Genotype Effects on ß-Carotene Conversion to Vitamin A: Implications on Reducing Vitamin A Deficiency in the Philippines.

BACKGROUND: The study aimed to identify 2 beta-carotene 15,15'-monooxygenase (BCMO1) mutations, namely R267S and A379V, and determine their association with vitamin A status among Filipinos 6 to 19 years old respondents of the 2013 Philippine National Nutrition Survey living in the National Capital Region. MATERIALS AND METHODS: This study followed cross-sectional design. Whole blood specimen was collected in the morning and was used as source of genomic DNA and serum for retinol concentration determination. Fisher exact test was performed to determine whether genotype frequencies were associated to retinol concentrations/vitamin A deficiency status. A level of P < .05 was identified as significant. RESULTS: A total of 693 Filipino children and adolescents were included. Of the 693, there were at least 7.6% who bear the combined mutations for R267S + A379V. Association analysis showed that an inverse relationship exists between the A379V TT variant and vitamin A status, although the exact role of these identified polymorphisms on retinol/carotenoid metabolism need to be confirmed in dedicated functional studies. CONCLUSION: This study has identified for the first time the presence of 2 nonsynonymous genetic variants/mutations in the coding region of BCMO1 gene. Interestingly, one of these 2 variants, the A379V T, was found to be associated with vitamin A status. It is, therefore, warranted to investigate the role of BCMO1 variants for the success of supplementation programs and fortification efforts among vulnerable populations in this region. Genetic variability should be considered for future provitamin A supplementation recommendations among children and adolescents in the Philippines.

Current state of iodine nutrition in Filipino school-aged children.

OBJECTIVES: Globally, although progress in eliminating iodine deficiency disorders (IDD) has been reported, IDD is still considered to be a global health problem. As school-aged children are the most accessible population group, their urinary iodine (UI) concentration data are accepted and used as an indicator of IDD for the general population. The aim of this study was to reassess the national, regional, and provincial estimates of UI as a measure of IDD among Filipino school-aged children. METHODS: Casual urine samples were collected from 22 588 children, 6 to 12 y of age, from participating households in the eighth National Nutrition Survey. UI was determined based on the catalytic action of iodine in the Sandell-Kolthoff reaction and IDD was evaluated using criteria from the World Health Organization, United Nations Children's Fund, International Council for Control of Iodine Deficiency Disorders criteria. RESULTS: The median UI level among Filipino school-aged children was 168 µg/L, corresponding to optimal iodine nutrition; whereas 23.2% had UI reflective of excessive iodine intake. Cjildren in the Zamboanga Peninsula Region had median UI level of 68 µg/L and 41.1% of participants had UI values <50 µg/L, which is indicative of mild iodine deficiency. Children from Guimaras and Zamboanga del Norte, or 2.4% of the provinces, had moderate iodine deficiency. CONCLUSION: Although the median UI level of school-age children was optimal, there are pockets of inadequacy and excessive intake that need special concern for targeted intervention.

Iodine Status in Filipino Women of Childbearing Age.

BACKGROUND: Iodine deficiency (ID) has become a concern not only among pregnant women, but in women of childbearing age as well. In fact, a recent report suggested that women with moderate to severe ID may experience a significantly longer time to conceive. This study aimed to investigate iodine status in Filipino women of childbearing age. METHODS: The iodine status of 6,194 Filipino women aged 15 to 45 years old was assessed through urinary iodine analysis. A casual spot urine sample was collected from women in households participating in the eighth National Nutrition Survey conducted by the Food and Nutrition Research Institute. The sample was analyzed using ammonium persulfate digestion followed by the Sandell-Kolthoff colorimetric reaction. A median urinary iodine concentration (UIC) of less than 100 µg/L was used to define ID. RESULTS: The median UIC was 123 µg/L, indicative of adequate iodine nutrition; however, 21.5% of participants had a UIC below 50 µg/L. The median UIC of women who lived in urban areas (142 µg/L), belonged to the middle to richest class (>124 µg/L), had reached a college education (136 µg/L), and used iodized salt (15 ppm and above; 148 to 179 µg/L) reflected adequate iodine nutrition. ID was found to have been eliminated in the regions of Central Luzon, Eastern Visayas, Calabarzon, Mimaropa, and the National Capital, while mild ID was identified in Western Visayas, Southern and Western Mindanao, and in the Autonomous Region in Muslim Mindanao. CONCLUSION: Pockets of ID among women of childbearing age exist in the Philippines. Proper information through education and the use of adequately iodized salt are key measures for improving the iodine status of the studied population.

Thalassemia and other hemoglobinopathies among anemic individuals in Metro Manila, Philippines and their intake of iron supplements.

BACKGROUND AND OBJECTIVES: Iron deficiency is the most common cause of anemia worldwide. In Southeast Asia, studies showed that genetic hemoglobin disorders also contribute significantly to the burden of anemia. The study aimed to estimate the proportion of thalassemia and other hemoglobinopathies versus iron deficiency and other causes in a sample of anemic individuals; describe the characteristics of thalassemic subjects in terms of severity of anemia, adequacy of iron stores, and hematological profile; examine the intake of iron supplements among individuals with varying causes of anemia. METHODS AND STUDY DESIGN: A random sample of 101 anemic individuals living in Metro Manila was examined. Hemoglobinopathy was determined using capillary electrophoresis. Iron deficiency was determined using immunoradiometric assay for serum ferritin. A questionnaire was used to obtain information on the use of iron supplements. RESULTS: The most frequent underlying cause of anemia was iron deficiency (37.6%), followed by anemia due to other causes (34.7%), and hemoglobinopathy (27.8%). The most prevalent form of hemoglobinopathy was alpha-thalassemia trait (20.8%), followed by betathalassemia trait (5%), iron deficiency anemia with concomitant HbE (1%), and beta-thalassemia HbE interacting (1%). Thalassemic subjects exhibited mild anemia, had either normal or excessive iron stores, and did not ingest iron supplements. CONCLUSION: The majority of anemia (62.5%) in this sample was due to other causes and hemoglobinopathy, rather than iron deficiency. Genetic hemoglobin disorders appear to be common among anemic individuals. Population screening is needed to determine the real prevalence of the disease. Further investigation is needed to identify other causes of anemia among Filipinos.

Improving the bioavailability of nutrients in plant foods at the household level.

Plant foods are the major staples of diets in developing countries, in which the consumption of animal-source foods is often low because of economic and/or religious concerns. However, such plant-based diets are often associated with micronutrient deficits, exacerbated in part by poor micronutrient bioavailability. Diet-related factors in plant foods that affect bioavailability include: the chemical form of the nutrient in food and/or nature of the food matrix; interactions between nutrients and other organic components (e.g. phytate, polyphenols, dietary fibre, oxalic acid, protein, fat, ascorbic acid); pretreatment of food as a result of processing and/or preparation practices. Consequently, household strategies that reduce the content or counteract the inhibiting effects of these factors on micronutrient bioavailability are urgently needed in developing-country settings. Examples of such strategies include: germination, microbial fermentation or soaking to reduce the phytate and polyphenol content of unrefined cereal porridges used for young child feeding; addition of ascorbic acid-containing fruits to enhance non-haem-Fe absorption; heating to destroy heat-labile anti-nutritional factors (e.g. goitrogens, thiaminases) or disrupt carotenoid-protein complexes. Such strategies have been employed in both experimental isotope-absorption and community-based studies. Increases in Fe, Zn and Ca absorption have been reported in adults fed dephytinized cereals compared with cereals containing their native phytate. In community-based studies in rural Malawi improvements in dietary quality and arm-muscle area and reductions in the incidence of anaemia and common infections in young children have been observed.

Household dietary strategies to enhance the content and bioavailability of iron, zinc and calcium of selected rice- and maize-based Philippine complementary foods.

Philippine complementary foods are predominantly plant-based, with a low content of readily available iron, zinc, and calcium, and a relatively high amount of phytate, a potent inhibitor of mineral absorption. Some of the phytate is water soluble, and hence can be removed by soaking. In this study we have compared the iron, zinc, and calcium content, and estimated iron and zinc bioavailability of rice- and maize-based Filipino complementary foods prepared with and without soaking and/or enrichment with chicken liver, egg yolk, small soft-boned fish, and mung bean grits. Analysis of iron, zinc, and calcium were performed by atomic absorption spectrometry, and phytate (based on hexa-(IP6) and penta-inositol phosphate (IP5) by HPLC; corresponding [Phy]/[Fe] and [Phy]/[Zn] molar ratios were calculated as predictors of iron and zinc bioavailability. Addition of chicken liver, followed by egg yolk, resulted in the greatest increases in iron and zinc content for both the rice- and maize-based complementary foods, whereas addition of small dried fish with bones had the greatest effect on calcium. The IP5 + IP6 content and [Phy]/[Zn] molar ratios were higher in the maize- than rice-based complementary foods, and were reduced by soaking, although only the maize plus mung bean grits, with and without soaking, had [Phy]/[Zn] molar ratios above 15. Enrichment with animal protein or soaking has the potential to enhance the content of absorbable iron, zinc, and probably calcium to varying degrees in rice- and maize-based Philippine complementary foods.

Macronutrient and selected vitamin intakes from complementary foods of infants and toddlers from Cebu, Philippines.

Intakes of macronutrients (energy, protein, fat, and carbohydrate) and vitamins (vitamin A, thiamin, riboflavin, niacin, and vitamin C) (per day and per 100 kcal) from complementary foods by a cohort of Filipino breast-fed infants and toddlers (n=1794) were studied at 10, 16, and 22 months of age using a single 24-h recall. With the exception of protein, intakes of energy and vitamins for all age groups were below the World Health Organization estimated needs and desired nutrient densities from complementary foods regardless of breast-feeding frequency. Nutrient deficits were greater for rural children compared with urban children, and were attributed to low intakes of energy, as well as cellular animal protein, fruits and vegetables.