Dietary evaluation of pregnant adolescents during first, second and third trimester

In order to identify risk of inadequate intake of calories and nutrients during pregnancy, 75 pregnant adolescents (14 to 18 years old) apparently healthy, from low socioeconomic level, in their first prenatal control (12 weeks) were studied by two 24 hour recalls and a food frequency questionnaire at each trimester. Nutritional status was assessed by body mass index (pregestation weight/height) and classified according to American Medicine Institute reference. Paired t-test, frequency distribution and ANOVA were used for statistical analysis. Low weight was found in 34.6% of adolescent at the first visit and 5.3% were overweight. Even though, caloric intake was below recommendation, significant increases were observed between first and second trimester for energy, carbohydrates, niacin and zinc (p < 0.001) and for fat, proteins, riboflavin, thiamin, vitamin C, calcium and iron (p < 0.05). From second to third trimester, differences (p < 0.05) were significant only for vitamin A. Between first and third trimester, differences were significant (p < 0.05) for energy, proteins, carbohydrates, niacin, riboflavin, zinc and for thiamin, vitamin A and calcium (p < 0.05). A high proportion of pregnant adolescent did not reach recommendations for energy, folate, calcium and zinc. Food intake pattern did not change significantly among trimesters. Mean total weight gain was 9.2 kg and 0.412 +/- 0.4 g/week. Newborn's mean weight was 3.221 +/- 418 grams. It is concluded that adolescents are at high nutritional risk and deficiency of dietary intake should be followed. Attention should be addressed from the preconceptional period to postpartum in order to improve maternal and fetal conditions.     

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.     

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 vitamin A during pregnancy and effects on obstetrics and perinatal outcomes in HIV infected pregnant women

To evaluate serum vitamin levels and its association with obstetrics and perinatal results in HIV infected pregnant women. Observational and prospective study carried out at Division of Infectious-Contagious Diseases in Gynecology and Obstetrics of the University Hospital, Medicine School of Ribeir?o Preto, University of S?o Paulo, involving 57 pregnant women divided into 3 groups: Group 1, with 12 normal pregnant women, it was the control group; Group 2, with 20 HIV infected pregnant women, using ZDV; and Group 3, with 25 HIV infected pregnant women, using therapy I contend ZDV, 3TC and nelfinavir. The evaluation of the serum vitamin level was obtained three times during pregnancy at equidistant time intervals and in the immediate period after birth. We also evaluated the levels of this vitamin and the hemoglobin in the blood of the umbilical cord. We obtained maternal and newborn infant anthropometric data, as well as the counting of lymphocyte TCD4 and viral load of the HIV during the pregnancy. Reduced serum vitamin levels were observed in the Group 1(25%), the Group 2(29,4%) and the Group 3(28,6%). Association was not observed between serum levels of maternal retinol and the duration of the gestation in groups 2 and 3. In groups 1 and 3, an association was observed between the maternal concentration of retinol and the newborn hemoglobin (p=0.05). In distinct way to the Control group, association was not observed between the retinol levels of the umbilical cord and the weight of the newborn in gestations of Group 2, while a trend to this association was observed in gestations of Group 3 (p=0.06). We observed high prevalence of hipovitaminosis A in the population of this study, regardless of antiretroviral scheme used.     

Pre-cooked corn flour intake and its contribution of iron and vitamin A in low income preschoolers

The objective of this study was to determine whether the addition of iron and vitamin A (VA) to corn flour, supplied through a national enrichment program since 1993, allows preschoolers to achieve an adequate intake of these nutrients. Data from the assessment of 196 children (4-6 year old) from Valencia, Venezuela is presented, including socio-demographic, anthropometric, anemia, VA deficiency (by conjunctival impression cytology (CIC) and serum retinol), and food intake. 92% of the children lived in poverty. 12% were below the norm for weight-for-height. 13% had anemia, 9% had VA deficiency according to CIC, and 0.5% according to serum retinol (< 0.70 mumol/L), 30% were at risk of VA deficiency (0.70-1.05 mmol/L). 17%, 37%, and 5% of the sample had an insufficient intake (< 80% of RDA) of energy, iron, and VA, respectively. When excluding from the analysis the amount of iron and VA from corn flour enrichment, an additional 38% and 10% of the sample showed deficient intakes of each nutrient, respectively. According to the weight-for-height indicator, iron intake was significantly lower in undernourished children (p < 0.05) than in those normal or above the norm; this was not so for VA. It is concluded that iron enrichment contributes to the improvement of the intake of this nutrient but is not enough to provide an adequate amount of it; and that the addition of VA does not seem to have an important effect on the diet of this age group.     

Prenatal diet, nutrient intake and pregnancy outcome in urban Ecuadorian primiparas.

A nutritional survey was conducted in an urban public maternity hospital, Hospital Gineco-Obstétrico Isidro Ayora (HGOIA), located in Quito, Ecuador. Seventy-four primiparas in the third trimester of pregnancy were recruited to assess the influence of sociedemographic factors on food patterns and nutrient intake, and the interrelationship between prenatal nutrient intake, maternal weight gain and pregnancy outcome. Results of the regression analysis indicated that maternal education was the factor most strongly associated with nutrient intake, followed by monthly per capita income. Maternal nutrient intake was next analyzed and compared with the WHO (1974, 1985) and NRC (1980) recommended daily allowances. Results also indicated the average daily intake of energy, protein, phosphorus, vitamins C and A, thiamine, riboflavin, and niacin met or exceeded the recommended daily allowances. Dietary calcium and iron intake, however, were below recommendations. Sodium and fat intake were both relatively high. Higher dietary fat intake was associated with increased birth weight, while lower protein intake was associated with increased risk of delivering a low-birth weight baby. Maternal weight gain during the third trimester predicted baby birth weight and height but not head circumference.     

Anemia and deficiency of vitamin A in children evaluated in a nutritional attention center from Caracas

In order to determine the prevalence of anemia and the deficiency of vitamin A in children under 10 years, the concentration of hemoglobin, transferrin saturation, serum iron and the nutritional state of vitamin A were studied between 1999 and 2000, in 124 children with moderate malnutrition and 98 healthy children who attend triage consultation in the Centro de Atención Nutricional Infantil Antímano (CANIA, Caracas) by means of plasma retinol test (high performance liquid chromatography), relative dose response test (RDR) and conjunctival impression cytology (CIC). The dietary intake was analyzed by 24 hour recall. The Student t and Chi-square test were used for the statistical analysis of the data. The prevalence of vitamin A deficiency was approximately 10% in malnourished and healthy children, the CIC test discriminated a proportion of vitamin A deficient children superior to 25% and RDR test detected a significantly smaller percentage of deficiency in healthy children (p < 0.05). The prevalence of anemia was significantly higher in malnourished (34.2%) than in healthy children (19.2%). In children under 2 years the percentage of anemia reached 75.8% in undernourished children and 50% in healthy children. The consumption of macronutrients and micronutrients was inadequate; more than 40% undernourished children had caloric and macronutrients intake adequacy below 85%, whereas this level of adequacy in healthy children was around 30%. These results indicate there were problems of moderate anemia and moderate vitamin A deficiency in the studied infantile population, without significant differences between moderate undernourished and healthy children.     

Vitamin A deficiency in preschool children of Recife, Northeast of Brazil

The purpose of the study was to evaluate the extent of vitamin A deficiency (VAD) among preschool children in the city of Recife, Northeast Brazil. The sample comprised 344 children of both sexes, 24 to 60 months old, in 18 public day care centres in the city of Recife, in 2007. The nutritional status of vitamin A was assessed by biochemical (serum retinol) and dietetic (vitamin A rich-food consumption) indicators and the pondo-stature status through anthropometric indicators weight-for-age, height-for-age and weight-for-height. The prevalence of hyporetinolemia (< 0.70 micromol/L) was 7.7% (IC 95% 4.88 - 11.81), which characterizes the VAD as a light-type public health problem, according to World Health Organization criteria. On the other hand, 29.6% (IC 95% 24.22 - 35.63) of children had acceptable or marginal levels (0.70 to 1.04 micromol/L) of retinol. Regarding the vitamin A rich-food intake, values below the EAR (Estimated Average Requirement) - 210 microg/ day for children of 1 to 3 years old and 275 microg/day for children of 4 to 8 years old - were 8.1% and 21.3% respectively. The prevalence of anthropometrical deficits (< -2 scores -Z) in preschool children were 2.5% for the indicator weight-for-age, 8.6% for height-for-age and 1.5% for weight-for-height. The research findings point out to the importance of institutionalization for the appropriate nutritional status of children and maintenance of adequate reserves of vitamin A. However, more studies are needed focusing on non-institutionalized preschool, or children living outside the privileged environment of public day care centres.     

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.     

Prematurity and maternal folate deficiency: anemia during pregnancy study group results in Valencia, Venezuela

The purpose of this study was to determine the association and its magnitude between prematurity and folate deficiency in women in their third trimester of pregnancy, and at labor. An incident case-control study was conducted using 2 controls per case. Data was obtained in a tertiary hospital in Valencia, Venezuela. A total of 543 women who delivered between May and December 1996 entered into the study. Women having a preterm delivery (< 37 weeks of gestation at delivery) were defined as cases (n = 181). Anemia was defined according to WHO as Hb less than 11 g/dL, when a pregnant woman had a folate serum level < 3 microg/ml was considered a folate deficiency. Logistic regression was used to analyze the data and likelihood ratio test was done for model comparison. Folate deficiency was found to be significantly associated with prematurity (Odds Ratio: 1.97; 95%CI = 1.06 to 3.68 P = .032), after adjusting for prior preterm labor, prenatal care visits, prior abortion, prior fetal death, placental abruption, and premature rupture oval membranes. In conclusion, maternal folate deficiency at the end of the third trimester of pregnancy, at labor, was associated with an increased risk of prematurity.     

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.     

Repletion of n-3 Fatty Acid Deficient Dams with α-Linolenic Acid: Effects on Fetal Brain and Liver Fatty Acid Composition

Docosahexaenoic acid (DHA) supply to the fetal brain depends upon the dam’s dietary intake of n-3 fats. In this study, we measured the incorporation of DHA into the fetal brain and liver in n-3 fatty acid deficient (0.1% alpha-linolenate) mice upon switching to an n-3 fatty acid adequate (2.1% alpha-linolenate) diet. Second generation mice raised and maintained on an n-3 deficient diet during mating were switched to an n-3 adequate diet on embryonic day 1 (ED 1) or ED 13. Fatty acid analysis was performed on fetal brains and livers and on maternal serum on ED 13, 15, 17, and 19. Although fetal brain and liver DHA began at a very low level (both exhibited an 85% decline), recovery was nearly complete by ED 15 in the group switched near conception but thereafter diverged. The maternal serum and fetal liver were very similar in their DHA and docosapentaenoic acid time courses. However, when repletion began on ED 13, brain DHA recovery was only about 44%. These results suggest that a nutritional intervention with alpha-linolenic acid can nearly but incompletely rescue the mouse fetal DHA deficiency if began at the time of conception but that the third trimester is too late, thus leaving a large DHA gap.     

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.     

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.     

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.     

Comparison of menaquinone-4 and menaquinone-7 bioavailability in healthy women

Background

Vitamin K₂ contributes to bone and cardiovascular health. Therefore, two vitamin K₂ homologues, menaquinone-4 (MK-4) and menaquinone-7 (MK-7), have been used as nutrients by the food industry and as nutritional supplements to support bone and cardiovascular health. However, little is known about the bioavailability of nutritional MK-4. To investigate MK-4 and MK-7 bioavailability, nutritional doses were administered to healthy Japanese women.

Findings

Single dose administration of MK-4 (420 ??g; 945 nmol) or MK-7 (420 ??g; 647 nmol) was given in the morning together with standardized breakfast. MK-7 was well absorbed and reached maximal serum level at 6 h after intake and was detected up to 48 h after intake. MK-4 was not detectable in the serum of all subjects at any time point. Consecutive administration of MK-4 (60 ??g; 135 nmol) or MK-7 (60 ??g; 92 nmol) for 7 days demonstrated that MK-4 supplementation did not increase serum MK-4 levels. However, consecutive administration of MK-7 increased serum MK-7 levels significantly in all subjects.

Conclusions

We conclude that MK-4 present in food does not contribute to the vitamin K status as measured by serum vitamin K levels. MK-7, however significantly increases serum MK-7 levels and therefore may be of particular importance for extrahepatic tissues.