Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine Suplementação oral de ferro na gravidez: recomendações atuais e medicina baseada na evidência

Abstract Objective To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia. Methods Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control. Results We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial. Discussion Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters. Conclusion Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.

Resumo Objetivo Rever a evidência sobre a necessidade de suplementação universal de ferro na gravidez para prevenção de anemia materna. Métodos Pesquisa bibliográfica de ensaios clínicos aleatorizados e controlados, metanálises, revisões sistemáticas e normas de orientação clínica, publicados entre agosto de 2009 e agosto de 2019, utilizando os termos MeSH: iron, terapêuticas use; pregnancy; anemia, preventivos and control. Resultados Incluímos seis normas de orientação clínica, três metanálises e um ensaio clínico randomizado e controlado. Discussão A maioria dos artigos aponta para a melhoria dos parâmetros hematológicos e redução do risco de anemia materna por meio da suplementação com ferro. Conclusões A suplementação universal com ferro na gravidez é controversa, pelo que atribuímos uma força de recomendação SORT C.

Hierro y ácido fólico: natural, enriquecido, fortificado y suplementos. Análisis de las fuentes alimentarias en la Ciudad de Buenos Aires / Iron and folic acid: natural, enriched, fortified, and supplements. Analysis of food sources in the Autonomous City of Buenos Aires

Introducción. La fortificación y suplementación son estrategias para la prevención de carencias de micronutrientes. El objetivo fue describir la procedencia de la ingesta del hierro y ácido fólico a lo largo del ciclo vital de la población de la Ciudad Autónoma de Buenos Aires. Población y métodos. Análisis de la información de la Primera Encuesta Alimentaria y Nutricional de la Ciudad Autónoma de Buenos Aires 2011, que tomó una muestra probabilística por conglomerados. El consumo se recabó con recordatorio de 24 horas. Se calculó el aporte de hierro y ácido fólico, y se categorizó en contenido natural, harina de trigo enriquecida, leche del Plan Materno Infantil, alimentos fortificados y suplementos. Resultados. De los 5369 individuos evaluados, prácticamente, la totalidad obtenía hierro y ácido fólico de contenido natural (el 58 % y el 29 % del consumo, respectivamente). Más del 90 % consumía harina de trigo enriquecida, que aportaba el 28 % del hierro y el 54 % del ácido fólico. Los alimentos fortificados mostraron consumo y aporte muy variable. La leche del Plan Materno Infantil mostró muy baja participación, inclusive en grupos específicos. El aporte de suplementos fue bajo, excepto en < 2 años (el 30 % consumía suplementos de hierro, que aportaban el 38 % de este).Conclusión. Además del aporte natural de los alimentos, la harina de trigo enriquecida representó una importante contribución en el consumo de ácido fólico y hierro de esta población; los alimentos fortificados y los suplementos tuvieron una participación diferente según el grupo etario.

Introduction. Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires.Population and methods. Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements.Results. Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron).Conclusion. In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.

El enriquecimiento de la harina de maíz precocida y de la harina de trigo en Venezuela. Una gestión con éxito / Enrichment of precooked corn flour and of wheat flour in Venezuela. A successful experience

La crisis iniciada en Venezuela a mediados de 1983 provocó un manifiesto deterioro en la cantidad y calidad del consumo de alimentos por parte de los sectores de mas bajos recursos. Los porcentajes de adecuación más bajos respecto a los Requerimientos de Energía y Nutrientes de la Población Venezolana corresponden a hierro, vitamina A y en menor grado a vitaminas del complejo B. El Instituto Nacional de Nutrición inició en 1990 la factibilidad de enriquecer la harina de maíz precocida, HMP, responsable por un 40 % de las Calorías derivadas de los cereales y de un 15 - 16 % del total de calorías de la dieta, con hierro (fumarato ferroso), vitamina A, tiamina, riboflavina y niacina. En 1992 se propuso un perfil de enriquecimiento requerido para que 50 g de HMP cubriese un 25 % de los requerimientos de estos nutrientes, ya tomados en cuenta las pérdidas durante la preparación de la arepa. El conocimiento de esta medida como política oficial, causó cierta molestia en el sector privado. En Agosto 1992, por Decreto Presidencial No 2.492 se crea la Comisión para el Enriquecimiento Nutricional de los Alimentos, CENA, con el específico propósito del enriquecimiento de la HMP. Con los esfuerzos coordinados del sector oficial y de la industria privada, se pudo llegar a un consenso sobre el perfil de enriquecimiento de la HMP, el cual fue anunciado por la CENA. (por kg): vitamina A: 2.700 ER; tiamina: 3,1 mg; riboflavina: 2,5 mg; niacina: 51 mg; hierro: 50 mg. Comisión Venezolana de Normas Industriales. COVENIN. Harina de maíz precocida. (3 era. Revisión) 2135:1996. Obligatorio cumplimento. Desde febrero 1993 toda la HMP comercializada en Venezuela debe estar enriquecida. Harina de trigo. HT. En noviembre 1992, la Asociación Venezolana de Productores de Trigo, AVPT, presentó un proyecto no obligatorio de fortificación. En Marzo la CENA rechazó el carácter no obligatorio y de acuerdo con la AVPT se acordó un perfil de enriquecimiento para la HT: (por kg): tiamina: 1,5 mg; riboflavina: 2,0 mg; niacina: 20 mg; hierro: 20 mg (como fumarato ferroso). Comisión Venezolana de Normas Industriales. COVENIN. Harina de trigo (4 ta. Revisión) 217: 2001. Obligatorio cumplimiento. Desde agosto 1993 toda la HT comercializada en Venezuela debe estar enriquecida(AU)

TIn Venezuela a severe economic crisis beginning in 1983 provoked a progressive reduction of the quality and quantity of food consumed by the low socioecnomic strata of the population. The lowest adequacy percentages with respect to Venezuelan RDAs were for iron, vitamin A and to a lesser extent, for vitamin B complex. Being precooked corn flour, PCF, responsible for 40 % of the Calories derived from cereals and for 15 -16 % of the total calories intake in the diet, an excellent and unique vehicle for enrichment, the National Institute of Nutrition, NIN, started the investigations toward its fortification with iron (as ferrous fumarate), vitamin A, thiamin, riboflavin and niacin. In 1992 a fortification profile was developed in such a way that 50 g of PCF (amount needed for a 110 g ready-to-eat arepa) covered approximately 25 % of the RDAs for the mentioned nutrients, after taking into consideration the losses due to the cooking process. The announcement of this measure as an official policy, provoked some adverse reactions among the private sector. In August 1992, by Presidential Decree No 2.492, the Commission for the Nutritional Enrichment of Foods, CENA, was created with the specific task of reconciling efforts and carry forward the enrichment of the PCF. With the attendance of key representatives of the corn and wheat industries, the government and the media, the CENA announced the official fortification profile of the PCF (per kg) : vitamin A: 2,700 RE; thiamin: 3.1 mg; riboflavin: 2.5 mg; niacin: 51 mg; iron: 50 mg. Official Venezuelan Bureau of Standars (COVENIN), mandatory Standard No 2135-1996. Since February 1993 all the PCF sold in Venezuela must be enriched. Wheat flour. WF. The Venezuelan Wheat Producers Association, VWPA, presented in november 1992 a tentative and non compulsory fortification profile. In march the CENA voted against the non compulsory character of the fortification of WF and upon agreement with the VWPA, set in force the mandatory fortification profile as follow (per kg): thiamin: 1.5 mg; riboflavin: 2.0 mg; niacin: 20 mg; iron: 20 mg (as ferrous fumarate). COVENIN mandatory Standard No 217:2001. Since august 1993 all the WF sold in Venezuela must be enriched(AU)

Functional iron deficiency in patients on hemodialysis: prevalence, nutritional assessment, and biomarkers of oxidative stress and inflammation / Deficiência funcional de ferro em pacientes em hemodiálise: prevalência, avaliação nutricional e de biomarcadores de estresse oxidativo e de inflamação

Abstract Introduction: Anemic patients with chronic kidney disease (CKD) can be divided into anemic patients without or with functional iron deficiency (FID). The increase in the number of cases of hemosiderosis in patients on hemodialysis (HD) attributed to excessive intravenous iron replacement has called for the investigation of the factors involved in the genesis of FID. Objectives: This study aimed to describe the prevalence of FID in patients with CKD on HD, characterize the included individuals in terms of clinical and workup parameters, and assess their nutritional, oxidative stress, and inflammation statuses. This cross-sectional study assembled a convenience sample of 183 patients with CKD on HD treated in Southern Brazil. Patients meeting the inclusion and exclusion criteria were divided into two groups, one with anemic subjects with FID and one with anemic patients without FID. Participants answered a questionnaire probing into socio-epidemiological factors, underwent anthropometric measurements, and were tested for markers of anemia, oxidative stress, inflammation, and nutrition. Statistical analysis: The date sets were treated on software package GraphPad InStat version 3.1. Variables were tested with the Kolmogorov-Smirnov, chi-square, Student's t, and Mann-Whitney tests. Statistical significance was attributed to differences with a p < 0.05. Results: Markers of inflammation were not statistically different between the two groups. Markers of anemia and nutrition were significantly lower in patients with FID. Patients with FID were prescribed higher doses of parenteral iron (p < 0,05). Discussion: FID was associated with lower nutritional marker levels, but not to increased levels of markers of inflammation or oxidative stress, as reported in the literature. Additional studies on the subject are needed.

Resumo Introdução: A anemia na DRC pode ser dividida em anemia sem deficiência funcional de ferro e com deficiência funcional de ferro (ADFF). Diante do aumento dos casos de hemossiderose em pacientes em hemodiálise, atribuídos à reposição excessiva de ferro endovenoso, maiores conhecimentos sobre os fatores envolvidos na gênese da ADFF são importantes. Objetivos: documentar a prevalência de ADFF em renais crônicos em hemodiálise. Caracterizar clínica e laboratorialmente os portadores de ADFF em HD e avaliar o estado nutricional, estresse oxidativo e inflamatório. Estudo transversal, amostra de conveniência, envolvendo 183 renais crônicos em hemodiálise no sul do Brasil. Após aplicação dos critérios de exclusão, os pacientes foram separados em dois grupos: portadores de anemia com e sem deficiência funcional de ferro. Foram submetidos a questionário socioepidemiológico, à análise antropométrica e análise laboratorial dos marcadores de anemia, estresse oxidativo, inflamatórios e nutricionais. Análise estatística: programa GraphPad InStat versão 3.1. Foram aplicados os testes: Kolmogorov-Smirnov, qui-quadrado, t de Student e Mann-Whitney. Nível de significância adotado de 5%. Resultados: não houve diferença significativa nos marcadores inflamatórios entre os dois grupos. Houve diferença significativa nos marcadores de anemia e nutrição, significativamente menores nos pacientes com ADFF. Pacientes com ADFF receberam doses mais elevadas de ferro parenteral (p < 0,05). Discussão: ADFF esteve associada a menores valores de marcadores nutricionais, mas não esteve associada a marcadores inflamatórios ou de estresse oxidativo aumentados, como relatado na literatura. Estudos adicionais sobre o tema são necessários.

Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses / Relationship between breastfeeding patterns and intake of vitamin A and iron in children 6-12 months

Resumo O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

Abstract The aim of this study was to analyze the association between breastfeeding type in the first six months of life and intake of vitamin A and iron in children 6-12 months of age. It is a cohort study with 226 children. The type of breastfeeding from 1-6 months of life and the food intake from 6 to 12 months were evaluated. Nutrient intake between groups was compared by the Kruskal-Wallis test. The association between nutrient intake and type of breastfeeding was analyzed by Poisson Regression. Consumption below the recommendation of vitamin A and iron was 33.6% and 67.7%, respectively. Infants exclusively and predominantly breastfed from birth to two months had higher vitamin A intake from 6-12 months of life. Infants who were breastfeeding at 6 months had higher vitamin A intake and lower iron by the bivariate analysis. The group that received mixed feeding and artificial feeding at 1 month and the group non-breastfed at 6 months had vitamin A intake below the recommended from 6-12 month of life. The results reinforce the importance of exclusive breastfeeding in the first six months of life contributing to the higher vitamin A intake. Iron intake was lower among breastfed children, but the bioavailability of this nutrient in breast milk is higher.

Guía de práctica clínica para el diagnóstico y manejo de la anemia en pacientes con enfermedad renal crónica / Clinical practice guideline for the diagnosis and management of anemia in patients with chronic kidney disease

La Guía de Práctica Clínica (GPC) tratará sobre la el diagnóstico y manejo de la anemia asociada a ERC en el paciente adulto, en el ámbito de todos los niveles de atención, servicios o unidades que presten servicios de a pacientes con Enfermedad Renal Crónica, en lo que corresponda a cada nivel.

Aceptabilidad de un atole fortificado con 21 micronutrientes e impacto en la salud y nutrición de niños menores de 6 años de edad en la ciudad de guatemala / Acceptability of a 21 micronutrient-fortified atole and its impact on health and nutrition in children under 6 years of age from guatemala city

Con el objetivo de reducir la desnutrición crónica de niños que asisten 6 jardines infantiles en la Ciudad de Guatemala, se utilizó una bebida a base de soya y maíz como vehículo para el aporte de 21 micronutrientes con niveles elevados de hierro (12mg) y zinc (9mg) y se ofreció a 747 niños entre los 6 meses y 6 años. Se realizó seguimiento antropométrico cada 3m, Hb cada 6m y se registró el número de episodios de enfermedad diarreica aguda e infección respiratoria aguda a lo largo de la intervención. Un ANOVA longitudinal de medidas repetidas demostró que la media de la Hb mejoró de manera significativa a los 6 y 12m de recibir la bebida fortificada (11,26, 11,64, y 11,89g/dL, respectivamente), p<0,01; la prevalencia de anemia disminuyó 44,2% después de 12m, p<0,01; la media del puntaje z de talla para la edad también mejoró, -1,25 (0m) y -1,07 (12m), p<0.01; la prevalencia de retardo del crecimiento disminuyó 25% a los 12m. Se observó una disminución significativa en la prevalencia de infección respiratoria aguda y no se observaron cambios en la prevalencia de diarrea. Un estudio de aceptabilidad demostró que los niños consumen más del 98% del producto. Los resultados sugieren que la intervención con el atole fortificado mejora el estado nutricional y de salud de los niños. El producto es aceptado por los niños y el personal de los jardines infantiles(AU)

With the aim to reduce chronic undernutrition in children that attended 6 Guatemala City daycare centers, a corn and soy-based beverage was used as a vehicle to provide 21 micronutrients and high concentrations of iron (12mg) and zinc (9 mg) and was provided to747 children aged 6 to 72 months. Children were followed for anthropometry every 3m, hemoglobin every 6m, and episodes of acute diarrhea and respiratory tract infections were registered throughout the intervention. A longitudinal Repeated Measures ANOVA demonstrated that mean hemoglobin significantly improved at 6 and 12m of receiving the beverage (11.26, 11.64, and 11.89g/dL, respectively), p<0.01; the prevalence of anemia decreased by 44.2% after 12m, p<0.01; mean height-for-age z score improved from -1.25 (0m) to -1.07 (12m), p<0.01; the prevalence of stunting decreased by 25% after 12m. A significant decrease in the prevalence of acute respiratory infection was observed. No changes were observed in the prevalence of diarrhea. Moreover, an acceptability study showed that children consumed more than 98% of the atole. These results suggest that this nutrition intervention with the fortified atole improves the health and nutritional status of children. The product is widely accepted by the children and staff at the nurseries(AU)

Identificação de transcritos diferencialmente expressos por Pasteurella multocida em condições de privação de ferro / Identification of differentially expressed transcripts by Pasteurella multocida iron-starved condition

Ferro (Fe) é um elemento essencial e a capacidade de adquiri-lo in vivo têm sido descrita em diversos agentes patogênicos através de fatores de virulência. Análises de transcritos durante a privação de Fe tem sido descritos através da técnica de "microarray", entretanto a técnica de RNA-seq recentemente tem demonstrado resultados superiores. Neste trabalho, o isolado de Pasteurella multocida (Pm 16759) altamente patogênico em suínos foi cultivado em duas condições com diferentes concentrações de Fe (controle e privação) com o objetivo de analisar transcritos diferencialmente expressos. O RNA total das duas condições foi extraído e sequenciado através da plataforma de nova geração Ion Torrent. Os dados foram analisados no Software Ion Reporter(tm) e processados no programa Rockhopper. Foram obtidas 1.341.615 leituras com tamanho médio de 81pb, com 96% de alinhamento com o genoma de Pasteurella multocida subsp. multocida 3480 e 98,8% de acurácia. No mapeamento das leituras das duas condições, observou-se 2,652 transcritos e destes, 177 (6,7%) foram diferencialmente expressos, sendo 93 na condição controle (Fe+) e 84 na condição de privação (Fe-). Na condição de privação de Fe, o perfil de transcritos foram associados a função de transporte celular (fbp ABC, permease de alta afinidade com Fe2+/Pb2+ e proteína periplasmática de alta afinidade com Fe2+ ), reguladores transcricionais e proteínas hipotéticas. O perfil na condição controle (Fe+) apresentou transcritos diferencialmente expressos associados ao RNAs anti-sense (asRNA) e genes do metabolismo energético (fructose-1,6-bisfosfatase). O estudo comprovou que a restrição de Fe aumenta a expressão de genes envolvidos no transporte celular, reguladores transcricionais, proteínas hipotéticas e desconhecidas e permitiu ainda a identificação de novos genes como a permease de alta afinidade com Fe2+/Pb2+ e proteina periplasmática de alta afinidade com Fe2+ , que configuram uma possível via alternativa de absorção de Fe.(AU)

Iron (Fe) is an essential element and the ability to acquire it in vivo has been described in several pathogens as virulence factors. Global analyses of transcripts during iron deprivation have been described by microarray studies, however recently RNA-seq analysis showed superior results. The high pathogenic swine strain of Pasteurella multocida (BRMSA 1113) was grown in two conditions with different concentrations of Fe (control and deprivation) in order to analyze the differentially expressed transcripts. The total RNA of the two conditions was extracted and sequenced by new generation Ion Torrent plataform. Data were analyzed in Ion Reporter(tm) Software and processed in Rockhopper software. Sequence analysis shows 1,341,615 readings with median length of 81pb, with 96% of alignment to the reference genome Pasteurella multocida strain 3489, and 98.8% accuracy. Reads mapping to genome of P. multocida in these two conditions detected 2,652 transcripts, which 177 (6.7%) were differentially expressed, with 93 in the control condition (Fe+) and 84 provided with iron deprivation condition (Fe-). In condition (Fe-), differential expressed transcript profile were associated to function of cellular transport (fbpABC, high-affinity Fe2+/Pb2+ permease and periplasmic protein probably involved in hight-affinity Fe2+ ), transcptional regulators and hypothetical proteins. The control condition (Fe+) shows differential expressed transcripts profile associated to RNA anti-sense (asRNA) energetic metabolism genes (fructose-1,6-bisphosphatase). The study showed that the Fe restriction increases the expression of genes involved in cellular transport, transcriptional regulators, hypothetical and unknown proteins, and also allowed the identification of High-affinity Fe2+/Pb2+ permease e Periplasmic protein probably involved in high-affinity Fe2+, that constitute a possible alternative route for Fe absorption.(AU)

A new family home approach to controlling iron deficiency anemia in all ages in less-developed and developing countries using iron-fortified water

Nutritional iron deficiency anemia is considered the main public health problem of poor less-developed and developing countries. The World Health Organization has estimated that 1.5-2.0 billion persons are anemic. It has been said that close to 1 million deaths are linked to iron deficiency anemia. The groups most vulnerable to this form of anemia are said to be small children and women of reproductive age. Our goal is to show that iron fortification in the water, will control anemia. The method used was a literature review. Methods have been identified to control anemia, but the fortification of water is a more efficient, low cost, reaches the entire population, prevents and treats deficiency anemia. We concluded that the iron fortification of drinking water at home is a simple, effective, and low-priced approach for the prevention of iron deficiency anemia prevalent in poor and developing countries(AU)

A anemia por deficiência nutricional de ferro é considerada o principal problema de saúde pública dos países menos-desenvolvidos e em desenvolvimento. A Organização Mundial de Saúde estimou que 1,5-2,0 milhões de pessoas são anêmicas. Aproximadamente 1 milhão de mortes estão ligadas a anemia por deficiência de ferro. Os grupos mais vulneráveis a anemia são crianças e mulheres em idade reprodutiva. Nosso objetivo é mostrar que fortificação de ferro na água, irá controlar anemia. O método utilizado foi revisão da literatura. Diversos métodos têm sido identificados para controle da anemia, mas a fortificação da água é uma forma mais eficiente e de baixo custo, atingindo toda a população, previnindo e tratando a anemia por deficiência. Concluímos que a fortificação de ferro na água potável em casa é uma abordagem simples, eficaz e de baixo custo para a prevenção da anemia ferropriva prevalente nos países pobres e em desenvolvimento(AU)

Registro de ações para prevenção de morbidade infantil na caderneta de saúde da criança / Recording actions to prevent child morbidity in children´s health cards

Resumo O objetivo deste estudo é analisar o registro de ações para a prevenção de morbidade na infância, a partir das informações de vacinação, suplementação de ferro e vitamina A presentes na caderneta de saúde da criança.Trata-se de um estudo transversal, com abordagem quantitativa, realizado em Unidades de Saúde da Família de João Pessoa-Paraíba, com amostragem por conveniência,totalizando 116 cadernetas. Os dados foram coletados a partir da observação dos registros nas cadernetas e analisados conforme estatística simples. A maior porcentagem das crianças estava com o calendário vacinal em dia (92,2%) e as que estavam em atraso tinham entre 6 e 12 meses de idade. Em 78,9% das cadernetas não constavam registros das duas suplementações de ferro e vitamina A. Em outras, havia apenas registro de uma das suplementações. A situação vacinal das crianças no primeiro ano de vida encontra-se satisfatória, porém foram observadas falhas nos registros da suplementação de ferro e vitamina A, o que dificulta o acompanhamento das condutas realizadas na criança pelos profissionais de saúde. Espera-se que este estudo possa contribuir para subsidiar discussões e estratégias que visem melhorar o acompanhamento e os registros das vacinações e das suplementações dos micronutrientes na caderneta de saúde da criança.

Abstract The aim of this study was to analyze the registering of preventative actions in relation to child morbidity using information regarding vaccinations, as well as iron and vitamin A supplements, which are recorded in children’s health cards. This transversal study used a quantitative approach and was performed in Family Health Units in the city of João Pessoa, Paraíba; the sampling was by convenience and totaled 116 children’s health cards. The data was collected by observing the cards and the analysis was simple, statistical. The highest percentage of children had their vaccination cards up to date (92.2%) and those that did not were aged between 6 and 12 months: 78.9% of the cards did not have records relating to iron and vitamin A supplements and others only had records of one of the supplements being administered. The vaccination status of children in the first year of life was found to be satisfactory; however, discrepancies were observed in the recordings of the administration of iron and vitamin A supplements, which complicates monitoring performed by child health care professionals. It is hoped that this study will contribute to discussions and strategies aimed at improving the monitoring and recording of micronutrients in children’s health cards.

Abordaje multidimensional de la anemia por deficiencia de hierro en niños menores de dos años de edad del Noreste Argentino: Años 2004-2005 / Multidimensional approach to iron deficiency anemia in infants younger than two years old in Northeast Argentina: 2004-2005

Introducción. La prevalencia de anemia por déficit de hierro (ADH) es alta en niños menores de dos años, especialmente en poblaciones carenciadas. Objetivo. Estudiar algunos determinantes sociales y biológicos que se asocian con la ADH en niños de 12 a 23,9 meses de edad de la región del Noreste Argentino durante los años 2004-2005. Metodología. Diseño transversal. Las variables explicativas fueron organizadas en tres niveles: distal (asistencia alimentaria, necesidades básicas insatisfechas, cobertura médica del j efe de hogar), intermedio (lactancia materna, suplementación con hierro y consumo de hierro) y proximal (estado nutricional, edad gestacional, peso al nacer, edad y sexo). La asociación entre las variables seleccionadas y ADH (Hb < 11 g/dl, ferritina < 12 ng/dl, glóbulos blancos < 15 000 ml) fue examinada con modelos de regresión logística con selecciónjerárquica de las variables. Resultados. La falta de asistencia alimentaria -#91;OR 1,85 (1,14; 3,02)-#93; y el consumo inadecuado de hierro -#91;OR 2,60 (1,18; 5,71)-#93; fueron asociados a ADH. Cuanto menor la edad gestacional -#91;OR 0,89 (0,81; 0,97)-#93; y menor la edad en meses -#91;OR 0,90 (0,84; 0,96)-#93;, mayor la prevalencia de anemia. Conclusiones. Este estudio pone en evidencia la estrecha y compleja relación entre los determinantes sociales y una enfermedad altamente prevalente en niños pequenos, como la anemia. Los programas de asistencia alimentaria tendrían un efecto protector sobre la ADH; el consumo de alimentos fortificados mejoraría la ingesta de hierro en los niños menores de dos años de edad. Se resalta, además, la necesidad de realizar evaluaciones del impacto de las políticas sobre la salud de la población.

Introduction. The prevalence of iron deficiency anemia (IDA) is high among infants younger than two years old, especially in disadvantaged populations. Objective. To study certain social and biological determinants associated with IDA in children aged 12 to 23.9 months old in Northeast Argentina in the 2004-2005 period. Methodology. Cross-sectional design. Explanatory outcome measures were organized in three levels: distal (food assistance, unmet basic needs, and head of household with medical coverage), intermediate (breastfeeding, iron supplementation, and iron intake), and proximal (nutritional status, gestational age, birth weight, age, and sex). The association between selected outcome measures and IDA (Hb< 11 g/dL, ferritin < 12 ng/dL, WBCs < 15 000/mL) was assessed using logistic regression models withhierarchical selection of outcome measures. Results. Lack of food assistance (OR: 1.85 -#91;1.14, 3.02-#93;) and inadequate iron intake (OR: 2.60 -#91;1.18, 5.71-#93;) were associated with IDA. The prevalence of anemia was higher with a younger gestational age (OR: 0.89 -#91;0.81, 0.97-#93;) and a younger age in months old (OR: 0.90 -#91;0.84, 0.96-#93;). Conclusions. This study evidences the strong and complex relationship between social determinants and anemia, a disease that is highly prevalent among young children. Food assistance programs may have a protective effect against IDA; consumption of fortified foods may improve iron intake in infants younger than two years old. In addition, emphasis is placed on the need to assess the impact of policies on population health.

Asociación entre los niveles de hierro plasmático en niños celíacos de la ciudad de San Luis y la adherencia a la dieta libre de prolaminas tóxicas

La enfermedad celíaca (EC) es una forma de enteropatía de base inmunológica debida a una intolerancia permanente al gluten, que afecta a individuos genéticamente predispuestos. Se conoce como gluten a un grupo complejo de proteínas con diversas variantes presentes en el trigo (gliadina), centeno (secalina), cebada (hordeína) y triticale (híbrido del trigo y el centeno). Es muy frecuente en la actualidad. Su prevalencia a nivel mundial varía en 1:100 a 1:300. Esta intolerancia provoca atrofia intestinal y desnutrición progresiva. La lesión intestinal genera trastornos en la absorción de nutrientes, entre ellos el hierro. La deficiencia severa de este mineral conlleva a la anemia ferropénica. Una alimentación libre de gluten estricta de por vida, permite a las personas celíacas a gozar de una óptima calidad de vida, evitando las carencias nutricionales. Así mismo, el apoyo familiar es fundamental para una adecuada adherencia al tratamiento

Abstract: Celiac desease (CD) is a form of immune-mediated enteropathy caused by permanent intolerance to gluten, which affects individuals with genetic predisposition. Glutenis known as a complex group of proteins, several of whose variants are part of wheat (gliadin), rye (secalin), barley (hordein) and triticale (a hybrid of wheat and rye). It a is a very common disorder at present. Its worrldwide prevalence varies between 1:100 and 1:300. This intolerance is the origin of intestinal atrophy and progressive malnutrition. Intestinal damage causes disorder in the absorption of nutrientes, includin iron. Severe iron deficiency leads to anemia. A strict, gluten-free diet for life allows celiac people for an optimal quality of life, and prevents nutritional deficiencies. Likewise, family support is fundamental for an adequate adherence to treatment

Guía de práctica clínica para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en niñas, niños y adolescentes en establecimientos de salud del primer nivel de atención / Clinical practice guideline for the diagnosis and treatment of iron deficiency anemia in children and adolescents in primary care health facilities

Contribuir en la mejora del estado de salud de las niñas, niños y adolescentes en el marco de la atención integral de salud. Estandarizar los criterios técnicos para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en las niñas, niños y adolescentes em establecimientos de salud del primer nivel de atención.

Comparison of efficacy of oral and intramuscular iron supplementation for treatment of iron deficiency anemia in children

To compare the efficacy of oral iron preparation with intramuscular iron sorbitol in treatment of iron deficiency anemia in children. Randomized controlled trial. Paediatric department of Combined Military Hospital Kharian, Pakistan, from October 2011 to March 2013. In total 200 anemic chldren from 6 months to 5 years of age were included. Cut off value for Hb was < 8 gm/dl. Patients were divided into two groups, each of 100, randomly. Group A received oral sodium feredetate [iron edetate] and group B received intramuscular iron sorbitol. Rise in Hb > 10 gm/dl was kept as the desired value. Maximum duration of treatment planned was 12 weeks for group A and 2 weeks for group B. Laboratory parameters such as Hb%, mean corpuscular volume [MCV], retic count and serum ferritin level were used to detect the responses in both groups at one week, two weeks, four weeks and twelve weeks of treatment. Among 200 patients, male and female distribution was 45% and 55% respectively. Desired rise in Hb in group B was achieved much earlier i.e. at two weeks as compared to group A. Progressive rise in laboratory parameters was observed but this rise was more evident in group B as compared to group A. After one week treatment in group A, rise in retic count, Hb, ferritin and MCV was 0.759 +/- 0.318, 0.814 +/- 0.387, 0.47 +/- 0.154 and 4.28 +/- 2.468 respectively. But rise in these values in group B was 2.235 +/- 0.632, 2.335 +/- 0.135, 6.31 +/- 1.123 and 12.11 +/- 0.414 respectively. Same persistent different trend was observed at 2 and 4 weeks. After 12 weeks treatment in group A, rise in retic count, Hb, ferritin and MCV was 1.044 +/- 0.222, 5.204 +/- 0.134, 17.39 +/- 2.551 and 16.61 +/- 1.214 respectively but rise in these laboratory indices in group B was 0.551 +/- 0.261, 6.097 +/- 0.21, 42.49 +/- 2.768 and 20.68 +/- 2.233 respectively. The comparison of hematological indices after 12 weeks in A and B groups show sigruficant differences. All these parameters improved in both groups but improvement in group B was drastically more prominent when compared with group A [p-value < 0.05]. Intramuscular iron sorbitol therapy is an alternative and comparatively better treatment option as compared to oral iron therapy, sodium feredetate, in regards of treatment duration and earlier rise in the laboratory indices

Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial

To compare the efficacy and safety profile of total dose infusion of low molecular weight iron dextran with divided doses of intravenous iron sucrose for the treatment of iron deficiency anemia during pregnancy. Randomized controlled trial. Shifa International Hospital, Islamabad, over a period of two years from January 2008 to December 2009. Pregnant women at gestational age more than 12 weeks with the confirmed diagnosis of Iron Deficiency Anemia [IDA] were divided into two groups. In the group-A, intravenous iron sucrose was given in divided doses while in the group-B, total daily intake of Low Molecular Weight [LMW] of iron dextran was given. Post-infusion Hemoglobin [Hb] was checked at 4 weeks and at the time of delivery for both groups. Paired sample t-test is applied and comparison [in terms of rise in hemoglobin from pre to post] of both groups was not found to be significant. In the group-A [iron sucrose group], mean pre-infusion Hb levels was 9.09 +/- 0.83 gm/dl. Mean increase in Hemoglobin [Hb] was 10.75 +/- 1.097 gm/dl after 4 weeks of infusion and 11.06 +/- 0.866 gm/dl at delivery [p < 0.001]. In group-B [iron dextran group] pre-infusion haemoglobin was 8.735 +/- 0.956 gm/dl and the mean increase in hemoglobin was 10.613 +/- 1.22 gm/dl at 4-week while mean increase of 10.859 +/- 1.11 gm/dl at the time of delivery [p < 0.001]. Both LMW iron dextran, as well as iron sucrose are equally effective in treatment of IDA during pregnancy, however, LMW iron dextran has the advantage of single visit treatment

Prescribing pattern of iron preparations in antenatal women in a tertiary care hospital.

Iron deficiency anemia in pregnant women is a major health problem in India. According to WHO, anemia in pregnant women is described as Hb% < 11g/dl or hematocrit < 33% and all pregnant women are to be given a standard dose of 60mg and 120mg elemental iron for prophylaxis and treatment of anemia respectively. As per ICMR guidelines, the dosage has increased from 60 to 100mg for treatment of anemia. This study was done to study the prescribing pattern of iron preparations in antenatal women and to compare the elemental iron content in the drug. Fifty pregnant women were included in the study. Prescription analysis showed that 94% were given oral iron preparations and 6% were given I.V. injections. The commonly prescribed drugs were Ferrous Ascorbate(42%) and Sodium Feredetate(40%) containing elemental iron 100mg and 33mg respectively. The I.V. preparation used was mainly iron sucrose (6%). Since both the oral iron preparations were prescribed once daily, Ferrous Ascorbate should be preferred over Sodium Feredetate since the total elemental iron in Sodium Feredetate is not sufficient as per WHO and ICMR guidelines.

Avances en la fortificación de harina de trigo a nivel global / Advances in the fortification of wheat flour

: Por 90 años, alimentos han sido industrialmente fortificados (o enriquecidos) con vitaminas y minerales. Los granos básicos, específicamente la harina de trigo, la harina de maíz y el arroz, son aptos para la fortificación debido a su alta disponibilidad en la mayoría de países del mundo. El propósito de este artículo es revisar la evidencia del impacto en salud pública de la fortificación de granos básicos (con un enfoque en harina de trigo), describir los retos mundiales que enfrenta la fortificación y enlistar las herramientas que puedan ayudar con el diseño, el monitoreo y la evaluación de programas de fortificación de alimentos. Hay evidencia sólida y consistente que la fortificación con ácido fólico aumenta el folato sérico y reduce defectos del tubo neural, además de que la fortificación con hierro aumenta la ferritina sérica. Sin embargo, para la hemoglobina, los resultados son contradictorios: algunos estudios reportan un aumento, otros una disminución y otros ningún cambio en hemoglobina después de fortificar los granos básicos con diferentes nutrientes. Los dos retos principales de la fortificación mundial es que varios países se podrían beneficiar de la fortificación de granos cereales, sin embargo, no implementan esta intervención de salud pública. Además, son pocos los países que de manera consistente reportan los resultados de monitoreo y evaluación de sus programas de fortificación. Para abordar estos retos, hay varias herramientas disponibles o en desarrollo que guían el diseño, el monitoreo y la evaluación de programas de fortificación de alimentos(AU)

Food has been industrially fortified (or enriched) with vitamins and minerals for 90 years. Cereal grains, specifically wheat flour, maize flour and rice, are good vehicles for fortification because they are available in large amounts in most countries around the world. The purpose of this paper is to review the evidence for the public-health impact of fortification, describe challenges to worldwide fortification, and list tools that are available to aid in the design, monitoring and evaluation of food-fortification programs. There is strong and consistent evidence that folic-acid fortification of cereal grains improves serum folate and reduces neural tube defects, and that iron-fortification increases serum ferritin levels. The results for hemoglobin are equivocal: some studies report increases, others decreases, and others no change in hemoglobin after cereal-grain fortification commenced with several nutrients. The two main challenges to worldwide fortification are that many countries that could benefit from cereal-grain fortification do not undertake this public-health intervention, and that few countries consistently report monitoring or evaluation data that suggests they are keeping track of the implementation of fortification. Finally, to overcome these challenges, many tools are available or under development to help with the design, monitoring and evaluation of food-fortification programs(AU)