1. Effectiveness of a large-scale iron fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico Juan A Rivera, Teresa Shamah, Salvador Villalpando, and Eric Monterrubio American Journal of Clinical Nutrition 2010; 91: 431-439
3. Iron (Fe) Found in every body cell (total 5g) Increased with dietary intake Heme (40% absorption) Non-heme (2-10% absorption) Increased with Intestinal absorption Decreased with sloughing of intestinal cells, blood loss Wardlaw, F.M., & Hampl J. S. Iron (Fe). In: Perspectives in Nutrition. 7th ed.
4. Hemoglobin & Myoglobin O2 carrying capacity Immune function Cognitive development Temp regulation Energy metabolism Work performance Functions of Iron Wardlaw, G.M., & Hampl J.S. Iron (Fe). In: Perspectives in Nutrition. 7th ed.
5. Adult Women 18 mg/day Men: 8 mg/day Adolescents Girls: 15 mg/ day Boys: 11 mg/day Children 7-10 mg/day Infants 11 mg/day 12 mg/day 17mg/day RDA’s Average Intake Centers for Disease Control
11. Fe Deficiency Most common nutritional deficiency around the world. Children under age 5 are one of the most affected age groups Peak prevalence occurs at age 12-23 mo Affects all socioeconomic status 30% in lowest group 17% in highest Am J Clin Nutr. 2010; 91(2) 431-439
12. Am J Clin Nutr 2010; 91:431-9 What does this mean? “Anemia and Iron Deficiency is associated with adverse effects on neurodevelopment”
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14. Had to use components that didn’t catalyze off-flavors, peroxidize the lipids, and yet still had good bioavailability
19. At the time of this study, there were no public health supplementation programs yet in MexicoAm J of Clin Nutr. 1982; 36 (6) 1162-1169
20. Milk Subsidized Program “Liconsa” Started in 1944 Distributes whole milk at centers through out the country Children aged 1-11 years old 400 mL of milk/ day Other family members living in poverty 2002- started fortifying milk Am J of Clin Nutri. 2010; 91 (2) 431-439.
75. “at these early ages, iron repletion's process and hematopoiesis during a critical time for brain and mental development, which may have long lasting effects on behavior, learning and mental performance”
Just some background info, we’ve learned in every nutrition class pretty much, but I just though it would be good to remind you of the basics. And also, there are some terms that will be important to know when we are discussing the study.Heme= animal sourcesNon- Heme = Plant sources
Got this table from the center for disease control. Topic of Preventing Fe DeficiencyA lot of these characteristics apply to the low income class of the Mexican population, and also of other third world countries.
Vacant binding sitesLow transferrin saturation means you have a lot of vacant sites where you could bind Fe.Highest in neonates, decreases by age 4 mo, and then increases through childhood and adulthood.Higher after meals
When this study was conducted, 27% of Mexican children aged 1-4 yo were anemic 52% were iron deficient at the time of the study
-The Mexican government started this program in order to target children who were at risk for nutritional deficiencies. -Supported by a grant from the secretary of social development
So the Government thought that if they could fortify the milk with these micronutrients they would be able to prevent nutritional deficiencies in a large part of their population. - This group was part of the lower economic status
Still had two more questions….This was the rationale for the featured study today
5 million participants in total- Researchers made a note, wanted to decrease the number of children that wouldn’t get the fortified milk (in fear of deficiencies)
Reconstitute milk from dry formOnce in the morning and in afternoon
Kcal, Pro, Fat, content all the sameFe & Zn = 5.28 gVit C – 48.0*If you all remember adding vit C to a meal, can help with Fe absorption
Felt the this measure would not be reliable for randomized measuresDecided to focus on Serum Soluble Transferrin Receptor because SF fluctuated so much with acute infectionsCollected capillary blood samples and finger pricks
Questionnaire was to determine socioeconomic status of household
Wanted to determine if there was any problems with the way they randomized the groups and wanted to determine if the groups were truly randomized…..
This meant that the two groups were truly randomized, and neither had an advantage over the other from the beginning
All three levels of anemiaMild, Mild- moderate, and Moderate anemiaThey set significance at p> .10 so all are significant
Estimated Iron Deficiency Prevalence as defined by sTfR over greater than 3.3 ug/L
Using fortified milk Indicators of Fe deficiency: SF and high sTfR
A lot of times when research is conducted, they take situations out of the field, and move it into a lab, so you have to be careful when recreating the data.But this was able to show, that with the resources that they currently have, they are still able to improve Fe statusOne of the exclusion criteria was if a baby had a Hb of , 90 g/L for ethical reasons they intervened using other methods, so the researchers felt that they might have even seen a more dramatic effect if all population was included in the study.
Even though they controlled for the for the confounders found upon statistical calculations, they felt that there would be other confounders when comparing the participants in the study to the rest of the population- Also these indicators vary greatly with infection, inflammation
- Adolescent girls had the highest iron-deficient prevelance
This shows the break down of the subgroups with highest prevelance of Fe Deficiency.- But even within these groups those who are not Fe-Deficient still have higher Math scores
