Mark Anthony Beinner

Iron-Fortified Rice Is As Efficacious As Supplemental Iron Drops in Infants and Young Children

How to improve iron status among infants and young children is of continued concern in low- to middle-income countries, including Brazil. In a double blind, 5-mo, home-based, randomized trial in Brazil, we gave one group of mildly anemic 6- to 24-mo-old children (n = 175) rice fortified with micronized ferric pyrophosphate using the Ultra Rice technology and a placebo solution (URG) and another group identical nonfortified rice and iron drops. We instructed parents on the correct dosage of iron drops and to feed their children rice as they normally would. We measured serum ferritin (SF) and hemoglobin (Hb) concentrations at baseline and at 5 mo. At baseline, the prevalences of iron deficiency and anemia in the total sample were 73.1 and 100%, respectively. At 5 mo, SF and Hb increased in both groups, although the change in the URG was larger (P < 0.01). Adult participants were unable to distinguish cooked fortified rice from unfortified rice in terms of smell, color, or taste. As rice is normally consumed at home, MPF-fortified rice increased iron stores and reduced anemia in a group of mildly anemic children 6-24 mo old. In populations where young children are routinely fed approximately 100 g of cooked rice daily, fortifying it with iron may improve iron status at least as well as providing free iron drops.

Recent Experience with Fortification of Foods and Beverages with Iron for the Control of Iron-Deficiency Anemia in Brazilian Children

Iron-deficiency-anemia affects 30% of the world population. Women of reproductive age and children are the most affected. Iron supplementation in the form of tablets and syrups has not been successful in developing countries, and iron deficiency is still the most important deficiency related to malnutrition. Iron-deficiency anemia affects physical and cognitive development at an early age in children, often resulting in irreversible outcomes. Studies from the last two decades have shown that the prevalence of iron-deficiency anemia can be reduced given adequate investments and political will directed at iron fortification of foods and liquids. A successful low-cost iron-fortification program incorporates implementation and strategic use of communication for program inception where education is in the forefront. A review of the available reports from experience in Brazil with iron fortification of foods and liquids is presented.A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

Effect of iron-fortified drinking water of daycare facilities on the hemoglobin status of young children.

Background: Anemia is the most prevalent nutrition problem in young children. One possible strategy to prevent anemia is affordable fortification of drinking water. Objective: The aim of this study was to evaluate the impact of iron-fortified drinking water of daycare facilities on the hemoglobin and anthropometric status of pre-school children. Design: Hemoglobin (Hb) status, weight and height measurements were assessed in 160 pre-school children aged 6 to 59 m before and after 8 m consumption of iron- (12 mg/L) and vitamin C- (90 mg/L) fortified drinking water. Results: Initially, 43.2% (69) of the children evaluated as being anemic decreased to 21% (37) at the end of study. At baseline, 42 (26.3%) children suffered from moderate anemia and 27 (16.9%) suffered severe anemia, but after iron fortification, total number of children suffering from moderate and severe anemia had decreased to 32 (20.7%) and 5 (3%), respectively. Weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) Z-scores increased significantly from −0.84 ± 1.03 to 0.06 ± 1.10, −0.84 ± 1.11 to 0.54 ± 1.10 and −0.39 ± 0.94 to −0.18 ± 1.14, respectively (p < 0.05). Daycare personnel reported increased appetite and food consumption and decreased absenteeism during intervention. Conclusion: Daily consumption of iron-fortified drinking water in daycare facilities is an effective, simple and inexpensive means of reducing and controlling for moderate and severe anemia in pre-school children.

Plasma zinc and hair zinc levels, anthropometric status and food intake of children in a rural area of Brazil

OBJETIVO: Investigar niveis plasmaticos de zinco, concentracao de zinco capilar, crescimento fisico, e consumo de zinco em criancas de 6 a 24 meses da regiao de Diamantina (MG), Brasil. METODOS: As concentracoes de zinco plasmatico e zinco capilar foram analisadas empregando as tecnicas de espectrometria atomica de absorcao e de ativacao neutronica, respectivamente. Peso-para-idade, peso-para-altura e altura-para-idade, expressos em escore-Z, foram medidos, de acordo as curvas de referencia da Organizacao Mundial de Saude. O zinco dietetico dos sujeitos foi avaliado a partir de tres registros alimentares, preenchidos pelas maes ou responsaveis. RESULTADOS: A deficiencia de zinco foi observada em 11,2% e em 16,8% das criancas, segundo os niveis de zinco plasmatico e zinco capilar, respectivamente. As medias em criancas com 11 meses ou menos (49) e 11 (127) meses ou mais de idade para niveis de zinco plasmatico e zinco em cabelos foram 15,4 (DP=4,2) µmol L-1 e 139,5 (DP= 72,1) µg g-1 e 16,0 (DP= 4,5) µmol L-1 e 134,3 (DP=110,3) µg g-1, respectivamente. Os resultados antropometricos mostraram que 8,0%, 6,8% e 3,4% das criancas foram classificadas com baixo peso, baixa estatura e emagrecidas, respectivamente. A media do consumo dietetico de zinco pelas criancas foi de 3,2 (DP=2,3) mg/zinco por dia, e um terco das criancas consumiam alimentos fonte de zinco abaixo do recomendado. Nao houve correlacao entre as variaveis zinco plasmatico, zinco em cabelos, antropometria e consumo de zinco. CONCLUSAO: Os resultados demonstram que a deficiencia de zinco e um problema na populacao estudada, nao somente nas criancas desnutridas. Atencao nutricional devera ser direcionada a esta populacao, com o intuito de melhorar o consumo de alimentos ricos neste mineral e monitorar a deficiencia de zinco.

Sensory evaluation of rice fortified with iron

The objective of this study was to examine sensory differences between conventional rice and iron-fortified Ultra Rice rice (UR) and determine consumer acceptance. Differences between both types of rice were analyzed using the Duo-Trio Test on 37 non-trained judges. The Acceptance Test evaluated general rice appearance, color, aroma and taste by 43 non-trained judges, using a 7-point hedonic scale with extremes ranging from “really disliked” and “really liked.” There were no significant differences between the analyzed samples of conventional rice and UR rice using Duo-Trio Test. Mean values from the Acceptance Test for the evaluated attributes (general appearance, color, aroma e taste) were 5.6 and 5.9, corresponding to “liked” and “really liked” according to the hedonic scale, respectively. The iron did not alter the sensory characteristics of the final product, and the iron-fortified rice was well accepted.

Determination of cadmium and lead in cassava employing slurry sampling and graphite furnace atomic absorption spectrometry after multivariate optimization

A low cost and efficient method to determine Cd and Pb levels in cassava by graphite furnace atomization atomic absorption spectrometry (GF AAS) employing slurry sampling was developed. Slurries were prepared by cryogenic grinding of samples (40 mg), sieving for grain size at 50 mesh and addition of 2% v/v nitric acid and 1% v/v hydrogenous peroxide up to 2 mL of volume. The slurry was maintained homogeneous using air bubbling by an aquarium pump. Tungsten (500 μg) and titanium (500 μg) were the best permanent modifiers for Cd and Pb, respectively. The parameters of merit obtained under optimized conditions, AT (atomization temperature) = 1400 °C, PT (pyrolysis temperature) = 600 °C, pt (pyrolysis time) = 20 s and permanent W (500 μg) for Cd; AT = 1400 °C, PT = 450 °C, pt = 20 s, and Ti (500 μg) for Pb were: linear working range up to 6 and 50 μg L−1 for Cd and Pb, respectively; limit of detection (0.001 and 0.02) μg g−1 for Cd and Pb, respectively; and aqueous calibration, with r2 > 0.99. The accuracy was evaluated by recovery tests and by analysis of certified reference material (NIST – SRM 1568a, rice flour) and was in agreement with the certified values for the two analytes: 0.021 ± 0.002 (n = 5 replicates) for Cd (certified value 0.022 ± 0.002) and <LOQ (n = 5) for Pb (certified value <0.010). The average sample concentrations (n = 3) were between <LOQ to 5.8 ng g−1 and 0.08 to 3.18 μg g−1 for Cd and Pb, respectively.

The profile of professionals in health and education fields at work in their communities

Social roles mold attitudes of actors who play the part in the community, and affect behavioral and moral attitudes and social conscience. There is a diversity of behaviors that demonstrates the extension to which individuals are in constant participation in the community life. A group profile of professionals health and education may supply information on the disciplinary approach in Community Health. Objective: to examine the profile of professionals at work in the Health and Education fields. Subjects participated in answering questions concerning professional work, leisure/religious activities, feeding/sleep habits, prevention and contraceptive methods, medical and/or psychological treatment and medicine/herbal use. Characteristics of the professional group regarding life style and the paradox of the practice of safe sex behavior were recorded. There exists the possibility to improve the quality of life for people in communities by reducing the sources of stress and tension by promoting physical and mental health. Methods should be investigated to allow for the promotion of a quality of life in a small fraction of the population engaged in health and education work in their own communities.

Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards

BACKGROUND To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. DESIGN This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level. FINDINGS At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics. KEY CONCLUSIONS The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.

Fast Determination of Iron and Zinc in Hair and Human Serum Samples After Alkaline Solubilization by GF AAS

Methods for the development and validation for determination of iron and zinc in human serum and hair samples by graphite furnace atomic absorption spectrometry (GF AAS) were performed. Solubilization was immediate by manual agitation in both samples with a 10 mL volume sample plus deionized water. Optimum pyrolysis and atomization temperatures were obtained by pyrolysis and atomization temperature curves in both matrices. For serum samples, the best temperatures were 1400 and 2500 °C (Fe) and 700 and 1600 °C (Zn), respectively. For hair samples, the best temperatures were 1000 and 2400 °C (Fe) and 800 and 1600 °C (Zn), respectively. Permanent modifiers and zirconium presented best the results for Zn in both matrices and for Fe in serum. Permanent modifier Nb was best for hair Zn. Serum and hair values were in agreement with the certified values for analytes and certified samples. The determined values for serum Fe and hair certified samples were 1.40 ± 0.2 and 114 ± 18 mg L-1, respectively. For Zn certified reference materials (CRMs), the certified samples values were 1720 ± 32 µg L-1 and 172 ± 5 mg kg-1. Simple, accurate and precise, this method represents a cost-effective detection protocol suitable for sample analysis for diagnosis of micronutrient malnutrition.

Development and validation of methods for the determination of copper and iron in serum of dogs with canine visceral Leishmaniasis using multivariate optimization and GF AAS

In this work efficient methods to determine copper and iron in dog serum samples by graphite furnace atomic absorption spectrometry were developed. The samples were diluted at a 1 : 9 or 1 : 19 (for Cu and Fe, respectively) ratio with 1% (v/v) nitric acid containing a 0.1% Triton X-100 solution. Rhodium for copper and no modifier for iron proved to be the better permanent modifier. Optimization included fractional factorial planning using Pareto and the CCD designs. For both analytes the working linear range was 0–100 mg L−1 (r2 > 0.99). The obtained LOQ was 19.3 ± 2.8 μg L−1 for Cu and 16.5 ± 0.2 μg L−1 for Fe. Aqueous and matrix matching calibration curves had average angular coefficients that were not statistically different, i.e. the matrix effect was absent for both analytes. The accuracy was checked by recovery tests with an average of 101 ± 4% (n = 45) for Cu and 90 ± 3% for Fe (n = 45). The certified reference material Seronorm™ Trace Elements Serum L-1 obtained was 1705 ± 20 μg L−1 for Cu (certified: 1691 ± 84 μg L−1) and 1.40 ± 1.22 mg L−1 for Fe (certified: 1.43 ± 0.08 mg L−1). Cu and Fe levels in 39 canine serum samples – 9 uninfected, 19 symptomatic and 11 asymptomatic dogs naturally infected with Leishmania chagasi – ranged from 374 to 913 μg L−1, and 1103 to 4260 μg L−1, respectively. Cu was higher in symptomatic than in asymptomatic and control dogs, and Fe was significantly lower in symptomatic than in either asymptomatic or control dogs.