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PubMed2006

Effect of multiple micronutrient supplementation during pregnancy on inflammatory markers in Nepalese women.

BACKGROUND: Multiple micronutrient supplementation of Nepalese women during pregnancy is associated with a significant increase in birth weight. OBJECTIVE: We tested the hypothesis that improved birth weight in infants of mothers supplemented with micronutrients is associated with a decrease in inflammatory responses and an increase in the production of T helper 1 cells and T helper 2 cells. DESIGN: The study was embedded in a randomized controlled trial of 15 micronutrients, compared with iron-folate supplementation (control), given during pregnancy with the aim of increasing birth weight. Blood samples were collected at 32 wk of gestation, 12-20 wk after supplementation began, for the measurement of inflammatory markers. Breast-milk samples were collected 1 mo after delivery for the measurement of the ratio of milk sodium to potassium (milk Na:K). In an opportunistically selected subgroup of 70 women, mitogen-stimulated cytokine production was measured ex vivo in whole blood. RESULTS: Blood eosinophils; plasma concentrations of the acute phase reactants C-reactive protein, alpha(1)-acid glycoprotein (AGP), neopterin, and ferritin; milk Na:K; and the production of interleukin (IL) 10, IL-4, interferon gamma, and tumor necrosis factor alpha in whole blood did not differ significantly between the supplemented and control groups. Plasma C-reactive protein and AGP were higher in women who had a preterm delivery, and AGP was higher in women who delivered a low-birth-weight term infant than in women who delivered a normal-birth-weight term infant. CONCLUSIONS: The results indicate an association between systemic inflammation in late pregnancy and compromised delivery outcome in Nepalese women but do not support the hypothesis that multiple micronutrient supplementation changes cytokine production or inflammatory markers.

Adult↗
PubMed2006

Low serum micronutrient concentrations predict frailty among older women living in the community.

BACKGROUND: Micronutrient deficiencies are common among older adults. We hypothesized that low serum micronutrient concentrations were predictive of frailty among older disabled women living in the community. METHODS: We studied 766 women, aged 65 and older, from the Women's Health and Aging Study I, a population-based study of moderately to severely disabled community-dwelling women in Baltimore, Maryland. Serum vitamins A, D, E, B(6), and B(12), carotenoids, folate, zinc, and selenium were measured at baseline. Frailty status was determined at baseline and during annual visits for 3 years of follow-up. RESULTS: At baseline, 250 women were frail and 516 women were not frail. Of 463 nonfrail women who had at least one follow-up visit, 205 (31.9%) became frail, with an overall incidence rate of 19.1 per 100 person-years. Compared with women in the upper three quartiles, women in the lowest quartile of serum carotenoids (hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.01-1.92), alpha-tocopherol (HR 1.39; 95% CI, 1.02-1.92), and 25-hydroxyvitamin D (HR 1.34; 95% CI, 0.94-1.90) had an increased risk of becoming frail. The number of nutritional deficiencies (HR 1.10; 95% CI, 1.01-1.20) was associated with an increased risk of becoming frail, after adjusting for age, smoking status, and chronic pulmonary disease. Adjusting for potential confounders, we found that women in the lowest quartile of serum carotenoids had a higher risk of becoming frail (HR 1.54; 95% CI, 1.11-2.13). CONCLUSIONS: Low serum micronutrient concentrations are an independent risk factor for frailty among disabled older women, and the risk of frailty increases with the number of micronutrient deficiencies.

Aged↗
PubMed1998

From research to global reality: the micronutrient story.

The professional life history of E. V. McCollum exemplifies how sound nutrition-related laboratory research was translated into practical realities that influenced individual and national nutrition-related decisions. Public health and educational programs emerging in the first third of this century improved health and nutritional well-being in the United States. Characteristics that surrounded pioneering efforts early in the century are similar to those that have reinvigorated global micronutrient concerns in the last third of the century. Sound community-oriented scientific research revealed the true consequences of iodine, vitamin A and iron micronutrient malnutrition. Repositioning the image of these three micronutrients from that of a clinical problem affecting relatively few to one with consequences for individual, national and global development affecting many more, and disseminating these facts through high-level political forums incited attention, commitment and actions. As in the early days of McCollum and his contemporaries, current nutrition scientists played a significant role, interacting with politically oriented counterparts, in taking micronutrient research to reality for improving health and quality of life globally. Lessons learned from the process, both past and present, should guide future nutrition-oriented endeavours in moving research to reality for betterment of global community health.

Deficiency Diseases↗
PubMed2002

Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants.

Many indicators of micronutrient status change during infection because of the acute phase response. In this study, relationships between the acute phase response, assessed by measuring concentrations of C-reactive protein (CRP), alpha(1)-antichymotrypsin (ACT) and alpha(1)-acid glycoprotein (AGP), and indicators of micronutrient status were analyzed in 418 infants who completed a 6-mo randomized, double-blind, placebo-controlled, supplementation trial with iron, zinc and/or beta-carotene. The acute phase response, defined by raised CRP (plasma concentration >10 mg/L), raised AGP (>1.2 g/L), or both raised CRP and AGP, significantly affected indicators of iron, vitamin A and zinc status, independently of the effects of supplementation. Plasma ferritin concentrations were higher by 15.7 (raised AGP) to 21.2 (raised CRP and AGP) micro g/L in infants with elevated acute phase proteins compared with infants without acute phase response (P < 0.001). In contrast, plasma concentrations of retinol were lower by 0.07 (P < 0.05, raised AGP) to 0.12 (P < 0.01, raised CRP) micro mol/L, and of zinc lower by 1.49 (P < 0.01, raised AGP) to 1.89 (P < 0.05, raised CRP and AGP) micro mol/L. Hemoglobin concentrations and the modified relative dose response were not affected. Consequently, the prevalence of iron deficiency anemia was underestimated in infants with raised acute phase proteins by >15%, whereas the prevalence of vitamin A deficiency was overestimated by >16% compared with infants without acute phase response. Hence, using indicators of micronutrient status without considering the effects of the acute phase response results in a distorted estimate of micronutrient deficiencies, whose extent depends on the prevalence of infection in the population.

Acute-Phase Proteins↗
PubMed2003

Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings.

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

Animals↗
PubMed2003

The effect of micronutrient deficiencies on child growth: a review of results from community-based supplementation trials.

Several micronutrients are required for adequate growth among children. However, it has been unclear as to which nutrient deficiencies contribute most often to growth faltering in populations at risk for poor nutrition and poor growth. Therefore, evidence from community-based, randomized, placebo-controlled, micronutrient supplementation trials was reviewed to determine which micronutrient deficiencies have been found to be causal to growth faltering. Although correction of growth-limiting nutrient deficiencies may be achieved through provision of pharmacological nutrient supplements, it also was of interest to review evidence for the use of animal source food supplements to improved growth among children in at-risk populations. There is strong evidence for the contribution of zinc deficiency to growth faltering among children; even mild to moderate zinc deficiency may affect growth. Vitamin A and iron deficiencies also have been demonstrated to cause growth faltering, however only when the deficiency state of these nutrients is severe. Several controlled, community-based intervention trials that have included animal source foods, either together with additional micronutrient supplements or with other supplemental food sources, have demonstrated positive growth responses among children. Three trials that used an animal source food alone (skim milk powder) also resulted in a positive growth response. However, the geographic scope of the latter three trials was limited, and it remains unclear to what extent supplemental animal source foods alone and which types of animal source foods can be used to improve growth among children in at-risk populations.

Child↗
PubMed2006

Treatment effects of maternal micronutrient supplementation vary by percentiles of the birth weight distribution in rural Nepal.

Certain antenatal micronutrient supplements increased birth weight by 40-70 g in rural Nepal. The effect was estimated by calculating the mean difference in birth weight between control and treatment groups, which assumes a constant treatment effect across the birth weight distribution. By estimating differences (and CI) in birth weight between treatment and control groups as a nonlinear, smooth function of the percentiles of the birth weight distribution, we can examine whether the shape of the birth weight distribution for a treatment group is different from that of the control group. Supplementation groups were folic acid, folic acid and iron, folic acid and iron and zinc, and a multiple micronutrient supplement all with vitamin A, compared with the control group of vitamin A alone. The shape of the birth weight distribution in the multiple micronutrient group was the same as that of the control group; however, the location of the distribution had shifted. The folic acid and iron group had fewer infants in the lower tail of its distribution but a similar proportion in the upper tail compared with the control group. The biologic pathways affecting intrauterine growth may vary by micronutrients such that some may confer a benefit among the most vulnerable infants, whereas others may have a more constant effect across the birth weight distribution. Future analytic approaches to estimating benefits of maternal supplementation on birth weight should examine whether there is a constant or variable treatment effect across the distribution of birth weight.

Adolescent↗
PubMed1996

Micronutrients and the risk of colorectal adenomas.

Recent studies suggest that micronutrients, especially folate, calcium, iron, and antioxidant vitamins, affect the risk of colorectal neoplasia. The objective of this case-control study was to examine the association between these micronutrients and the risk of colorectal adenomas. The study was based on 236 cases with adenomatous polyps or cancer and 409 controls, all colonoscopy patients at University of North Carolina Hospitals between July 1988 and March 1991. After colonoscopy, subjects were interviewed using a semi-quantitative food frequency questionnaire, and average daily nutrient intakes were calculated. Sex-specific odds ratios relative to the lowest quartile of intake for each micronutrient were determined using unconditional logistic regression while adjusting for a number of potential confounders. In women, folate, iron, and vitamin C were inversely related to the risk of adenomas. Folate appeared to be most protective, with women in the highest quartile only 40% as likely to develop adenomas compared with women in the lowest (odds ratio = 0.39, 95% confidence interval 0.15-1.01). In men, greater vitamin E and calcium intakes were associated with reduced risk of adenomas, with vitamin E showing the strongest inverse association. Men in the highest vitamin E quartile had a risk of 0.35 (95% confidence interval 0.14-0.92) relative to those in the lowest. These study results support previous research findings that selected micronutrients protect against colorectal neoplasia.

Adenoma↗
PubMed2003

A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok.

OBJECTIVES: To examine the impact of high-dose multiple micronutrient supplementation on survival and disease progression among HIV-infected individuals in Thailand. DESIGN: Randomized placebo-controlled trial. METHODS: Four-hundred and eighty-one HIV-infected men and women living in and around Bangkok with CD4 cell counts in the range 50 x 10(6)- 550 x 10(6)/l were randomized to receive micronutrients or placebo for a period of 48 weeks. Trial participants were examined clinically 12-weekly and tested for CD4 cell count 24-weekly. A subset were tested for HIV plasma viral load at 48 weeks. RESULTS: Seventy-nine (16%) trial participants were lost to follow-up and 23 (5%) died. The death rate was lower in the micronutrients arm with the mortality hazard ratios [95% confidence interval (CI)] of 0.53 (0.22-1.25; P = 0.1) overall and 0.37 (0.13-1.06; P = 0.052) and 0.26 (0.07-0.97; P = 0.03) among those with CD4 cell counts < 200 x 10(6)/l and < 100 x 10(6)/l respectively. There was no impact on CD4 cell count or plasma viral load. CONCLUSIONS: Multiple micronutrient supplementation may enhance the survival of HIV-infected individuals with CD4 cell counts < 200 x 10(6)/l. This could have important public health implications in the developing world where access to antiretrovirals remains poor. The clinical findings need to be reproduced in other settings and the mechanism, which appears to be independent of change in CD4 cell count, merits further investigation.

Adolescent↗
PubMed2002

Update on micronutrients: iron and zinc.

The past few years have seen several substantial advances in our understanding of the importance of micronutrients in child health and nutrition. Although historically child nutrition in developing countries has focused on protein and energy sufficiency, more recent efforts have been made to evaluate and eliminate micronutrient deficiencies. Accumulating data have underlined the important long-term health effects that may occur with iron deficiency, and studies continue to confirm the benefits of successful treatment of iron deficiency anemia. Zinc is another micronutrient whose significance to child health is increasingly appreciated. Although breakthroughs in micronutrient research have generally come from populations in developing countries, children in industrialized countries also benefit from increasing knowledge about nutritional requirements and interventions.

Adolescent↗
PubMed1998

Micronutrients in adult nutritional support: requirements and benefits.

The prevention of micronutrient deficiency alone is no longer an adequate objective in micronutrient provision. New research indicates that many micronutrients are involved in other aspects of cell metabolism, especially in preventing cell damage caused by free radicals produced as part of oxidative metabolism. Clinical trials of micronutrient supplements are now becoming available, so that biochemical changes can be related to physiological, immunological, and clinical endpoints.

Adult↗
PubMed2006

Micronutrient interventions and HIV infection: a review of current evidence.

OBJECTIVE: To review the current evidence on the role of micronutrient supplementation in HIV transmission and progression. METHOD: Literature review. RESULTS: The importance of micronutrients in the prevention and treatment of childhood infections is well known, and evidence is emerging that micronutrient interventions may also affect HIV transmission and progression. CONCLUSION: Interventions to improve micronutrient intake and status could contribute to a reduction in the magnitude and impact of the global HIV epidemic. However, more research is needed before specific recommendations can be made.

Dietary Supplements↗
PubMed1999

Micronutrient deficiencies. A major cause of DNA damage.

Deficiencies of the vitamins B12, B6, C, E, folate, or niacin, or of iron or zinc mimic radiation in damaging DNA by causing single- and double-strand breaks, oxidative lesions, or both. The percentage of the population of the United States that has a low intake (< 50% of the RDA) for each of these eight micronutrients ranges from 2% to 20+ percent. A level of folate deficiency causing chromosome breaks occurred in approximately 10% of the population of the United States, and in a much higher percentage of the poor. Folate deficiency causes extensive incorporation of uracil into human DNA (4 million/cell), leading to chromosomal breaks. This mechanism is the likely cause of the increased colon cancer risk associated with low folate intake. Some evidence, and mechanistic considerations, suggest that vitamin B12 and B6 deficiencies also cause high uracil and chromosome breaks. Micronutrient deficiency may explain, in good part, why the quarter of the population that eats the fewest fruits and vegetables (five portions a day is advised) has about double the cancer rate for most types of cancer when compared to the quarter with the highest intake. Eighty percent of American children and adolescents and 68% of adults do not eat five portions a day. Common micronutrient deficiencies are likely to damage DNA by the same mechanism as radiation and many chemicals, appear to be orders of magnitude more important, and should be compared for perspective. Remedying micronutrient deficiencies is likely to lead to a major improvement in health and an increase in longevity at low cost.

Adult↗
PubMed1997

Developing industrial-governmental-academic partnerships to address micronutrient malnutrition.

Micronutrient malnutrition affects approximately 2 billion people and has a significant impact on mortality, morbidity, reproductive health, individual growth and development, and economic productivity. The World Bank has suggested that micronutrient interventions are among the most cost-effective of all health interventions. Therefore, greatly increased collaborative efforts are needed to bring about further reductions in micronutrient malnutrition. At the FAO/WHO International Conference on Nutrition, the importance of various partners in improving nutrition was recognized in the World Declaration on Nutrition and adopted unanimously by 159 governments: "Governments, academic institutions and industry should support the development of fundamental and applied research directed towards improving the scientific and technological knowledge base" for addressing malnutrition, including micronutrient malnutrition. Food-based strategies, including fortification, provide a good example.

Government↗
PubMed2004

Micronutrients and cancer therapy.

The effect of micronutrient supplementation on the effectiveness of cancer chemotherapeutic agents is reviewed, and the efficacy of antioxidants, folic acid, and other vitamins and minerals is discussed. Although some micronutrients show promise in enhancing the cytotoxicity of anticancer agents in vitro, caution should be exercised in recommending micronutrient supplementation for cancer patients receiving chemotherapeutic drugs. To date, few well-controlled clinical trials have been conducted to evaluate the efficacy of micronutrients in promoting the sensitivity of tumors to chemotherapeutic agents.

Animals↗
PubMed2000

Micronutrient intakes in a group of UK vegans and the contribution of self-selected dietary supplements.

Micronutrient intakes and the contribution of self-selected dietary supplements were investigated in 26 vegans, comprising 17 non-supplement users (NSU) and nine supplement users (SU), consuming their habitual diet. Micronutrient intakes were estimated using a four-day weighed record and the contribution of self-selected dietary supplements was assessed according to the manufacturers' declarations on the packaging. Mean daily intakes from food sources were similar in NSU and SU. Dietary supplements significantly increased intakes of riboflavin (p < 0.05), niacin (p < 0.05), folate (p < 0.01), vitamin A (p < 0.05) and vitamin D (p < 0.05). The mean daily contribution of dietary supplements ranged from 7-1640% of the reference nutrient intake (RNI). Intakes of vitamin B12 and selenium (Se) were below the appropriate lower reference nutrient intake (LRNI) in 80% and 65% of NSU respectively. After supplements, 33% of SU remained below the LRNI for vitamin B12 and 33% below the LRNI for Se. Some vegans who took supplements were not taking certain micronutrients in amounts sufficient to meet the RNIs but were taking a mix of micronutrients, some of which they needed and others which they did not need. Some vegans who did not take supplements had a potential need for the addition of supplements to their diets. Advice on the appropriate usage of dietary supplements for those on a vegan diet is needed.

Adult↗
PubMed2003

Multiple-micronutrient fortification technology development and evaluation: from lab to market.

At the World Summit for Children (New York, 1990), a resolution was passed to eliminate vitamin A and iodine deficiencies and significantly reduce iron-deficiency anemia by the year 2000. In responding to this urgent call, we developed a unique multiple-micronutrient fortification delivery system called "GrowthPlus/CreciPlus." Using this technology, a fortified powder fruit drink has been formulated and extensively evaluated. One serving of the product delivers the following US recommended dietary allowances: 20-30% of iron; 10-35% of vitamin A; 25-35% of iodine; 100-120% of vitamin C; 25-35% of zinc; 15-35% of folate; and 10-50% of vitamins E, B2, B6, and B12. This was accomplished through (a) identifying and selecting the right fortificants, and (b) understanding their chemical and physical properties that contribute to multiple problems (product acceptability, stability, and bioavailability). Data from a home-use test showed fortification with the "Multiple-Fortification Technology" has no effect on the appearance and taste of the eventually consumed powder fruit drink. One-year stability studies demonstrated that iodine and the vitamins have adequate stability. Bioavailability evaluation by using double-isotope labeling technique showed that the iron from the fortified powder drink has excellent bioavailability (23.4% +/- 6.7). In conclusion, a powder fruit drink has been clinically demonstrated to deliver multiple micronutrients, which include adequate levels of bioavailable iron, vitamin A, iodine, zinc, vitamin C, and B vitamins, without compromising taste, appearance, and bioavailability. The critical limiting step in the micronutrient fortification program is the production and distribution of the multiple-micronutrient-fortified product. The fortified powder drink was marketed in Venezuela under the brand name NutriStar.

Beverages↗
PubMed2000

Blood micronutrient and thyroid hormone concentrations in the oldest-old.

Several micronutrients are involved in thyroid hormone metabolism, but it is unclear whether their marginal deficits may contribute to the alterations in thyroid function observed in extreme aging. The relationships among blood concentrations of thyroid hormones and selenium, zinc, retinol, and alpha-tocopherol were studied in 44 healthy Northern Italian oldest-old subjects (age range, 90-107 yr), selected by the criteria of the SENIEUR protocol. Control groups included 44 healthy adult (age range, 20-65 yr) and 44 SENIEUR elderly (age range, 65-89 yr) subjects. Oldest-old subjects had higher TSH (P < 0.01) and lower free T3 (FT3)/freeT4 (FT4) ratio, zinc, and selenium serum values (P < 0.001) than adult and elderly control subjects. No significant difference was found for plasma retinol and a-tocopherol values. The associations between micronutrients and thyroid hormones were evaluated by multivariate analysis. In oldest-old subjects, plasma retinol was negatively associated with FT4 (P = 0.019) and TSH serum levels (P = 0.040), whereas serum zinc was positively associated with serum FT3 (P = 0.010) and FT3/FT4 ratio (P = 0.011). In younger subjects, no significant association was found among thyroid variables and micronutrients. In conclusion, blood levels of specific micronutrients are associated with serum iodothyronine levels in extreme aging.

Adult↗