Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA): Project Overview
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Abstract:
There is a need to further understand the relationship between inflammation and nutrition biomarkers and refine the relative contribution of nutritional and other risk factors for anemia across settings. The CDC, GAIN, and NICHD formed a collaborative research group called Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA). We identified data from nationally and regionally representative surveys that included preschool children (PSC, 6–59 mo), school‐age children (SAC, 5–14 yr) and women of reproductive age (WRA, 15–49 yr) that at minimum measured hemoglobin, inflammation (C‐reactive protein and/or alpha1‐acid glycoprotein), and iron status. Of 23 datasets identified, permission to date was received for 15. Individual country and aggregated analyses will be performed. Priority research topics generated include: 1) association among inflammation, anemia, iron, and vitamin A, as well as and approaches to account for the effect to adjust for the effects of inflammation on nutrient interpretation; and 2) risk factors and their relative contribution to anemia. BRINDA results will inform guidelines on the measurement and interpretation of anemia and micronutrients. Findings will also guide the development of a research agenda for future longitudinal studies. Research support: Bill & Melinda Gates Foundation, CDC, GAIN, NICHDBackground: The coverage of 90 Fe tablets in Semarang in 2015 was 26.619 of 29.490 pregnant women (97%) but the incidence of anemia in pregnant women was still quite high. One important factor which influences the levels of hemoglobin is multi micronutrient.
Objective: This study aims to analyze the changes in hemoglobin levels with multi micronutrient supplementation in pregnant women with anemia.
Methods: A quasi-experimental study with randomized control group pre-posttest design. The study samples were 40 pregnant women with gestational age of 20 ± 1 weeks divided into two groups, the intervention group (multi micronutrient supplementation) and the control group (Fe supplementation) for six weeks. The study was conducted from November 2016 to January 2017. The levels of hemoglobin were measured using cyanmethemoglobin. Paired t test and independent t test were used for data analyses.
Results: The average of the increase in hemoglobin levels after multi micronutrient supplementation was 1.545 (1.292) g/dl, whereas the average of the increase in hemoglobin levels after Fe supplementation was 0.757 (0.742) g/dl. The difference in hemoglobin levels before and after multi micronutrient supplementation was significantly different (p=0.049). Cohen’s d effect size test showed value of 0.748.
Conclusion: Multi micronutrient supplementation could improve hemoglobin levels. The increase in the levels of hemoglobin with multi micronutrient supplementation was higher than Fe supplementation.
Micronutrient deficiency
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Micronutrients perform a key role in almost all vital body functions like those related to vision, immunity, bone formation, brain function and many others that help in proper growth and maintaining good health. Deficiency of any one or more of the micronutrients can have a negative impact on the overall health. The causes of micronutrient deficiencies and their signs and symptoms are explained in this chapter in a precise manner. Plant and animal food sources with high micronutrient contents with ready-to-eat food supplements per serving size are illustrated for each micronutrient. These can serve as a guideline for preventive measures and diet therapy. Micronutrients are increasingly used as an adjunct therapy in managing various health problems. Effective therapeutic uses of vitamins and minerals are exemplified for a ready reference. Overdose of synthetic supplements of micronutrients and certain environmental conditions may result in toxic effects. To address this, the upper limit for micronutrient intakes and toxic effects of excess micronutrient intakes are also described. The relevance of the yogic concept of ‘sattvic’ diet in modern nutrition and the potential of yoga for micronutrient absorption is also highlighted. The approach of yoga towards healthy diet and the relation between diet and psychological health is explained based on experimental data. The importance of specific micronutrients in health at different stages of life, from pregnancy to old age, is elucidated and remedial measures are suggested. Lastly, evidence for micronutrient supplements as an adjunct therapy for COVID-19 is briefly described. <br>
Micronutrient deficiency
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Micronutrient deficiencies compromise the health and development of many school-age children worldwide. Previous research suggests that micronutrient interventions might benefit the health and development of school-age children and that multiple micronutrients might be more effective than single micronutrients. Fortification of food is a practical way to provide extra micronutrients to children. Earlier reviews of (multiple) micronutrient interventions in school-age children did not distinguish between supplementation or fortification studies. The present review includes studies that tested the impact of multiple micronutrients provided via fortification on the micronutrient status, growth, health, and cognitive development of schoolchildren. Twelve eligible studies were identified. Eleven of them tested the effects of multiple micronutrients provided via fortified food compared to unfortified food. One study compared fortification with multiple micronutrients to fortification with iodine alone. Multi-micronutrient food fortification consistently improved micronutrient status and reduced anemia prevalence. Some studies reported positive effects on morbidity, growth, and cognitive outcomes, but the overall effects on these outcomes were equivocal.
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No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion.The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission.Scoping review.Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness.NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted.711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients.During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the 'absence of evidence should not imply evidence of absence', and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
Micronutrient deficiency
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Micronutrient deficiency
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Adequate micronutrient intake throughout life course is essential for the maintenance of health. Micronutrients are necessary for the maintenance of intermediary metabolism, play a crucial role as co-factors or co-enzymes in the activity of virtually all enzymes, and have important functions to neutralise the deleterious effects of oxidant species. Claims have been made for the benefits of micronutrient supplementation. Clinical benefit of a supplementation is obvious in those individuals who are severely depleted and at risk of complications. More recently, the concept of subclinical deficit has been developed, which essentially relies upon biochemical abnormalities the interpretation of which remains doubtful in most instances. Symptomatology related to such subclinical deficit is non specific and the potential advantages of micronutrient supplements remain marginal and largely not well-established. In contrast, provision of excess supplements to individuals who do not need them may be harmful. In the general population, a well-balanced diet supplies an adequate intake of micronutrient. Further research is needed to identify the best markers of micronutrient and antioxidant status, so that at risk patients can be identified and appropriate supplementation provided accordingly. New large-scale trials of different doses of micronutrients, based on precise outcome markers, are required to optimise intakes in different groups of patients as well as in the general population.
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Micronutrient deficiency
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Micronutrients play a crucial role in maintaining good health as they are required for various processes within the body. Every individual has different micronutrient needs depending on their metabolic condition. To achieve optimal health, these needs must be met adequately.
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Objective: In order to investigate the effect of zinc and/or micronutrients compound intervention on the physicaldevelopment in pre-school children. Methods: 480 children were divided into 3 groups: zinc group, micronutrients group, zincplus micronutrients group. During the experiment of 10 weeks, the children were supplied with zinc, micronutrients or zinc plusmicronutrients respectively. Results: The data showed that the increases of children's height and weight were significantly higherin micronutrients and zinc plus micronutrients groups than those in zinc group. Conclusion: it suggests that the supplementationof mieronutrients compound should promote children's growth and development, and that attention should be paid to the supplementation of other nutrients while zinc be supplied for children.
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Vitamins, zinc and selenium are important micronutrients that play crucial functions at the cellular and molecular level. Immune response of several different cell types can be modulated by these micronutrients. Deficiency in micronutrients has been extensively reported in HIV-1-infected individuals and further correlated with CD4+ T-cell count, HIV-1 plasma viral load, disease progression and mortality. Supplementation by micronutrients has had controversial effects. Thorough future investigations and trials are certainly needed to strategically plan evidence-based interventions. Here, we review the available data on use of micronutrients during the course of HIV-1 infection.
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In metabolism and tissue performance, micronutrients play a key role. Sufficient amount of intake is required to maintain tissue function and metabolic processes. In those people who are extremely depleted and the possibility for complications, the clinical benefits of micronutrient supplements are more advantageous in health improvement. Zinc and vitamin A supplements have contributed to lowered diarrhoea and pneumonia in children in developing countries. In slightly malnourished children, there are some indications that micronutrient supplements have cognitive influence. In several diseases, there is strong proof of the benefit of micronutrient supplements. A well-balanced diet tends to support most of the micronutrients.
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