Prevalencia de ingesta inadecuada de micronutrientes en la población urbana de Costa Rica / Micronutrients inadequacy in urban population of Costa Rica

La inadecuación de micronutrientes es frecuente en los países en vías de desarrollo. En Costa Rica existe poca información acerca de la ingesta de micronutrientes y del impacto de los programas de fortificación obligatoria de alimentos. El objetivo de este estudio fue evaluar la ingesta de vitaminas y minerales y el aporte de la fortificación de alimentos a la ingesta total de micronutrientes en la población urbana costarricense. Se analizó el consumo de alimentos en una muestra de la población urbana costarricense, participantes del Estudio Latinoamericano de Nutrición y Salud (ELANS). El riesgo de ingesta inadecuada se estimó según sexo y grupo de edad, utilizando el método de punto de corte del Requerimiento Medio Estimado (EAR). Para el hierro, se utilizó el método de aproximación probabilística. Más del 85% de la muestra presentó riesgo de ingesta inadecuada para vitamina E, calcio y vitamina D. Una menor prevalencia de riesgo de ingesta inadecuada se presentó para la niacina, tiamina, folatos, hierro y selenio. La fortificación de alimentos tiene un efecto notorio en la ingesta de micronutrientes, especialmente de hierro, niacina, tiamina y folatos. La ingesta de calcio, vitamina D y vitamina E es preocupantemente inadecuada, siendo las mujeres y las personas mayores de 50 años los grupos más afectados. Resulta fundamental el establecimiento de programas y políticas públicas para asegurar el cumplimiento del requerimiento establecido para los diferentes micronutrientes(AU)

Micronutrient deficiencies are still very common in developing countries. In Costa Rica there is little information on micronutrients intake and the impact of food fortification.This study aimed to determine the contribution of food fortification to the total intake, and to estimate the risk of inadequate intake of vitamins and minerals in an urban Costa Rican population. As a part of the Latin American Nutrition and Health Study, we analyzed data from a nationally representative sample of 798 urban residents from Costa Rica (15-65 years old) whom provided two 24-h dietary recalls. The prevalence of inadequate micronutrient intake was estimated according to the EAR cut-point method. Iron was analyze using the probability approach. We observed a 100% of the sample are at risk of inadequate intake of vitamin D, and similar percentages were obtained for calcium and vitamin E, ranging from 92.9 to 100% and 85.5 to 99.2% respectively. A lower risk of inadequate intake was observed for niacin, thiamin, folate, iron and selenium. Food fortificationmakes an important contribution to folate, thiamin, iron and niacin intake. Despite the efforts that have been made to ensure adequate micronutrient intake in Costa Rica, the intake of calcium, vitamin D and vitamin E is still very low, especially among women and people over 50 are the most affected. Based on the above, it is recommended to promote a healthy diet through nutritional education as part of public health policies, in order to facilitates compliance to nutritional requirement(AU)

Mechanical Thrombectomy Using Retrievable Stents in Pediatric Acute Ischemic Stroke

Objectives: To report efficacy and outcome of mechanical thrombectomy for treatment ofpediatric acute ischemic stroke with large vessel occlusion using stent retrievers. Methods:Retrospective record review of institutional database for patients <18 years of age. Results:Five boys aged between 6 to 17 years received reperfusion therapy using mechanicalthrombectomy for acute ischemic stroke with large vessel occlusion (2 basilar, 2 middlecerebral and 1 internal carotid artery). Pediatric National Institute of Health Stroke Scale(PedNIHSS) at onset ranged from 12 to 21. Complete recanalization as defined by themodified Treatment In Cerebral Infarction scale (mTICI 3 or 2b) was achieved in all, usingstent retreivers. Favorable outcome as per the modified Rankin scale (mRS 0-1) wasachieved in all with no peri-procedural complications. Conclusions: Mechanicalthrombectomy using retrievable stents is a safe and effective therapy for pediatric ischemicstroke due to large vessel occlusion, and may be offered in carefully selected patients.

Meta-analysis of efficacy of iron and iodine fortified salt in improving iron nutrition status

Background: Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. Objective: To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. Methods: Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. Results: Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference ?0.16; 95% CI: ?0.26, ?0.06) and ID (risk difference ?0.20; 95% CI: ?0.32, ?0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 ?g/L; 95% CI: ?0.12, 1.37), serum TfR levels (mean difference ?0.23 mg/dL; 95% CI: ?0.85, 0.38), and IDA (risk difference ?0.08; 95% CI: ?0.28, 0.11). Conclusion: DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

A feasibility study of multiple micronutrient supplement for home fortification of foods among Orang Asli children in Negeri Sembilan, Malaysia

@# Introduction: The prevalence of child undernutrition and micronutrient deficiencies are higher in the Orang Asli (OA) than the general Malaysian population. The World Health Organization recommends the use of multiple micronutrient supplement (MMS) that is a blend of micronutrients in powder form that can be sprinkled onto foods for home fortification to prevent undernutrition among children. This pilot study aimed to assess the feasibility of using MMS among OA children. Methods: A total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2 months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks. Caregivers were instructed to add MMS to three types of food from the same food group per week varying with a different food group weekly. Written instruction for using MMS in simple language was given prior to the supplementation. Caregivers were interviewed for information on socio-demographics, compliance, acceptance, preference and adverse effect of MMS. Results: A high level of compliance was observed (85%). All caregivers reported that the instructions for use were easy to read. No noticeable changes to the foods mixed with MMS were observed and no adverse effects were reported. Conclusion: This study demonstrated feasibility of the use of MMS for future trials among OA children. The easy to read information that comes with the MMS, frequent monitoring of MMS use and support to caregivers were required to ensure compliance. Cultural feeding practices and financial constraints may limit the types of food that can be mixed with MMS.

Folatos y embarazo, conceptos actuales: ¿Es necesaria una suplementación con Acido Fólico? / Folate and pregnancy, current concepts: It is required folic acid supplementation?

El aporte de folatos durante el embarazo es esencial para un desarrollo fetal y placentario adecuados y para la salud del individuo a largo plazo. Su deficiencia puede inducir alteraciones y patologías fetales como bajo peso al nacer, recién nacidos de pre término y defectos del tubo neural (DTN). Por ello, varios países han decidido implementar políticas públicas de fortificación de alimentos con ácido fólico (AF). Chile inició la fortificación de la harina de trigo con AF en el año 2000, logrando reducir en un 43% la prevalencia de DTN. Sin embargo, además de la elevada ingesta de pan de nuestra población (principal alimento fortificado con AF), muchas mujeres embarazadas consumen suplementos de AF, lo que podría estar superando las concentraciones máximas de AF recomendadas. Adicionalmente, si la dieta materna es reducida en vitamina B12 (vit B12), se alteraría la razón óptima folatos/vit B12 lo que modificaría la metilación de genes específicos y otras vías metabólicas pudiendo afectar el desarrollo fetal y la salud de los recién nacidos a largo plazo. Creemos que, transcurridos 17 años del inicio de la fortificación de la harina de trigo con AF, es necesario evaluar los posibles efectos secundarios de un alto consumo de AF, no solo durante el embarazo, sino también en la población general. Presentamos antecedentes acerca del mecanismo de acción de folatos y vit B12 a nivel celular, y conceptos actuales sobre las posibles consecuencias de un aporte materno elevado de AF sobre la descendencia.

Folate intake during pregnancy is essential for an adequate fetal and placental development and for the long time health of the individual. Its deficiency may induce fetal pathologies, including neural tube disease (NTD). Therefore, several countries implemented public policies to fortify foods with folic acid (FA). Chile started the fortification of wheat flour with FA in the year 2000, decreasing a 43% the prevalence of NTD. However, despite the high consumption of bread (the main fortified food with FA) by our population, a high number of pregnant women consume FA supplements, thus, over passing the maximal recommended FA intake. Additionally, if the diet is reduced in vitamin B12, the optimal ratio folates/vit B12 may be altered, thus inducing changes in the methylation of specific genes and other metabolic pathways, affecting fetal development and the long-term health of the neonates. We think that, after 16 years of the initiation of the fortification of wheat flour with FA, it is necessary to evaluate the possible side effects of a high intake of FA in the pregnant population and their offspring. This article shows antecedents about mechanisms of folates and vit B12 at cellular level, and their possible consequences of an elevated FA maternal intake on the offspring.

Prevalencia de defectos del tubo neural y estimación de casos evitados posfortificación en Argentina / Prevalence of neural tube defects and estimation of cases averted in the post-fortification period in Argentina

La ingesta periconcepcional de ácido fólico ha demostrado ser efectiva en la reducción de la frecuencia de defectos del tubo neural, y la fortificación de los alimentos ha sido una estrategia para incrementarla. Se presenta una actualización de la reducción de las prevalencias de defectos del tubo neural posfortificación en Argentina y la estimación de los casos evitados en el período 2005-2013 como consecuencia de esta intervención. Al comparar la prevalencia observada en el período posfortificación con la reportada en el período de prefortificación, se observa un descenso significativo de 66% para anencefalia y encefalocele, y de 47% para espina bífida. El número de casos evitados estimados fue mayor para anencefalia, seguido por espina bífida; encefalocele presentó el menor número de casos evitados, dado que la prevalencia de este defecto fue menor. El descenso de la prevalencia observado apoya los resultados de estudios previos sobre el efecto de la fortificación.

Periconceptional intake of folic acid has demonstrated to be effective to reduce the frequency of neural tube defects, and food fortification has been one of the strategies implemented to increase it. An update is herein presented on the reduced prevalence of neural tube defect cases in the post-fortification period in Argentina and an estimation of cases averted in the 2005-2013 period as a result of this intervention. When comparing the prevalence observed in the post-fortification period to that reported in the pre-fortification period, anencephaly and encephalocele decreased by 66%, and spina bifida, by 47%, which were significant reductions. The estimated number of cases averted was higher for anencephaly, followed by spina bifida; encephalocele showed the lowest number of cases averted given that the prevalence of this defect was smaller. The decrease observed in the prevalence supports findings from previous studies on the impact of fortification.

Effect of NaFeEDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To assess the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA)-fortified soy sauce on anemia prevalence in the Chinese population.</p><p><b>METHODS</b>A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations.</p><p><b>RESULTS</b>After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 (95% CI 0.19-0.35). For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L (95% CI 5.96-11.67).</p><p><b>CONCLUSION</b>NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.</p>

Análisis de la politica pública de fortificación de alimentos con hierro en Perú en el periodo 2000 - 2012 / Analysis of public policy of food fortification with iron in Peru in the period 2000 - 2012

El gobierno peruano desde 1996 ha comenzado a reglamentar la fortificación dealimentos con hierro como una estrategia para disminuir la prevalencia de anemia en la población peruana, en el año 2004 y 2006, en forma obligatoria se incrementa losniveles de fortificación con hierro en la harina de trigo, el presente estudio tiene como Objetivo Realizar un análisis de los alimentos consumidos por la población peruana para identificar posibles vehículos de fortificación con hierro, asi como las barreras y los facilitadores de la política pública Metodología.- Se analizó cuantitativamente dos encuestas de consumo de alimentos, se realizaron entrevistas a actores de la política publica para identificar las barreras y facilitadores de la política pública y se hizo una revisión bibliográfica de los potensiales alimentos vehículos de fortificación con hierro. Resultados Del análisis de las dos encuestas de consumo se encontró alimentos a ser considerados posibles vehículos de fortificación con hierro: el agua (como bebida eingrediente de preparaciones), la sal, el arroz, el azúcar y las leches (evaporada y frescaentera), las barreras mas mencionadas por los actores que están involucrados en el proceso estan relacionadas a costos de la fortificación de alimentos y como facilitadores al conocimiento acerca de anemia y deficiencia de micronutrientes (especialmente enhierro). Conclusiones.- Hay alimentos identificados como vehículos potenciales de la fortificación con hierro, que han demostrado un efecto positivo y es necesario generar compromisos entre los actores involucrados en la política pública de la fortificación de alimentos para avanzar en el tema...

The Peruvian government since 1996 has begun to regulate iron fortification as astrategy to reduce the prevalence of anemia in the Peruvian population, in 2004 and2006, mandatory fortification levels of iron increases in flour wheat. ObjectivePerformed an analysis of the food by the Peruvian population to identify possiblevehicles of iron fortification, as well as identify the barriers and enhancer of publicpolicy Methodology -. Two surveys of food consumption are quantitatively analyzed,interviews with actors of public policy were conducted to identify barriers and enhancerof public policy and scientific literature was reviewed about potentials iron foodfortification. Results The analysis of two surveys foods showed potential vehicles ofiron fortification: water (beverage and ingredient preparations), salt, rice, sugar and milk(evaporated and whole fresh), the most mentioned barrier is the fortification costs andthe most enhancer is the knowledge about anemia and deficiency of micronutrients(particularly focus in iron). Conclusions -. There are foods identified potential vehiclesof iron fortification, that have showned a positive effects and it is necessary to generatecompromises between the actors involved in the public policy of food fortification toadvance the issue...

Vitamin D Status in Korea

The majority of the vitamin D in our body is produced by cutaneous synthesis in response to sunlight. As more and more people live in cities and spend the bulk of their time indoors, it can be difficult to get sufficient sun exposure for adequate cutaneous production of vitamin D. Therefore, vitamin D insufficiency has become a very common health problem worldwide. The Korea National Health and Nutrition Examination Survey IV 2008 showed that the prevalence of vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D [25(OH)D] level below 50 nmol/L, was 47.3% in males and 64.5% in females. Only 13.2% of males and 6.7% of females had a serum 25(OH)D level of greater than 75 nmol/L. In Korea, vitamin D insufficiency was more prevalent in young adults than in elderly people, likely due to the indoor lifestyle of younger people. Compared with the United States and Canada, Korea has a lower mean 25(OH)D level and a higher prevalence of vitamin D insufficiency. To improve the vitamin D status of the Korean population, more aggressive policies on food fortification and vitamin D supplementation are needed.

Disponibilidad potencial in vitro de hierro y zinc en una dieta infantil con pan fortificado con distintas fuentes de hierro o con agregado de promotores de la absorción / Iron and zinc in vitro potential availability in an infant diet with fortified bread with different iron sources or with the adition of different iron absorption promoters

Los alimentos complementarios más utilizados son las dietas caseras. En el presente trabajo se evaluó la disponibilidad de hierro y zinc en una dieta infantil de consumo habitual conteniendo pan fortificado con diferentes fuentes de hierro: sulfato ferroso, bisglicinato ferroso, NaFeEDTA. También se utilizó pan sin fortificar con agregado de ácido ascórbico, citrato de sodio o Na2EDTA como promotores de la absorción, combinada con diversas bebidas. La dieta (papa, zapallo, sémola, pan y manzana) se combinó con agua, leche, té, bebida cola y bebida artificial a base de naranja. La dializabilidad (D) mineral, como indicador de la disponibilidad potencial fue determinada utilizando un método in vitro. El análisis estadístico se realizó utilizando ANOVA, con test de Tukey a posteriori. No hubo diferencias significativas en la DFe entre las dietas del pan fortificado con sulfato o bisglicinato; con el NaFeEDTA aumentó significativamente (p<0,05). El aumento de la DFe fue mayor en las dietas que tenían panes con promotores que en las que tenían panes fortificados. La bebida a base de naranja aumentó la DFe, mientras que el té y la leche la disminuyeron significativamente (p<0,05). La DZn aumentó en forma significativa cuando el pan estaba fortificado con sulfato o NaFeEDTA, pero no cuando se fortificó con bisglicinato. El agregado de té o leche disminuyó la DZn mientras que la bebida a base de naranja la aumentó significativamente (p<0,05). En relación a los promotores, las mayores DFe y DZn se observaron en las dietas con el pan sin fortificar, con agregado de Na2EDTA.

Home-made diets are the most frequently used complementary foods. In the present work we evaluated iron and zinc availability in a usually consumed infant diet containing either iron-fortified bread with different iron sources: ferrous sulfate, ferrous bisglycinate, NaFeEDTA. We also used non-fortified bread with absorption promoters: ascorbic acid, sodium citrate, Na2EDTA, combined with different beverages. The diet (potato, pumpkin, grits, bread, and apple) was combined with water, milk, tea, a soft drink and an orange-based artificial drink. Mineral dialyzability (D) as an indicator of potential availability was determined using an in vitro method. Statistical analysis was performed by ANOVA, and a posteriori Tukey test. There were no significant differences in FeD between diets with ferrous sulfate or ferrous bisglycinate fortified bread; in NaFeEDTA fortified bread it increased significantly (p<0.05). Iron D increase was greater in diets with bread containing absorption promoters than in those with fortified bread. The orange-based artificial drink increased FeD, while tea and milk decreased it significantly (p<0.05). Zinc D increased significantly when the bread was fortified either with ferrous sulfate or NaFeEDTA, but remained unchanged in diets with ferrous bisglycinate fortified bread. The addition of tea or milk decreased ZnD while the orange-based artificial drink increased it significantly (p<0.05). Regarding absorption promoters, the greater values both in FeD and ZnD were observed in diets with iron nonfortified bread containing Na2EDTA.

Associação da deficiência de ácido fólico com alterações patológicas e estratégias para sua prevenção: uma visão crítica / Association between folic acid deficiency and disease and prevention strategies: a critical view

A deficiência de ácido fólico está associada às doenças crônicas não-transmissíveis, complicações na gestação e doenças neurodegenerativas. Objetivou-se discutir o papel do ácido fólico na prevenção de doenças, os aspectos epidemiológicos de sua deficiência, fortificação dos alimentos e suplementação medicamentosa. Realizou-se levantamento bibliográfico, consultando as bases de dados para a obtenção dos artigos completos: MedLine, SciELO, PubMed, Highwire Press e Science Direct. Foram selecionados estudos realizados com seres humanos publicados entre 2004 e 2010. O ácido fólico é importante para as reações de metilação do ácido desoxirribonucléico, prevenção da hiper-homocisteinemia e atua como antioxidante. A deficiência dessa vitamina é descrita em adolescentes, mulheres em idade fértil, gestantes e em idosos. Seu alcance pela dieta é difícil, sendo necessária a inclusão de alimentos fortificados ou suplementos. É importante avaliar o estado nutricional de ácido fólico dos indivíduos antes e após a adoção dessas estratégias, de modo a gerar subsídios para ela-boração de medidas governamentais mais adequadas e eficazes. Destacamos ainda a necessidade da reeducação nutricional para a população brasileira a fim de aumentar o consumo de alimentos fontes de ácido fólico.

Folic acid deficiency is associated with non-communicable chronic diseases, pregnancy-associated complications and neurodegenerative diseases. The objective of this paper was to discuss the role of folic acid in disease prevention, the epidemiological aspects of its deficiency and food fortification and supplementation. Articles were searched in the following databases: MedLine, SciELO, PubMed, Highwire Press and Science Direct. Only original studies with humans published between 2004 and 2010 were included. Folic acid is important for DNA methylation and prevention of hyperhomocysteinemia. It also presents antioxidant activity. Folic acid deficiency has been described in adolescents, women of childbearing age, pregnant women and the elderly. It is difficult to meet the folic acid requirement with diet alone, so fortified foods and supplements are necessary. It is important to assess folic acid levels before and after the implementation of such strategies to enable the development of better and more effective public strategies. It is also important to provide nutrition education for the Brazilian population for them to increase their consumption of dietary sources of folic acid.

Prevalência de anemia em crianças, antes e durante a participação em programa de fortificação alimentar com ferro / Prevalence of anemia in children, before and during participation in the iron fortification program

The objective of this study was to compare the prevalence of anaemia inchildren, before and after 6 months consuming iron-fortifi ed milk suppliedby Vivaleite Project, together with nutritional information. The present studywas developed in Itapeva, Piracicaba, São José dos Campos, Taubaté andSão Paulo, cities which were selected because of the signifi cant increase inthe number of children included in Vivaleite Project. A total of 399 children,aged 6 to 36 months, were included in the study. A questionnaire wasapplied to get information about the family and the child. The diagnosisof anemia was achieved through the dosage of hemoglobin concentrationin blood, using HemoCue® diagnostic kit and the critical value of 11.0g/dLadopted by WHO. Statistical analyses used the Student t test and Pearson X2test with p<0,05. This study found a signifi cant difference (p<0.05) betweenhemoglobin levels before (10.18g/dL) and after (10.99g/dL) six monthsconsuming fortifi ed milk supplied by Vivaleite Project. There was an increaseof 0.81g/dL in children hemoglobin levels. Also, there was a signifi cantdecrease (p<0.05) in the prevalence of anemia among children, that is,38.8% of the children with anemia in the beginning of the study were notanemic at the end. The effectiveness of the intervention proposed by VivaleiteProject on the control of martial defi ciency is well documented. The proposedintervention should also be accompanied by constant nutritional counseling,such as the one provided in this study, which probably contributed to thesuccess of the program.

El objetivo de este estudio fue comparar la prevalencia de anemia en niños, antes y después de 6 meses de consumo de leche reforzado conhierro, del Programa "Vivaleite", acompañado de orientación nutricional. El estudio fue realizado en Itapeva, Piracicaba, São José dos Campos, Taubaté y São Paulo, ciudades brasileñas seleccionadas por presentar unaumento significativo del numero de niños beneficiados por el Programa. La muestra constaba de 399 niños, de 6 a 36 meses de edad.La colecta de datos de los niños y de la familia fue realizada mediante aplicación de formulario. El diagnóstico de anemia fue efectuado pordeterminación de la hemoglobina, utilizando el equipo HemoCue®, y el valor crítico propuesto por la Organización Mundial de la Salud (OMS)de 11,0g/dL. Los niveles medios de concentración de hemoglobina fueron comparados por los testes t-student y Pearson X2, con nivel de correlación significativa de 5%. Fue detectada una diferenciasignificativa (p<0,05) entre las concentraciones de hemoglobina antes (10,18g/dL) y después del consumo de leche del Programa ?Vivaleite?(10,99g/dl), verificándose un aumento de 0,81g/dL en los índices de hemoglobina. Esto resultó en una disminución significativa(p<0,05) en la prevalencia de niños con anemia, de manera que el 38,8% de los niños que presentaban anemia al inicio del estudio noeran anémicos al final del mismo. Está muy bien documentada la efectividad de la intervención propuesta por el Programa "Vivaleite" para elcontrol de la deficiencia, la cual debe ser acompañada de orientación nutricional permanente, como la realizada en este trabajo, que probablemente fue motivo del éxito del programa.

O trabalho objetivou comparar a prevalência de anemia de crianças, antes e após 6 meses de consumo de leite fortifi cado com ferro, do Projeto Vivaleite, acompanhados de orientação nutricional. O estudo foi realizado em Itapeva, Piracicaba, São José dos Campos, Taubaté e São Paulo, locais selecionados devido ao aumento representativo do número decrianças benefi ciadas pelo Projeto. A amostra foi constituída de 399 crianças, de 6 a 36 meses de idade. Os dados da criança e da família foram obtidos mediante aplicação de formulário. O diagnóstico da anemia foi efetuado por meio da dosagem de hemoglobina, utilizando-se o aparelho HemoCue® e o valor crítico proposto pela OMS, de 11,0g/dL. Os níveis médios de concentração de hemoglobina foram comparados pelo Teste T Pareado e Qui-quadrado de Pearson, com nível de significância de 5%. Foi encontrada diferença significativa (p<0,05) entre as concentrações de hemoglobina antes (10,18g/dL) e após oconsumo do leite do Vivaleite (10,99 g/dL), verifi cando-se um incremento de 0,81g/dL nos índices de hemoglobina. Ainda, houve uma diminuição significativa (p<0,05) na prevalência de crianças com anemia, ou seja,38,8% das crianças que apresentavam anemia no início do estudo não estavam anêmicas no final. Está bem documentada a efetividade daintervenção proposta pelo Vivaleite no controle da deficiência marcial, sendo que a proposta deve ser acompanhada por atividades deorientação nutricional constante, como as aplicadas neste trabalho o que, provavelmente, motivou o sucesso do programa.

Increased Folate Intake is Recommended / 日本補完代替医療学会誌

Folic acid antagonists, which include such common drugs as trimethoprim, triamterene, carbamazepine, phenytoin, phenobarbital and primidone, may increase the risk not only of neural-tube defects but also of cardiovascular defect, oral clefts, and urinary tract defects. Folate supplementation before conception and during the first trimester reduces the risk of having infants with neural-tube defects and has the potential to reduce the risk of having infants with other congenital malformations and Down’s syndrome. Long-term use of multivitamins containing folic acid may reduce risks for hypertension, colon cancer, and breast cancer. The fortification of enriched grain products with folic acid also reduces the number of middle-aged and older adults with hyperhomocyteinemia, which is known to be a risk factor for deep-vein thrombosis, myocardial infarction, dementia and Alzheimer’s disease, congestive heart failure, and osteoporotic fracture. Therefore, folate supplementation has the potential to reduce the risk of a wide variety of conditions and diseases. For example, treatment with folate and mecobalamin (B12) reduced risk of hip fracture successfully in elderly patients with hemiplegia following stroke in a Japanese population. However, compared with specifically supplemented/fortified foods, consumption of naturally-occurring levels of folate in non-supplemented/fortified foods has been shown to be relatively ineffective at increasing folate status. Therefore, advice to consume folate-rich foods as a means of optimizing folate status may be misleading. Rather, increased folate intake with supplements is highly recommended.<br>

HPLC analysis of nicotinamide, pyridoxine,riboflavin and thiamin in some selected food products in Nigeria

Food fortification is an important tool for improving the health of the population. Motivated by this; the National Agency for Food and Drug Administration and Control (NAFDAC) has in the past few years embarked on a campaign to create this awareness. There has been varying degree of compliance to this; and so it is of utmost importance to know the food products that contribute significantly to the dietary vitamin B intake. This study investigates the amount of four Vitamin B compounds; namely nicotinamide; pyridoxine; riboflavin and thiamin; present in different packaged food items available in Lagos metropolis of Nigeria. The food items analyzed include dairy products; fruit juices and cereal products. These foods were chosen because of their widespread consumption in the area. The analysis was done using a high performance liquid chromatographic technique with a UV detector. The separation was carried out on a C18 column; using a mobile phase made up of 70buffer (a solution of sodium salt of hexane sulphonic acid) and 30HPLC grade methanol. The identification was based on retention time match against a standard while the quantitation was based on the peak area match against those of a standard. The calibration curves for the standards were linear with a linear regression coefficient close to unity

Current Status of Nutrient Fortification in Processed Foods and Food Fortification Policies in Other Countries

Nutrition fortification of processed foods with microelements is a popular practice in many countries to improve nutritional status of target population. In this study the current food fortification in Korea was evaluated and the regulations and guidelines for food fortification in other countries were presented. Most commonly added nutrients were calcium, vit.C, fiber, vit.Bs and iron. The level of fortified nutrients and the vehicle foods were variable. vit.C and fiber appeared to be overfortified in some foods and the necessity of fortification of these nutrients needs to be examined since the intakes of these elements appears to meet the RDA. Most of other nutrients such as vit.A, vit.B1, vit.B2, and iron were added at the level of 10~25% RDA per serving size. The vehicle foods for fortification were snacks, milk, ramyun, breakfast cereal, juices, candies and ready-to-eat retort pouch foods but not rice which is a staple food in Korea. The guideline and regulation for food fortification is required to ensure safe and proper supplementation of needed nutrients in processed foods.

Current Status of Nutrient Fortification in Processed Foods and Nutrition Labeling

Current status of nutrient fortification in processed food in Korea were presented by analyzing the information shown on food labels. The obtained information was assessed by the regulations on food fortification in both Korea and other countries including Codex. The most current regulations were gathered from internet. The results are summarized as follows. 1. Major nutrients fortified were calcium, Vit C, Vit B complex, iron and fiber. The forfified foods were not limitted to certain food group with more frequent fortification in snackfoods, cereal, ramyun, retort pouch foods, milk, and youguart. The descriptive terms of nutrition label for the fortification were various including high, supplemented, added, source, fortified, and abundance though the difference among these terms were not distinct. 2. Current regulation on nutrition laber requires to give the content of the fortified nutrient and % RDA. However not all of food items carry above information. Also some ingredients such as chitosan, DHA, taurine, omega-3 fatty acid, chondrichin, bifidus were supplemented mainly to the snack foods which FDA(USA) does not allow to be fortified. 3. The nutrient most frequently fortified was calcium and general practice of fortification appears to follow the regulation in Korea. Presently the regulation itself is not well described, this nutient fortification can cause toxic effect. Since calcium was supplemented to wide range of food group consumers who are not conscious of the safe upper limit may intake the fortified food up to the level of 2g/day. 4. For the effective fortification in Korea, the regulation on fortification should be reformed in accordance with the international guideline Codex and the regulations in other countries especially in America and Japan.