0% versus 31.4%, P < 0.0001), doubling in girls from 32.5% at 10 to 69.7% at 13 years of age. Vitamin D deficiency was highest in winter and zinc deficiency highest during the monsoon. In preliminary analyses, micronutrient deficiencies were not significantly associated with dietary intake patterns derived from three 7-day food frequencies collected over ∼1 year. Conclusions Young adolescents in rural northern Bangladesh experienced anemia and vitamin D, iodine and zinc deficiencies; however, iron, folate, and B12 deficiencies, hyperhomocysteinemia, and inflammation were uncommon. Further resolution of dietary data and exploration of other contextual features may reveal specific risk factors for micronutrient deficiencies, informing our understanding of adolescent nutritional status in this setting. Funding Sources The Bill and Melinda Gates Foundation, Sight and Life.

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