Concurrent Micronutrient Deficiencies Are Low and Micronutrient Status Is Not Related to Common Health Indicators in Ghanaian Women Expecting to Become Pregnant.

BACKGROUND: Micronutrients are important for reproductive health and pregnancy, but the status of multiple vitamins and minerals is rarely measured in women before pregnancy. OBJECTIVES: We aimed to assess the status and concurrent deficiencies of micronutrients among women before pregnancy and their relation with common health indicators. METHODS: This was a cross-sectional study that recruited women who expected to become pregnant within the next 6 mo in Asesewa, Ghana, a semi-urban community. Women self-reported demographics and health history. We measured blood pressure, height, and weight and conducted a blood draw and hemoglobin assessment (n = 98). We measured serum/plasma concentrations of ferritin, iron, total iron binding capacity, zinc, copper, retinol, and 25-hydroxyvitamin D, in addition to markers of inflammation. We used established cutoffs for deficiency and insufficiency/low status for each micronutrient after adjusting ferritin, zinc, and retinol for inflammation. We compared biomarker distributions by common health indicators. RESULTS: Forty percent of women had overweight/obesity, 33% were anemic, and 23% had elevated blood pressure. Overall, 27% had ≥1 deficiencies, whereas only 4% had 2 deficiencies. Fifty-eight percent of women had ≥1 insufficiencies and 18% had ≥2 insufficiencies. Prevalence of individual deficiencies was 12%, 7%, 7%, 4%, and 0% and prevalence of individual insufficiencies was 18%, 12%, 29%, 13%, and 13% for iron, copper, vitamin A, zinc, and vitamin D, respectively. Iron biomarkers and retinol concentrations differed by anemia status, and copper was higher in those with elevated blood pressure. Micronutrient concentrations were not associated with self-reported medical history (parity or history of anemia, malaria, or night blindness). CONCLUSIONS: In Asesewa, Ghana, there was a relatively low prevalence of individual micronutrient deficiencies, but the majority of women were insufficient in ≥1 micronutrients. Iron and vitamin A status was lower in those with anemia, but otherwise, micronutrient status did not relate to common health markers.

Enteric dysfunction and other factors associated with attained size at 5 years: MAL-ED birth cohort study findings.

BACKGROUND: Poor growth in early childhood has been associated with increased risk of mortality and morbidity, as well as long-term deficits in cognitive development and economic productivity. OBJECTIVES: Data from the MAL-ED cohort study were used to identify factors in the first 2 y of life that are associated with height-for-age, weight-for-age, and body mass index z-scores (HAZ, WAZ, BMIZ) at 5 y of age. METHODS: A total of 1017 children were followed from near birth until 5 y of age at sites in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania. Data were collected on their growth, environmental enteric dysfunction (EED), micronutrient status, enteric pathogen burden, illness prevalence, dietary intake, and various other socio-economic and environmental factors. RESULTS: EED biomarkers were related to size at 5 y. Mean lactulose:mannitol z-scores during the first 2 y of life were negatively associated with all of the growth measures (HAZ: -0.11 [95% CI: -0.19, -0.03]; WAZ: -0.16 [95% CI: -0.26, -0.06]; BMIZ: -0.11 [95% CI: -0.23, 0.0]). Myeloperoxidase was negatively associated with weight (WAZ: -0.52 [95% CI: -0.78, -0.26] and BMIZ: -0.56 [95% CI: -0.86, -0.26]); whereas α-1-antitrypsin had a negative association with HAZ (-0.28 [95% CI: -0.52, -0.04]). Transferrin receptor was positively related to HAZ (0.18 [95% CI: 0.06, 0.30]) and WAZ (0.21 [95% CI: 0.07, 0.35]). Hemoglobin was positively related to HAZ (0.06 [95% CI: 0.00, 0.12]), and ferritin was negatively related to HAZ (-0.08 [95% CI: -0.12, -0.04]). Bacterial density in stool was negatively associated with HAZ (-0.04 [95% CI: -0.08, 0.00]), but illness symptoms did not have any effect on size at 5 y. CONCLUSIONS: EED markers, bacterial density, and iron markers are associated with growth at 5 y of age. Interventions to reduce bacterial burden and EED may improve long-term growth in low-income settings.

Tree Nut Consumption and Adipose Tissue Mass: Mechanisms of Action.

There is concern that tree nuts may cause weight gain due to their energy density, yet evidence shows that tree nuts do not adversely affect weight status. Epidemiologic and experimental studies have shown a reduced risk of chronic diseases with tree nut consumption without an increased risk of weight gain. In fact, tree nuts may protect against weight gain and benefit weight-loss interventions. However, the relation between tree nut consumption and adiposity is not well understood at the mechanistic level. This review summarizes the proposed underlying mechanisms that might account for this relation. Evidence suggests that tree nuts may affect adiposity through appetite control, displacement of unfavorable nutrients, increased diet-induced thermogenesis, availability of metabolizable energy, antiobesity action of bioactive compounds, and improved functionality of the gut microbiome. The gut microbiome is a common factor among these mechanisms and may mediate, in part, the relation between tree nut consumption and reduced adiposity. Further research is needed to understand the impact of tree nuts on the gut microbiome and how the gut microbial environment affects the nutrient absorption and metabolism of tree nuts. The evidence to date suggests that tree nut consumption favorably affects body composition through different mechanisms that involve the gut microbiome. A better understanding of these mechanisms will contribute to the evolving science base that addresses the causes and treatments for overweight and obesity.

Cognitive Performance in Indian School-Going Adolescents Is Positively Affected by Consumption of Iron-Biofortified Pearl Millet: A 6-Month Randomized Controlled Efficacy Trial.

BACKGROUND: Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies have examined how iron status relates to cognition in adolescents. Iron biofortification of staple food crops is being scaled up, yet it is unknown whether consuming biofortified crops can benefit cognition. Objective: Our objective was to determine the efficacy of iron-biofortified pearl millet in improving attention and memory in Indian school-going adolescents. Methods: A double-blind, randomized, intervention study was conducted in 140 Indian boys and girls, aged 12-16 y, who were assigned to consume iron-biofortified [Fe = 86 parts per million (ppm)] or conventional (Fe = 21-52 ppm) pearl millet. Hemoglobin, ferritin, and transferrin receptor (TfR) were measured and body iron (BI) was calculated at baseline and after 4 and 6 mo. Five measures of cognitive function were obtained at baseline and 6 mo: simple reaction time (SRT), Go/No-Go (GNG) task, Attentional Network Task (ANT), Composite Face Effect (CFE) task, and Cued Recognition Task (CRT). Intention-to-treat analysis was used. Results: Daily iron intake from pearl millet was higher in those consuming biofortified compared with conventional pearl millet (19.6 compared with 4.8 mg/d). Effects on ferritin, TfR, and BI at 4 mo, and on TfR at 6 mo (all P < 0.05), indicated efficacy of biofortified pearl millet over conventional pearl millet in improving iron status. Compared with conventional pearl millet, the consumption of biofortified pearl millet resulted in greater improvement in attention (SRT, GNG, and ANT) and memory (CFE and CRT). Reaction time decreased twice as much from 0 to 6 mo in those consuming biofortified compared with conventional pearl millet on attention tasks (SRT: -123 compared with -63 ms; GNG: -67 compared with -30 ms; ANT double cue: -74 compared with -32 ms; all P < 0.01). Conclusion: Consuming iron-biofortified pearl millet improves iron status and some measures of cognitive performance in Indian adolescents. This trial was registered at http://www.clinicaltrials.gov as NCT02152150.

Risk-Based Questionnaires Fail to Detect Adolescent Iron Deficiency and Anemia.

OBJECTIVE: To evaluate the predictive ability of screening questionnaires to identify adolescent women at high-risk for iron deficiency or iron deficiency anemia who warrant objective laboratory testing. STUDY DESIGN: Cross-sectional study of 96 female individuals 12-21 years old seen at an academic medical center. Participants completed an iron deficiency risk assessment questionnaire including the 4 Bright Futures Adolescent Previsit Questionnaire anemia questions, along with depression, attention, food insecurity, and daytime sleepiness screens. Multiple linear regression controlling for age, race, and hormonal contraception use compared the predictive ability of 2 models for adolescent iron deficiency (defined as ferritin <12 mcg/L) and anemia (hemoglobin <12 g/dL). Model 1, the Bright Futures questions, was compared with model 2, which included the 4 aforementioned screens and body mass index percentile. RESULTS: Among participants, 18% (17/96) had iron deficiency and 5% (5/96) had iron deficiency anemia. Model 1 (Bright Futures) poorly predicted ferritin and hemoglobin values (R2 = 0.03 and 0.08, respectively). Model 2 demonstrated similarly poor predictive ability (R2 = 0.05 and 0.06, respectively). Mean differences for depressive symptoms (0.3, 95% CI -0.2, 0.8), attention difficulty (-0.1, 95% CI -0.5, 0.4), food insecurity (0.04, 95% CI -0.5, 0.6), daytime sleepiness (0.1, 95% CI -0.1, 0.3), and body mass index percentile (-0.04, 95% CI -0.3, 0.2) were not significantly associated with ferritin in model 2. Mean differences for hemoglobin were also nonsignificant. CONCLUSIONS: Risk-based surveys poorly predict objective measures of iron status using ferritin and hemoglobin. Next steps are to establish the optimal timing for objective assessment of adolescent iron deficiency and anemia.

Iron Status Is Associated with Performance on Executive Functioning Tasks in Nonanemic Young Women.

BACKGROUND: Iron deficiency (ID) is prevalent, particularly among women of reproductive age (WRA). How mild ID without anemia relates to cognition is poorly understood. Executive functioning (EF) has emerged as potentially being affected by mild ID in WRA. OBJECTIVE: We sought to examine how iron markers relate to performance on EF tasks in nonanemic WRA. METHODS: Participants included 127 females aged 18-35 y. Hematological indicators included hemoglobin, RBC distribution width, transferrin saturation (TSAT), ferritin, transferrin receptor (TfR), and total body iron (TBI). EF was assessed using 5 tasks. Associations between EF outcomes and iron status were examined using continuous iron predictors and group comparisons. RESULTS: Better iron status was associated with better attention [faster reaction time (RT) with lower TfR (P = 0.028) and higher TSAT (P = 0.013)], inhibitory control [lower RT variability with higher TSAT (P = 0.042) and planning ability (faster planning time and a smaller planning time increase with increasing difficulty with higher ferritin; P = 0.010)]. No associations with iron status were found for several EF outcomes, possibly due to performance ceilings. Paradoxically, worse performance on a working memory task was related to better iron status, which may reflect hippocampal-frontal interference [lower capacity with lower TfR (P = 0.034) and higher TBI (P = 0.043) and a larger accuracy change with increasing difficulty with higher TBI (P = 0.016)]. Longer RTs on a working memory task were observed among those with positive TBI (iron surplus; P = 0.021) and <2 abnormal iron markers (P = 0.013) compared with those with negative TBI (iron deficit) and ≥2 abnormal markers, respectively. CONCLUSIONS: These findings suggest cognitive ramifications of mild ID in otherwise healthy WRA and have implications for daily well-being. Future investigators should explore how brain system interactions change according to iron availability.

The role of pre-primary classes on school-age cognition in rural Nepal.

OBJECTIVES: In rural Nepal, we assessed the factors associated with pre-primary school attendance and its relationship to cognitive testing and school progress. STUDY DESIGN: Sociodemographic, household, and schooling data were collected among 1466 children age 7-9 years from Sarlahi, Nepal. We performed the Universal Nonverbal Intelligence Test, backward digit span, go/no-go test, Movement Assessment Battery for Children, finger-tapping test, and Stroop numbers test. We conducted adjusted regression analyses to determine the association of pre-primary school attendance with test results and school progress. RESULTS: We found that pre-primary class enrollment was lower among children of female sex, Madheshi ethnicity, and low socioeconomic status. In adjusted analyses, pre-primary school enrollment was associated with beneficial scores on all cognitive tests. In addition, children who attended pre-primary school were less likely to repeat grade 1 (prevalence ratio 0.15, 95% CI 0.08-0.30, P < .001) or ever fail a grade (prevalence ratio 0.48, 95% CI 0.26-0.90, P = .02). CONCLUSIONS: In rural Nepal, there continue to be disparities in pre-primary school attendance; however, independent of these factors, pre-primary school attendance was associated with benefits in multiple cognitive domains and early school performance.

Postpartum depressive symptoms across time and place: structural invariance of the Self-Reporting Questionnaire among women from the international, multi-site MAL-ED study.

BACKGROUND: The Self-Reporting Questionnaire (SRQ) is a screening instrument that has been shown to be an effective measure of depression in postpartum women and is widely used in developing nations. METHODS: The SRQ was administered to 2028 mothers from eight nations at two time points: one and six months postpartum. All data were obtained from the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study. The sample included women from MAL-ED sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. This study examined three aspects of validity of SRQ scores including (a) structural validity, (b) cross-cultural invariance, and (c) invariance over time. RESULTS: A 16-item, one-factor structure with items reflecting somatic symptoms removed was deemed to be superior to the original structure in this postpartum population. Although differential item functioning (DIF) across sites was evident the one-factor model was a good fit to the data from seven sites, and the structure was invariant across the one- and six-month time points. LIMITATIONS: Findings are based on data from self-report scales. No information about the clinical status of the participants was available. CONCLUSIONS: Overall, findings support the validity of a modified model of the SRQ among postpartum women. Somatic symptoms (e.g., headaches, not sleeping well) may not reflect internalizing problems in a postpartum population. Implications for researchers and practitioners are discussed.

Interpretation of serum ferritin concentrations as indicators of total-body iron stores in survey populations: the role of biomarkers for the acute phase response.

BACKGROUND: Nutritional surveys use acute phase protein (APP) biomarkers such as C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to identify the influence of inflammation on the distribution of iron status biomarkers. Few, however, have examined which biomarker better identifies persons with spurious elevations in iron status markers. OBJECTIVE: We explored the relations of APP biomarkers to iron-status biomarkers in infants and school-age children. DESIGN: In screening surveys, we identified a sample of African American infants (n = 351) and Guatemalan school-age children (n = 375). We used a common set of APP and iron-status biomarkers to examine the association between the 2 sets of markers (laboratory variables). RESULTS: The overall prevalence of either inflammation or iron deficiency was <10% in both samples. The log AGP and CRP values were significantly correlated (r = 0.70), but the unexplained variance still was >50%. Serum ferritin-but not transferrin receptor, transferrin receptor index, or serum iron-was related to APP concentrations, but poor positive predictive value (<72%) and low kappa scores were found. Ferritin concentrations >1 geometric SD above the geometric mean were poorly predicted by either elevated AGP or CRP. Qualitative CRP analysis was not effective in identifying persons who had other indications of mild inflammation. CONCLUSIONS: These analyses show that a low prevalence of inflammation has little influence on the distribution of ferritin, and 2 common indicators of inflammation do not perform equally well in identifying persons who may have elevations in ferritin due to inflammation.