RESUMO

In January 2000, Chilean Ministry of Health mandated the addition of folic acid (FA) to wheat flour in order to reduce the risk of neural tube defects (NTDs). This policy resulted in significant increases in serum and red cell folate in women of fertile age 1 year after fortification. To evaluate the effect of wheat flour fortification on the prevalence of NTDs in Chile we designed a prospective hospital-based surveillance program to monitor the frequency of NTDs in all births (live and stillbirths) with birth weight≥500 g at the nine public maternity hospitals of Santiago, Chile from 1999 to 2009. During the pre-fortification period (1999-2000) the NTD rate was 17.1/10,000 births in a total of 120,566 newborns. During the post-fortification period (2001-2009) the NTD rate decreased to 8.6/10,000 births in a total of 489,915 newborns, which translates into a rate reduction of 50% (RR: 0.5; 95% CI: 0.42-0.59) for all NTDs. The rate reduction by type of NTD studied was: 50% in anencephaly (RR: 0.5; 95% CI: 0.38-0.67), 42% in cephalocele (RR: 0.58; 95% CI: 0.37-0.89), and 52% in spina bifida (RR: 0.48; 95% CI: 0.38-0.6). Rates showed significant reduction both in stillbirths and live births: 510.3 to 183.6/10,000 (RR=0.36; 95% CI: 0.25-0.53) and 13.3 to 7.5/10,000 (RR=0.56; 95% CI: 0.47-0.68), respectively. In Chile, fortification of wheat flour with FA has proven to be an effective strategy for the primary prevention of NTDs.

Assuntos

RESUMO

Zinc (Zn) deficiency and obesity can be observed together in some developing countries. Zn deficiency may enhance fat deposition and decrease lean mass accrual, which in turn, appears to influence physical activity (PA), although this has not yet been evaluated in obese children. The objective of the study was to find out the association between measurements of plasma Zn and serum leptin, body composition, and PA in Chilean obese preschool children. Seventy-two 18- to 36-month-old obese children [weight-for-length/height z score (WHZ) > 2.0 SD], belonging to low socioeconomic communities, participated in the study. Plasma Zn, serum leptin, weight, waist circumference, height, total body water (TBW) assessed by deuterium isotopic dilution technique and daily activity, measured by registering 48 h with an accelerometer, were evaluated. We found 82% of children with WHZ > 3 SD. The geometric mean Zn intake was 6.2 +/- 2.5 mg/day. The mean plasma Zn was 91.8 +/- 11.4 microg/dL, with 10% of the children having levels <80 microg/dL. No correlation was found between plasma Zn concentrations and either weight, WHZ, or waist circumference. Serum leptin was lower in males than in females (2.9 +/- 2.8 vs 6.8 +/- 5.0 ng/mL, respectively; p < 0.001). TBW was different between males and females (56.2 +/- 5.4 vs 52.8 +/- 4.3% body weight, respectively; p = 0.004), but no significant association was found between TBW and plasma Zn. Moderate + intense PA, (as percentage of wake time), was greater in males than in females (6.3 +/- 3.1% vs 3.4 +/- 2.3%, respectively; p < 0.001), but it was not significantly correlated to plasma Zn. In conclusion, plasma Zn was not associated with body composition as assessed by TBW, serum leptin, or with the magnitude of physical activity in Chilean overweight preschool children.

Assuntos

RESUMO

BACKGROUND: Fortification of wheat flour with folic acid in Chile, started in January 2000. This fortification should decrease the incidence of neural tube defects. AIM: To study the incidence of neural tube defects among Chilean newborns, during 1999. MATERIAL AND METHODS: The records of all newborns and stillbirths with a birth weight over 500 g from 9 public maternity hospitals in Santiago in 1999, were reviewed. All neural tube defects, associated or not to other malformations were taken into account. RESULTS: During the study period, 59.627 newborns and 455 stillbirths were analyzed. The global incidence of neural tube defects was 1.56 per 1.000 born (57% women, 42% men and 1% ambiguous sex). Spina bifida was the most frequent neural tube defect found. CONCLUSION: These baseline data will be useful to assess the impact of folic acid fortification of wheat flour.

Assuntos

RESUMO

OBJECTIVE: To evaluate the effect of zinc supplementation on growth and development during infancy. DESIGN: We randomized 150 term neonates of low socioeconomic status to receive supplemental zinc 5 mg/d (SG) or a lactose placebo (PG); 112 completed a 1-year follow-up. All were breast-fed and given cow milk formula after weaning; solid foods and iron were added at 5 months. Anthropometry measured monthly, psychomotor development (PDI), mental development (MDI), and behavior including motor quality factor were assessed by Bayley Scales at 6 and 12 months. The groups were comparable in maternal characteristics, birth weight, home environment, and mother-infant interaction. RESULTS: No effects of zinc on weight, length, and weight for length at 12 months were found controlling for sex and breast-feeding. The mean PDI (SG: 84.5 +/- 11.5 vs PG: 87.6 +/- 9.9) and MDI (90.9 +/- 10.5 vs 88.9 +/- 9.1) were similar; however, 46 of 52 infants in the PG scored <100 in MDI vs 42 of 57 in the SG (P <.05). A smaller proportion of the SG, 2 of 57, scored low in motor quality factor at 6 months compared with the PG, 8 of 52 (P =.02). The mean at 12 months for the SG was 31.9 +/- 2.8 and for the PG 30.8 +/- 2.9 (P <.05); zinc supplementation entered the multiple regression at 12 months (P =.037). CONCLUSIONS: Zinc supplementation may have a beneficial effect on mental development and motor quality behavior of healthy term infants.

Assuntos

RESUMO

BACKGROUND: The serum transferrin receptor (TfR) and the ratio of TfR to serum ferritin (TfR:SF) have been shown to be useful as early indicators of iron deficiency. OBJECTIVE: The objective of this study was to evaluate the performance of TfR and TfR:SF in the assessment of iron deficiency in infants and to analyze age-related changes in both variables. DESIGN: A total of 716 blood samples obtained from 515 healthy infants aged 8-15 mo were studied. RESULTS: In 144 samples in which all other laboratory indicators of iron status were within the reference range, the median and 95% CI for TfR and TfR:SF were 8.5 mg/L (95% CI: 5.9, 13.5) and 497 (95% CI: 134, 975), respectively. TfR and TfR:SF were significantly correlated with the other laboratory indicators of iron status. Furthermore, as the severity of iron deficiency progressed, there was a gradual increase in mean TfR concentration (P: < 0.00001; analysis of variance). The sensitivity of TfR > 13.5 mg/L and TfR:SF > 975 in the diagnosis of iron deficiency was 23.6% and 68.4%, respectively. The specificity was 98.3% and 63.3% for TfR and TfR:SF, respectively. The sensitivity and specificity of SF < 10 microg/L were 63.7% and 60.8%, respectively. Receiver operator characteristic analysis showed that TfR and TfR:SF were more accurate than was SF alone in the diagnosis of iron deficiency. CONCLUSIONS: TfR and TfR:SF showed age-related changes; TfR and TfR:SF appear to be better diagnostic tests for iron deficiency in infants than SF.

Assuntos

RESUMO

OBJECTIVE: Aging is associated with increased risk of developing anemia and micronutrient deficiencies. Wheat-based staple foods are iron fortified in Chile. We aimed to establish the prevalence and etiology of anemia in apparently healthy free-living elderly subjects. DESIGN AND SETTING: A cross-sectional study was performed in an outpatient clinic of Santiago, Chile. SUBJECTS AND METHODS: A group of 274 subjects (93 men, 181 women)>/=60 y old living at home and apparently healthy was studied. Clinical and anthropometric evaluations and dietary survey were performed. Complete blood count, and status of iron, copper, folate, vitamins B12 and A and C-reactive protein, and erythrocyte sedimentation rate were measured. RESULTS: Prevalence of anemia was 5.4% for men and 4.4% for women. Subjects with inflammatory process had a higher prevalence of anemia (22.2% men, 31.6% women). Abnormal serum retinol (<0.35 micromol/l) was found in 13.7% of men and 15.9% of women. Prevalence of folate deficiency (<7 nmol/l) was 50.5% in men and 33.1% in women. Low serum vitamin B12 (<148 pmol/l) was present in 51.1% of men and 30. 9% of women. Iron and copper deficiencies were infrequent. CONCLUSIONS: Anemia is not prevalent in free-living elderly subjects when iron intake is adequate. Inflammatory process is the main etiology of anemia in this age group. Vitamin A, folate and vitamin B12 deficiencies were found in a significant proportion of the study group. SPONSORSHIP: Sandoz Foundation for Gerontological Research.

Assuntos

Assuntos

RESUMO

Iron deficiency is the single most common nutritional disorder world-wide and the main cause of anaemia in infancy, childhood and pregnancy. It is prevalent in most of the developing world and it is probably the only nutritional deficiency of consideration in industrialised countries. In the developing world the prevalence of iron deficiency is high, and is due mainly to a low intake of bioavailable iron. However, in this setting, iron deficiency often co-exists with other conditions such as, malnutrition, vitamin A deficiency, folate deficiency, and infection. In tropical regions, parasitic infestation and haemoglobinopathies are also a common cause of anaemia. In the developed world iron deficiency is mainly a single nutritional problem. The conditions previously mentioned might contribute to the development of iron deficiency or they present difficulties in the laboratory diagnosis of iron deficiency.

Assuntos

RESUMO

Iron bioavailability was evaluated in people living in high altitudes. Absorption was estimated from a reference dose of ferrous ascorbate and from a standard diet of wheat flour, using extrinsic tag radioisotope technique of 55Fe and 59Fe. Twenty four volunteers, healthy women, with ages ranging from 28 to 45 years, participated. Of those, eleven lived at 3450 meters above sea level (m.a.s.l.) in Huancayo city-Peru (study group), and 13 lived in Santiago de Chile at 630 m.a.s.l. (control group). Iron absorption from reference dose of ferrous ascorbate was 32.0% and 31.1% in the study and control groups respectively. The geometric mean of iron absorption from the standard diet, corrected to 40% of absorption of reference dose, was 9.0% and 6.9% in the study and control groups respectively (NS). The results suggest that altitude does not produce a high iron absorption in highlander residents.

Assuntos

RESUMO

The chemical properties of ferrous bis-glycine chelate allow for its use as a fortificant in fluid, high fat vehicles. This chemical form may also protect iron from the inhibitory or enhancing effects of the diet on iron absorption. Alternatively, iron bis-glycine chelate may be absorbed by a mechanism independent of an individual's iron stores. To test these hypotheses, the bioavailability of iron bis-glycine chelate added to water and milk was studied using a double-isotopic method in two groups of 14 women. Iron absorption from aqueous solutions of 0.27 mmol/L (15 mg/L) of elemental iron as either iron bis-glycine or ferrous ascorbate was not significantly different (34.6 and 29.9%, respectively). There were significant correlations between (log) iron absorption of iron bis-glycine with (log) serum ferritin (r = -0.60, P < 0.03) and with (log) iron absorption from ferrous ascorbate (r = 0.71, P < 0.006), suggesting that iron bis-glycine chelate bioavailability is indeed affected by iron stores. Iron absorption of iron bis-glycine given in milk was significantly lower (P < 0.002) than when given in water, with values of 11.1 and 46.3%, respectively (standardized to 40% absorption of the reference dose). With the addition of 0.57 mmol/L ascorbic acid (100 mg/L), iron absorption of iron bis-glycine given in milk increased significantly from 11.1 to 15.4% (P < 0.05). These findings show that milk and ascorbic acid affect iron bis-glycine chelate bioavailability and also demonstrate that iron stores may influence its bioavailability as well. The good bioavailability of iron bis-glycine makes this compound a suitable alternative to be considered in iron fortification programs.

Assuntos