Iron deficiency: causes,consequences, and strategies to overcome this nutritional problem

Iron deficiency and anemia affect a substantial portion of the world's population, provoking severe health problems to the people suffering these conditions, as well as important economic losses to the regions in which this nutritional deficiency is significant. In this work, the principal causes and consequences produced by this deficiency are discussed, as well as the different strategies that can be applied in order to prevent and solve this nutritional problem.     

Pathological lesions attributable to vitamin deficiency in skeletal remains from Puy St. Pierre (Briançon, France)

The aim of the present study was to evaluate the presence of pathological alterations attributable to vitamin deficiency in osteological remains from the church of St. Pierre in Puy de St. Pierre, Briançon, France. We recorded alterations referable to scurvy, an acquired osteodystrophy due to vitamin C deficiency, which causes both skeletal and vascular lesions in humans. Scurvy presents a different clinical picture in children and adults: in the latter, in leaves skeletal signs on the palate and teeth. The recording of osteodystrophies attributable to vitamin deficiency allowed us to make general inferences about the nutritional profile of the group under study. The study of this pathology, as well as that of nutritional stresses, can be related to the geographical-environmental conditions of the population to which the sample belongs. This is important from the anthropological point of view, especially in order to examine alimentary habits within the context of the man-environments relationship.     

The role of nutrition and effects on the cytokine milieu in allogeneic hematopoietic stem cell transplantation

Nutritional deficiency is very common after allogeneic stem cell transplantation (HSCT) despite careful assessment and nutritional supplementation (total parenteral or oral nutrition). The importance of nutrition in the immune system has been well defined during the past several years, as it has modulatory effects on the immune system. One of the most frequent questions in nutrition is whether nutritionally at-risk hosts have a defect in their immune system and whether such defects can be corrected by nutritional supplementation. Addressing nutritional supplementation starting from early post-transplantation might decrease the risk of infectious complication and GVHD after HSCT via the immunomodulatory role of a variety of nutrients and supplements. Given the well-established link between nutrition and immunomodulation, we hypothesize that timely nutritional supplementation can potentially play a direct or indirect role in decreasing non-relapse morbidity and mortality after HSCT. In this article, we discuss the possible link between nutritional deficiency and its effects on the cytokine milieu after HSCT.     

血液肿瘤住院患儿营养风险筛查及高度营养风险的危险因素分析

摘要 目的：筛查血液肿瘤住院患儿营养风险,并对其营养不良风险的危险因素进行分析。方法：选取2019年1月-2019年12月我院收治的的血液肿瘤住院患儿290例,采用自制问卷调查表,调查患儿的一般资料情况,采用欧洲肠外肠内营养协会推荐使用的儿科营养风险筛查工具（STAMP）评价患儿营养风险状况,采用单因素及多因素Logistic回归分析高度营养风险的危险因素。结果：依据STAMP评分标准,对研究对象290例患儿进行评价,高度营养风险的患儿247例,占比85.17%。中度营养风险的患儿43例,占比14.83%。低度营养风险患儿0例,占比0.00%。单因素分析结果显示,血液肿瘤住院患儿营养不良风险与年龄、化疗次数、肿瘤分期、总蛋白缺乏、血红蛋白缺乏有关（P<0.05）,而与居住地、性别、肿瘤类型、家庭人均月收入、患儿监护人文化程度无关（P>0.05）。Logistic回归分析发现,年龄为1~3岁、化疗次数＞5次、肿瘤分期为晚期、存在血红蛋白缺乏是血液肿瘤住院患儿高度营养风险的危险因素（P＜0.05）。结论：血液肿瘤住院患儿存在较高比例的营养不良风险,且受年龄、化疗次数、肿瘤分期、血红蛋白缺乏等多种因素影响,临床可考虑针对此类群体进行营养筛查,并给予及时的干预,以改善血液肿瘤住院患儿的营养状况。     

Malnutrition,anemia, micronutrient deficiency and parasitic infections among schoolchildren in rural Tanzania

BackgroundMalnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries. However, not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania.Methodology/Principal findingsThis cross-sectional study enrolled primary schoolchildren aged 6–12 years from Kikwawila and Kiberege wards, Tanzania. In total, 471 schoolchildren underwent a physical examination and provided blood, stool and urine samples for an assessment of the levels of different micronutrients, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14.0% of schoolchildren were found to be anemic. Children diagnosed with Plasmodium falciparum infection were more likely to have low levels of ferritin (aOR: 10.40, 95% CI: 2.88-40.53) and elevated levels of serum soluble transferrin receptor (aOR: 3.59, 95% CI: 1.27-11.23), respectively. Vitamin A (34.71%) and vitamin B12 (8.79%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38–11.44).Conclusions/SignificanceMalnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable.     

Effect of vermicompost leachate in <Emphasis Type="Italic">Ceratotheca triloba</Emphasis> under nutrient deficiency

Ceratotheca triloba (Bernh.) Hook.f. commonly known as an African foxglove is an indigenous plant which occurs in most parts of South Africa. The species is commonly consumed as a leafy vegetable and utilized for its medicinal properties. Although the high nutritional value of the species and medicinal properties are well documented, information related to critical aspect of cultivation is currently limited. Therefore, this study aimed to evaluate the effect of vermicompost leachate (VCL) on growth, nutritional, phytochemical, and antioxidant levels in C. triloba at different growth stages under nutrient-deficient conditions. After in vitro germination, seedlings were grown in the greenhouse for 2 and 4 months under nitrogen (–N); phosphorus (–P); and potassium (–K) deficiency conditions, and were treated with VCL. Vermicompost leachate did not improve the growth of C. triloba plants under the nutrient-deficient conditions. Although –N-deficient plants with or without VCL caused a decline in growth parameters, they significantly enhanced phytochemicals in 2-month-old plants. In most cases, the application of VCL to –P- and –K-deficient plants improved the photosynthetic pigments, protein, and phenolic, as well as flavonoid accumulation. Harvesting time was also found to play a crucial role in the accumulation of evaluated parameters in nutrient-deprived plants. From these findings, it can be deduced that VCL has a potential to minimize the effect of nutrient deficiency especially under –P and –K deficiency in C. triloba plants.     

Immunoquantification of flavodoxin and ferredoxin from Scenedesmus vacuolatus (Chlorophyta) as iron-stress molecular markers

Quantification of the iron nutritional status of phytoplankton is of great interest not only for the study of the oceans but also for fresh waters. Flavodoxin is a small flavoprotein proposed as a molecular marker for iron stress, since it is induced as a consequence of iron deprivation, replacing the iron-sulphur protein ferredoxin. Flavodoxin and ferredoxin from Scenedesmus vacuolatus have been immunoquantified in cells grown under different iron nutritional conditions. Flavodoxin and ferredoxin levels correlate with the iron availability, and the calculated flavodoxin index can be used as an iron-stress marker. Other physiological parameters such as copper deficiency, heterotrophic or mixotrophic growth, nitrogen source and salt stress were also tested as potential factors influencing flavodoxin expression. Salt stress and heterotrophic growth conditions alter flavodoxin and ferredoxin expression. Once flavodoxin expression is repressed by iron (and severe deficiency alleviated), S.vacuolatus still increases its ferredoxin from 0·5 to 1·6 mol of ferredoxin per mole of ferredoxin-NADP⁺ reductase, and this ratio can be used for the evaluation of mild deficiency.     

Cell cycle regulation and cytoskeletal remodelling are critical processes in the nutritional programming of embryonic development

Many mechanisms purport to explain how nutritional signals during early development are manifested as disease in the adult offspring. While these describe processes leading from nutritional insult to development of the actual pathology, the initial underlying cause of the programming effect remains elusive. To establish the primary drivers of programming, this study aimed to capture embryonic gene and protein changes in the whole embryo at the time of nutritional insult rather than downstream phenotypic effects. By using a cross-over design of two well established models of maternal protein and iron restriction we aimed to identify putative common "gatekeepers" which may drive nutritional programming.Both protein and iron deficiency in utero reduced the nephron complement in adult male Wistar and Rowett Hooded Lister rats (P<0.05). This occurred in the absence of damage to the glomerular ultrastructure. Microarray, proteomic and pathway analyses identified diet-specific and strain-specific gatekeeper genes, proteins and processes which shared a common association with the regulation of the cell cycle, especially the G1/S and G2/M checkpoints, and cytoskeletal remodelling. A cell cycle-specific PCR array confirmed the down-regulation of cyclins with protein restriction and the up-regulation of apoptotic genes with iron deficiency.The timing and experimental design of this study have been carefully controlled to isolate the common molecular mechanisms which may initiate the sequelae of events involved in nutritional programming of embryonic development. We propose that despite differences in the individual genes and proteins affected in each strain and with each diet, the general response to nutrient deficiency in utero is perturbation of the cell cycle, at the level of interaction with the cytoskeleton and the mitotic checkpoints, thereby diminishing control over the integrity of DNA which is allowed to replicate. These findings offer novel insight into the primary causes and mechanisms leading to the pathologies which have been identified by previous programming studies.     

Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro

BACKGROUND: Heterologous antiserum to the visceral yolk sac (AVYS) is teratogenic, inducing a spectrum of malformations in vivo and producing similar effects in vitro. Numerous studies support the concept that AVYS-induced malformations result from embryonic nutritional deficiency, without affecting the maternal nutritional status. This has provided a useful model with which to investigate the nutritional requirements of the early embryo, as well as the role of various nutrients in the etiology of congenital defects. METHODS: In the current investigation, we examined the effects of methionine and other nutrients on AVYS-induced embryotoxicity in vitro. For these experiments, we cultured rat embryos (9.5 p.c) for 48 hr with AVYS and/or methionine at several concentration levels. RESULTS: The addition of L-methionine to AVYS-exposed cultures reduced dysmorphology and open neural tube; this effect was concentration dependent. AVYS-induced dysmorphology was completely prevented at a concentration of L-methionine corresponding to 50-fold the basal serum concentration. Utilization of D-methionine, L-leucine, or folic acid (5-methyltetrahydrofolate, MTHF) instead of L-methionine had no protective effects. CONCLUSIONS: These results suggest that, although AVYS limits the supply of all amino acids to the embryo, embryopathy largely results from a deficiency of methionine. Furthermore, although endocytosis and degradation of proteins by the VYS supplies most amino acids to the embryo, free amino acids may be compensatory when this source is reduced. These results support those of previous investigations that suggest methionine is required for normal NT closure and that methionine is a limiting nutrient for embryonic development.     

Nutritional deficiency anemias in nonhuman primates

The purpose of this report is to review past studies in which anemias, occurred spontaneously in nonhuman primates due to feeding inadequate diets or were induced by feeding diets deficient in a nutrient. Included is a review of anemias induced by deficiencies of iron, niacin, pyridoxine, pantothenic acid, protein, riboflavin, cyanocobalamin, folic acid, ascorbic acid and alpha-tocopherol. The anemia induced by deficiency of each nutrient is discussed with emphasis on the major clinical signs as well as peripheral blood and bone marrow pathology. Results of supplementation of the diet following induction of deficiency states are discussed also. Whenever applicable, a discussion is included of the use of nonhuman primates as animal models for studies simulating parallel nutritional deficiencies in man.     

Discovery and importance of zinc in human nutrition

The present explosion in knowledge of zinc has been the result of several factors, the major ones being the recognition of the important role of zinc in human health and diseases, its vital functions in biochemical reactions, and the technological advances that make it feasible to quantitate this essential trace element in biological fluids. Deficiency of zinc in humans due to nutritional factors and several disease states has now been recognized. The high phytate content of cereal proteins is known to decrease the availability of zinc; thus, the prevalence of zinc deficiency is likely to be high in a population consuming large quantities of proteins. Alcoholism, malabsorption, sickle cell anemia, chronic renal disease, and chronically debilitating diseases are now known to be predisposing factors for zinc deficiency. A severe deficiency of zinc such as that seen in patients with acrodermatitis enteropathica may be life-threatening. A spectrum of clinical manifestations ranging from mild to severe degrees has now been recognized in human zinc deficiency states. Zinc appears to be involved in many biological functions including DNA synthesis. Roles for zinc in enzymatic functions, cell membranes, and immunity are now well established.     

Hypervitaminosis A in experimental nonhuman primates: evidence,causes, and the road to recovery

One of the great underlying assumptions made by all scientists utilizing primate models for their research is that the optimal nutritional status and health of the animals in use has been achieved. That is, no nutrient deficiency or excess has compromised their health in any detectable way. To meet this assumption, we rely on the National Research Council's (NRC's) nutritional recommendations for nonhuman primates to provide accurate guidance for proper dietary formulations. We also rely on feed manufacturers to follow these guidelines. With that in mind, the purpose of this commentary is to discuss three related points that we believe have significant ramifications for the health and well being of captive primates as well as for their effective use in biomedical research. First, our laboratory has shown that most experimental primates are likely in a state of hypervitaminosis A. Second, it is apparent that many primate diets are providing vitamin A at levels higher than the NRC's recommendation. Third, the recommendation itself is based on inadequate information about nutrient needs and is likely too high, especially when compared with human requirements. Am. J. Primatol. 71:813–816, 2009. © 2009 Wiley‐Liss, Inc.     

Iodine biofortification and antioxidant capacity of lettuce: potential benefits for cultivation and human health

Iodine is considered an essential trace element for mammals, and its deficiency is related to numerous pathologies as severe as goitre, reproductive failure, mental retardation and brain damage, among others. Currently, about 30% of the world's population are affected by this deficiency, and thus, in an attempt to ameliorate these nutritional disorders, we propose a biofortification programme with iodine by an application of different dosages and forms of this element (iodide versus iodate) in lettuce plants. In this work, a study has been made of the iodine concentration in roots and edible leaves and their influence on nutritional quality through an analysis of its antioxidant capacity. The results showed that the most appropriate application rates in hydroponic cultivation were 40 μM or lower in the form I⁻ because these concentrations did not reduce biomass in the treated plants with respect to control plants and caused a foliar accumulation of this element that guarantees the viability of this type of programmes. Furthermore, these data are novel, given that the treated plants show a significant increase in antioxidant compounds after the application of iodine.     

Interaction of genes and metals in development.

Examples are presented in interactions between genetic factors and certain trace during development in experimental animals. One type of interaction irenatal nutritional manipulation. The other involved strain differences, which lead differential responses to dietary deficiency. The mutant gene pallid in mice produces abnormal development of the inner ear similar to that resulting from intrauterine manganese deficiency. This abnormality is prevented by manganese supplementation of prenant mutant mice, and as in manganese deficiency, appears to result from depressed synthesis of mucopolysaccharides. Are interaction between copper and the mutant gene cribkled in mice is describes. High dietary copper curing prenatal and abnormal life doubled postnatal survival of mutants and brought about alterations in other parameters. In A/J mice, which have a significant incidence of spontaneous cleft lip and palate, a marginal deficiency prenetally of dietary zinc did not cause an increased incidence of this anomaly. However, the incidence of other malformations was greatly increased in this strain but not in hybird controls. It is proposed that in man as in animals teratogenesis might involve genetic-nutritional interactions as well as multifractorial interactions including genes, nutrients, drugs, and other environmental agents.     

Beriberi (Thiamine Deficiency) and High Infant Mortality in Northern Laos

BackgroundInfantile beriberi (thiamine deficiency) occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos.ConclusionThiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers’ and children’s symptoms are compatible with thiamine deficiency. The severity of this nutritional situation requires urgent attention in Laos.     

Advantages and disadvantages of the animal models v. in vitro studies in iron metabolism: a review

Iron deficiency is the most common nutritional deficiency in the world. Special molecules have evolved for iron acquisition, transport and storage in soluble, nontoxic forms. Studies about the effects of iron on health are focused on iron metabolism or nutrition to prevent or treat iron deficiency and anemia. These studies are focused in two main aspects: (1) basic studies to elucidate iron metabolism and (2) nutritional studies to evaluate the efficacy of iron supplementation to prevent or treat iron deficiency and anemia. This paper reviews the advantages and disadvantages of the experimental models commonly used as well as the methods that are more used in studies related to iron. In vitro studies have used different parts of the gut. In vivo studies are done in humans and animals such as mice, rats, pigs and monkeys. Iron metabolism is a complex process that includes interactions at the systemic level. In vitro studies, despite physiological differences to humans, are useful to increase knowledge related to this essential micronutrient. Isotopic techniques are the most recommended in studies related to iron, but their high cost and required logistic, making them difficult to use. The depletion–-repletion of hemoglobin is a method commonly used in animal studies. Three depletion–-repletion techniques are mostly used: hemoglobin regeneration efficiency, relative biological values (RBV) and metabolic balance, which are official methods of the association of official analytical chemists. These techniques are well-validated to be used as studies related to iron and their results can be extrapolated to humans. Knowledge about the main advantages and disadvantages of the in vitro and animal models, and methods used in these studies, could increase confidence of researchers in the experimental results with less costs.     

Integrated strategies needed to prevent iron deficiency and to promote early child development

Iron deficiency (ID) and iron deficiency anemia (IDA) are global public health problems that differentially impact pregnant women and infants in low and middle income countries. IDA during the first 1000 days of life (prenatally through 24 months) has been associated with long term deficits in children's socio-emotional, motor, cognitive, and physiological functioning. Mechanisms linking iron deficiency to children's development may include alterations to dopamine metabolism, myelination, and hippocampal structure and function, as well as maternal depression and unresponsive caregiving, potentially associated with maternal ID. Iron supplementation trials have had mixed success in promoting children's development. Evidence suggests that the most effective interventions to prevent iron deficiency and to promote early child development begin early in life and integrate strategies to ensure adequate iron and nutritional status, along with strategies to promote responsive mother-child interactions and early learning opportunities.     

Erythrocytary zinc and the infant growth profile in northeast Brazil

This study evaluated nutritional status linked to zinc levels in 239 randomly selected children at crèches in Teresina, Brazil, aged 3 to 6. Blood samples were collected after fasting of 10 h. Erythrocytary zinc levels were determined through flame atomic absorption spectrophotometry. Zinc deficiency was determined as below 40 microg Zn/g Hb. Infant linear growth was evaluated measuring weight and height, and nutritional status by height/age, weight/height, and weight/age indices, expressed as Z scores, in line with the National Center for Health Statistics. The mean zinc concentration was 35.50 +/- 10.95 microg Zn/g Hb. Zinc distribution in the 10, 50, 75, and 90 percentiles was 24.73 microg Zn/g Hb, 35.45 microg Zn/g Hb, 40.73 microg Zn/g Hb and 52.77 microg Zn/g Hb, respectively. Based on this distribution, normal values were found only from the 75th percentile and above. Since the cutoff point adopted was 40 microg Zn/g Hb, the prevalence of zinc deficiency was 74.3%. As for growth profile, 8.4% were chronically malnourished, although the statistical association between linear impairment and nutritional status regarding zinc was insignificant. The study revealed that an important segment of the infant population was mineral deficient; however, the degree of deficiency did not influence growth profiles.     

Porotic hyperostosis: a new perspective.

Porotic hyperostosis is a paleopathologic condition that has intrigued researchers for over a century and a half. It is now generally accepted that anemia, most probably an iron deficiency anemia, is the etiologic factor responsible for lesion production. Although there can be a number of factors involved in the development of iron deficiency anemia, a dietary explanation has often been invoked to explain the occurrence of porotic hyperostosis in past human skeletal populations. In fact, porotic hyperostosis has been referred to as a "nutritional" stress indicator. Traditionally those groups with a higher incidence of porotic hyperostosis have been considered to be less successful in adapting to their environment or more nutritionally disadvantaged than other groups. A new perspective is emerging that is challenging previous views of the role of iron in health and disease, thus having profound implications for the understanding of porotic hyperostosis. There is a new appreciation of the adaptability and flexibility of iron metabolism; as a result it has become apparent that diet plays a very minor role in the development of iron deficiency anemia. It is now understood that, rather than being detrimental, hypoferremia (deficiency of iron in the blood) is actually an adaptation to disease and microorganism invasion. When faced with chronic and/or heavy pathogen loads individuals become hypoferremic as part of their defense against these pathogens, thus increasing their susceptibility to iron deficiency anemia. Within the context of this new perspective porotic hyperostosis is seen not as a nutritional stress indicator, but as a indication that a population is attempting to adapt to the pathogen load in its environment.     

Are Neglected Plants the Food for the Future?

Malnutrition, poor health, hunger, and even starvation are still the world's greatest challenges. Malnutrition is defined as deficiency of nutrition due to not ingesting the proper amounts of nutrients by simply not eating enough food and/or by consuming nutrient-poor food in respect to the daily nutritional requirements. Moreover, malnutrition and disease are closely associated and incidences of such diet-related diseases increase particularly in low- and middle-income states. While foods of animal origin are often unaffordable to low-income families, various neglected crops can offer an alternative source of micronutrients, vitamins, as well as health-promoting secondary plant metabolites. Therefore, agricultural and horticultural research should develop strategies not only to produce more food, but also to improve access to more nutritious food. In this context, one promising approach is to promote biodiversity in the dietary pattern of low-income people by getting access to nutritional as well as affordable food and providing recommendations for food selection and preparation. Worldwide, a multitude of various plant species are assigned to be consumed as grains, vegetables, and fruits, but only a limited number of these species are used as commercial cash crops. Consequently, numerous neglected and underutilized species offer the potential to diversify not only the human diet, but also increase food production levels, and, thus, enable more sustainable and resilient agro- and horti-food systems. To exploit the potential of neglected plant (NP) species, coordinated approaches on the local, regional, and international level have to be integrated that consequently demand the involvement of numerous multi-stakeholders. Thus, the objective of the present review is to evaluate whether NP species are important as “Future Food” for improving the nutritional status of humans as well as increasing resilience of agro- and horti-food systems.