Anaemia in pregnancy: possible causes and risk factors in Nepali women.

OBJECTIVE: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. DESIGN: Case-control study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). RESULTS: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. CONCLUSIONS: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8

Anaemia and iron deficiency screening in adolescence: a pilot study of iron stores and haemoglobin response to iron treatment in a population of 14-15-year-olds in Norway.

Screening for haemoglobin (Hb) and s-ferritin, in 176 of all 189 (93%) pupils at 8th grade (14-15-years-old) in one Norwegian community was performed in order to map the prevalence of anaemia and depleted iron stores. In order to determine the clinical significance of the findings, a questionnaire aimed at detecting symptoms or risk factors for iron deficiency was completed by all participants, and a 3 mo therapeutic trial with iron was offered to subjects with s-ferritin values below 15 microg/l. Four percent of girls and 8% of boys were anaemic according to WHO cut-off levels. S-ferritin <15 microg/l was found in 25% of girls and 30% of boys. Forty-four of 48 pupils with s-ferritin <15 microg/l completed the therapeutic trial. Only three pupils had a clinically significant increase in Hb, representing less than 2% of the population. The questionnaire gave no clues that could identify subjects with depleted iron stores. To increase Hb in one 14-15-y-old with depleted iron stores, 59 (95% CHI: 20-285) had to be screened and 16 (6-76) had to be given iron treatment. This pilot study suggests that functional iron deficiency is rare in Norwegian adolescents despite a high frequency of low iron stores. A double blind, placebo controlled study covering the entire span of pubescence is needed to confirm these results.

Iron supplementation in pregnancy: is less enough? A randomized, placebo controlled trial of low dose iron supplementation with and without heme iron.

BACKGROUND: The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component, prescribed for women in the second half of pregnancy. METHOD: A randomized, double-blind, placebo controlled trial. Thirty-one women received a daily dose of 27 mg elemental iron in a product containing both heme iron and non-heme iron (Hemofer), 30 women received the same dose as pure non-heme iron with vitamin C (Collets jern med vitamin C), and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron status markers (s-ferritin, s-iron, Total Iron Binding Capacity and erythrocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpartum. The results were analyzed according to the 'intention to treat' principle. RESULTS: The hematological effects were equal in the two treatment groups. 25% of the supplemented women fell below 110 g/l in Hb vs 52% in the placebo group (p < 0.05); none fell below 100 g/l in the supplemented groups, 14% in the placebo group. Iron status was significantly better for all measured parameters in the heme iron group compared to placebo at the end of pregnancy. Differences between the other groups were only shown for some parameters, probably due to the small sample size. In the heme iron group there were fewer women with empty iron stores postpartum than at the start of pregnancy (from 14% to 8%), in the non-heme iron group there was a significant increase (from 3% to 27%), and in the placebo group the percentage of women with empty iron stores was more than doubled (from 21% to 52%). CONCLUSIONS: A daily dose of 27 mg elemental iron, containing a heme component, given in the second half of pregnancy, prevents depletion of iron stores after birth in most women. An equivalent dose of pure inorganic iron seems less effective, but the sample size in this study was too small to demonstrate significant differences between the two treatment groups.

Sexual desire in men: effects of oral ingestion of a product derived from fertilized eggs.

A commercial product, Libido (Libid, Libbido, Erosom and Ardorare, names used in different markets), which is based on components derived from fertilized, partly incubated chickens' eggs, has been used to treat diminished sexual desire in men. The results from two double-blind cross-over placebo-controlled experiments indicate that Libido has a significant enhancing effect on sexual desire in men with normal and reduced sexual drive. Over periods as short as 2 weeks, 58% of the participants with low sexual desire noticed improvement as assessed using a visual analogue scale. Data obtained from consumers suggest significant effects on the frequency of sexual intercourse, on increased self-esteem, on the level of happiness, and on stamina. In a separate Swedish study, 84% of 31 men reported increased sexual desire during 3 weeks on Libido. It takes 1-2 weeks of regular use of Libido (3 g twice daily) before noticeable changes are observed.

Iron supplementation in pregnancy. General practitioners' compliance with official recommendations.

UNLABELLED: OBJECTIVE--To compare general practitioners' routines regarding iron supplementation in pregnancy with national recommendations. DESIGN: Mailed questionnaire to general practitioners. SETTING: A county in western Norway. SUBJECTS: 184 general practitioners. MAIN OUTCOME MEASURES: Descriptive registration of reported routines regarding assessment and supplementation of iron. RESULTS: 11% of general practitioners reported complete adherence to the national programme recommending iron supplements for everyone in the second half of pregnancy and use of s-ferritin estimation if Hb falls below 11 g/dl. 36% of the doctors prescribed iron supplements routinely irrespective of iron status. 87% reported use of s-ferritin estimation in antenatal care; usually on indication of low Hb, almost 20% as a routine screening in all pregnancies. CONCLUSION: General practitioners' compliance with national recommendations for iron supplementation in pregnancy is very low and probably reveals a need both for a review of the national recommendations and for an approach to increase compliance with given standards.

The modifying effect of multiple generation selection and dietary cadmium on methyl mercury toxicity in Japanese quail.

Japanese quails were exposed to dietary methyl mercury chloride in graded amounts from 2--8 ppm through a series of multiple-generation experiments with the experimental periods lasting from 6--12 weeks, starting with the experimental diets when the birds were 6 weeks old. Cadmium chloride was added to diets with and without mercury and fed to groups in three of the five experiments. Hatchability was depressed at 8 ppm mercury. The mortality of chicks from 8 ppm exposed parents was 100% in the first two generations, while chick mortality at the 4 ppm level in the same experiments was 54--63%. After six generations mortality in chicks hatched in 8 ppm group was reduced to about 50%. Cadmium supplementation at a level of 5 ppm counteracted the mercury-induced toxicity but failed to be effective in preventing the effects of mercury toxicity when added at 15 ppm level. Significant toxic effects of cadmium alone did not occur until the level was raised to 60 ppm. The morphology of mercury-induced encephalopathy was similar to the brain lesions reported in other bird species, with the injuries predominantly being localized to the cerebellar cortex and medulla.

A fine structural study of liver (littoral) cells of methylmercury fed Japanese quail (Coturnix coturnix japonica).

Tissues of Japanese quails were subjected to electron microscopical study. The birds had received 0-8 ppm methylmercury added to their diets for 6 weeks. The ultrastructural changes in the littoral cells of the liver were swollen mitochondria, with dilatation of the endoplasmic reticulum, loss of ribosomes from the rough endoplasmic reticulum and an increase in the number of vesicles in the cytoplasm. The nuclear membrane in some littoral cells became dilated, and the nuclear chromatin was condensed. The physiological effect of the destruction of the littoral cells is discussed.