Nutritional status of vitamin A in mother/newborn pairs from 2 hospital nurseries in Rio de Janeiro, Brazil

The aim of the present study was to assess maternal and newborn (umbilical blood) vitamin status in 220 mothers/newborns at birth from two public health centers in Rio de Janeiro, Brazil. The proportion of low retinol levels (cut-off point 1.05 mumol/L) in the umbilical cord of newborns (55.4%) was greater than found in their mothers (23.6%). A highly significant correlation (X2 = 14.2; p < 0.0001) was found between the levels of retinol of mothers and newborns. The overall prevalence of low levels of retinol in the mother was 23.6% whereas that of newborns was 55.4%. Umbilical cord mean concentration less than 1.05 mumol/L was significantly lower (2.49 +/- 1.08 mumol/L) in mother with vitamin A deficiency (3.21 +/- 0.97 mumol/L; p < 0.0001). Low birth weight was associated with vitamin A deficiency (X2 = 6.86; p < 0.01). These data reinforce the need for close pre-natal attention in vitamin A status.     

Influence of gestational age and parity on the concentration of retinol in human colostrums

Vitamin A is particularly important during the critical periods of growth, proliferation and development of tissues such as pregnancy, neonatal period and childhood. This study aims to evaluate the influence of maternal variables such as gestational age and parity, on the levels of retinol in colostrum and verify that the concentration of vitamin A in the colostrum of those mothers provides the recommended amount of this micronutrient for newborns. We recruited 84 healthy pregnant women attended at a Brazilian public hospital. Retinol concentrations in colostrum were analyzed by high performance liquid chromatography. The retinol in colostrum from mothers at term (n=49) and preterm (n=35) showed values of 111.3 +/- 12.4 microg/dL and 79.2 +/- 10.6 microg/dL (p < 0.0001), respectively, and retinol concentration in colostrum from primiparous (n=40) (82.5 +/- 8.8 microg/dL) and multiparous (n=44) (116.9 +/- 10.3 microg/dL) was also statistically different (p < 0.0001). Retinol levels in colostrum at term and those whose mothers had one or more than one child in this study meet the needs of the child (400 microg retinol/day). However, levels of retinol in colostrum of preterm infants are not consistent with the recommendations of the DRI for premature infants, which is 420 microg retinol/day. These results demonstrate the need to supplement with vitamin A preterm mothers to ensure an adequate supply of this vitamin to the newborn.     

FA composition of cholesteryl esters and phospholipids in maternal plasma during pregnancy and at delivery and in cord plasma at birth

The purpose of this study was to assess the FA composition of both cholesteryl esters (CE) and phospholipids (PL) in maternal plasma during pregnancy and at delivery and in umbilical plasma at birth. A longitudinal study of 32 normal pregnant women was carried out with three cutoff points during pregnancy (first, second, and third trimester) and at delivery. Few significant differences occurred in the FA profile of maternal CE: 18∶1n−9 increased, 18∶2n−6 dropped slightly, and 18∶3n−3 decreased with progressing gestation. In maternal PL, long-chain highly unsaturated FA concentrations dropped and were replaced by saturated FA as gestation progressed. Additionally, changes in saturated FA in PL occurred: Shorter-chain 16∶0 was higher whereas longer-chain 18∶0 was lower at delivery compared to early pregnancy. The FA profile of umbilical venous plasma was strikingly different from that of maternal plasma at delivery. Cord plasma CE contained more saturated and monounsaturated FA than maternal CE. The polyunsaturates 18∶2n−6 and 18∶3n−3 are lower in umbilical CE than in maternal CE whereas 20∶4n−6 and 22∶6n−3 are twice as high in umbilical CE. Cord plasma PL have a higher content of long-chain highly unsaturated FA than maternal plasma PL at delivery. In contrast to maternal plasma PL, 16∶0 was lower and longer-chain saturated FA were higher in cord plasma PL. The FA profile of umbilical plasma at birth shows preferential accumulation of 20∶4n−6 and 22∶6n−3, with low concentrations of 18∶2n−6 and 18∶3n−3 in CE and PL, indicating a preferential supply of the fetus with long-chain highly unsaturated FA needed for fetal development.     

Increased docosahexaenoic acid levels in human newborn infants by administration of sardines and fish oil during pregnancy

In rhesus monkeys, maternal n-3 fatty acid deficiency during pregnancy produces infant monkeys deficient in n-3 fatty acids at birth. These results stimulated current experiments to find out if n-3 fatty acids from fish in the diets of pregnant women would influence the concentration of docosahexaenoic acid (DHA, 22:6 n-3) in the newborn human infant. Fifteen healthy pregnant women were enrolled to receive a 9-wk dietary supplementation of n-3 fatty acids from the 26th to the 35th wk of pregnancy. Sixteen pregnant women were not supplemented and served as controls. n-3 Fatty acid supplementation consisted of sardines and additional fish oil, which provided a total of 2.6 g of n-3 fatty acids per day (d) for the 9-wk period of supplementation. This included 1.01 g DHA. The end point of this study was the blood concentrations of DHA in the newborn infant. DHA in maternal red blood cells increased from 4.69% of total fatty acids to 7.15% at the end of the supplement period and at the time of delivery decreased (as expected) to 5.97% of total fatty acids. Maternal plasma showed a similar change from 2.12 to 3.51% of total fatty acids and then decreased to 2.35%. Levels of DHA in plasma and red blood cells of unsupplemented mothers did not change during the same time period. Levels of DHA in blood of newborn infants differed greatly in infants born from n-3-supplemented mothers compared with control infants. In red blood cells, DHA was 7.92% of total fatty acids compared with 5.86% (control infants). Plasma values showed a similar difference: 5.05% vs. 3.47% (controls). In n-3-supplemented infants, DHA concentrations were 35.2% higher than in control infants in red blood cells and 45.5% higher in plasma. These data indicate the importance of maternal dietary n-3 fatty acids and, in particular, maternal dietary DHA in promoting higher concentrations of DHA in the blood of the newborn infant.     

48例妊娠合并甲亢临床分析

目的探讨甲亢对妊娠妇女和新生儿的影响。方法通过对孕期、产前测定甲亢孕妇外周血甲状腺[素三碘甲状腺原氨酸(T3)]和甲状腺素T4,促甲状腺素(TSH)水平的变化,了解甲亢的并发症,对新生儿脐血查T3、T4、TSH了解新生儿甲状腺功能。结果甲亢未治疗组甲状腺激素T3、T4、TSH水平明显高于治疗组(P<0.01)。未经治疗的甲亢并发症多,与治疗组相比,有显著性差异(P<0.01)。结论孕前及孕期对甲亢的合理治疗可以减少妊娠并发症和新生儿甲亢。     

孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义

目的探讨孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义。方法筛查4200份孕妇血清中红细胞血型不规则抗体,阳性者检测抗体特异性、免疫球蛋白类型及效价;对检测出IgG类不规则抗体者,分娩时取脐血(或新生儿血)检测血清(浆)游离抗体,并进行红细胞直接抗球蛋白试验和红细胞放散试验,以诊断其是否发生HDN。结果4200份孕妇血清中检出红细胞血型不规则抗体44份(阳性率为1.05%),其中20份孕妇血清的抗体为IgG类或IgG及IgM混合抗体,脐血(或新生儿血)检测结果,10名婴儿发生了Non-ABO-HDN,1名发生了宫内死胎。致病的抗体特异性分布为:抗-D2例、抗-c1例、抗-E2例、抗-cE1例、抗-M4例(其中1例并有抗-A)。结论孕妇体内IgG类的Rh血型系统的抗体及抗-M易引起non-ABO-HDN,检测孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN、鉴别引发HDN的抗体型别、评估HDN的严重程度及制定治疗方案均具有重要意义。     

Decrease in serum levels of retinol and its binding protein (RBP) in infection

The main purpose of the present study was to determine the qualitative and quantiative effect of various infectious epsiodes on the blood serum levels of retinol and retinol-binding protein (RBP). Twenty-four children and 30 adult subjects were studied. The infections studied included chickenpox (n = 7); bronchitis (n = 9) upper respiratory infection (n = 30); tonsillitis (n = 2); diarrhea (n = 2) and one case each of: febrile stomatitis, nonspecific gastrointestinal alteration, urinary infection and shigellosis. In addition to retinol and RBP, the study determined changes in serum carotene, proteins, albumin and globulins. The results clearly demonstrate the marked depressing effect of infections on serum retinol, with a magnitude which in many cases reached more than 20 micrograms/dl, and in others more than 30 micrograms/dl. The RBP levels were significantly correlated with retinol, decreasing proportionally with infection. Serum albumin also decreased in most instances; and the globulin levels of the children, but not of the adults, were significantly higher during the infections. Carotene did not show important variations. The effects were more intense when fever accompanied the infectious episodes. These results are considered of great public health significance, in view of the large majorities, mainly children, who ordinarily subsist with very low serum retinol levels in the underdeveloped regions of the world. As infections attack these underpriviledged children, their serum retinol and RBP levels will likely drop a magnitude similar to that observed in the subjects of this study. They may then reach even more critically deficient retinol levels and be in serious danger of developing a severe acute state of clinical vitamin A deficiency.     

Vitamin A deficiency in elderly attending the Health Family Programme in Camaragibe, PE, Brazil

Vitamin A deficiency (VAD) is a major nutritional problem in many developing countries. However, the extent of the problem among elderly people has not been well established. The current study aimed at identifying the prevalence of VAD among elderly people attending the Family Health Programme (FHP) in the city of Camaragibe, PE, Northeast Brazil. Following a systematic sampling procedure, a cross-sectional study was carried out involving 315 subjects = 60 years, of both sexes, in 2003. VAD was assessed by serum retinol levels and vitamin A-rich-food intake by a food frequency method. The prevalence of VAD (Serum ret. < 1.05 microMol/L) was 26.1% (95% CI 21.2 - 31.6) and the frequency of animal and vegetal origin vitamin A-rich foods intake = 3x/week was 46.1% (IC95% 40.7 - 52.0) and 63.2% (IC95% 57.5 - 69.5), respectively. Serum retinol levels were not correlated to sex (p = 0.54) and age (p = 0.34) distribution. In the same way, serum retinol was not related to vitamin A rich-food intake (p > 0.05). VAD seems to be very prevalent among elderly people attending the HFP in Camaragibe. Concerted actions to prevent and control VAD are strongly recommended in this ecological context.     

Serum levels and urinary excretion of magnesium in pregnancy. Effect of milk intake

Magnesium levels in serum, as well as 24-hr urine and 2-hr post-fasting urine levels, were studied in 107 pregnant women, who were later separated into two groups. One group was advised to follow their usual intake, and the other, to supplement the diet with 750 cc of milk. The control group (30 healthy non-pregnant women) underwent the same protocol. Magnesium intake in pregnant women was much lower than that recommended for gestation. In both groups of pregnant women, serum magnesium levels were lower than those of the controls, in the second and third trimester of pregnancy. Urinary magnesium in 24-hr urine was higher in each trimester of pregnancy than the controls. Hypomagnesemia and hypermagnesuria not influenced by milk intake was observed.     

Effect of the quality and quantity of dietary proteins on vitamin A depletion rate, and biological availability of vitamin A precursors

The effect of quantity and quality of protein from cereal and legume sources on the rate of vitamin A depletion was evaluated through changes in retinol serum levels and liver stores in male and female Wistar strain rats. A total of 64 animals were distributed into four groups and fed ad libitum with diets adequate in all nutrients, except vitamin A. The protein in the diets was derived from 91% common maize (Diet A); 91% Opaque-2 maize (Diet B), 64% common maize plus 27% precooked common black bean flour (Diet C), and 64% Opaque-2 maize with 27% bean flour (Diet D). The total depletion period lasted 60 days and four rats per group were sacrificed at 15, 30 and 60 days. A total of 4 animals were sacrificed at 0 day to count with a basal serum and hepatic retinol concentration value. The 16 depleted remaining rats were used for the carotene bioavailability study with dehydrated carrots. During the first 15 days the greater rate of depletion was observed in animals fed the highest protein quality diet made from Opaque-2 maize and beans (Diet D), which also caused the greatest weight increase. The least depletion rate and lowest weight gain was obtained with the common corn diet (Diet A). Diets B and C caused intermediate depletion rates, with Diet B (Opaque-2 maize) being more effective than Diet C in spite of its lower protein content. At the end of 60 days all groups presented depletion levels not statistically different. Thus, these results confirm that protein quantity and quality from basic staple foods influence mobilization of retinol liver reserves. The 16 remaining depleted rats were then divided into four groups and fed a standard 14% casein diet to which 25, 50 and 75% of the retinol requirements was added to obtain a reference standard biological response. The fourth group was fed with an amount of dehydrated and ground carrot containing 67.1 mg % of total carotenoids. After seven days, serum and hepatic retinol were obtained, from which a regression equation of liver retinol to diet retinol was calculated (microgram % liver retinol per 100 g of rat) = 2.47 + 0.063 (microgram retinol/g diet) (r = 0.585). From this equation the bioavailability of carrot carotenoids was established with a value of 21.8% comparable to the FAO/WHO value previously reported.     

Reduced Maternal Erythrocyte Long Chain Polyunsaturated Fatty Acids Exist in Early Pregnancy in Preeclampsia

The present prospective study examines proportions of maternal erythrocyte fatty acids across gestation and their association with cord erythrocyte fatty acids in normotensive control (NC) and preeclamptic pregnancies. We hypothesize that maternal fatty acid status in early pregnancy influences fetal fatty acid stores in preeclampsia. 137 NC women and 58 women with preeclampsia were included in this study. Maternal blood was collected at 3 time points during pregnancy (16–20th weeks, 26–30th weeks and at delivery). Cord blood was collected at delivery. Fatty acids were analyzed using gas chromatography. The proportions of maternal erythrocyte α‐linolenic acid, docosahexaenoic acid, nervonic acid, and monounsaturated fatty acids (MUFA) (p < 0.05 for all) were lower while total n‐6 fatty acids were higher (p < 0.05) at 16–20th weeks of gestation in preeclampsia as compared with NC. Cord 18:3n‐3, 22:6n‐3, 24:1n‐9, MUFA, and total n‐3 fatty acids (p < 0.05 for all) were also lower in preeclampsia as compared with NC. A positive association was observed between maternal erythrocyte 22:6n‐3 and 24:1n‐9 at 16–20th weeks with the same fatty acids in cord erythrocytes (p < 0.05 for both) in preeclampsia. Our study for the first time indicates alteration in maternal erythrocyte fatty acids at 16th weeks of gestation which is further reflected in cord erythrocytes at delivery in preeclampsia.     

Vitamin A status of pregnant women assessed by a biochemical indicator and a simplified Food Frequency Questionnaire

The aim of this study was to compare plasma concentrations of vitamin A in 710 women after delivery, with a simplified Food Frequency Questionnaire (FFQ). Vitamin A was determined in plasma, by HPLC. The FFQ included 55 foods, and was based on the typical diet of the low socioeconomic families in the Southeast of Brazil. For calculation purposes, first were identified all potential sources of retinol and carotenoids; the portion sizes being assigned to each food item on the basis of a previous study in the same area. Daily, weekly and monthly frequencies of consumption of foods with high, moderate and low concentrations of vitamin A were grouped according to the IVACG recommendations (1) in usual pattern of food consumption (UPF) scores. Pregnant women were allocated by these scores in 3 different categories (high, moderate and low) according to their risk of developing vitamin A deficiency. The categories of risk were based on the safe level of vitamin A intake of 800 RE/day (5600 RE/week) (7) and the basal requirement of 370 RE/day for pregnant women (8). 1.3% of the women had plasma concentrations of vitamin A < or = 0.70 mumol/l, 10.2% between 0.71-1.05 mumol/l and 88.5% > 1.05 mumol/l. According to the score categories, 49.5% of the women were at low risk for vitamin A deficiency, and 50.5% were at moderate risk. There was a weak statistically significant correlation between the plasma concentrations of vitamin A and the score categories (r = 0.11; p = 0.005). Our results indicate that the FFQ does not provide a very precise information on vitamin A status, probably because of the day to day variation in vitamin A intake, and the insensitivity of plasma concentrations to consumption of vitamin A. However, by using a simple score based on the FFQ, we were able to predict that the majority of the mothers were not at high risk for vitamin A deficiency.     

Lipid peroxidation and antioxidant status is affected by different vitamin E levels when feeding fish oil

The protective role of vitamin E and changes in the status of several physiological antioxidants after feeding rats a fish oil diet were investigated. Six-week-old male Sprague-Dawley rats were divided into four groups and fed experimental diets for 8 wk. Three fish oil (FO) groups were fed a menhaden fish oil and soybean oil (SO) (9∶1) mixture as 10% (w/w) of the diet. These groups were provided with ≤3, 45 or 209 IU of vitamin E/kg diet. One SO group was used as control and was fed ≤45 IU of vitamin E/kg diet. Plasma vitamin E levels, when expressed as vitamin E per mL plasma, were extremely low in the group fed FO and ≤3 IU of vitamin E, and were lower in the groups fed FO than in the group fed SO. However, plasma vitamin E levels when expressed per mg plasma lipid were higher in the FO groups provided with ≤45 and 209 IU of vitamin E than in the SO group. Compared with the SO group, plasma levels of thiobarbituric acid reactive substances (TBARS), when expressed per mg lipid, were higher in the three FO groups, plasma retinol levels were lower in the FO groups provided with ≤3 and 45 IU of vitamin E, and ascorbic acid levels were lower only in the FO group provided with ≤3 IU of vitamin E. Blood glutathione (GSH) levels were lower in all three FO groups than in the SO group. Liver vitamin E levels increased as the dietary level of vitamin E increased, but all FO groups had higher liver levels of TBARS than the SO group. The dietary vitamin E levels were correlated positively with plasma vitamin E (r=0.71) and negatively with TBARS in both the plasma and liver of rats fed FO. Among the antioxidants measured, correlations were found between plasma retinol and vitamin C (r=0.64), and plasma vitamin C, uric acid (r=0.72) and blood GSH (r=0.60). Weaker correlations were found between plasma retinol, uric acid and blood GSH. It is concluded that vitamin E requirements are higher when feeding fish oil. Vitamin E seems necessary to prevent enhanced lipid peroxidation and to maintain appropriate levels of other physiological antioxidants.     

Iron and vitamin A deficiencies and prevalence of anemia in boys and girls between 6 to 24 months of age in Chaco,Argentina

To determine the prevalence of anemia, and iron (ID) and vitamin A deficiencies aiming at their prevention, 414 children between 6 and 24 months of age, were randomly selected from the whole province of Chaco. A sociodemographic survey was implemented, and hemoglobin (Hb), plasma ferritin and retinol were measured. Anemia prevalence (Hb < 110 g/L) was 66.4%, without differences between age groups, and included 18% with Hb < 90 g/L. These cases were significantly less in children 6-8 month of age (5.1%) than in the others (approximately equal to 20%) (P: 0.007). Mean Hb was also higher in 6-8 months old children and was associated with lower prevalence of ID (ferritin < 12 micrograms/L) (p < 0.000) but not with age (p = 0.8865). ID already present, however, in 36.6% of children in this age group, reached a prevalence of 72.9% in children older than 18 months. Anemia prevalence was significantly higher in males, in children whose birth weight was < 3000 g, in those who had never taken iron supplements and among the poor, both structural and by income. Retinol values < 20 micrograms/dl occurred only in 5.1% of children. Iron nutrition prior to, during pregnancy and in children during the first 2 years of life must be improved by joining strategies based on community empowerment aimed at improving dietary iron, assuring effective preventive supplementation and promoting the opportune umbilical cord ligation.     

Gene expression of Interleukin 1 in vitamin A and proteins deficiency

The influence of low levels of protein and vitamin A on indicators of the immune response was assayed in rats. The levels of protein and vitamin A intake of the Cuban population affected by epidemic neuropathy in 1993 was reproduced in 4 diets: control, protein deficiency (DP), vitamin A deficiency (DA), protein and vitamin A deficiency (DAP). The Peyer's patches evaluated the Interleukin 1 expression gene and was related with corporal weight, food intake, serum protein, vitamin A, immunology indicators and histology evaluation (spleen, thymus and liver). Protein deficiency generated a significant decrease of the expression gene of Interleukin 1. Atrophy signs in lymphoid tissues and morphologic changes in the liver were associated with the dietary protein utilization. Protein and vitamin A deficiency generated significant stimulation of the Interleukin 1 expression gene with increase of the level of the inflammatory state indicators as serum alpha protein, total complement and neutrophils. This stimulation could be generated by a deficient retinol mobilization to tissues. These results support the hypothesis of the function of cytokines as mediators of subclinical symptoms of the immune system during the nutritional affectations.     

Plasma micronutrient status is improved after a 3-month dietary intervention with 5 daily portions of fruits and vegetables: implications for optimal antioxidant levels

To explore the effects of increasing fruit and vegetable intake and the resulting effects on levels of circulating micronutrients in a community-dwelling population with an already high consumption of fruits and vegetables, 112 volunteers (86% women) underwent targeted dietary counseling for three months. At the beginning of the study and after 4, 8 and 12 weeks a food frequency questionnaire was filled in, and plasma levels of dietary antioxidants as well as biomarkers of oxidative lipid and protein damage were determined. Compared to baseline, especially the intake of fruits was significantly improved after 3 months of intervention, and mean plasma levels of lutein, zeaxanthin, β-cryptoxanthin, lycopene, α- and β-carotene, retinol, α-tocopherol, vitamin C and vitamin B6 were increased. Biomarkers of oxidative stress remained unchanged. Thus, a nutritional counseling program is capable of improving plasma levels of antioxidants even in a health-conscious population. A decrease in biomarkers of oxidative stress, however, does not occur.     

Impact of oral vitamin D supplementation on serum 25-hydroxyvitamin D levels in oncology

Background  

Serum 25-hydroxyvitamin D [25(OH)D] is the major circulating form of vitamin D and a standard indicator of vitamin D status. Emerging evidence in the literature suggests a high prevalence of suboptimal vitamin D (as defined by serum 25(OH)D levels of <32 ng/ml) as well as an association between lower serum levels and higher mortality in cancer. We investigated the effect of oral vitamin D supplementation as a means for restoring suboptimal levels to optimal levels in cancer.     

1例Rh缺失型D--导致新生儿溶血病临床及家系的调查分析

目的分析1例受检产妇交叉配血不合及患儿新生儿溶血病(HDN)发生的原因,初步探讨产妇Rh缺失型D--形成的遗传背景。方法对产妇、其夫及患儿标本进行ABO及Rh血型鉴定,对产妇及患儿标本进行血型抗体检测,并对产妇家系作血型调查。结果产妇为Rh缺失型D--,产生IgG的多凝集抗体。结论产妇为Rh缺失型D--,产生IgG的多凝集抗体,是造成其交叉配血不合及患儿HDN发生的原因;产妇Rh缺失型D--形成,有一定遗传因素的影响。