To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and ...neonatal deaths.
A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum.
Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77).
Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
Zinc bioavailability and homeostasis Hambidge, K. Michael; Miller, Leland V; Westcott, Jamie E ...
The American journal of clinical nutrition,
05/2010, Letnik:
91, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Zinc has earned recognition recently as a micronutrient of outstanding and diverse biological, clinical, and global public health importance. Regulation of absorption by zinc transporters in the ...enterocyte, together with saturation kinetics of the absorption process into and across the enterocyte, are the principal means by which whole-body zinc homeostasis is maintained. Several physiologic factors, most notably the quantity of zinc ingested, determine the quantity of zinc absorbed and the efficiency of absorption. Other factors are age and the time over which zinc is ingested. Zinc from supplements has not been shown to be absorbed differently from that taken with meals that lack inhibitors of zinc absorption. The principal dietary factor known to impair zinc bioavailability is inositol hexa- (and penta-) phosphate or phytate. Modeling of zinc absorption as a function of dietary zinc and phytate accounts for >80% of the variability in the quantity of zinc absorbed. Fitting the model to new data has resulted in continual improvement in parameter estimates, which currently indicate a maximal absorption in adults of almost equal to6 mg Zn/d and that the average estimated dietary requirement doubles with 1000 mg dietary phytate/d. Intestinal excretion of endogenous zinc is regulated in response to recent absorption and to zinc status. The quantitative relation of intestinal excretion of endogenous zinc to zinc absorption is currently considered to be of major importance in the determination of zinc requirements. The effects of phytate on intestinal losses of endogenous zinc merit further investigation but are probably not of the same magnitude as its inhibitory effects on absorption of exogenous zinc.
To characterize the macronutrient, energy, and zinc composition of pasteurized donor human milk pools and evaluate how composition varies based on pooling practices and “time postpartum” (ie, elapsed ...time from parturition to expression date) of individual milk donations.
The Mothers' Milk Bank (Arvada, Colorado) donated 128 donor human milk pools. Caloric density was assessed via mid-infrared spectroscopy, and zinc concentration was measured by atomic absorption spectroscopy. Pool time postpartum was calculated as the unweighted average of the time postpartum of all milk donations included in any given pool.
Time postpartum of donor human milk pools ranged from 3 days to 9.8 months. The majority (91%) of donor human milk pools included milk from either 1 donor or 2 donors. Pool energy density ranged from 14.7 to 23.1 kcal/oz, and protein ranged from 0.52 to 1.43 g/dL. Milk zinc concentrations were higher in preterm pools and were negatively correlated with pool time postpartum. We present an equation that estimates donor human milk pool zinc content based on time postpartum and explains 49% of the variability in zinc concentrations (P < .0001). Including more donors in donor human milk pools decreased the variability in protein, but not zinc, concentrations.
Donor human milk pools were lower in calories than is normally assumed in standard human milk fortification practices. Zinc concentrations were related to donor human milk time postpartum and were on average insufficient to meet preterm and term infants' needs without fortification or supplementation.
This review focuses on pre- and post-natal iron supplementation in malaria endemic settings. Although iron supplementation can reduce iron deficiency, malaria infection may counteract this effect by ...the increase of hepcidin, and iron supplementation may further worsen malaria infection by providing additional iron for the parasites. However, most iron supplementation intervention studies in pregnant women with malaria have not shown a negative impact, although malaria treatment with iron supplementation may be beneficial in terms of improving birth outcomes. In infants and young children in malaria endemic settings, the adverse effects of iron supplementation has been well documented and malaria prevention and treatment with iron supplementation is recommended. Besides fostering the growth of malaria parasites, iron may also promote potential pathogens in the gut and cause an inflammatory response in young children. Overall, iron supplementation is beneficial for treating iron deficiency, but needs to be considered in the context of malaria prevention and treatment in pregnant women, infants and young children for safety and effectiveness.
•The concentrations of PFCs in 35 consumer products were measured from 2007 to 2011.•A non-parametric statistical method, the sign test, was performed.•The PFCA contents in products have shown an ...overall downward trend.•Future research is recommended.
Certain perfluorinated chemicals (PFCs) in consumer products used indoors are potential indoor PFCs sources and have been associated with developmental toxicity and other adverse health effects in laboratory animals (Lao et al., 2007). The concentrations of selected PFCs including perfluorooctanoic acid (PFOA) and other perfluorocarboxylic acids (PFCAs), in 35 selected consumer products that are commonly used in indoors were measured from the year of 2007 through 2011. The products collected included carpet, commercial carpet-care liquids, household carpet/fabric-care liquids, treated apparel, treated home textiles, treated non-woven medical garments, floor waxes, food-contact paper, membranes for apparel, and thread-sealant tapes. They were purchased from retail outlets in the United States between March 2007 and September 2011. The perfluorocarboxylic acid (PFCA) contents in the products have shown an overall downward trend. However, PFOA (C8) could still be detected in many products that we analyzed. Reductions of PFCAs were shown in both short-chain PFCAs (sum of C4 to C7) and long-chain PFCAs (sum of C8 to C12) over the study period. There were no significant changes observed between short-chain PFCAs and long-chain PFCAs. Fourteen products were analyzed to determine the amounts of perfluoroalkyl sulfonates (PFASs) they contained. These limited data show the pronounced increase of perfluoro-butane sulfonate (PFBS), an alternative to perfluorooctanoic sulfonate (PFOS), in the samples. A longer and wider range of study will be required to confirm this observed trend.
Training community-based birth attendants in rural communities in developing countries in the Essential Newborn Care program (routine care and resuscitation) was not associated with a reduction in ...the rate of neonatal death in the 7 days after birth, but the rate of stillbirth was significantly reduced. In a subsequent cluster-randomized trial, training in the Neonatal Resuscitation Program (more advanced resuscitation training) did not significantly reduce rates of neonatal death or stillbirth.
Training community-based birth attendants in rural communities in developing countries in routine care and resuscitation was not associated with a reduction in the rate of neonatal death in the 7 days after birth, but the rate of stillbirth was significantly reduced.
Annually, there are approximately 3.7 million neonatal deaths and 3.3 million stillbirths worldwide.
1
Approximately 38% of deaths among children younger than 5 years of age occur during the first 28 days of life, and 75% of the neonatal deaths occur within the first 7 days.
1
–
3
Without a major reduction in neonatal deaths in the first 7 days after birth, achievement of the United Nations' Millennium Development Goal 4 — a reduction in mortality by two thirds among children younger than 5 years of age
2
— is unlikely to be realized.
In areas of the world with high rates of . . .
To test the long-term effect on growth status at 24 months of age in formula-fed infants who were randomized to consume a meat- or dairy-based complementary diet from 5 to 12 months of age.
...Observational assessments, including anthropometric, dietary, and blood biomarkers, were conducted at 24 months of age, 1 year after the intervention ended.
The retention rate at 24 months of age was 84% for the meat group and 81% for the dairy group. Mean (±SD) protein intakes at 24 months of age were 4.1 ± 1.2 and 4.0 ± 1.1 g/kmeat (n = 27) and dairy (n = 26) groups, respectively, and comparable with the estimates of US population intake. At 24 months of age, weight-for-age z score did not differ significantly between groups and was similar to that at 12 months. Length-for-age z score remained significantly higher in the meat group compared with the dairy group, and the average length was 1.9 cm greater in the meat group. Weight-for-length z score also did not differ significantly between groups. Insulin-like growth factor 1 significantly increased from 12 to 24 months of age in both groups, but insulin-like growth factor-binding protein 3 and blood urea nitrogen did not change significantly from 12 to 24 months of age and were comparable between groups.
The protein source-induced distinctive growth patterns observed during infancy persisted at 24 months of age, suggesting a potential long-term impact of early protein quality on growth trajectories in formula-fed infants.
ClinicalTrials.gov: NCT02142647.
The accurate estimation of zinc deficiency at the population level is important, as it guides the design, targeting, and evaluation of nutrition interventions. Plasma or serum zinc concentration ...(PZC) is recommended to estimate zinc nutritional status; however, concentrations may decrease in the presence of inflammation.
We aimed to assess the relation between PZC and inflammation in preschool children (PSC; 6–59 mo) and nonpregnant women of reproductive age (WRA; 15–49 y), and to compare different inflammation adjustment approaches, if adjustment is warranted.
Cross-sectional data from 13 nationally representative surveys (18,859 PSC, 22,695 WRA) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed. Correlation and decile analyses were conducted, and the following 3 adjustment methods were compared if a consistent negative association between PZC and C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) was observed: 1) exclude individuals with CRP > 5 mg/L or AGP > 1 g/L; 2) apply arithmetic correction factors; and 3) use the BRINDA regression correction (RC) approach.
In 6 of 12 PSC surveys, the estimated prevalence of zinc deficiency increased with increasing CRP deciles, and to a lesser extent, with increasing AGP deciles. In WRA, the association of PZC with CRP and AGP was weak and inconsistent. In the 6 PSC surveys in which adjustment methods were compared, application of RC reduced the estimated prevalence of zinc deficiency by a median of 11 (range: 4–18) percentage points, compared with the unadjusted prevalence.
Relations between PZC and inflammatory markers were inconsistent, suggesting that correlation and decile analyses should be conducted before applying any inflammation adjustments. In populations of PSC that exhibit a significant negative association between PZC and CRP or AGP, application of the RC approach is supported. At this time, there is insufficient evidence to warrant inflammation adjustment in WRA.
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