Nutritional Deficiencies and Features of Nutritional Provision in Primary School Children

Introduction. The nutrition of primary school children does not always meet modern nutritional standards. The frequency of nutritional deficiencies, including calcium and vitamin D, among this age group remains unstudied. The aim of the study. To establish the characteristics of nutritional provision and the prevalence of nutrient deficiencies in the daily nutrition of primary school children, including calcium and vitamin D deficiencies and to propose methods of correction. Materials and methods. 5 consecutive stages of the study were conducted. At the first stage in 2019, the assessment of eating behavior in 190 children of grades 1-4 of two schools in the city of Lviv was conducted using a questionnaire. In the second stage, the features of the diet and ration and daily nutritional intake were determined using a special licensed program Dietplan 7 (UK). The analysis of daily nutrient intake was performed for 172 children. In the third stage, a study was conducted on the level of total, ionized calcium and 25-hydroxyvitamin D in the blood, and a study on the calcium content in the hair of 56 children with insufficient daily intake of calcium and / or vitamin D. In the fourth stage, 30 children with reduced levels of calcium in the hair were detected, differentiated correction measures were performed. To do this, the children were divided into two groups: the control group - 15 children whose deficiencies were corrected by diet modification, and the main group - 15 children - whose deficiencies were corrected by diet modification and the intake of calcium at a dose of 500.0 mg and vitamin D at a dose of 5.0 mg (200.0 IU) once a day for three months. In the fifth stage, to evaluate the effectiveness of treatment after three months of follow-up, all 30 children were re-analyzed for calcium content in the hair using atomic absorption spectrophotometry. Results. Appetite disturbance was observed in 28.9 % of schoolchildren, 17.4 % ate under duress, 14.3 % ate irregularly, 13.7% ate insufficient portions, 11.0 % were on different diets, many schoolchildren had eating disorders: ate before sleep (83.6 %), while watching TV (33.6 %). The diet was often unbalanced, children consumed insufficient fish (58.9 %), vegetables (43.2 %), dairy products (33.7 %), meat (26.8 %) Low calcium intake was observed in 50.6 % boys and 70.7 % of girls, vitamin D in 84.9 % of boys and 96.9 % of girls. Among children with a reduced daily intake of calcium and vitamin D, 42.9 % of children had a reduced level of total and / or ionized calcium, 48.2 % had a reduced level of vitamin D in the blood serum, and 53.6 % had a reduced calcium content in the hair. After 3 months of correction, we found that in the hair of children in the main group, who underwent dietary correction and were prescribed calcium and vitamin D, a significant increase in the average calcium content (up to 293.6 ± 80.6 mg/kg; p < 0.01) was observed, while in control group children who received only a modified diet, had only a tendency to increase the average amount of calcium in the hair (up to 185.14 ± 82.38 mg/kg; p > 0.05). Conclusions. For most primary school children, nutrition is unbalanced, which does not meet all the needs of a rapidly growing and intensively developing child's metabolism. A significant number of children have eating disorders: they do not eat regularly, do not eat enough food, eat food while watching TV, just before bed, do not have lunch at school, like fast food, 10% of students are on various diets. Almost a third of schoolchildren have a deficiency of daily intake of proteins, fats, carbohydrates and energy, and half of schoolchildren have a deficiency in the consumption of dietary fiber, polyunsaturated fatty acids and monounsaturated fatty acids. Most students have a daily deficiency of iodine, magnesium, selenium, iron and calcium, vitamin E, biotin, vitamin D, retinol, vitamin C, carotene, pantothenate. Among children with reduced daily intake of calcium and vitamin D in 42.9 % of children a reduced content of total and / or ionized calcium in the blood was found, and in 53.6 % of children in this group - in the hair. The use of a non-invasive method of studying the calcium content in the hair allows to determine the calcium deficiency in the child's body and control the process of its recovery. For children with insufficient daily intake of calcium and vitamin D, it is advisable to recommend a diet modification with increased consumption of milk, dairy products, yogurt and cheese, beans, spinach, broccoli, other leafy greens, wheat germ, nuts, sesame seeds, fish. To correct the existing calcium deficiency, it is advisable to use calcium supplements with vitamin D, combining this with a modification of the diet with an increase in food that contains the nutrients mentioned above. Keywords: schoolchildren, food deficiencies, calcium, vitamin D.

Risk factors for and effects of persistent and severe hypophosphatemia following ferric carboxymaltose

Context Hypophosphatemia, osteomalacia and fractures are complications of certain intravenous iron formulations. Objective To investigate risk factors for incident, severe and persistent hypophosphatemia, and associated alterations in bone and mineral biomarkers following intravenous iron treatment. Design Secondary analysis of the PHOPHARE-IDA randomized clinical trials. Setting Thirty outpatient clinics in the United States. Patients 245 patients aged 18 years or older with iron deficiency anemia. Interventions Intravenous ferric carboxymaltose (FCM) versus ferric derisomaltose (FDI). Main Outcome Measures Serum phosphate, intact fibroblast growth factor-23 (iFGF23), 1,25-dihydroxyvitamin D (1,25(OH)2D), ionized calcium, parathyroid hormone (PTH), and alkaline phosphatase. Results FCM was the only consistent risk factor for incident hypophosphatemia (&lt;2.0 mg/dl; odds ratio versus FDI: 38.37; 95% confidence interval [CI]: 16.62, 88.56; p&lt;0.001). Only FCM-treated patients developed severe hypophosphatemia (&lt;1.0 mg/dl; 11.3%; 13/115) or persistent hypophosphatemia (&lt;2.0 mg/dl at study end; 40.0%; 46/115). More severe hypophosphatemia associated with significantly greater increases in iFGF23, PTH, and alkaline phosphatase, and more severe decreases in 1,25(OH)2D and ionized calcium (all p&lt;0.05). Patients with persistent versus resolved hypophosphatemia demonstrated significantly greater changes in iFGF23, PTH, 1,25(OH)2D and N-terminal procollagen-1 peptide levels (all p&lt;0.01), but alkaline phosphatase increased similarly in both groups. Conclusions Treatment with FCM was the only consistent risk factor for hypophosphatemia. Patients who developed severe or persistent hypophosphatemia after FCM treatment manifested more severe derangements in bone and mineral metabolism. Changes in bone biomarkers continued beyond resolution of hypophosphatemia, suggesting ongoing effects on bone that may help explain the association of FCM with osteomalacia and fractures.

Association of Vitamin D and Calcium Levels in E-waste Workers and Environmentally Exposed Participants in Southwestern Nigeria

Exposure to e-waste either by occupation or through the environment have been implicated in cancer development. The growing influx of e-waste to Nigeria and inadequate recycling, part salvaging, distribution and disposal of discarded or obsolete electronic devices is creating new sets of environmental and public health challenges. This study investigated the effect of exposure on vitamin D (25(OH) Vit D), total and ionized calcium levels in workers and individuals environmentally exposed to e-waste in Lagos, Benin and Ibadan cities in Southwestern Nigeria. Six hundred and thirty-two participants from three major cities in Nigeria were recruited for this study. They included e-waste workers, environmental e-waste exposed individuals and age matched unexposed individuals. 25(OH) Vit D was determined using ELISA, while total and ionized calcium by colorimetric method. Total calcium (tCa) in e-waste workers was significantly different from environmental exposed groups (p=0.000) while ionized calcium (iCa) was significantly increased for both e-waste exposed groups when compared with the unexposed group. 25(OH)Vit D level was significantly increased in e-waste workers compared with environmental and unexposed populations (p<0.001). Optimal levels of tCa, iCa and vitamin D in the e-waste exposed population may offer some forms of defense against the severity of existing and undiagnosed cancers or reduce the risk of cancer development in the e-waste exposed participants. However, e-waste may unfavourably modulate these expected beneficial roles in the e-waste exposed populations with continued exposure.

Assessment of the prevalence of anemia in patients with primary hyperparathyroidism: a single-center observational study

BACKGROUND: The combination of primary hyperparathyroidism (PHPT) with anemia was first described in 1931. It remains unclear whether PHPT is the direct cause of anemia, or it develops due to PHPT’s complications. The frequency of PHPT-­associated anemia in the Russian population is unknown.AIM: To assess the prevalence of anemia in patients with PHPT admitted to the Department of Parathyroid Glands Pathology in the Endocrinology Research Centre from January 2017 to August 2020.MATERIALS AND METHODS: The study included patients with PHPT over 18 years old. A single-center observational one-stage one-sample uncontrolled study was carried out. We analyzed laboratory and instrumental data obtained during inpatient examination in accordance with the standards of medical care. Statistical analysis was performed using Statistica 13 (StatSoft, USA) and SPSS (IBM, USA) software packages.RESULTS: The study included 327 patients with PHPT, 28 (9%) men and 299 (91%) women. The median age was 59 years [51; 66]. 26 patients (8%) with anemia were identified. Statistically significant differences between patients with and without anemia were found only in the GFR. Comparison of patients with and without anemia didn’t reveal any significant differences in the incidence of PHPT’s complications.Significant differences in serum hemoglobin concentration and average hemoglobin concentration in erythrocytes were revealed between patients with and without vertebrae fractures. In the group of patients without compression fractures these parameters were higher.In the subgroup of patients with total calcium concentration above 3 mmol/L and PTH above 3 normal values, the incidence of anemia reached 21% (95% CI: 10%; 35%). Within this group we revealed tendencies to higher levels of PTH, ionized calcium and osteocalcin in patients with anemia.CONCLUSION: In general, there was no correlation between hypercalcemia, the degree of PTH elevation and the presence of anemia in patients with PHPT. However, in the subgroup of patients with severe hypercalcemia, there was a relationship between the concentration of PTH, ionized calcium and the presence of anemia. In patients with PHPT and vertebral fractures, significantly lower concentrations of blood hemoglobin and hemoglobin in erythrocytes were observed.

Osteopathy incidence in children and adolescents consuming drinking water with high content of natural strontium

Introduction. Excessive intake of heavy metals of natural origin with drinking water increases the risk of the formation of non-infectious diseases of systems and organs, depending on the tropism of the chemical compound. The aim is to study the incidence of disorders of bone density and structure (osteopathies) in children and adolescents who consume drinking water with an increased strontium content due to the geochemical characteristics of the territory. Materials and methods. The observation group consisted of 93 children living in a geochemical province with a stable strontium content of more than 2 MPC in the centralized drinking water supply system. The comparison group included 148 children living in an area where strontium concentration in drinking water does not exceed 1 MPC. The incidence evaluation was carried out according to the official data of statistical materials. The analysis of the average values of the concentration in the blood of strontium, ionized calcium, inorganic phosphorus and alkaline phosphatase activity and the frequency of deviations from the norm of the studied parameters was carried out in the studied groups. The value of bone mineral density (Z-index) was determined according to the results of ultrasonic densitometry. Results. The level of long-term incidence of osteopathies for the period 2010-2019 in children and adolescents, the observation area was 6.59 ± 1.32 and 11.26 ± 2.07 ‰, respectively, which was 1.8 and 2.0 times higher than the level of the comparison territory (p = 0.0003-0.0004 ). The concentration of strontium in the blood of children living in the territory of the geochemical province exceeded 2.1 times the permissible reference (p <0.001) and 2.9 times the index of the comparison group (p = 0.0001). In ¾ children of the observation group, increased content of strontium in the blood was recorded, which was 5.2 times more often than the comparison area (p <0.001). In 57% of cases, the children of the observation group had a reduced level of ionized calcium in the blood (p = 0.0001). Low bone mineral density (Z-index) in the observation group occurred 2.3 times more often (17.2 versus 7.4%, p = 0.019). Significant dependences were established by lowering the level of ionized calcium and the value of the Z-index with increasing strontium content in the blood. Conclusion. In children living in geochemical provinces with an elevated strontium content, an increase in the incidence of osteopathy was noted, manifested by a reduced level of ionized calcium in the blood and low bone mineral density, which must be taken into account for the timely diagnosis and prevention of these conditions.

Ionic homeostasis, acid-base balance and the risk of citrate accumulation in patients after cardiovascular surgery treated with continuous veno-venous haemofiltration with post-dilution regional citrate anticoagulation – An observational case-control stud

Background: Patients after cardiovascular surgery, requiring renal replacement therapy, can benefit from adequate non-heparin circuit anticoagulation. Simplified regional citrate anticoagulation (RCA) protocol proposes the use of citric acid dextrose formula A (ACD-A) during post-dilutional continuous veno-venous hemofiltration (CVVH) with standard bicarbonate buffered calcium containing replacement solution. Citrate accumulation diagnosed upon total to ionized calcium ratio (tCa/iCa) and low ionized calcium (iCa) are considered as the biggest risks related to regional citrate accumulation. Methods: This prospective observational case-control study evaluated electrolyte and acid-base homeostasis in cardiovascular surgery patients treated with post-dilution CVVH with a simplified RCA protocol with ACD-A. In total, 50 consecutive cardiovascular surgery patients were evaluated. Base excess, pH, bicarbonate, lactate, Na+, Cl-, Mg++, and inorganic phosphate concentrations, the total to ionized calcium ratio (tCa/iCa), and high anion gap metabolic acidosis were assessed during haemofiltration treatment in survivors and non-survivors. Results: Thirty-three (66%) patients died. The therapies were very well balanced in sodium and chloride homeostasis. The lactate concentration and anion gap decreased during CVVH sessions lasting longer than 72 hours, but no inter-group difference was observed. The tCa/iCa ratio exceeded 4.5% and was significantly higher in non-survivors (p=0.037). Initial lactate concentration did not correlate with tCa/iCa ratio during haemofiltration. Magnesium and phosphate concentrations decreased and additional supplementation with magnesium was necessary. The magnesium concentration was lower in the non-survivors. Conclusions: The incidence of citrate accumulation exceeded 4% and was significantly higher in non-survivors. Supplementation with magnesium and phosphate ions is needed in CVVH with RCA.

Predicting ionized hypocalcemia: External validation of an ionized calcium prediction model in patients with COVID-19 and renal failure

Background Ionized hypocalcemia is common in critically ill patients with COVID-19 and is associated with adverse outcomes. We previously developed a linear model that estimates ionized calcium (ICa) by adjusting total calcium (TCa) for the three components of the anion gap and albumin. On internal validation, it outperformed the popular method that corrects TCa for albumin alone (cTCa) in diagnosing low ICa. In this study, we sought to externally validate our ICa model in hospitalized COVID-19 positive patients. Methods We retrospectively studied all 200 patients with COVID-19 who were admitted to the State University of New York Downstate Medical Center between March 11th and April 30th 2020 and referred to the nephrology service for renal failure, and who had ICa measured on a venous blood gas within 25 min of a comprehensive metabolic panel. We compared the performance of the ICa model and cTCa in diagnosing low ICa by ROC analysis, and also examined the accuracy of the absolute values predicted by the two methods relative to measured ICa. Results On ROC analysis, the ICa model was better than cTCa (area under ROC curve: 0.872 [0.025] vs. 0.835 [0.028]; p = 0.045). The ICa model estimated ICa accurately, but the cTCa method seemed to overcorrect TCa, as a substantial number of patients with clearly normal cTCa values had low ICa. Conclusions In an external validation cohort, the ICa model estimated ICa accurately and was better than cTCa in the diagnosis of low ICa. This finding can be useful in guiding direct ICa testing.