Efectividad del consumo de Brownies de sangrecita y el nivel de hemoglobina en niños de una institución educativa inicial pública, Ica / Effectiveness of the consumption of sangrecita brownies and the hemoglobin level in children of the Initial Educational Institution Public, Ica

Según la OPS, los países desarrollados alcanzan un 11% de prevalencia de anemia, mientras que en los países en vías de desarrollo afecta al tercio poblacional, llegando a superar el 50% en el continente africano y asiático. El estudio tuvo como Objetivo: Analizar la efectividad del consumo de brownies de sangrecita sobre los niveles de hemoglobina en niños de la Institución Educativa Inicial Pública, Ica. Material y métodos: Para el desarrollo se utilizó la metodología de tipo cuasi experimental, nivel aplicativo y de enfoque cuantitativo. La población de estudio estuvo conformada por 100 niños, se realizó el descarte de anemia mediante el analizador de hemoglobina (hemo Q), micro cubetas, lancetas y demás implementos médicos. Para analizar los resultados se tuvo en consideración los valores normales emitidos por el Ministerio de Salud(MINSA) y se utilizaron fichas de control. Resultados: Se captó a 4 niños de la IEI Nº14 Mercedes Dibós de Camino al realizar el tamizaje inicial de anemia, quienes tenían un nivel de hemoglobina inferior a los valores normales de acuerdo a la normativa del MINSA; luego de consumir los brownies de sangrecita en un intervalo de 3 veces por semana durante 7 semanas se evidenció un incremento en sus niveles de hemoglobina respecto al tamizaje inicial. Conclusiones: El consumo de brownie de sangrecita es efectivo en el tratamiento de la anemia en los niños, incrementando su nivel de hemoglobina entre 1.9 g/dl a 2.3 g/dl

According to PAHO, developed countries reach an 11% prevalence of anemia, while in developing countries it affects one third of the population, reaching over 50% in the African and Asian continents. The study had the Objective: To analyze the effectiveness of the consumption of sangrecita brownies on hemoglobin levels in children of the Initial Educational Institution Public, Ica. Material and methods: A quasi-experimental methodology with a quantitative approach was used for the development of the study. The study population consisted of 100 children. Anemia was ruled out using the hemoglobin analyzer (hemoQ), micro cuvettes, lancets and other medical implements. To analyze the results, the normal values issued by MINSA were taken into consideration and control cards were used. Results:4 children from the IEI Nº14 Mercedes Dibós de Camino were caught during the initial screening for anemia, who had a hemoglobin level below the normal values according to MINSA regulations; but after consuming the blood brownies at an interval of 3 times per week for 7 weeks, an increase in their hemoglobin levels was evidenced with respect to the initial screening. Conclusion: The consumption of sangrecita brownie is effective in the treatment of anemia in children by increasing their hemoglobin level, the increase value was between 1.9 g/dl and 2.3 g/dl.Key Words:Anemia, sangrecita brownie, hemoglobin, fortification, children.

Childhood and Adolescent Anemia Burden in India: The Way Forward

The burden of anemia in Indian children, based on capillary blood sampling, is believed to be profound and worsening (67.1%) according to the successive National Family Health Surveys (NFHS). This might be an overestimate. The recent Comprehensive National Nutrition Survey of Indian children, that used venous blood sampling, found only less than half (30.7%) the NFHS prevalence, of which only one third was due to iron deficiency (ID). Unfortunately, the apparently worsening NFHS anemia burden estimate has been interpreted as an inadequacy of the present iron supplementation policy. This has led to additional iron supply through mandatory rice fortification. However, the lack of efficacy of iron supplementation appears inevitable, if the true prevalence of iron deficiency anemia is only about 10%. Thus, etiology is a critical consideration when devising appropriate and effective prevention policies. Future policies must focus on precision, thoughtfulness, restraint, and community engagement.

Achievements of agricultural biotechnology: An initiative to double the farmer’s income through cutting edge technology

The population of the world is increasing nearly exponentially over time. To feed this population following the environment conservation protocol, it is essential to enhance the agricultural productivity even in the synchronizing agrarian land use pattern. To enhance the quality and productivity in agriculture sector, introducing the cutting edge technology is need of the hour.From ancient times, traditional approaches like selective breeding, adoption of agronomic management practices and application of indigenous technical knowledge have been used to attain resilience against various abiotic and biotic stresses. However, these traditional approaches are not sufficient to tackle the increasing repercussions of climate change and feed quality food to the expanding population. Therefore, in order to address these issues of climate change, population explosion and malnutrition, biotechnological interventions can be a promising approach. In the past, biotechnology based approaches have given successful products like Herbicide-resistant Soybean, Pusa Basmati 1, Bt Cotton, Bt Brinjal, Flavr-Savr tomato, a therapeutically significant product of Lithospermum erythrorhizon and Panax ginseng. Besides that many more need based products are in pipeline which is under scrutiny of regulatory bodies, policymakers and environmentalists. It is profoundly expected that in the coming day’s agricultural biotechnology applications will bring revolutionary changes to existing agricultural scenario. Therefore, in this review, we have summarized the achievement of agricultural biotechnology that is assisting to enhance the agricultural produce to double the income of farmers. However, this much is not enough; hence full utilization of all the sustainable agricultural biotechnological tools must come into the existence that definitely will boost the agricultural productivity.

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.

Desarrollo de productos lácteos funcionales y sus implicaciones en la salud: Una revisión de literatura

RESUMEN El grupo de la leche y sus derivados ha sido ampliamente estudiado, debido a su alta calidad nutricional y sus potenciales beneficios en salud, contribuyendo así a la modulación y prevención de enfermedades no transmisibles (ENT). Además, son productos de gran aceptación por la población mundial y poseen una alta versatilidad tecnológica. Por lo anterior, se buscó establecer un marco de referencia en torno a la investigación en el desarrollo de alimentos funcionales derivados de la matriz láctea. En la actualidad, los principales compuestos bioactivos adicionados en el desarrollo de derivados lácteos funcionales son prebióticos, probióticos, fibra, antioxidantes y ácidos grasos insaturados y la principal estrategia tecnológica empleada para su adición es la encapsulación, debido a que promueve la retención de nutrientes en la matriz láctea, su estabilidad y biodisponibilidad en el organismo, potenciando los beneficios en salud de los mismos. Se ha visto que los beneficios en salud de los lácteos funcionales se centran en la mejora de biomarcadores de salud cardio-metabólica, regulación del apetito y la saciedad y modulación de la microbiota intestinal, dependiendo del compuesto adicionado. En conclusión, el desarrollo de productos lácteos funcionales hoy en día se constituye como una tendencia mundial de exploración científica, que ha evolucionado debido a su versatilidad como vehículo de compuestos bioactivos con potenciales efectos benéficos en la salud de los individuos y de las poblaciones, sin embargo, es necesario realizar más estudios que respalden los beneficios en salud de estos alimentos sobre diferentes enfermedades.

ABSTRACT Milk and dairy products have been studied in food processing due to their high nutritional quality and potential health benefits, contributing to the modulation and prevention of non-communicable diseases. In addition, these products have great acceptance by the population, are frequently consumed and have high technological versatility. As a result, they have been widely studied in the field of functional foods. The aim of this review was to compile information on the development of functional dairy foods. Currently, the main bioactive compounds added in the development of functional dairy products are prebiotics, probiotics, fiber, antioxidants and unsaturated fatty acids. Encapsulation is the main technological strategy used for incorporation because it improves nutrient retention and stability in the dairy matrix and promotes bioavailability in the body, enhancing the potential health benefits. The main health benefits of functional dairy products are the improvement of cardio-metabolic health biomarkers, appetite and satiety regulation, and gut microbiota modulation, depending on the added compound. In conclusion, the development of functional dairy products is a global trend of scientific exploration, which has evolved due to its versatility as a vehicle for bioactive compounds with potential health benefits for consumers. However, more studies are needed to evaluate the health benefits of these foods for the prevention of different diseases.

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)

Eficácia dos cones vaginais no fortalecimento do assoalho pélvico na incontinência urinária feminina pós- menopausa: estudo de casos / Effectiveness of vaginal cones in strengthening pelvic floor in post-menopause female urinary incontinence: case report

INTRODUÇÃO: A incontinência urinária (IU), pode afetar ambos os sexos, porém apresenta alta prevalência no sexo feminino, sendo as mulheres, na terceira idade, as mais acometidas. A IU afeta a qualidade de vida (QV), pois causa desconforto, redução da autoconfiança, alteração do comportamento, interferência na sexualidade, no convívio social, na saúde física e emocional. OBJETIVO: Avaliar o uso de cones vaginais no fortalecimento do assolho pélvico (AP) em mulheres com incontinência urinaria pós-menopausa. MÉTODOS: Estudo quantitativo, de delineamento observacional exploratório do tipo estudo de casos, realizado com 2 mulheres inscritas para tratamento de IU. Foi realizado a aplicação do questionário International Consultation on Incontinense Questionnaire (ICIQ-SF) e avaliação funcional do AP por meio do perineômetro, antes e após 10 sessões, realizadas 3 vezes por semana, durante 45 minutos, através de um programa de tratamento com uso de cones vaginais e cinesioterapia, associando aos exercícios de Kegel. RESULTADOS: Quanto ao ICIQ-SF, a paciente 1, na avaliação pontou o escore de 10 pontos (muito grave) e na reavaliação 2 (leve impacto). A paciente 2, inicialmente pontuou 9 (grave impacto) e após o tratamento, 1 (leve impacto).. Na avaliação da contração muscular a paciente 1 obteve 40 sauers (normal) e passou para 44 (bom). A paciente 2 passou de 16 sauers (regular) para 28 (normal). CONCLUSÃO: Os cones vaginais beneficiaram mulheres com incontinência urinário de esforço, fortalecendo os músculos do assoalho pélvico, proporcionando melhora na qualidade de vida.

INTRODUCTION: Urinary incontinence (UI) can affect both sexes, but it has a high prevalence in females, and women in the third age are the most affected. UI affects quality of life (QOL) because it causes discomfort, reduced self-confidence, behavioral change, interference with sexuality, social life, physical and emotional health. OBJECTIVE: To evaluate the use of vaginal cones in strengthening pelvic stinging (AP) in women with postmenopausal urinary incontinence. METHODS: A quantitative, observational exploratory case study design, conducted with 2 women enrolled for UI treatment. The International Consultation on Incontinence Questionnaire (ICIQ-SF) was applied and the functional assessment of the AP by the perineometer, before and after 10 sessions, performed 3 times a week, for 45 minutes, through a treatment program. of vaginal cones and kinesiotherapy, associated with Kegel exercises. RESULTS: Regarding the ICIQ-SF, patient 1, in the evaluation, scored 10 points (very severe) and reevaluation 2 (mild impact). Patient 2 initially scored 9 (severe impact), and after treatment 1 (mild impact) both had stress UI. In the evaluation of muscle contraction, patient 1 obtained 40 sauers (normal) and went to 44 (good). Patient 2 went from 16 sauers (regular) to 28 (normal). CONCLUSION: The vaginal cones benefited women with stress urinary incontinence, strengthening the pelvic floor muscles, providing improved quality of life.

Consumption of Fortified Wheat Flour and Associations with Anemia and Low Serum Ferritin in Colombia / Consumo de harina de trigo fortificada en Colombia y su asociación con anemia y ferritina sérica baja

Background: Colombia's mandatory wheat flour fortification program has yet to be evaluated. Objective: Examine associations between consumption of fortified wheat flour and low serum fer¬ritin (LSF) and anemia prevalence. Materials and Methods: A secondary analysis of the 2005 national nutrition survey (ENSIN) was completed for 3988 children 2-4 y, 5669 children 5-12 y and 2053 nonpregnant women 13-49 y. The relationship between consumption (quartiles) of wheat flour containing food (WFCF) and LSF and anemia was examined using chi-square analyses and logistic regression models. Results: In adjusted models, controlling for socio-economic status, intake of animal-origin foods, and supplement use in the last 24 hours, a correlation was found between WFCF and anemia in the preschool aged group, when comparing the quartile of highest WFCF consumption with the lowest quartile (OR: 0.7, 95 % CI: 0.6-0.9). The prevalence of LSF was similar across all quartiles of WFCF consumption in all age groups. The highest prevalence of anemia was observed in the lowest WFCF consumption quartiles in all age groups, but was not significantly different in non-pregnant women 13-49 y. No association between WFCF and LSF was observed in adjusted or unadjusted models. Conclusions: In Colombia, consumption of wheat flour containing foods is associated with lower levels of anemia in pre-school aged children.

Antecedentes: la fortificación obligatoria de harina de trigo en Colombia no se ha evaluado. Objetivo: examinar las asociaciones entre el consumo de harina y ferritina sérica baja (BSF) y la prevalencia de anemia. Materiales y métodos: se completó un análisis secundario de la Encuesta Nacional de la Situación Nutricional de 2005 (ENSIN) para 3988 niños de 2-4 años, 5669 escolares de 5-12 años y 2053 mujeres no embarazadas de 13-49 años. Se examinó la relación entre el consumo (cuartiles) de alimentos que contenían harina (ACHT) y la BSF y la anemia mediante análisis de ji al cuadrado y modelos de regresión logística. Resultados: en modelos ajustados, controlando por el estado socioeconómico, alimentos de origen animal y la ingesta de suplementos en las 24 horas anteriores, existía relación entre ACHT y la anemia en los preescolares, al comparar el cuartil más alto del consumo de ACHT con el cuartil más bajo (OR: 0,7; IC 95 %: 0,6-0,9). No se observó asociación entre ACHT y BFS en modelos ajustados. Conclusiones: en Colombia, el consumo de alimentos que contienen harina de trigo se asocia con niveles más bajos de anemia en preescolares.

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.

Influencia de un recubrimiento comestible adicionado con calcio sobre la calidad de la mora de Castilla / Influence of edible coating added with calcium on andean blackberry quality

RESUMEN La creciente necesidad de los consumidores por alimentos saludables ha suscitado, en la industria, la búsqueda de tecnologías efectivas, que ofrezcan alimentos seguros y aceptables, sensorialmente, por el consumidor moderno. Los recubrimientos comestibles adicionados con componentes activos aplicados en estructuras vegetales, además de proteger la estructura y conferir mayor conservación, pueden aportar valor nutricional. El objetivo de la investigación fue evaluar la influencia de un recubrimiento comestible a base de alginato de sodio y calcio sobre los atributos de calidad de la mora de Castilla. Se aplicó la metodología de superficie de respuesta, con un diseño central compuesto cara centrado (21 experimentos), considerando las variables independientes: alginato de sodio (2,0-3,0%), cera de abeja (0,5-1,0%), sucroéster (0,15-0,25%), alginato/glicerol (2,0-3,0). La mejor formulación fue: alginato de sodio (2,85%), cera de abeja (1,00%), alginato de sodio/glicerol (2,0) y sucroéste (0,18%), siendo los atributos de calidad de la mora con el recubrimiento comestible: humedad (83,7±1,7%), actividad de agua (0,964±0,010), pH (2,7±0,0), acidez (2,6±0,0%), °Brix (8,1±0,2%), firmeza (12,3±0,7 N), fenoles totales (105,3±4,5mg AG/100g), actividad antioxidante (ABTS: 962,7±15,1mg Trolox/100g y DPPH: 319,3±9,4mg Trolox/100g), luminosidad (22,5±0,7); cromaticidad a* (8,47±0,88); cromaticidad b* (2,12±0,37) y calcio = 144,6±2,7 mg /200g. Los recubrimientos comestibles adicionados con calcio aplicados en la mora de Castilla representan una alternativa efectiva contra los daños mecánicos del fruto y para conservar su calidad, lo cual, podrá mejorar la vida útil durante el almacenamiento.

ABSTRACT The growing need of consumers for healthy food has led to the search for effective technologies in food industry that offer safe and sensorially acceptable options to the modern consumer. Edible coatings added with active components applied to vegetable structures, besides protecting the structure and conferring greater conservation, can provide nutritional value. The objective of this investigation was to evaluate the influence of an edible coating based on sodium alginate and calcium on the attributes of quality of Andean blackberry of Castilla. The response surface methodology was applied with a composite central design (21 experiments), considering the independent variables: sodium alginate (2.0-3.0%), beeswax (0.5-1.0%), sucroester (0.15-0.25%), sodium alginate/glycerol (2.0-3.0). The best formulation was: sodium alginate (2.85%), beeswax (1.00%), sodium alginate/glycerol (2.0%) and sucroester (0.162%), being the quality attributes of the of the blackberry with the edible coating: moisture (83.7±1.7%), water activity (0.964±0.010), pH (2.7±0.0), acidity (2.6±0.0%), °Brix (8.1±0.2%), firmness (12.3±0.7 N); total phenols (105.3±4.5 mg GA/100 g), antioxidant activity (ABTS: 962.7±15.1 mg Trolox/100 g) and DPPH: 319.3±9.4 mg Trolox/100 g), lightness (22,5±0,7); chromaticity a* (8,47±0,88); chromaticity b* (2,12±0,37) and calcium=144,6±2,7 mg/200g. Edible coatings added with calcium applied to Andean blackberry of Castilla represent an effective alternative against mechanical damages of the fruit and to conserve its quality, which will improve shelf life.

A Comparative Study on the Effectiveness of Coating and Dusting Technologies on Fortification of Acha (Digitaria exilis) Grains

Background: Reports have shown that consumption of acha (Digitaria exilis) is beneficial to both diabetic and hypertensive patients considering its low glycaemic index, if fortified could assist to improve health and in combating hidden hunger. Aims: This work was aimed at establishing the technology of fortifying acha (Digitaria exilis) grains with vitamin A, Iron, copper and zinc by comparing the effectiveness of coating and dusting technologies and analysing the vitamin A, iron, zinc and copper levels of acha grains fortified by both methods. Methodology: Vitamin A was quantified by High Performance Liquid Chromatography (HPLC) method, while iron, zinc and copper were quantified using Atomic Absorption Spectroscopy (AAS) method. Results: Vitamin A was undetected in unfortified grain, but present at 29,904.18 IU/kg and 29,657.66 IU/kg in coated and dusted grains respectively. The iron content(58 mg/kg) in unfortified grain increased by 22% and 15% for coated and dusted respectively, Copper increased by 25% and 14% and Zinc by 32% and 45% with coating and dusting respectively. Conclusion: This study suggests that coating is a more promising technology for fortifying acha grains with Vitamin A, iron and copper, which will assist in delivering these critical micronutrients in the vulnerable population and also be used as a strategy for dietary improvement.

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.

Prevalence of hypovitaminosis D in India & way forward

Deficiency of vitamin D or hypovitaminosis D is widespread irrespective of age, gender, race and geography and has emerged as an important area of research. Vitamin D deficiency may lead to osteoporosis (osteomalacia in adults and rickets in children) along with calcium deficiency. Its deficiency is linked with low bone mass, weakness of muscles and increased risk of fracture. However, further research is needed to link deficiency of vitamin D with extra-skeletal consequences such as cancer, cardiovascular disease, diabetes, infections and autoimmune disorders. The causes of vitamin D deficiency include length and timing of sun exposure, amount of skin exposed, latitude, season, level of pollution in atmosphere, clothing, skin pigmentation, application of sunscreen, dietary factors and genetic factors. The primary source is sunlight, and the dietary sources include animal products such as fatty fish, food items fortified with vitamin D and supplements. Different cut-offs have been used to define hypovitaminosis D and its severity in different studies. Based on the findings from some Indian studies, a high prevalence of hypovitaminosis D was observed among different age groups. Hypovitaminosis D ranged from 84.9 to 100 per cent among school-going children, 42 to 74 per cent among pregnant women, 44.3 to 66.7 per cent among infants, 70 to 81.1 per cent among lactating mothers and 30 to 91.2 per cent among adults. To tackle the problem of hypovitaminosis D in India, vitamin D fortification in staple foods, supplementation of vitamin D along with calcium, inclusion of local fortified food items in supplementary nutrition programmes launched by the government, cooperation from stakeholders from food industry and creating awareness among physicians and the general population may help in combating the problem to some extent.

Double Fortified Salt in India: Coverage, Efficacy and Way Forward

Iron deficiency remains the world’s most widespread nutritional disorder and India is one of the countries very worst afflicted. India has successfully reduced the burden of iodine-deficiency disorders through mandatory iodization of salt for more than 20 years. This has resulted in a significant decrease in the prevalence of iodine deficiency diseases. Building on the success with iodization, double fortification of salt with iodine and iron is gaining ground and can be integrated with established iodization processes. DFS contemplates the creation and distribution of a powerful innovative product with demonstrated health effects, building on existing distribution platforms for salt through public distribution channels targeted to some of the most impoverished populations in the country at minimal expense and without requiring changes in cultural habits and compliance. Two formulations have been approved by Food Safety and Standard Authority of India (FSSAI) with iron either in the form of encapsulated ferrous fumarate or ferrous sulphate. A meta-analysis showed that DFS increased hemoglobin concentrations significantly. This intervention as part of a broader anemia strategy has the potential to effect large-scale anemia reduction across populations in India on a permanent and economically self-sustaining basis.

Ingesta de hierro y gen HFE en varones adultos de Buenos Aires / Iron intake and HFE gen in male adults from Buenos Aires

El consumo excesivo de hierro (Fe) en portadores de mutaciones en el gen HFE puede resultar en sobrecarga. Para evaluar el riesgo de sobrecarga de Fe fueron investigados 166 varones adultos donantes de sangre de la ciudad de Buenos Aires. Se estimó la ingesta diaria de Fe (IFe), de Fe hemínico y de Fe proveniente de harinas enriquecidas con SO4Fe. Se determinó ferritina sérica y porcentaje de saturación de transferrina (criterio de sobrecarga de Fe: ferritina sérica > 300 ng/ml y saturación de transferrina ≥ 50%). Las mutaciones C282Y, H63D y S65C fueron investigadas en sangre mediante PCR-RFLP. Todos los participantes cubrieron ampliamente el requerimiento estimado promedio de Fe (6 mg Fe/día) y 3.0% superó el máximo tolerable (45 mg Fe/día). El Fe hemínico correspondió al 9.4% de la IFe y el de harinas enriquecidas al 47.7%. Se observó una asociación entre el aumento de IFe y el de ferritina sérica (p = 0.0472), y el 2.3% de los donantes presentaron ferritina sérica > 300 ng/ml y saturación de transferrina ≥ 50%. El 29.3% de los donantes eran portadores de los genotipos H63D, S65C o C282Y, asociados a hemocromatosis hereditaria, y tenían valores de saturación de transferrina significativamente mayores a los de los donantes wild type (p = 0.0167). Si bien la incidencia clínica de hemocromatosis hereditaria fue baja en el grupo estudiado (1.2%), el consumo excesivo de Fe plantea un riesgo potencial para la salud de individuos que ignoran sus antecedentes familiares de sobrecarga de Fe.

Excess iron (Fe) intake in subjects carrying certain mutations in the HFE gene may result in Fe overload. To estimate risk of Fe overload, 166 male blood donors (19-65 years) from Buenos Aires city were investigated. Daily Fe intake (FeI), hem Fe intake, and Fe intake from SO4Fe enriched flours were estimated (SARA Computer Program and Food Composition Table, USDA). Serum ferritin and transferrin saturation were determined; criteria for Fe overload was serum ferritin > 300 ng/ml and transferrin saturation ≥ 50%. HFE genotypes C282Y, H63D and S65C were analyzed by PCR-RFLP in blood samples. No participant presented FeI lower than the estimated average requirement (6 mg Fe/day) and 3.0% was over the upper level (45 mg Fe/day). Hem Fe and Fe from flour enrichment were 9.4% and 47.7% of daily Fe intake, respectively. A significant association was observed between the increase in serum ferritin (ng/ml) and the increase in FeI (p = 0.0472); 2.3% of the donors presented serum ferritin > 300 ng/ml and transferrin saturation ≥ 50%. Genotypes associated with hereditary hemochromatosis (H63D, S65C and C282Y) were found in 29.3% of the donors. The percentage of transferrin saturation was higher in subjects carrying mutation than in wild type subjects (p = 0.0167). Although penetrance of hereditary hemochromatosis in the studied group was only 1.2%, an excessive Fe intake could enhance adverse effects in individuals unaware of any family history of Fe overload.

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.

Food Fortification in Indonesia

The paper highlights the history, policy, programs of food fortification intervention and its impact on reducing micronutrient deficiency, especially iodine deficiency disorders (IDD), iron deficiency anaemia (IDA), and vitamin A deficiency (VAD) in Indonesia. General issues in the management of food fortification, and lessons learned from the Indonesian experience are discussed in this paper.

Elevated folic acid results in contrasting cancer cell line growth with implications for mandatory folic acid fortification / 한국영양학회지

PURPOSE: The initiation of mandatory folic acid fortification using pteroylmonoglutamic acid (PteGlu) has reduced the rate of congenital malformations. However, it also appears to be responsible for several adverse effects, including increased cancer incidence. This may be related to physicho-chemical characteristics of PteGlu. This study examines the potential effect of high concentrations of PteGlu on a population subjected to mandatory folic acid fortification using an in vitro model. METHODS: Caco-2 (colorectal cancer) and MCF7 (breast cancer) cell lines were cultured at 6 different PteGlu concentrations (0, 0.1, 1, 50, 250, and 500µg/ml) for 6 days. Cell growth was determined using thiazolyl blue tetrazolium bromide assay. The genotype of dihydrofolate reductase 19bp deletion/insertion (DHFR 19-del) was also scored in cell lines using a restriction fragment length polymorphism technique to examine whether genetic variations may factor in cell proliferation. RESULTS: PteGlu exhibited differential growth promoting properties between cell lines. Caco-2 cells did not show a significant growth difference at low concentrations compared to control, however, at higher concentrations, the growth showed a contrasting trend in the early experimental period, while MCF7 showed enhanced cell growth at all concentrations. The DHFR 19-del genotype differed in the two cell lines. CONCLUSION: Altered response to PteGlu by Caco-2 and MCF7 may reflect a tissue specific disease aetiology or genotype specific differential enzyme activity, for example by DHFR, to critical levels of PteGlu. As folic acid fortification is a blanket intervention, and DHFR and other enzyme activities vary between individuals, PteGlu intake may have an as yet undefined effect on health. These findings may be relevant when considering mandatory folic acid fortification for disease prevention.

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.