This clinical report covers diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that iron-deficiency anemia and iron deficiency without anemia during infancy and childhood can have long-lasting detrimental effects on neurodevelopment. Therefore, pediatricians and other health care providers should strive to eliminate iron deficiency and iron-deficiency anemia. Appropriate iron intakes for infants and toddlers as well as methods for screening for iron deficiency and iron-deficiency anemia are presented.

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Clinical Report—Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age)

“Ill being” and “ill health” is a multidimensional term covering not only disease but also other dimensions such as hunger, exclusion, isolation, insecurity and powerlessness. This ill health can consequently prevent individuals from realizing their full potential. Good health, in contrast, is identified as a vital component of a good quality of life. That is why access to good health is recognized as a basic human need and a fundamental human right. The WHO‘s definition of health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” applies to all human beings regardless of age gender, nationality and culture. Inequalities and deficiencies in health thus affect the well being of an individual and welfare of a society as a whole.

Health and Nutrition

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies. Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1. Results: Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children. Conclusion: Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality.

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Micronutrient fortification of food and its impact on woman and child health: a systematic review

BackgroundIron fortification of wheat flour is widely used as a strategy to combat iron deficiency.ObjectiveTo review recent efficacy studies and update the guidelines for the iron fortification of...

https://journals.sagepub.com/doi/pdf/10.1177/15648265100311S102

Revised recommendations for iron fortification of wheat flour and an evaluation of the expected impact of current national wheat flour fortification programs

The recent search for new anti-cancer drugs focuses more on natural compounds from the regular human diet because these compounds rarely exhibit severe side-effects yet effi ciently act on a wide range of molecular targets involved in carcinogenesis. One promising compound, which is now being tested in clinical studies, is the tomato-derived carotenoid lycopene. This review summarizes the current knowledge about the cellular action of lycopene and presents the molecular targets responsible for its remarkable chemopreventive and anti-proliferative activity. Its antioxidant effects include a considerable reactive oxygen species (ROS) scavenging activity, which allows lycopene to prevent lipid peroxidation and DNA damage. Simultaneously, lycopene induces enzymes of the cellular antioxidant defense systems by activating the antioxidant response element transcription system. As another chemopreventive strategy, lycopene increases gap junctional communication, which is suppressed during carcinogenesis. This review focuses also on the synergistic effects of lycopene with other natural antioxidants that might be important for its future application in anti-cancer treatment. Lastly, this review provides evidence for the biological activity of some oxidized lycopene metabolites, which seem to be partially responsible for the strong and manifold anti-cancer potential of lycopene.

Antioxidant and anti-proliferative properties of lycopene

The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population. This was an 18-month, randomized, placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City, Guizhou Province, China, using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce (29.6 mg Fe/100 ml). The study data included measurements of food consumption, hemoglobin, serum ferritin, and serum retinol. The results showed that the diet consisted primarily of cereals, fruits, and vegetables, with very little meat. Food consumption remained unchanged during the study period and was similar in the fortified and control groups. The average daily soy sauce consumption of the group consuming the fortified product was 16.4 ml per person, which provided 4.9 mg of iron from NaFeEDTA. At the end of the trial, all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels, a lower prevalence of anemia, and higher plasma ferritin levels than the controls. The effects became statistically significant after six months of intervention and were maintained throughout the study period. We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men, women, and children. NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population.

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Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial:

OBJECTIVE In order to evaluate the effect of coenzyme Q10 (CQ) or combined with carotenoids (lycopene and lutein, LL) or/and mineral nutrients (zinc and selenium, ZS) on the antioxidant defense system, The rats were randomized into 6 groups: control, CQ [CQ 10 mg/(kg x d)], CQ+ ZS[CQ 10 mg/(kg x d), Zn 1 mg/(kg x d), Se 4 microg/(kg x d)], CQ+ LL [CQ 10 mg/(kg x d), Lutein 1 mg/(kg x d), Lycopene 2 mg/(kg x d)], CQ + ZS + LL [CQ 10 mg/(kg x d), Zn 1 mg/(kg x d), Se 4 microg/(kg x d), Lutein 1 mg/(kg x d), Lycopene 2 mg/(kg x d)] and VE [VE 2 mg/(kg x d)], and then fed with a diet based on AIN-76 rodent diet but containing 4% lard as well as 4% corn oil. The supplement were given by oral for 8 weeks, and the plasma and liver antioxidant enzymes activity, malondialdehyde levels and lymphocyte DNA damage were determined. The results showed that the groups treated with CQ had a higher plasma SOD and TOAC level and liver SOD and GPX activity than those of the control group. Combination treatments further enhanced antioxidant enzymes activity and reduced MDA levels & DNA damage. Most of the parameters had reached statistical significance in comparison with the control. These findings suggested that CQ exerted antioxidative effects in rats, and when it was supplemented in combination with other antioxidants, the effects were raised to some extent.

Effects of coenzyme Q10 or combined with micronutrients on antioxidant defense system in rats

To study the effect of multi-micronutrients supplementation on nutritional status of children, 220 students aged 8-12 years were observed for 6 months. A half of them were given the supplements, another half placebo. The results showed that in comparison with the placebo, the supplemented children had a higher urine excretion of vitamin B2 and vitamin C after loading; a higher concentration of serum 25-OH-D3, a high content of hydroxy-proline and hydroxy-proline/creatinine ratio in fast urine, and a higher bone mineral content and bone mass density of the mid-ulna. The supplemented children performed significantly better than the placebo in reading speed, learning capacity and arithmetic examinations. It is concluded that micronutrients supplementation played a notable rule in resulting better nutritional status and learning ability of school children.

Study on the effect of micronutrients supplementation on health status of children

OBJECTIVE Study the efficiency of the NaFeEDTA fortified soy sauce on anemia prevention among the children from iron deficiency anemia (IDA) prevalence region. METHODS A double blind controlled random intervention in Bijie, Guizhou was conducted for 18 months. The finger hemoglobin (Hb) was detected at baseline and after 6, 12, 18 months intervention. Anthropometrics were also taken at baseline and after 12 months intervention. RESULTS The Hb level increased significantly in the intervention group [(111.08 +/- 11.31) g/L at baseline and (122.99 +/- 8.43) g/L after 12 months], the anemia prevalence decreased markedly (58.0% at baseline, 17.6% after 12 months). After 12 months intervention, a significantly gain of the weight for age Z-score (WAZ) was observed in the intervention group. The abdomen and triceps skin folders were thicker in the intervention group, and the intervention group had greater gains of the abdomen and triceps skin folders than those in the control group. CONCLUSION The soy sauce fortified with NaFeEDTA can increase the Hb level and decrease the prevalence of anemia in the children, and the NaFeEDTA fortified soy sauce can enhance the weight gain and the pull up of the subcutaneous fat. It is suggested that using NaFeEDTA fortified soy sauce in high IDA prevalence population was an efficient way for IDA preventing.

Efficiency of NaFeEDTA fortified soy sauce on anemia prevention

Flavonoids may be natural components came from many vegetables and fruits. A variety of heath effects of these compounds were found. However, a few safety studies indicated that certain adverse effects of these compounds could influence on human health, which could involve genotoxic/carcinogenic effects or interaction with thyroid hormone biosynthesis. Isoflavones' estrogenic activity could influence on sexual development of young animals and children. Furthermore, flavonoids could inhibit the absorption of some nutrients, interact with certain drug pharmacokinetics and affect neurobehavioral development. In this paper, the potential toxicities of flavonoids from recently published papers were reviewed.

Xianfeng Zhao

Papers

Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial:

Effects of coenzyme Q10 or combined with micronutrients on antioxidant defense system in rats

Study on the effect of micronutrients supplementation on health status of children

Efficiency of NaFeEDTA fortified soy sauce on anemia prevention

Potential toxicities of flavonoids