Vitamin D deficiency in bedridden elderly people at home

SUMMARY OBJECTIVE: The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS: This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS: The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION: Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid and preterm delivery in women / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid(MMFA) and risk of preterm delivery in women with natural conception, singleton pregnancy and vaginal delivery.@*METHODS@#A retrospective cohort study was performed based on the prenatal health care system and hospital information system of Tongzhou Maternal and Child Health Hospital of Beijing and the women who had their prenatal care in the hospital from January 2015 to December 2018 were included. The information of 16 332 women who conceived naturally, had a singleton pregnancy, and delivered vaginally was collected. Compliance scores were constructed based on the time of initiation and the frequency of taking nutritional supplements. The association between maternal periconceptional micronutrient supplementation, including pure folic acid (FA) pills or MMFA and the rate of preterm delivery was evaluated using Logistic regression models.@*RESULTS@#The preterm delivery rate (gestational week < 37 weeks) of the study population was 3.8%, and the mean (standard deviation) of gestational age was (38.98±1.37) weeks. A total of 6 174 (37.8%) women took FA during the periconceptional period, 8 646 (52.9%) women took MMFA, and 1 512 (9.3%) women did not take any nutritional supplements. The association between periconceptional supplementation of FA or MMFA and risk of preterm delivery in women was not statistically significant [adjusted odds ratio (aOR)=1.01, 95%CI: 0.74-1.37]. The associations with preterm birth were not statistically significant in further analysis by the type of nutritional supplements, time of initiation, and the frequency of supplementation. In addition, the association between the compliance score of taking supplements and the rate of preterm delivery was not statistically significant, either.@*CONCLUSION@#This study did not find an association between the risk of preterm delivery and the use of FA or MMFA during the periconcep-tional period in women with natural conception, singleton pregnancy, and vaginal delivery. In the future, multicenter studies with large-scale prospective cohort or population-based randomized controlled trials are warranted to confirm the association between taking FA or MMFA during the periconceptional period and preterm delivery among women.

Dietary phytate induces subclinical mechanical allodynia in mice

Neuropathic pain is a condition with varying origins, including reduced dietary micronutrient intake. Phytate is a polyphosphate found in seeds and grains that can act as an antinutrient due to the ability of sequester essential divalent metals. Here we tested whether moderate dietary phytate intake could alter nociceptive pain. We subjected weaning mice to a chow supplemented with 1% phytate for eight weeks. Body weight gain, glycemic responses, food ingestion, water ingestion, and liver and adipose tissue weights were not altered compared to controls. We observed a decreased mechanical allodynia threshold in the intervention group, although there were no changes in heat- or cold-induced pain. Animals consuming phytate showed reduced spinal cord tumor necrosis factor (TNF), indicating altered inflammatory process. These data provide evidence for a subclinical induction of mechanical allodynia that is independent of phytate consumption in animals with otherwise normal phenotypic pattern.

Large-scale Staple Food Fortification as a Complementary Strategy to Address Vitamin and Mineral Vulnerabilities in India: A Critical Review

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling?up scientifically proven, cost?effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost?effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large?scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.

Dietary diversity as a sustainable approach towards micronutrient Deficiencies in India

The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.

Evaluation of Proximate Composition, Minerals and Micronutrient Contents of Finger Millet Herbi Dumpling

Finger millet is an important crop in Maharashtra, Orissa, and Tamil Nadu. Millet production and consumption have been on the decline for some years. Finger millet samples were gathered from regional locations in Nashik and Kolhapur, Maharashtra. These were also taken as samples for chemical composition and proximate analysis. Standard analytical procedures were used to determine the results. The result of the chemical composition, Nashik (sample one) was found to be Ca mg (6.19), Mg (0.52), Fe (1.09), Zn (1.74± 0.96), Cu (0.10), P (8.90) These findings suggest that finger millet is a good source of calcium and phosphorus. These can be utilised as calcium supplement foods, and their composite flours can be used to preserve a variety of nutrient-dense recipes that can be employed as part of a supplement feeding regimen.

Ragi Traditional But Nutritional Especially in the Era of COVID-19

Finger millet is the name commonly used to denote the crop Eleusine coracana. It is known as Ragi in many parts of India, which is an important member of the family of cereals. In fact, it is superior to many cereals like wheat and rice in terms of its micronutrient content and bioavailability. Several indigenous processing techniques may be applied to finger millets allowing it to be processed into various value-added products, which may be better in appearance, taste, flavor and acceptability. Development of value-added products that contain Ragi as one of their major components can be beneficial for food and nutrition security of Indians. Ragi may contribute to solving the issue of micronutrient deficiency and nutrition security as it is an important source of micronutrients and can be easily incorporated in various recipes and value-added products. It can therefore be a part of various nutritional programs to enhance the nutritional density of foods.

Interpretation of the European Society for Clinical Nutrition and Metabolism micronutrient guideline (2022) / 中华临床营养杂志

Micronutrient (MN) deficiency is common in many acute and chronic diseases and should be monitored and managed. In February 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) released the MN guidelines. This guideline aimed to inform the evaluation, monitoring and treatment principles in MN management as part of daily clinical nutrition practice with standardized terminology to avoid confusion. Extensive literature review was conducted covering multiple databases including Medline, PubMed, Cochrane, Google Scholar, and CINAHL databases. For each kind of MN, information was summarized concerning main functions, optimal detection methods, susceptibility to inflammation, potential toxicity and recommended dose for supplementation via enteral or parenteral nutrition. Practical recommendations on MN supplementation and monitoring were provided to manage MN deficiency in high-risk diseases. This review was based on the contents in the guidelines with an emphasis on interpreting the critical issues.

Niveles de micronutrientes en niños escolares colombianos e inseguridad alimentaria / Food Insecurity and micronutrient status biomarkers in school-age Colombian children

Resumen Introducción. La mitad de los hogares colombianos padecen inseguridad alimentaria. Esta se ha asociado con malnutrición, la que, según algunos estudios, podría reflejarse en un déficit de micronutrientes en los niños, aunque los datos no son concluyentes. Objetivo. Establecer la asociación entre la inseguridad alimentaria y los niveles de hemoglobina, hierro, vitamina A, vitamina B12, folato y cinc, en escolares de Bogotá. Materiales y métodos. Se hizo un estudio de corte transversal. Se aplicó la escala del Household Food Security Survey Module (HFSSM) validada en español en una muestra de hogares de escolares de Bogotá, para establecer la prevalencia de inseguridad alimentaria. Utilizando el índice de propensión, se exploró la asociación entre la inseguridad alimentaria, el hambre grave y las concentraciones de hierro, vitamina A, folato, vitamina B12 y cinc, estimadas en muestras de suero provenientes de los escolares. Resultados. Se incluyeron 2.660 escolares. En el 76 % de los hogares había inseguridad alimentaria, de los cuales el 11,6 % se clasificaba como inseguridad alimentaria con hambre grave. La deficiencia marginal de vitamina B12 fue del 17 % y las de vitamina A y cinc, de 14 y 1,4 %, respectivamente. Aunque se encontraron niveles promedios más bajos de vitamina A (-0,009 µmol/L; IC95% -0,13 - 0,03 µmol/L), vitamina B12 (-19,57 pmol/L; IC95% -72,55 - 29,94 pmol/L) y folato (-9,25 nmol/L; IC95% -29,55 - 18,66 nmol/L) en los niños expuestos a inseguridad alimentaria con hambre grave, al compararlos con los de los no expuestos, las diferencias no fueron estadísticamente significativas. Conclusiones. La inseguridad alimentaria con hambre grave no se asoció los valores de micronutrientes o sus deficiencias en los escolares. La escala del HFSSM mide adecuadamente la dificultad en la adquisición de alimentos por falta de recursos, pero no permite establecer una asociación con las concentraciones de micronutrientes.

Abstract Introduction: Half of the Colombian households experience some degree of food insecurity. Food insecurity has been associated with malnutrition, which could result in micronutrient deficiencies in children; however, the evidence is not conclusive. Objective: To examine the associations between food insecurity and blood concentrations of hemoglobin, ferritin, vitamin A, vitamin B12, folate, and zinc in school-age children from Bogotá, Colombia. Materials and methods: We conducted a cross-sectional study among 2,660 children aged 5-12 from Bogotá's public schools. We assessed their household food insecurity level with the Spanish version of the Household Food Security Survey Module (HFSSM), a validated scale, and quantified blood biomarkers of iron, vitamin A, folate, vitamin B12, and zinc status. We examined the associations between food insecurity, severe hunger, and micronutrient status biomarkers using propensity scores. Results: Three-quarters of households had some degree of food insecurity and 12 % had food insecurity and severe hunger. Prevalence of marginal vitamin B12 status and vitamin A and zinc deficiencies were, respectively, 17%, 14%, and 1.4%. Compared with children from households without severe hunger, those exposed to it had lower adjusted mean concentrations of vitamin A, vitamin B12, and folate, but these differences were not statistically significant. Conclusion: Food insecurity with severe hunger was not associated with micronutrient status biomarkers in Colombian school-age children. The HFSSM may adequately measure hardship in food acquisition due to lack of resources, but it does not yield an index that is associated with micronutrient status biomarkers.

Nutritional status of iron, vitamin B12, vitamin A and anemia in Mexican children: results from the Ensanut 2018-19 / Estado de nutrición de hierro, vitamina B12, vitamina A y anemia en niños mexicanos: resultados de la Ensanut 2018-19

Abstract Objective: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children. Materials and methods: Serum data from 1 382 pre-school-age children (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between sociodemographic characteristics of children and MD. Results: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia. Conclusions: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.

Resumen Objetivo: Describir la situación actual de deficiencias de micronutrimentos (DM) y anemia en niños mexicanos. Material y métodos: Se analizó información sérica de 1 382 niños de 1-4 años y de 3 590 niños de 5-11 años participantes de la Ensanut 2018-19. Se categorizó la deficiencia de hierro (DH), B12 (DB12), depleción de vitamina A (DepVA) y anemia. Se emplearon modelos de regresión logística para identificar las características asociadas con la DM. Resultados: La anemia afectó al 28.9 y 19.2%, DH al 10 y 5.1%, DB12 al 5.1y 4.8% y DepVA al 4.7 y 4.3% de los niños preescolares y escolares respectivamente. El 18.5 y 13% de los niños tuvo al menos una DM asociada con anemia. Conclusiones: Los niños más jóvenes tuvieron las prevalencias más altas de DM y anemia. Es necesario el refuerzo en los programas de fortificación y suplementación para evitar las consecuencias a largo plazo asociadas con las DM.

Doses, methods and times of application of boron in soybean under field conditions / Doses, métodos e épocas de aplicação de boro na soja sob condições de campo

The boron (B) fertilization in soybean is important to ensure great yields. Boron correction must be applied in deficient soils repairing losses, exports and leaching. The objective of this study was to evaluate the effects of doses, methods and times of application of B in soybean B content and yield. The field experiments were conducted during the 2015/16 and 2016/17 cropping seasons and set as a randomized block design with nine treatments (0, 0.5, 1, 1.5, 2 kg ha-1 of B, 0.5 kg ha-1 of B mixed with NPK (02-28-18) in furrow during sowing, foliar application with 0.3 kg ha-1 of B in V4 soybean stage, foliar application with 0.3 kg ha-1 of B in R1 soybean stage, and foliar application of 0.15 kg ha-1 in V4 plus 0.15 kg ha-1 of B in R1 soybean stage) and four replications. Boric acid was the B source and the variables analyzed were: B leaf content, B exported in seeds, number of pods per plant, number of seeds per pod, weight of 100 seeds (g) and productivity (kg ha-1). The levels of B in leaf were between 30.1 and 43.8 mg kg-1 and between 65.0 and 92.6 mg kg-1 in the 2015/16 and 2016/17 growing season, respectively. Exports of B in seeds were estimated between 166 and 248 g ha-1 and between 208.9 to 260.8 g ha-1 in the 2015/16 and 2016/17 growing season, respectively. Great productivity (3,820 kg ha-1) was observed in the 2016/17 growing season, with an estimated dose of 0.95 kg ha-1 of B.

A fertilização de boro na soja é importante para garantir boas produtividades, corrigir solos deficientes e repor perdas, exportação ou lixiviação. O objetivo deste estudo foi avaliar os efeitos de doses, avaliar modos e épocas de aplicação de B na produtividade da soja. Os experimentos foram implantados na Fazenda Experimental da UEG, Campus Ipameri, nas safras 2015/2016 e 2016/2017 com delineamento em blocos ao acaso, com nove tratamentos e quatro repetições. 0,0; 0,5; 1,0; 1,5; 2,0 kg ha-1 de boro, - 0,5 kg ha-1 de B junto com NPK 2-28-18 no sulco de semeadura; aplicação foliar com 0,3 kg ha-1 de boro em V4; aplicação foliar com 0,3 kg ha-1 de boro em R1; aplicação foliar de 0,150 kg ha-1 em V4 mais 0,150 kg ha-1 de boro em R1. Foi utilizado como fonte o ácido bórico. As variáveis respostas analisadas foram: teor na folha, exportação pelos grãos, número de vagens por planta, número de grãos por vagem, massa de 100 grãos e produtividade. Os teores de B encontrados ficaram entre 30,12 e 43,83 mg kg-1 na folha de soja na safra 2015/2016 e entre 65,0 e 92,6 mg kg-1 na safra 2016/2017. As exportações de Boro foram estimadas entre 166 e 248 g ha-1 e 208,9 a 260,8 g ha-1 na primeira e segunda safra, respectivamente. Houve maior produtividade na segunda safra (3820 kg ha-1) com dose estimada de 0,95 kg ha-1

Study of Mineral Nutrient Accumulation in Different Cultivars of Guava Fruits

Guava, is one of the most promising fruit crops of India and is considered to be one of the exquisite nutritionally valuable and remunerative crops. We are unaware of any report describing macro and micronutrient dynamics in fruit at different growth stages of guava. Micronutrients play an important role in production and their deficiency lead in lowering the productivity. For conducting this experiment fruit of variety Allahabad Safeda, L-49, Lalit, Shweta, Arka Kiran, Salithong, Kimchu were collected at different stages like Marble, Stone hardening & Harvest stage for estimation of primary nutrient (N, P, K), secondary nutrient (Ca, Mg) & micronutrient (Fe, Mn, Zn, Cu). The nutrient content particularly N, K, Mg, and Mn are highest in variety of Allahabad Safeda, whereas, P and Ca are highest in variety Lalit. Micronutrient Fe recorded highest in Salithong while Zn and Cu were accumulated maximum in Arka Kiran and Kimchu respectively. Recommendation of fertilizer at various growth stages is paramount for precise nutritional management for which the requirement of different nutrition is essential.

Factors influencing the uptake of pulse vitamin A supplementation among children in a rural area in India: a cross sectional study

Background: The change in strategy of India's National Program for the prevention and control of nutritional blindness due to Vitamin A deficiency during 2006, aims for all children aged 9 months to 5 years to receive biannual pulse dose of Vitamin A with a total nine mega doses of Vitamin A. Micronutrient initiative (MI) was providing technical assistance to the State Health department of Karnataka in implementing the new bi-annual strategy, in partnership with UNICEF during the period 2006 to 2010.Methods: During July 2006, the Investigator evaluated its coverage in Gulbarga district. This study assessed the factors influencing the uptake of pulse Vitamin A supplementation (VAS) among children from impoverished background. Using oral questionnaires, a total of 30 Parents (Mothers) of these children, 12 childcare workers (AWWs), 12 peripheral health workers (ANMs) were interviewed regarding barriers towards implementing this Program and assessment of the facilities (12 Anganwadi centres) were conducted.Results: Only 28% of the facility had some IEC display regarding VAS. 75% of ANMs were aware that either green leafy vegetables or fish or fruits are the main source of micronutrients. A similar number of ANMs knew that Vitamin A deficiency causes night blindness, >90% of AWW had informed parents about the program during the monthly mother meetings. <20% of parents were aware of the current pulse VAS program and a similar number were aware of the next round of supplementation.Conclusions: Regular interaction with families, monitoring the activities of field level health workers and supportive supervision will enable uptake of VAS Program. Future action should prioritize sub-district level units ' blocks and villages, with higher concentration of poor households.

Influence of Molybdenum doses in inoculation and mineral fertilization in cowpea beans / Influência de doses de molibdênio na inoculação e na fertilização nitrogenada em feijão caupi

In some leguminous plants, associations with nitrogen-fixing microorganisms allow their nutrition with nitrogen (N) from the atmosphere. This process is known as Biological Nitrogen Fixation (BNF), where through nitrogenase enzymes, N2 is converted to an available form. This process can replace in part, or in total, nitrogen fertilizers. Cowpea bean is a legume species that is recognized for its high capacity to carry out BNF. In the last decades, studies have encouraged small farmers from north and northeast Brazil to use inoculants with rhizobia species since the results of researches have demonstrated that inoculation is an interesting strategy to improve cowpea production. Considering the specific function of molybdenum (Mo) in the N assimilation, different doses of Mo were tested in this study in order to find doses that could improve and enhance BNF. Therefore, this study aimed to compare nitrogen fertilization and BNF in the N assimilation by plants with different Mo doses. Inoculation was performed with the strains UFLA 03-84 and INPA 03-11B. Doses of Mo were applied in seeds and each pot contained five seeds. Thirty-five days after germination, the plants were analyzed for shoot dry matter and fresh matter, N contents and accumulation, as well as the Soil-Plant Analysis Development (SPAD) Index and nodulation in inoculated plants. The different doses of Mo and also the nodulation treatments did not show significant differences in the contents of N. Plants with N fertilization had significant higher shoot dry matter and root dry matter production, in addition to higher N foliar contents and N accumulation. Therefore, BNF was not as efficient as nitrogen fertilization in the evaluated experimental conditions using cowpea beans.

Em algumas plantas de leguminosas, as associações com microorganismos de fixação permitem a sua nutrição com N (nitrogênio) da atmosfera. Este processo é conhecido como Fixação Biológica de Nitrogênio (FBN), onde através de enzimas nitrogenase N2 é convertido na forma disponível. Este processo pode substituir em parte, ou no total, fertilizantes nitrogenados. O feijão-caupi é uma espécie de leguminosa que é reconhecida pela sua alta capacidade de FBN. Nas últimas décadas, estudos encorajaram os pequenos agricultores do norte e nordeste do Brasil a usar inoculantes com espécies de rizobio, uma vez que os resultados das pesquisas têm demonstrado que a inoculação é uma estratégia interessante para melhorar a produção dessa cultura. Considerando a função específica do molibdênio (Mo) na assimilação do N, diferentes doses de Mo foram testadas neste estudo, a fim de encontrar doses que possam melhorar e potencializar a FBN. A inoculação foi feita com as estirpes UFLA 03-84 e INPA 03-11B. As diferentes doses de Mo foram aplicadas na semente, cinco sementes por vaso. Trinta e cinco dias após a germinação, as plantas foram analisadas com relação à matéria seca aérea e radicular, teor de N e acúmulo, índice de análise de desenvolvimento solo-planta (SPAD) e nodulação nas plantas inoculadas. As diferentes doses de Mo não mostraram diferenças significativas no conteúdo de N, nem no processo de nodulação. As plantas com adubação nitrogenada tiveram mattera seca da parte aérea e de raízes superior as inoculadas, além de maiores teores foliares de N. Portanto, para feijão-caupi, a FBN não foi tão eficiente quanto o fertilizante nitrogenado nas condições experimentais avaliadas.

Zinc Supplementation for Promoting Growth in Children Under 5 years of age in Low- and Middle-income Countries: A Systematic Review

Objective: To study the effect of zinc supplementation in children under 5 years of age from low- and middle-income countries (LMICs) onanthropometry and prevalence of malnutrition.Design: Systematic review of randomized controlled trials and cluster randomized trials.Setting: Low- and middle-income countries.Participants: 63 trials with zinc supplementation, incorporating data on 27372 children. Trials conducted exclusively in specificallydiseased participants and in children with severe acute malnutrition were excluded.Intervention: Zinc supplementation, provided either as medicinal supplementation or through food fortification.Outcome Measures: (i) Anthropometry: weight, height, weight-for-height, mid-arm circumference, head circumference; (ii) Prevalenceof malnutrition.Results: There was no evidence of effect on height-for-age Z score at the end of supplementation period (25 trials; 9165 participants;MD= 0.00 Z; 95% CI -0.07, 0.07; P=0.98; moderate quality evidence) with significant heterogeneity (I² = 57%; P<0.001) related to doseand duration of zinc between trials. There was little or no effect on change in height-for-age Z score (13 trials; 8852 participants; MD= 0.11Z; 95% CI -0.00, 0.21; P=0.05), but the heterogeneity was considerable (I²=94%; P<0.001). There was no evidence of effect on length(6303 participants; MD= 1.18 cm; 95% CI -0.63, 2.99 cm, P=0.20; moderate quality evidence; considerable heterogeneity, I²=99%) but alittle positive effect on change in length (19 trials; 10783 participants; MD= 0.43 cm; 95% CI 0.16, 0.70, P=0.002; moderate qualityevidence; considerable heterogeneity, I²=93%). There was no evidence of effect on weight-for-age Z score or change in weight-for-age Zscore but a little positive effect on weight (19 trials; 8851 study participants; MD= 0.23 kg; 95% CI 0.03, 0.42; P=0.02; considerableheterogeneity, I²=91%) and change in weight (kg) (23 trials; 10143 study participants; MD= 0.11 kg; 95% CI 0.05, 0.17, P<0.001,substantial heterogeneity, I²=80%). There was no evidence of effect on weight-for-height Z score, and mid upper arm circumference at theend of supplementation period, but there was a little positive effect on change in mid-arm circumference from baseline (8 trials; 1724participants; MD = 0.09 cm; 95% CI 0.01, 0.16; P=0.03; no heterogeneity, I²=0%). Head circumference in zinc supplemented group wasmarginally higher compared to control (2966 study participants; MD= 0.39 cm; 95% CI 0.03, 0.75; P=0.03; substantial heterogeneity,I²=67%). There was no evidence of benefit in stunting (10 trials; 11838 study participants; RR= 1.0; 95% CI 0.95, 1.06; P=0.89; moderatequality evidence; no significant heterogeneity, I²=11%), wasting (7 trials; 8988 study participants; RR= 0.94; 95% CI 0.82, 1.06; P=0.31;moderate quality evidence; no significant heterogeneity, I²=13%) or underweight (7 trials; 8677 study participants; RR= 1.08; 95% CI 0.96,1.21; P=0.19; moderate quality evidence; substantial heterogeneity, I²=73%).Conclusion: Available evidence suggests that zinc supplementation probably leads to little or no improvement in anthropometric indicesand malnutrition (stunting, underweight and wasting) in children under five years of age in LMICs. Advocating zinc supplementation as apublic health measure to improve growth, therefore, appears unjustified in these settings with scarce resources.

El hambre oculta y la fibromialgia: Una revisión sistemática / The hidden hunger and fibromyalgia: A systematic review

RESUMEN Recientemente há sido discutida la posibilidad de una relación causal entre la fibromialgia (FM) y la deficiencia de micronutrientes, un tipo de deficiencia nutricional conocida como "hambre oculta". Sin embargo, los estudios son pocos y los resultados controversiales, lo que genera debates sobre la influencia real del "hambre oculta" en el proceso de la enfermedad en las personas con fibromialgia. En está revisión se presentan y discuten evidencias científicas relacionadas con la deficiencia de micronutrientes y FM, destacando los principales micronutrientes relacionados. El levantamiento de información fue realizado en los bases de datos de PubMed y Science Direct en estudios observacionales publicados entre los años 2000 y 2017. Fueron seleccionados 14 estudios, ocho dirigidos a la asociación de la deficiencia de vitamina D y la presencia de FM y seis enfocados en la asociación de la deficiencia de minerales con FM. Se sugiere una relación entre la deficiencia de vitamina D y el aumento de la sensibilidad al dolor en la FM. Aunque esa insuficiencia también está asociada a otras enfermedades muscoesqueléticas crónicas. Además, parece que la deficiencia mineral (p.ej.o., hierro, magnesio, zinc y calcio) también desempeña un papel importante en el inicio de la FM y sus principales síntomas.

ABSTRACT Recently the possibility of a causal link between fibromyalgia (FM) and micronutrient deficiency, a type of malnutrition known as "hidden hunger", has been suggested. However, the results are controversial, which raises questions and debates on the actual influence of "hidden hunger" on the development of FM. In this review, we present and discuss scientific evidence related to micronutrient deficiencies and FM, highlighting key micronutrients involved. We searched PubMed and Science Direct databases for all observational studies published between 2000 to March 2017. We selected fourteen observational studies, eight studies aimed at linking vitamin D deficiency to the presence of FM and six studies focused on the association of mineral deficiency with FM. The association between vitamin D deficiency and increased pain sensitivity in FM is suggested, although such insufficiency is also associated with other chronic musculoskeletal disorders. It appears that mineral deficiency (e.g., iron, magnesium, manganese, zinc and calcium) plays an important role in the onset of FM and its main symptoms.

Impact of Dietary Pattern on Nutritional Status of Pregnant Women in Low and High Strata between the Age Group of 30-39 Years in Mumbai

Background: Maternal Nutrition plays an important role in shaping the mother’s and fetal health. Therefore intake of high salt, high fat, high sugar in the diet might lead to over nutrition among pregnant women due to varied food choices of the since most of the subjects consumed outside food, Sugar Sweetened Beverages such as (Cola, Pepsi, Thumps Up, Soda, Sherbet etc), Processed Food such as(Ready to eat food, Mayonnaise, Cheese spread etc) which consist of increase amount of preservative which might affect the mother and foetal’s health. Since there was increase intake of above food groups and decrease intake of macro and micronutrients in the diet through food group such as Fruits, Nuts and Oilseed, Green Leafy Vegetables etc. Therefore there might be increased risk of Over nutrition among women which might lead to GDM (Gestational Diabetes Mellitus), IUGR(Intra Uterine Growth Retardation), Low Birth weight etc.Aim: To study the impact of dietary pattern on Nutritional of pregnant women in Low and High Strata. Method: A purposive random sampling was done among pregnant women because only 2ndtrimester pregnant women were selected for the study. The 50 subjects were divided into LSES (Lower Socioeconomic Strata) &HSES (Higher Socioeconomic Strata) on the basis of Kuppuswamy Index. The dietary pattern of the subjects was assessed through FFQ (Food Frequency Questionnaire) & 3 Day Diet Recall. Result: There was increase consumptionof High Fat, High Salt, High Sugar in the diet through consumption if food group such as Outside Food, Processed Food, Sugar Sweetened Beverages etc and in comparison the consumption of Macro and Micronutrient rich food group was lower which included Fruits, Green Leafy Vegetables, Nuts and oilseed etc. In Lower Strata the consumption of above food group was low because they were financially not stable therefore they were given additional services where the company paid their ration balance so that they could consume selective food group which were costing comparatively more. Since the RDA(Recommended Dietary Allowances) requirements were not met therefore the women were prescribed Iron, Calcium and Folic Acid supplements in the diet to decrease the risk ofMaternal and fetal complication such as GDM(Gestational Diabetes Mellitus), NTD(Neural Tube Defect), IUGR(Intra Uterine Growth Retardation) etc.Conclusion: Therefore to decrease the risk of Maternal and Fetal Complications intake of Macro and Micro nutritions in the diet is imperative and it is important to organize Nutrition Intervention programmes and counsel the pregnant women about Maternal Nutrition and how decrease intake of Nutrients in the diet might lead to Maternal Under nutrition and over nutrition and its related risk

Effects of micronutrients supplementation on plasma homocysteine level and global cognitive function among older adults in long-term care facilities: a randomized controlled study / 中华临床营养杂志

Objective@#To investigate the effects of micronutrient supplementation for the elderly on plasma homocysteine level and cognitive function in institutional older adults.@*Methods@#A total of 98 older adults with the score≤11 by mini nutritional assessment short-form aged 65-100 years were enrolled and assigned to either intervention group or control group (n=49 each), with either a package of micronutrient pack or placebo daily, for three months. Fasting blood samples were collected both at baseline and the end of study to detect serum vitamin B12, folate and plasma homocysteine (Hcy) concentrations. Global cognitive function was assessed using the mini-mental state examination (MMSE). The paired t test was used to compare the continuous variables between the two groups after intervention. The relationship between changes in MMSE score and changes in plasma Hcy concentrations was examined by least-squares linear regression.@*Results@#Eighty-two patients completed the study, and 17 patients withdrew from the study due to diarrhea and hospital discharge with the drop rate of 17.3%. Compared to the control group, concentrations of serum vitamin B12 (128.8±34.8 vs 13.3±16.0 pmol/L, P=0.003) and folate (21.1±1.6 vs 0.6±0.5 nmol/L, P<0.01) significantly increased in the intervention group over 3-month supplementation, while plasma Hcy levels were remarkably reduced (-5.3±0.7 vs 1.7±0.3 μmol/L, P<0.01). The incidences of deficiency of folate, deficiency of serum vitamin B12and high Hcy all decreased in intervention group. Although individual item scores in MMSE were not changed markedly, change of total MMSE score in intervention group were higher than that in the control group (1.2±3.0 vs -0.2±2.5, P<0.05).@*Conclusions@#The supplementation of the micronutrient pack in long-term care facilities can reduce the incidence of hyperhomocysteinemia, and improve the total MMSE score.

The effect of micronutrients supplement on geriatric cognitive function: The latest research progresses / 中华老年医学杂志

Geriatric ability to live independently will be severely impaired when mild cognitive impairments(MCI)eventually develop into dementia.Patients with dementia usually suffer from micronutrients deficiencies(MNDs). In turn, MNDs may accelerate cognitive decline based on disruption of one carbon metabolism, DNA damage repair, mitochondrial function and glucose, lipid and phospholipids metabolism which lead to the damage of neurotransmitter synthesis, myelination and synaptogenesis.Clinical evidences show that the oral supplementation of B-group vitamins(vitamin B6 10-25 mg/d, vitamin B120.025-0.500 mg/d and folate 0.4-2.0 mg/d)and specific micronutrients compounds for at least 3 months may improve overall cognitive function and short-term memory ability of the elderly.More double-blind, placebo-controlled, randomized human intervention studies are still needed to evaluate effects of micronutrients supplementation on geriatric cognitive function and to determine the requirements, dosage and time of intervention.

The effect of micronutrients supplement on geriatric cognitive function:The latest research progresses / 中华老年医学杂志

Geriatric ability to live independently will be severely impaired when mild cognitive impairments(MCI) eventually develop into dementia.Patients with dementia usually suffer from micronutrients deficiencies (MNDs).In turn,MNDs may accelerate cognitive decline based on disruption of one carbon metabolism,DNA damage repair,mitochondrial function and glucose,lipid and phospholipids metabolism which lead to the damage of neurotransmitter synthesis,myelination and synaptogenesis.Clinical evidences show that the oral supplementation of B-group vitamins(vitamin B6 10-25 mg/d,vitamin B12 0.025-0.500 mg/d and folate 0.4-2.0 mg/d) and specific micronutrients compounds for at least 3 months may improve overall cognitive function and short-term memory ability of the elderly.More double-blind,placebo-controlled,randomized human intervention studies are still needed to evaluate effects of micronutrients supplementation on geriatric cognitive function and to determine the requirements,dosage and time of intervention.