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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Single interventions for helminthic infections and micronutrient deficiencies are effective, but it is not clear whether combined interventions will provide equal, additive or synergistic effects to improve children's health. The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children. A double-blind, randomized, placebo-controlled trial in 11 rural South African primary school randomly allocated 579 children aged between 8 and 10 years into six study groups, half of whom received antihelminthic treatment at baseline. The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits, either unfortified or fortified with vitamin A and iron or with vitamin A only, given daily for 16 weeks. The outcome measures were anthropometric, micronutrient and parasite status, and scholastic and cognitive test scores. There was a significant treatment effect of vitamin A on serum retinol (p < 0.01), and the suggestion of an additive effect between vitamin A fortification and de-worming. Fortified biscuits improved micronutrient status in rural primary school children; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection. The burden of micronutrient deficiency (anaemia, iron and vitamin A) and stunting in this study population was low and, coupled with the restricted duration of the intervention (16 weeks), might have limited the impact of the interventions.
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PMID:A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children. 1173 50

Iron overload could promote the generation of free radicals and result in deleterious cellular damages. A physiological increase of oxidative stress has been observed in pregnancy. A routine iron supplement, especially a combined iron and vitamin C supplementation, without biological justifications (low hemoglobin [Hb] and iron stores) could therefore aggravate this oxidative risk. We investigated the effect of a daily combined iron supplementation (100 mg/d as fumarate) and vitamin C (500 mg/d as ascorbate) for the third trimester of pregnancy on lipid peroxidation (plasma TBARS), antioxidant micronutriments (Zn, Se, retinol, vitamin E, (beta-carotene) and antioxidant metalloenzymes (RBC Cu-Zn SOD and Se-GPX). The iron-supplemented group (n = 27) was compared to a control group (n = 27), age and number of pregnancies matched. At delivery, all the women exhibited normal Hb and ferritin values. In the supplemented group, plasma iron level was higher than in the control group (26.90 +/- 5.52 mmol/L) and TBARs plasma levels were significantly enhanced (p < 0.05) (3.62 +/- 0.36 vs 3.01 +/- 0.37 mmol/L). No significant changes were observed in plasma trace elements and red blood cell antioxidant metalloenzymes. Furthermore, the alpha-tocopherol plasma level was lowered in the iron-supplemented groups, suggesting an increased utilization of vitamin E. These data show that pharmalogical doses of iron, associated with high vitamin C intakes, can result in uncontrolled lipid peroxidation. This is predictive of adverse effects for the mother and the fetus. This study illustrates the potential harmful effects of iron supplementation when prescribed only on the assumption of anemia and not on the bases of biological criteria.
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PMID:Increased lipid peroxidation in pregnant women after iron and vitamin C supplementation. 1176 27

Vitamin A is a pivotal biochemical factor required for normal proliferation and differentiation as well as for specialized functions, such as vision. The dietary intake of 1500 IU/day is recommended in the first year of life. Here, we report the case of an infant who had been given 62 000 IU/day for 80 days. The infant showed several clinical signs of retinol intoxication, including severe anemia and thrombocytopenia. Bone marrow showed a remarkably reduced number of erythroid and megakaryocytic cells. The interruption of vitamin A treatment was immediately followed by clinical and biochemical recovery. To clarify whether the effects of retinol are due to a direct action on bone marrow cell proliferation, we investigated the activity of retinol (both the drug and the pure molecule) on the growth of K-562, a multipotent hematopoietic cell line, and on bone marrow mesenchymal stem cells. We observed that vitamin A strongly inhibited the proliferation of the cells at concentrations similar to those reached in vivo. Subsequent biochemical analyses of the cell cycle suggested that the effect was mediated by the up-regulation of cyclin-dependent kinase inhibitors, p21(Cip1) and p27(Kip1). These are the first findings to demonstrate that infant hypervitaminosis A causes a severe anemia and thrombocytopenia and that this is probably due to the direct effect of the molecule on the growth of all bone marrow cellular components. Our data also suggest potential bone marrow functional alterations after excessive vitamin A intake because of emerging social habits.
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PMID:Infant hypervitaminosis A causes severe anemia and thrombocytopenia: evidence of a retinol-dependent bone marrow cell growth inhibition. 1187 74

Vitamin A is essential for immunity and growth. A controlled clinical that involved 697 human immunodeficiency virus (HIV)-infected pregnant women was conducted to determine whether vitamin A prevents anemia, low birth weight, growth failure, HIV transmission, and mortality. Women received daily doses of iron and folate, either alone or combined with vitamin A (3 mg retinol equivalent), from 18-28 weeks' gestation until delivery. In the vitamin A and control groups, respectively, the mean (+/-SE) birth weights were 2895+/-31 g and 2805+/-32 g (P=.05), the proportions of low-birth-weight infants were 14.0% and 21.1% (P=.03), the proportions of anemic infants at 6 weeks postpartum were 23.4% and 40.6% (P<.001), and the respective cumulative proportions of infants who were HIV infected at 6 weeks and 24 months of age were 26.6% and 27.8% (P=.76) and 27.7% and 32.8% (P=.21). Receipt of vitamin A improved birth weight and neonatal growth and reduced anemia, but it did not affect perinatal HIV transmission.
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PMID:Antenatal vitamin A supplementation increases birth weight and decreases anemia among infants born to human immunodeficiency virus-infected women in Malawi. 1217 39

Comprehensive recommendations for the assessment and control of vitamin A deficiency (VAD) were rigorously reviewed and revised by a working group and presented for discussion at the XX International Vitamin A Consultative Group meeting in Hanoi, Vietnam. These recommendations include standardized definitions of VAD and VAD disorders. VAD is defined as liver stores below 20 micro g (0.07 micro mol) of retinol per gram. VAD disorders are defined as any health and physiologic consequences attributable to VAD, whether clinically evident (xerophthalmia, anemia, growth retardation, increased infectious morbidity and mortality) or not (impaired iron mobilization, disturbed cellular differentiation and depressed immune response). An estimated 140 million preschool-aged children and at least 7.2 million pregnant women are vitamin A deficient, of whom >10 million suffer clinical complications, principally xerophthalmia but also increased mortality, each year. A maternal history of night blindness during a recent pregnancy was added to the clinical criteria for assessing vitamin A status of a population, and the serum retinol criterion for a "public health problem" was revised to 15% or more of children sampled having levels of <20 micro g/dL (0.7 micro mol/L). Clinical trials and kinetic models indicate that young children in developing countries cannot achieve normal vitamin A status from plant diets alone. Fortification, supplementation, or other means of increasing vitamin A intake are needed to correct widespread deficiency. To improve the status of young infants, the vitamin A supplements provided to mothers during their first 6 wk postpartum and to young infants during their first 6 mo of life should be doubled.
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PMID:Assessment and control of vitamin A deficiency: the Annecy Accords. 1222 Dec 59

Anaemia in pregnancy is a major public health problem in China. Anaemia in pregnant women may be related to dietary intake of nutrients. To examine the relationship between iron status and dietary nutrients, a cross-sectional study in pregnant women was carried out. The intake of foods and food ingredients were surveyed by using 24-h dietary recall. Blood haemoglobin, haematocrit, serum iron, serum ferritin, transferrin and soluble transferrin receptor were measured in 1189 clinically normal pregnant women in the third trimester of pregnancy. The results showed that the average daily intake of rice and wheat was 504.2 g in the anaemia group and 468.6 g in the normal group. Carbohydrates accounted for 63.69% and 63.09% of energy in the anaemia and normal groups, respectively. Intake of fat was very low; 18.38% of energy in anaemia group and 19.23% of energy in normal group. Soybean intake was 109.4 g/day and 63.6 g/day in the anaemia and normal groups, respectively (P < 0.001). There were lower intakes of green vegetables (172.1 g/day) and fruits (154.9 g/day) in the anaemia group than in the normal group (246.2 g/day green vegetables (P < 0.001) and 196.4 g/day fruit (P < 0.001)). Intakes of retinol and ascorbic acid were much lower in the anaemia than in the normal group (P < 0.001). In the anaemia group, vitamin A intake was only 54.76% of the Chinese recommended daily allowance (RDA) and ascorbic acid intake was 53.35% of the Chinese RDA. Intake of total vitamin E was 14.55 mg/day in the anaemia group compared with 17.35 mg/day in the normal group (P < 0.016). Moreover, intake of iron in pregnant women with anaemia was slightly lower than that in the normal group. Comparison of iron status between the anaemia and normal groups found serum iron in women with anaemia at 0.89 microg/L, which was significantly lower than 1.09 microg/L in the normal group (P < 0.001). There were lower average values of ferritin (14.70) microg/L) and transferrin (3.34 g/L) in the anaemia group than in the normal group (20.40 microg/L ferritin (P < 0.001) and 3.44 g/L transferrin (P < 0.001)). Soluble transferrin receptor was significantly higher (32.90 nmol/L) in the anaemia than in the normal group (23.58 nmol/L; P < 0.001). The results of this study indicate that anaemia might be attributed to a low iron intake, a low intake of enhancers of iron absorption and a high intake of inhibitors of iron absorption from a traditional Chinese diet rich in grains.
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PMID:Iron status and dietary intake of Chinese pregnant women with anaemia in the third trimester. 1223 Feb 29

Observations of nutritional level were made in 2338 lower income whi te women receiving care at the Vanderbilt University obstetric clinic. 73% received no dietary supplement while the remaining 27% received varied supplementation seldom extending through the whole period of gestation. There was a decrease of approximately 200 calories daily in the average intake between the second and third trimesters, partly in response to the physician's request and partly due to the mother's initiative. It is postulated that this reflects lessened activity on the part of the mother. The change in blood constitutents fell into 4 patterns: 1) for total serum protein, serum Vitamin A, and urinary excretion of thiamine and riboflavin there was a decline during Weeks 32-34 of gestation followed by a postpartum rise; 2) for serum carotene, tocopherol, and the urinary excretion of N'-methylnicotinamide there was a progressive increase during pregnancy followed by a postpartum decline ; 3) for serum Vitamin C there was a slight decrease during gestation followed by a sharp decline in lactating mothers; 4) for iron there was a progressive increase in the absorption and utilization as pregnancy advances. Although the group had generally good nutrition some were underweight or overweight, some ate poorly, some excessively, some had low nutrient levels, and some had obstetric and pediatric complications. The underweight women were concentrated in the lower parity groups and had a higher incidence of prematurity but fewer neonatal deaths and congenitally malformed infants. The overweight group had a threefold increase in preeclampsia, more stillborn children, lowered frequency of puerperal morbidity, and more toxemia. The low hemoglobin group had excessive blood loss during the later 1/2 of pregnancy, delivery, or puerperium. Other studies have shown that infants of such women have anemia at 1 year and supplemental infant feeding is indicated. It appears that the recommended standards for calories are too high for the expectant mother of today. A diet that will provide essential nutrients is readily obtainable from food sources and except for specific supplementation in specific cases, the common obstetric routine of broad-spectrum nutrition supplementation is questioned.
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PMID:Vanderbilt cooperative study of maternal and infant nutrition. 1223 89

Vitamin A, which is available from dietary sources, vitamin supplements, and fortified products, affects numerous bodily processes through its impact on cellular differentiation. More than 300 genes are regulated by the rapid action of the vitamin. It has recently been recognized that mild vitamin A deficiency is widespread among children and pregnant women in developing countries. This deficiency increases severity of infectious diseases, iron-related anemia, and growth disturbances. Improving the vitamin A status of all deficient children could avert a million or more deaths annually, and administration of high-dose vitamin A has been advised for treatment of measles. There is also an apparent association between high beta carotene status (which may represent vitamin A status) and lower rates of some forms of cancer, but this has yet to be confirmed. Supplementation programs in developing countries rely on periodic administration of high-dose vitamin A in doses of 100,000 IU orally for those under 1 year old and 200,000 IU for those older once every 3-6 months. The optimal dosing schedule is unknown, but no cases of death have been linked to isolated vitamin A toxicity. Experts also disagree about the window of safety during which a high-dose of vitamin A can be given to pregnant and postpartum women without causing teratogenicity. It is unwise to administer high-dose vitamin A to women of reproductive age after the first 6 weeks postpartum. All women at risk should receive small daily doses or 20,000 IU weekly doses. In the US, where general dietary status is good, women should not use more than 8000 IU supplements except when indicated for a specific reason.
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PMID:Uses and misuses of vitamin A. 1229 46

A child responds to a deficiency of an essential nutrient either by continuing to grow and consuming body stores with eventual reduction in the bodily functions (Type I) or by reducing growth and avidly conserving the nutrient to maintain the concentration of the nutrient in the tissues (Type II). Examples of Type I nutrient deficiency are anemia (iron deficiency), beri-beri (thiamin deficiency), pellagra (niacin or nicotinic acid deficiency), scurvy (vitamin C or ascorbic acid deficiency), xerophthalmia (vitamin A or retinol deficiency) and iodine deficiency disorders. Diagnosis is relatively simple via clinical symptoms and measurement of the concentration of the nutrient itself. There are no characteristic symptoms to distinguish which Type II nutrient deficiency an individual has; all deficiencies result in the poor growth, stunting, and wasting generally ascribed to protein-energy malnutrition. In Type II, growth stops, the body starts to conserve the nutrient, and its excretion falls to very low levels. In severe deficiency the body may start to break down its own tissues and the reduction of appetite accompanies this condition. An animal can die from zinc deficiency even though it is has a normal concentration of zinc in its tissues, but it can respond rapidly to small amount of dietary zinc. The mechanisms by which the body stops growing in response to nutritional lack are similar to the hormonal picture seen in endocrine disease (reduction of the production of the hormonal mediators of growth, down-regulation of receptors, and reduction of protein synthesis). Growth failure is the clinical sign characteristic of a diet deficient in protein, zinc, magnesium, phosphorus, and potassium. Wasting may be also ascribed to toxins, infection, worms, or persistent diarrhea. Anorexia is another common response in nutrient deficiency. Only a supplementation diet with a balance of nutrients will promote rapid recovery.
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PMID:Specific deficiencies versus growth failure: type I and type II nutrients. 1234 13

This longitudinal study assessed growth and vitamin A status of schoolchildren after earlier surveys had linked stunting among Jordanian children to dietary zinc and iron inadequacies. A group of 1,023 subjects ages 5.5 to 9.9 years were randomly recruited for study from seven disadvantaged semirural districts. Baseline assessment included anthropometric and laboratory data with the relevant dietary information. Over nine months of study, the subjects received a daily snack meal. Immediately before the final assessment, each student received one 100,000 IU vitamin A capsule. At baseline there was a 19.9% prevalence of stunting, 18.8% for anemia, and 21.8% for subclinical vitamin A deficiency. Mean and median serum retinol concentrations were 248 (sd +/- 66) and 242 micrograms/L, respectively. In 98% of the cases, vitamin A-rich vegetables were consumed three or more days per week. About 60% of subjects had serum retinol levels in the range 200 to 300 micrograms/L. Only vitamin A foods from animal sources showed an influence (p < .05) on mean serum vitamin A values and growth score. Dietary and capsule supplementation had a significant positive impact only on serum retinol levels (p < .01) and on the anemia (p < .05) indicators. The conclusion underlines vitamin A deficiency among schoolchildren as a public health problem, and that the situation is anticipated to be more profound among preschool children, who are usually at greater risk of becoming deficient. Launching another, but controlled, intervention study in other sites, preferably with use of a tracer to rule out malabsorption in young children, is highly indicated.
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PMID:High prevalence of subclinical vitamin A deficiency in Jordan: a forgotten risk. 1236 2


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