An analysis of the etiology of anemia and iron deficiency in young women of low socioeconomic status in Bangalore, India

BACKGROUND: Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. OBJECTIVES: Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. METHODS: A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. RESULTS: The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. CONCLUSIONS: An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.     

孕中期女性营养素补充剂使用状况分析

目的：了解孕期女性在怀孕期间各种营养素补充剂的使用情况,为进一步针对孕期营养指导和干预提供科学依据。方法：在北京医院产科常规查体的孕妇在孕22w记录3d的饮食记录,其中包含营养素补充剂的使用情况。计算出3d饮食及营养素补充剂中主要营养素的摄入量等。结果：孕期多种营养素补充剂的使用率均超过50％（其中钙62．7％、铁56．9％、锌55．6％、维生素A54．2％、B族维生素56．2％）,钙的摄入量仍然偏低,平均为891．39±359．93mg／d,其它主要营养素的摄入量均达到推荐摄入量;但没有使用孕期营养素补充剂的孕妇,除了维生素c以外,多数营养素均低于中国居民膳食推荐摄入量。结论：营养素补充剂在孕妇每日饮食摄入中占据重要作用,孕期应合理补充。     

Iron, folate, and vitamin B12 stores among pregnant women in a rural area of Haryana State, India

BACKGROUND: Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager. OBJECTIVE: We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State. METHODS: The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/ mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels <3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores). RESULTS: The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women. CONCLUSIONS: Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.     

唐山市孕中晚期妇女膳食营养状况调查

目的：了解并分析河北省唐山市孕中晚期妇女的膳食营养状况,为进一步对孕期妇女进行营养干预和指导提供科学依据。方法：采用24h膳食回顾法对2013年3—6月在河北省唐山市某三甲医院产检的187例孕中晚期妇女进行膳食调查。结果：能量、蛋白质、铁在孕中晚期妇女中均能满足需求;孕晚期维生素C和锌的摄入量充足,其余营养素均存在不同程度的缺乏或过量;三大产能营养素的供能比例合适;优质蛋白质摄入充足。结论：应增加孕中晚期妇女海产品、牛奶及其制品、豆制品、新鲜蔬果和粗粮的摄入量;适当控制胆固醇的摄入量。     

Development and validation of a short food-frequency questionnaire for screening women of childbearing age for vitamin A status in northwestern Iran

A high percentage of women in their childbearing years suffer from subclinical vitamin A deficiency; 10% to 20% of pregnant women worldwide are vitamin A deficient. This study aimed to design and validate a short food-frequency questionnaire to serve as a simple screening tool for vitamin A status in women of childbearing age. The sample consisted of 187 healthy, nonpregnant, nonlactating women 15 to 49 years of age, from urban and rural areas of Marand district in East Azerbaijan. Dietary intake was evaluated by a face-to-face interview using a 24-hour dietary recall for two consecutive days and a 41-item qualitative food frequency questionnaire. Height, weight, and serum retinol were measured. Serum retinol values were less than 20 micrograms/dl for three subjects, while an additional 34 subjects (18%) had values between 21 and 30 micrograms/dl. Principal-component analysis performed on the food-frequency questionnaire identified five components that together defined 34.4% of the variance in estimated vitamin A intake and were used to derive a 20-item short food-frequency questionnaire. Internal consistency of the short instrument was acceptable (Cronbach's alpha = .59). Serum retinol was significantly correlated with total vitamin A intake and with intake of vitamin A from plant sources, as estimated by the short food-frequency questionnaire. Important sources of provitamin A in these women's diets included some not typical of other populations: nuts and green leaves of types used elsewhere in small quantities as herbs, but important in Iran because the amount and frequency of consumption are relatively high. We conclude that the questionnaire is relatively valid and potentially useful in identifying women at risk for vitamin A deficiency in this population.     

Misclassification of maternal smoking status and its effects on an epidemiologic study of pregnancy outcomes.

Reliance on self-reported smoking status among pregnant women can result in exposure misclassification. We used data from the Calcium for Preeclampsia Prevention trial, a randomized study of nulliparous women conducted from 1992 to 1995, to characterize tobacco exposure misclassification among women who reported at study enrollment that they had quit smoking. Urinary cotinine concentration was used to validate quit status, and factors associated with exposure misclassification and the effects of misclassification on associations between smoking and pregnancy outcomes were evaluated using logistic regression. Of 4,289 women enrolled, 508 were self-reported smokers and 771 were self-reported quitters. Of 737 self-reported quitters with a valid cotinine measurement, 21.6% had evidence of active smoking and were reclassified as smokers. Women who reported having quit smoking during pregnancy were more likely to be reclassified than women who reported quitting before pregnancy (p<.001). Among smokers, factors independently associated with misclassification of smoking status included fewer cigarettes smoked per day and fewer years smoked. After reclassification the odds ratio for a small-for-gestational-age birth among smokers decreased by 14%, and the smoking-related reduction in birth weight decreased by 15%. Effects of misclassification on the association with hypertensive disorders of pregnancy were present but less dramatic. In conclusion, use of self-reported smoking status collected at the time of study enrollment resulted in the introduction of bias into our study of smoking and pregnancy outcomes. The potential for this type of bias should be considered when conducting and interpreting epidemiologic studies of smoking and pregnancy outcomes.     

Urinary iodine concentration of pregnant women and female adolescents as an indicator of excessive iodine intake in Sri Lanka

BACKGROUND: Mild deficiencies and excesses of iodine have deleterious effects in both females and males. The iodine status of the population after implementation of the universal salt iodization program in Sri Lanka is not known. OBJECTIVE: This cross-sectional study was carried out to assess the iodine status of pregnant women and female adolescents, with urinary iodine concentration used as the measure of outcome. METHODS: The participants were 100 women in the first trimester of pregnancy and 99 female adolescents in Kuliyapitiya, Kurunegala District, North-Western Province, Sri Lanka. The urinary iodine concentration was measured in a casual urine sample from each subject. The iodate contents of salt samples collected from households of the adolescents participating in the study were also measured. RESULTS: The median urinary iodine concentration of 185.0 microg/L and the prevalence of values under 50 microg/L of only 1% among the pregnant women indicate adequate iodine intake and optimal iodine nutrition. The median urinary iodine concentration (213.1 microg/L) among female adolescents indicates a more than adequate iodine intake and a risk of iodine-induced hyperthyroidism. Approximately 8% and 4% of the adolescents and pregnant women, respectively, had urinary iodine concentrations in the range of mild iodine deficiency (51 to 100 microg/L). More than half of the adolescents (56%) and 39% of the pregnant women had urinary iodine concentrations higher than optimal. The median iodine content in salt samples was 12.7 ppm. Only 20.2% of the samples were adequately iodized, and 10.1% of the samples had very high iodine levels. CONCLUSIONS: Female adolescents and pregnant women had no iodine deficiency, but a considerable proportion of them, especially female adolescents, were at risk for iodine-induced hyperthyroidism. There is thus a need for proper monitoring of the salt iodization program to achieve acceptable iodine status.     

孕妇妊娠期糖尿病调查及其与饮食状况的关系分析

目的探讨孕妇妊娠期糖尿病调查及其与饮食状况的关系分析。方法回顾性调查2014年9月至2017年9月本院收治552例孕妇的临床资料,分析孕妇饮食状况与妊娠期糖尿病的关系。结果本次调查中,妊娠期糖尿病孕妇54例(9.78%);妊娠期糖尿病孕妇和健康孕妇日摄入总能量、年龄、孕次水平基本相同,差异无统计学意义(P0.05),妊娠期糖尿病孕妇孕前BMI、脂肪摄入量、蛋白质摄入量、碳水化合物摄入量和甜食喜好、夜宵食用、荤菜量过多、豆制品量过少占比明显高于健康孕妇,差异有统计学意义(P0.05);logistic回归分析法显示,脂肪摄入量、甜食喜好、荤菜量过多、豆制品量过少是孕妇妊娠期糖尿病发生的危险因素(P0.05)。结论孕妇的饮食状况与妊娠期糖尿病的发生有关,应重视脂肪摄入量、甜食喜好、荤菜量过多、豆制品量过少等孕妇的营养干预,以防治娠糖尿病的发生。     

孕中晚期女性能量摄入及营养状况调查分析

目的:了解孕期女性在怀孕期间能量及各种营养素的摄入水平,为进一步针对孕期营养指导和干预提供科学依据。方法:在北京医院产科常规查体的孕妇从建档开始分别在孕22w、26w、30w、36w进行为期3d的饮食记录,计算出三大营养素的供能比、各种主要营养素的摄入水平及其占推荐摄入量RNI的百分比。结果:三大营养素供能比例不合理,钙、锌等摄入存在不同程度不足;铁及维生素类摄入量达到推荐量标准。结论:孕妇膳食营养结构不合理,需加强孕期教育。     

Aflatoxin M1 in milk in Hisar city,Haryana, India and risk assessment

ABSTRACT

Aflatoxin M1 (AFM1) contamination in 150 samples of milk, sold in market of Hisar city of Haryana, India, was investigated by using High Pressure Liquid Chromatography (HPLC). Out of these, 40 samples contained AFM1 at a concentration below the limit of detection (LOD) of 0.052 μg/kg. Among the AFM1 contaminated samples, 46 raw milk samples contained a concentration above the LOD but less than the limit of quantitation (LOQ), whereas 64 samples were above the LOQ. Of these samples, 31 exceeded the maximum limit of 0.5 μg/kg prescribed by FSSAI, India. Based on this study, the dietary intake of AFM1 for adults through consumption of milk was estimated. The results indicated that AFM1 contamination can be a food safety issue for raw and pasteurised milk consumed in India. Therefore, there is a need for a national monitoring programme to control the level of mycotoxins in milk.     

Dietary intakes of some essential and non-essential trace elements, nitrate, nitrite and N-nitrosamines, by Dutch adults: estimated via a 24-hour duplicate portion study

Duplicate portions of 24-hour diets of 110 adults have been analyzed for aluminium, cadmium, copper, lead, manganese, mercury, zinc, nitrate, nitrite and volatile N-nitrosamines. The mean daily intake of copper (1.2 mg) is only about 50% of recommended values; mean daily intakes for manganese (3.3 mg) and zinc (8.4 mg) are adequate and marginal respectively with respect to recommended amounts. For the non-essential elements Al, Cd, Hg and Pb, mean daily intakes of 3.1 mg, 0.01 mg, 0.002 mg and 0.034 mg were found, respectively. For Cd this amounts to 17% of the acceptable daily amount, for Al, Hg and Pb 5%, 5% and 8%, respectively. Since 1976-1978 the dietary intake of lead has been reduced by a factor three; for the other six elements daily dietary intakes are almost the same as in 1976-1978. Average nitrate intake was 52 mg NO3-/day, about 25% of the ADI. Only 16 diets contained a measurable amount of nitrite. The highest daily intake (0.7 mg NO2-) is less than 10% of the ADI. Volatile N-nitrosamines were detectable in two duplicate diets (NDMA and NPIP). It is estimated that the daily dietary intake of volatile N-nitrosamines is around 0.1 microgram or less.     

Suppression of leptin-induced hypothalamic JAK/STAT signalling and feeding response during pregnancy in the mouse

Hyperphagia during pregnancy, despite rising concentrations of the satiety hormone leptin, suggests that a state of leptin resistance develops. This study investigated the satiety response and hypothalamic responses to leptin during pregnancy in the mouse. Pregnant (day 13) and nonpregnant mice received an i.p. injection of either leptin or vehicle and then 24-h food intake was measured. Further groups of pregnant and nonpregnant mice were perfused 2 h after leptin or vehicle injections and brains were processed for pSTAT3 and pSTAT5 immunohistochemistry. Leptin treatment significantly decreased food intake in nonpregnant mice. In pregnant mice, however, leptin treatment did not suppress food intake, indicating a state of leptin resistance. In the arcuate nucleus, leptin treatment increased the number of cells positive for pSTAT3, a marker of leptin activity, to a similar degree in both nonpregnant and pregnant mice. In the ventromedial nucleus (VMN), the leptin-induced increase in pSTAT3-positive cell number was significantly reduced in pregnant mice compared to that in nonpregnant mice. In nonpregnant mice, leptin treatment had no effect on the number of pSTAT5-positive cells, suggesting that in this animal model, leptin does not act through STAT5. In pregnant mice, basal levels of pSTAT5 were higher than in nonpregnant mice, and leptin treatment led to a decrease in the number of pSTAT5-positive cells in the hypothalamus. Overall, these results demonstrate that during pregnancy in the mouse, a state of leptin resistance develops, and this is associated with a reduced sensitivity of the VMN to leptin.     

Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan

BACKGROUND: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight. OBJECTIVE: To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. METHODS: This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment. RESULTS: The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/ dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger. CONCLUSIONS: A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.     

Time trends in the intrafamily distribution of dietary energy in rural India

The intrafamily distribution of dietary energy in 5,458 households from seven states in India was assessed from 24-hour dietary recall data collected by the National Nutrition Monitoring Bureau during 1996-97. The energy consumption, expressed as percentage of recommended dietary intake (%RDI), of preschool children, schoolchildren, and adolescents was compared with that of adult men and women in the same households. Time trends in the intrafamily distribution of dietary energy were assessed by comparing the data with those collected in 1975-80 using the same procedures in the same villages. About one-third of the preschool children had an inadequate intake of energy, even when their adult counterparts had an adequate intake, whereas only about 7% of the preschoolers and their parents were consuming inadequate amounts of energy. The extent of energy inadequacy was much less in adolescents and school-age children than in preschool children. This was true even when the adults in the same households had an adequate energy intake. In 1996-97, there was a significant increase in the proportion of households with preschool children consuming inadequate energy, although both adult men and women were consuming energy-adequate diets as compared with the dietary data collected in the same villages in 1975-80. The results indicate the need to provide effective nutrition education for parents regarding the nutritional needs of their children.     

Dietary interview. I. Comparison between dietary history versus repeated daily recalls]

In the course of 12 months, 43 men and 53 women aged 30-40 years were subjected to 14 24-hours recalls and one dietary history concerned with their individual dietary habits. The mean values yielded by the first and the second method for energy, 4 nutrient groups and 8 food groups were statistically evaluated and compared with each other, from which the following conclusions can be drawn as to the reliability and the precision of the dietary history: 1. The dietary history permits the quantitative estimate of the energy and nutrient intake in groups of about 50 subjects with an error of less than 10%. Underestimation of the actual food intake is more likely than overestimation. 2. The same holds true for the quantitative estimate of the consumption of foods from great food groups. The method is considerably less precise in case of single food or irregularly consumed foods. The differences between the results from the two methods ranged from 0 to 25%. 3. The precision of the individual results obtained for energy and nutrient intake from the dietary history was +/- 20% with a probability of 80-90%. In 75% of the cases, the differences in the consumption of food groups as determined by the two methods were smaller than 20%. As to single foods, however, individual misestimations ranging from 30 to 50% are to be expected.     

Role of protein kinase Cbeta in rhythmic contractions of human pregnant myometrium

To assess the role of protein kinase Cbeta (PKCbeta) in human myometrial contractions during pregnancy, we evaluated the effect of a PKCbeta inhibitor (LY333531) on the pregnant and nonpregnant myometrial contractions and compared the level of PKCbeta in the pregnant myometrium with that in the nonpregnant myometrium. The effects of LY333531 on the myometrial contractions were examined by measuring contractile activity (frequency and amplitude). PKCbeta in human myometrium was assessed at mRNA level using real-time PCR method. The characteristics of contractile activity were different between the pregnant and the nonpregnant myometrium. The amplitude of rhythmic contractions in the preterm and term myometrium was increased 2- to 2.5-fold when compared with that in the nonpregnant myometrium, but the frequency of rhythmic contractions was decreased by about half. LY333531 (10(-6) M) reduced the increased amplitude in the preterm and term myometrium by about 50%, and the inhibitory effects of LY333531 in the pregnant myometrium were significantly greater than that in the nonpregnant myometrium (about 50 vs 25%). However, the frequency in the pregnant and nonpregnant myometrium was not influenced by LY333531. Real-time PCR revealed a significant, five- to sevenfold increase in the expression of PKCbeta mRNA in the preterm and term myometrium when compared with the nonpregnant myometrium. These findings suggest that the increased amplitude of human myometrial contractions during pregnancy is related to the increased level of PKCbeta. A PKCbeta inhibitor may reduce preterm uterine contractions and prevent preterm delivery.     

Nutrient inadequacies among elderly residents of long-term care facilities.

PURPOSE: Regular, non-therapeutic diets were examined in long-term care (LTC) residents to determine whether these residents consumed adequate nutrients according to current recommendations. METHODS: Elderly (88 +/- 8 years) residents (31 female, 17 male) in five Saskatoon LTC centres participated. All were receiving regular diets. Dietary intakes were collected for three days at breakfast, lunch, and dinner, by using simultaneous weighed and observation methods. Snacks provided and eaten were also recorded. RESULTS: Observed intakes provided more complete data on nutrient intake than did weighed intakes. Inadequacy was most prevalent (in 70% or more of participants) for folate (according to prefortification intake levels), magnesium, zinc, vitamin E, and vitamin B6; inadequacy prevalence was below 50% for protein, vitamin C, and thiamine. Mean intakes of calcium, vitamin D, and dietary fibre were well below their respective Adequate Intake (AI) values. Energy consumed at meals and with snacks was 16% less than that offered at meals alone; other nutrients ingested ranged from 0% to 32% below energy offered. To model nutrient planning, target usual intake distributions were calculated where possible. CONCLUSIONS: These data suggest that nutrient-dense foods alone may not allow elderly LTC residents to meet intake requirements for many nutrients. Assessment of dietary adequacy in institutionalized elderly people allows for the development of realistic nutrition goals.     

Milk production in lactating buffalo receiving recombinantly produced bovine somatotropin

Thirty healthy Murrah buffalo (Bubalus bubalis) in their second to fourth lactations were selected from the herd at the National Dairy Research Institute, Karnal, Haryana, India, for use in a 35-d study to determine the effects of recombinantly produced bovine somatotropin on milk production, milk composition, and dry matter intake. Treatments were daily injections of 0, 25, or 50 mg somatotropin per animal for 14 d. All buffalo consumed green chopped fodder ad libitum plus a predetermined quantity of concentrate mixture to each animal, based on individual milk production during the 14-d pretreatment period. The quantity of concentrate mixture fed to each buffalo was not altered during the study. Net increase in milk volume for groups receiving 25 and 30 mg somatotropin was 16.8 and 29.5% over controls. Milk composition, DM intake, and body weights were not affected by treatment.     

Seasonal variations of vitamin sufficiency in pregnant women (Mzensk City)

The investigation of sufficiency of vitamin C, A, E, B2, B6, carotenoids and iron dietary intake has been carried out in 61 pregnant women in spring and early autumn 1998. There were no women adequately supplied with all vitamins irrespective of season and residence. Most of them (70-80 per cent) had combined deficiency of 3-5 vitamins in spring. About 50 per cent of women had combined insufficiency of vitamins and iron. Intake of vitamins improved in autumn especially due to vitamins C, A, E and carotenoids. The frequency of 3-5 vitamins deficit decreased while occurrence of combined deficiency of vitamin B6 and carotenoids still often took place. Thus, normalization of vitamin status of pregnant women is necessary all year round.