Consequences of Micronutrient Deficiency and Interventions to Improve Micronutrient Status
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Infants are prone to micronutrient deficiency and indeed millions of infants worldwide are deficient in at least one micronutrient [1], although most infants are deficient in several micronutrients at the same time [2]. An important reason why micronutrient deficiencies often occur concurrently is that the same causal factors to some degree underlie deficiencies of many different nutrients. Monotonous and unbalanced diets, lack of animal-based food products in the diet, and anti-nutritional or absorption-inhibiting factors in the diet will all reduce the nutritional value of a diet [3]. For instance, potent cation-binding substances such as phytates, which are commonly found in cereal diets, make those diets have a particularly low bioavailability for iron as well as for zinc [3, 4]. Such dietary flaws are associated with poverty, and will result in nutritional deficiencies, even when basic energy and protein needs are met, which is often not even the case. As a result, infants and children are at risk for deficiency of not just a single micronutrient but often a whole range of micronutrients to varying extents, the exact combinations determined by the general dietary pattern (e.g., rice-based or maize-based) and the gaps between intake and requirement.Keywords:
Micronutrient deficiency
Anaemia in pregnancy is a common and worldwide problem that deserves more attention. For many developing countries, prevalence rates of up to 75% are reported. Anaemia is frequently severe in these situations and can be expected to contribute significantly to maternal mortality and morbidity. After a discussion of definitions, screening for anaemia and prevalence, the relationship between anaemia and maternal mortality and morbidity will be reviewed. Micronutrient deficiency and especially iron deficiency is believed to be the main underlying cause for anaemia. More recently the role of vitamin A deficiency as a contributing factor to anaemia has also been examined. The difficulties of assessment of micronutrient sufficiency or deficiency in pregnancy are described, as is the interaction between infection and micronutrient deficiency states.
Micronutrient deficiency
Nutritional deficiency
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The effect of combining a multi-micronutrient supplement with a milk-based cornstarch porridge on the bioavailability of iron, zinc, folate, and vitamin C was evaluated using the plasma curve response over time (8 hours) in healthy women. Three tests were carried out in a crossover design: S (multi-micronutrient supplement), MS (multi-micronutrient supplement plus test meal), and M (test meal). Relative bioavailability was determined as the percent ratio of the area under the curve (AUC) in MS corrected by M, and AUC in S. Compared to S, AUC in MS was smaller for iron (p < .05), for zinc (p < .01), and for folate (p < .05), but not different for vitamin C. Relative bioavailability was lower (p < .05) than 100% for iron (80%), zinc (70%), and folate (85%). The decrease in bioavailability of these nutrients when the multi-micronutrient supplement is combined with a milk-based cornstarch porridge is small. Therefore, the tested meal is a suitable vehicle for the multi-micronutrient supplement.
Biofortification
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An evaluation of the adequacy of dietary intakes of nutrients requires not only knowledge of the nutrient content of the foods ingested but also the extent to which the nutrient present in the diet is available for absorption and utilization, that is, its bioavailability. What is meant by bioavailability? Bioavailability is considered to be the relative absorption of a nutrient from the diet, but this definition may be extended to include the relative accumulation of a nutrient into storage pools and various tissues. Obviously, nutrients ingested but not released during the digestive process for absorption and utilization have no nutritional value. Thus, overall bioavailability may refer to the degree to which a nutrient becomes available to the target tissue after ingestion from the diet.1
Essential nutrient
Absorption efficiency
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Phytosiderophore (PS) release, which occurs mainly under iron deficiencies in the representative Poaceae, has been speculated to be a general adaptive response to enhance the acquisition of micronutrient metals. However, it is very common to encounter deficiency of micronutrients other than iron (Fe) in soils and interactions with respect of multi-micronutrient deficiency to effect on PS release are not known. Further, the diurnal rhythm for the release of PS may also be affected under multiple micronutrient deficiency. PS release capacity and PS content of roots and the diurnal rhythm of PS release was measured in selected efficient and inefficient wheat genotypes varied on individual and combined deficiency of Fe, zinc (Zn), copper (Cu) and manganese (Mn) in nutrient solution culture. A nutrient sufficient treatment was also taken as experimental control. Lack of Fe in the nutrient medium caused a significantly higher release of PSs followed by Zn, Mn and Cu in the same order. The diurnal rhythm of PS release was similar in the absence of either of the micronutrients or under their combined deficiency. Micronutrient sufficient control did not release any PS. Fe-use-efficient cultivars produced and released a larger amount of PS and differed from the inefficient cultivars in terms of the PS release but not in the PS biosynthesis in the roots. Thus, indicating that the limitation at the level of release of the PS is responsible for low Fe use efficiency of the Fe deficiency susceptible cultivars. Further, the diurnal variation in the PS release was similar for all the investigated wheat cultivars and did not influence the variation in the Fe use efficiency.
Micronutrient deficiency
Diurnal temperature variation
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In recent years, there has been a reduction in caloric intake in populations with decreased energy demands. This has place a greater emphasis on the bioavailability of nutrients in foods because the total intake of nutrients is generally closely linked with total caloric intake. An assessment of the adequacy of dietary intakes of nutrients requires not only knowledge of the nutrient content of the foods ingested but also the extent to which the nutrient present in the diet is available for absorption and utilization. Nutrients ingested but not released during the digestive process for absorption are of no nutritional value. Bioavailability may be considered the relative absorption of a nutrient from the diet. An index of bioavailability may be extended to include the relative accumulation of a nutrient into various tissues. Various nutrients and dietary components interfere with the bioavailability of vitamins. Hence, requirements for vitamins cannot be considered independently, but must be evaluated in relationship to other nutrients and compounds consumed by an individual. An overview has been presented as to the factors that influence the bioavailability of vitamins in the human food supply.
Essential nutrient
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Micronutrient deficiency
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Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micronutrients in a subset of children with cancer (n = 23) participating in a randomized trial of the neutropenic diet. Ninety-six percent of children had ≥1 micronutrient deficiency and 39% had ≥3 micronutrient deficiencies. Eighty-six percent of children had vitamin C deficiency, 87% had 25-hydroxyvitamin D deficiency, 50% had zinc deficiency, and 13% had vitamin A deficiency. Dietary intake did not correlate with micronutrient deficiency status. More data are needed regarding the prevalence and etiology of micronutrient deficiencies in children with cancer to further understand their implications and treatment.
Micronutrient deficiency
Nutritional deficiency
Etiology
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Micronutrient deficiencies are the most prevalent form of malnutrition worldwide. Although commonly related to underweight, micronutrient deficiencies can occur in both normal and overweight children in medium- and low-income populations undergoing nutritional transition.To describe haemoglobin and micronutrient levels in infants from a low-income area in Brazil in relation to their weight-for-length Z-score.A cross-sectional survey was undertaken of 2-11-month-old infants in Laranjeiras, a small urban community in North-east-Brazil between April 2009 and February 2010. Anthropometry and assays for haemoglobin, ferritin, plasma zinc, copper and selenium and erythrocyte zinc and copper concentrations were investigated.The total number of full-term infants born in the study period was 222, of whom 153 were available for the study. Three (2%) children were wasted, 98 (66%) were of normal weight, 37 (25%) were at risk of overweight and 11 (7%) were overweight or obese. Nearly all (97%) children had at least one micronutrient deficiency, 102 (67%) had anaemia, 86 (58%) and 100 (67%) had plasma and erythrocyte zinc deficiency, respectively, and 7 (5%) and 113 (76%) had plasma and erythrocyte copper deficiency, respectively. 138 (91%) children had selenium deficiency. Except for plasma zinc, the proportion of infants with micronutrient deficiencies did not differ by weight-for-length status.The increased risk of overweight and micronutrient deficiencies in this population highlights the need to address the double burden of excess weight with micronutrient deficiencies in medium- and low-income settings.
Underweight
Micronutrient deficiency
Nutrition Transition
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Dietary and human factors have been found to be the major factors influencing the bioavailability of micronutrients, such as provitamin A carotenoid (pVAC), iron, and zinc, in biofortified crops. Dietary factors are related to food matrix structure and composition. Processing can improve pVAC bioavailability by disrupting the food matrix but can also result in carotenoid losses. By degrading antinutrients, such as phytate, processing can also enhance mineral bioavailability. In in vivo interventions, biofortified crops have been shown to be overall efficacious in reducing micronutrient deficiency, with bioconversion factors varying between 2.3:1 and 10.4:1 for trans ‐β‐carotene and amounts of iron and zinc absorbed varying between 0.7 and 1.1 mg/day and 1.1 and 2.1 mg/day, respectively. Micronutrient bioavailability was dependent on the crop type and the presence of fat for pVACs and on antinutrients for minerals. In addition to dietary factors, human factors, such as inflammation and disease, can affect micronutrient status. Understanding the interactions between micronutrients is also essential, for example, the synergic effect of iron and pVACs or the competitive effect of iron and zinc. Future efficacy trials should consider human status and genetic polymorphisms linked to interindividual variations.
Biofortification
Micronutrient deficiency
Food fortification
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Micronutrient deficiency
Morbidly obese
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