José Eduardo Dutra-de-Oliveira

Drinking water as an iron carrier to control anemia in preschool children in a day-care center.

OBJECTIVE Several foods have been used as iron (Fe) carriers to fight widespread global Fe deficiency and anemia. This paper describes the longitudinal effect of Fe-fortified drinking water given to a group of Brazilian preschool children. DESIGN The experimental design included 31 preschool children who attended a day-care institution. Hemoglobin and serum ferritin were the blood parameters used to check the Fe status. Fe++ sulfate (20 mg Fe/L) was added daily to their drinking water container and measurements were obtained before the addition, 4 and 8 months later. RESULTS The number of Fe-deficient children decreased drastically after they started drinking the Fe-enriched water. Mean hemoglobin values increased from 10.6 to 13.7 g/dL and serum ferritin from 13.7 to 25.6 micrograms/L. There were no problems related to the salt addition or to the children drinking the Fe-enriched water. CONCLUSION Fe-enriched drinking water was shown to be a practical alternative to supply Fe to children attending a day-care institution.

Control of iron-deficiency anaemia in Brazilian preschool children using iron-fortified orange juice

Different fortified foods have been used for the control of iron-deficiency anaemia in children. In Brazil, a low cost, abundant and culturally accepted food but not yet used for fortification, is orange juice. To evaluate the usefulness of fortified orange juice, 50 preschool children enrolled in a day-care centre in the town of Pontal, Southeast Brazil, received two flasks of 200 ml orange juice fortified with 20 mg ferrous sulfate heptahydrate, providing 2 mg elemental/100 ml, from Monday to Friday for 4 months (a total of 84 days). Capillary haemoglobin and z scores of the anthropometric indicators weight-for-age, weight-for-height and height-for-age were determined at the beginning of the study and after 4 months. Mean haemoglobin increased from 10.48 ± 1.66 to 11.60 ± 1.09 mg/dl (p = 0.00003) and the prevalence of anaemia (Hb < 11 mg/dl) decreased from 60 to 20%. No significant alterations in the mean z scores of the anthropometric indicators were observed. The acceptance of fortified juice was excellent and no undesired effect was observed. We conclude that the consumption of iron-fortified orange juice is an adequate strategy to complement iron intake in preschool children and, therefore, to treat and prevent iron-deficiency anaemia.

Effect of fortification of drinking water with iron plus ascorbic acid or with ascorbic acid alone on hemoglobin values and anthropometric indicators in preschool children in day-care centers in Southeast Brazil.

Background Iron-deficiency anemia currently is the most frequently occurring nutritional disorder worldwide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. Objective The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. Methods A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. Results The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. Conclusions Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of nonheme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.

Jardinópolis sem anemia, primeira fase: avaliação antropométrica e do estado nutricional de ferro

OBJETIVOS: Com a finalidade de preparar um programa municipal de fortificacao da agua de beber com ferro, foi realizado levantamento antropometrico e do estado nutricional de ferro das criancas institucionalizadas nas cinco creches de periodo integral da cidade de Jardinopolis, Sao Paulo. METODOS: Em estudo transversal, foram avaliadas 184 criancas com idades entre 12 e 59,9 meses, no periodo entre 1o e 31 de agosto de 2006. De cada crianca, foram obtidos dados pessoais, peso, estatura e colhida amostra de sangue para dosagem de hemoglobina, volume corpuscular medio (VCM), indice de saturacao da transferrina (IST) e o red cell distribution width (RDW). RESULTADOS: A prevalencia global de anemia foi de 29,3% e a media de hemoglobina de 11,5g/dL. Deficiencia de ferro foi observada em 75% das criancas. As prevalencias de deficit (escore Z 2) foi de 2,2%. CONCLUSOES: Apesar de inferior a outros estudos brasileiros, a prevalencia de anemia mostrou-se elevada. A antropometria mostrou que a oferta de macronutrientes esta bastante proxima do ideal, mas a elevada prevalencia de criancas deficientes em ferro indica a necessidade da adocao de medidas para aprimorar a oferta de ferro.

Absorption, by humans, of β-carotene from fortified soybean oil added to rice : Effect of heat treatment

OBJECTIVE This study was carried out to evaluate the absorption of beta-carotene in humans when rice is prepared with refined cooking soybean oil fortified with beta-carotene and to assess the effect of heat treatment on its bioavailability. METHODS Sixteen healthy adults subjects participated in two experimental trials. Studies were carried out during two experimental periods of 11 days with a 12-day interval between them. Beta carotene was added to the soybean cooking oil and rice was cooked with it or it was added to the rice after cooking. Experimental diets included these two kinds of rice during the first day and fasting blood samples were collected on different days. All of the test diets were low in carotenoids. Plasma carotenoids were measured by HPLC method. beta-carotene absorption was calculated through postabsorptive peak rise in plasma beta-carotene and the total area under the absorption curve was determined by the trapezoidal method for the 11-day period. RESULTS Absorption of carotene from heated or unheated fortified soybean oil were similar. Peak plasma carotene rise was different in men and women, p < 0.05 (0.66 +/- 0.097 vs. 1.04 +/- 0.117 mumol/l, respectively). Plasma alpha-carotene and retinol showed no variation. CONCLUSIONS Results demonstrate that beta-carotene added to soybean oil used in the preparation of rice is absorbed, heated or not, and could be a practical source of provitamin A. Developing countries looking for strategies to increase vitamin A intake could use fortification of vegetable oils with synthetic beta-carotene as a simple method.

Fortification of Drinking Water to Control Iron- Deficiency Anemia in Preschool Children

Background Iron-deficiency anemia is the most common type of micronutrient malnutrition in the world. Its etiology and control are well understood, but the problem persists and is increasing in some developing countries. Iron fortification of mass-consumption foods is considered one of the most viable approaches to deliver bioavailable iron to the population. Objective To review and analyze the use of drinking water as an iron vehicle to reduce ferropenic anemia in developing countries. Methods Drinking water with added iron compounds was offered to preschool children at day-care centers in Brazil. Iron solutions were prepared with 10 mg to 20 mg iron/L. Clinical and anthropometric measurements and blood hemoglobin concentrations were obtained at the beginning of each study and 4 to 8 months later. Results No problems with acceptability or side effects were observed. Daily water intake by children was around 500 mL. Iron-deficiency anemia was found in all studies. Control children not receiving iron sup- plementation mantained their initial hemoglobin level. Anemia was reduced in the groups receiving iron-fortified drinking water. Conclusions Based on physical properties, tests in rats, and studies on preschool children at Brazilian day-care centers, we have shown that drinking water locally fortified with iron compounds should be considered and used as a worldwide available vehicle to control iron-deficiency anemia. Drinking water, besides being universally available, is a locally available vehicle, easily fortified, can be a vehicle for hydrosoluble iron, and reduces iron-deficiency anemia in preschool children.

Effect of heat treatment on the biological value of β-carotene added to soybean cooking oil in rats

Vitamin A deficiency is one of the major nutritional problems in the world, most common in developing countries. Food fortification is a recognised approach to supply vitamins and minerals to needed populations. Vegetable cooking oils were previously suggested by us as a carrier for vitamin A fortification. Fortification of cooking oil with beta-carotene could also be a strategy to prevent vitamin A deficiency. The objective of this article is to start studies on the use of cooking soya oil as a vehicle for synthetic carotene, to evaluate its stability to heat treatment, and to test its bioavailability and bioconversion to vitamin A in rats. Batches of carotene-fortified soybean oil were prepared, containing 2, 4 and 8 RE/g of diet. Some of them were heated to test its stability. At 100 degrees C there was no loss of carotene, at higher temperature carotene retention was 65%. The bioavailability and bioconversion of beta-carotene added to soybean oil was measured through feeding nursing rats and their pups method. Weight gain was good and plasma vitamin A increased significantly in all groups. Liver vitamin A values of rats fed diets with fortified soybean oil heated at 100 degrees C was similar to the 4 RE non-heated fortified oil group (0.72 +/- 0.06 and 0.64 +/- 0.08 mumol/g, respectively). Heated at 170 degrees C the liver total vitamin A value was reduced (0.45 +/- 0.04 mumol/g), but kept bioavailable vitamin A equivalent to 2 RE (0.47 +/- 0.09 mumol/g). Bioconversion of beta-carotene to vitamin A was validated by the plasma and liver findings. beta-carotene added to soybean oil showed good stability to heat and its bioconversion to vitamin A was shown in rat assays. beta-carotene mixed well with edible soybean oil and the fortified cooking oil showed potential as a carrier to be used for the prevention of vitamin A deficiency.

Iron-Fortified Drinking Water Studies for the Prevention of Children's Anemia in Developing Countries

Anemia and iron deficiency should receive special attention considering their high prevalence and serious consequences. For prevention, globally it is recommended to increase dietary iron intake, iron fortification of industrialized foods, and medical iron supplementation. Food fortification for the prevention of iron deficiency in developing countries should consider carriers locally available and consumed daily, requiring limited infrastructure and technology. Drinking water is the iron carrier we have been working for years for the prevention of iron deficiency and anemia in small children in Brazil. It was shown that studies with iron-fortified drinking water were proved to be effective on childrens anemia prevention. Water is found everywhere, consumed daily by everyone may be easily fortified with simple technology, is low priced and was effective on the prevention of childrens anemia. Fortification of drinking water with iron was locally implemented with the direct participation of the government and community. Government authorities, health personnel and population were part of the project and responsible for its community implementation. The mayor/municipality permitted and supported the proposal to supply it to children at their day-care centers. To keep the children drinking water iron fortified supply an officially authorized legislation was also approved.

Bioavailability of iron measurement in two nutrients multiple solutions by in vitro and in vivo: a comparative methodology between methods

OBJECTIVES The bioavailability of dietary iron present in a nutritional formulation may be evaluated by in vitro and in vivo methods since they provide for a cohesive line study and provided in the literature. The aim of this study was to evaluate the bioavailability of iron targeting a comparative analysis of two nutritional supplement formulations (A and B). METHODS For this study were using in vitro and in vivo methods, both described in the literature for availability of iron in an enteral feeding after ingestion supplement nutrition with much nutrients. RESULTS The results obtained by in vitro simulation of the human gastrointestinal tract were 0.70 ± 0.02 and 0.80 ± 0.01 % iron availability by formulations A and B. In vivo studies, as measured by the curves of serum iron in humans after ingestion of formulations allowed the calculation of coefficient of variation Δ < 0, indicating that there was a low absorption of iron. The bioavailability of iron as two multi-nutrients solutions obtained by in vitro and in vivo showed that there were comparisons of those methodologies used in this study.

Iron (FeSo4) bioavailability in obese subjects submitted to bariatric surgery.

BACKGROUND Iron bioavailability in obese subjects after the ingestion of a nutritional supplement was the aim of this work. METHODS Fourteen persons were studied before and after bariatric surgery after the ingestion of a nutritional formulation containing 25 mg iron, 25 g fiber and 800 mg calcium. RESULTS The following ferremia values (median and minimum--maximum) were obtained before and after bariatric surgery, respectively: Fasting, 105 (70 - 364) μg/dL and 198 (38 - 617) μg/dL; 1 hour, 103 (63 - 305) μg/dL and 160 (11 - 207) μg/dL; 2 hours, 103 (62 - 150) μg/dL and 141 (10 - 412) μg/dL; 3 hours. 97 (63 - 190) μg/dL and 153 (6 - 270) μg/dL; 4 hours, 91 (58 - 163) μg/dL and 156 (40 - 251) μg/dL (p>0.05), with no association of serum iron levels with time. There was a difference in total triglycerides (95 ± 29 mg/dL and 60 ± 10 mg/dL) which were correlated with a decrease in serum ferritin levels (r = 0,926, p = 0.008), UIBC (r = 0.910, p = 0.01), total cholesterol (r = 0,918, p = 0.01) and LDL-c fraction (r = 0.830, p = 0.04), with an increase in HDL-c fraction (r = 0,807, p = 0.05). CONCLUSION Iron bioavailability in obese subjects was affected by the ingestion of the nutritional formulation containing calcium and fiber, a fact that may cause these patients to develop iron deficiency.