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Langer fit met beter eten
Smit, A. ; Groot, C.P.G.M. de; Kremer, S. ; Ziylan, C. ; Peppelenbos, H.W. - \ 2015
WageningenWorld (2015)1. - ISSN 2210-7908 - p. 10 - 15.
ouderen - ouderenvoeding - voeding en gezondheid - ondervoeding - voedingstoestand - eiwitrijke voedingsmiddelen - voedselverrijking - voedselconsumptie - gezondheidsbevordering - elderly - elderly nutrition - nutrition and health - undernutrition - nutritional state - protein foods - food enrichment - food consumption - health promotion
Ouderen die zelfstandig thuis wonen, lopen het risico ondervoed te raken. Wageningen UR onderzoekt hoe dat is te voorkomen met producten en maaltijden die verrijkt zijn met extra eiwit. Maar hoe breng je die op de markt? De meeste ouderen voelen zich niet oud en zijn zich totaal niet bewust van hun voedingsstatus.
Evaluatie van de voedingsstatus van Nederlandse patiënten met chronische inflammatoire darmziekten : een pilotonderzoek
Berg, M.C. van den; Plas, M. ; Mares, W. ; Witteman, B.J.M. ; Klein Gunnewiek, J.M.T. ; Vries, J.H.M. de - \ 2014
Nederlands Tijdschrift voor Voeding en Dietetiek 60 (2014)1. - ISSN 1875-9955 - p. S1 - S12.
voedingstoestand - darmziekten - chronische darmontstekingen - ondervoeding - patiënten - voeding en gezondheid - nutritional state - intestinal diseases - inflammatory bowel diseases - undernutrition - patients - nutrition and health
Introductie Het doel van deze pilotstudie was het verkrijgen van inzicht in de voedingsstatus van Nederlandse patiënten met chronische inflammatoire darmziekten (IBD). Methoden De voedingsstatus werd onderzocht op basis van MUST-score, handknijpkracht, micronutriëntstatus in het bloed en voedingsinname. Daarnaast werden leeftijd, geslacht, ziektebeeld, ziekteactiviteit, kwaliteit van leven en medicatiegebruik geïnventariseerd en gecorreleerd aan ziekteactiviteit. Resultaten 41 personen met IBD (17 mannen en 24 vrouwen, 19-74 jaar), onder wie 22 met colitis ulcerosa en 19 met de ziekte van Crohn, namen deel aan het onderzoek. 4 deelnemers hadden volgens de MUST-score een verhoogd risico op ondervoeding. Van 4 deelnemers was de handknijpkracht onder de referentiewaarde. 14 personen hadden een tekort aan vitamine D, 3 aan selenium, 3 aan foliumzuur, 1 aan vitamine B12 en 1 aan magnesium. De micronutriëntconcentraties verschilden niet tussen deelnemers met verschillende ziektebeelden, MUST-scores of handknijpkracht. Serum vitamine B1 verschilde als enige micronutriënt tussen mannen en vrouwen (p=0,047). Foliumzuurconcentraties waren hoger bij hogere ziekteactiviteit (p=0,022) en bij lagere kwaliteit van leven (p=0,030). Serumspiegels van vitamine D en vitamine E waren hoger voor deelnemers boven de leeftijdsmediaan dan voor deelnemers daaronder (50 jaar, respectievelijk: p
Yellow cassava: efficacy of provitamin A rich cassava on improvement of vitamin A status in Kenyan schoolchildren
Talsma, E.F. - \ 2014
Wageningen University. Promotor(en): Michael Zimmermann; Frans Kok, co-promotor(en): Inge Brouwer; Alida Melse-Boonstra. - Wageningen : Wageningen University - ISBN 9789461738554 - 143
cassave - provitaminen - retinol - vitamine a tekort - voedingstoestand - schoolkinderen - kenya - fortificatie - cassava - provitamins - vitamin a deficiency - nutritional state - school children - fortification
Background: Biofortified yellow cassava has great potential to alleviate vitamin A deficiency in sub-Saharan Africa and can be used as a complementary approach to other interventions. However, direct evidence whether yellow cassava can significantly contribute to the vitamin A intake and status of populations is required. The overall aim of this thesis is to provide proof of principle whether biofortified yellow cassava can improve the vitamin A status of schoolchildren in Kenya.
Methods: The research was conducted in Kibwezi district, Eastern Kenya. First the effect of daily consumption of yellow cassava was assessed in 342 primary school children in Kenya in a randomized controlled feeding trial with serum retinol concentration as primary outcome. Furthermore we investigated the sensory and cultural acceptability of yellow cassava in a cross-sectional study (n=140) in three primary schools for children as well as their caretakers. Next we studied the diagnostic performance of several proxy markers to assess vitamin A deficiency in comparison with serum retinol concentration as a field based method to assess vitamin A deficiency (n=375). And last we used the dietary intake data of children in the randomized controlled trial to model the potential contribution of yellow cassava to the nutrient adequacy of micronutrient intake using linear programming.
Results: The randomized controlled feeding trial collected complete data for 337 children with a compliance of 100%. Primary analyses (per protocol) showed that serum retinol concentrations in the yellow cassava group, increased with 0.04 μmol/L (95%CI: 0.00‒0.07 μmol/L) compared to the white cassava group and secondary analyses showed that serum β-carotene concentration increased with 524% (448%‒608%). No evidence of effect modification by initial vitamin A status, zinc status, or polymorphisms in the β-carotene monooxygenase gene was found. In the acceptability study 72% of caretakers and children were able to detect a significant difference in taste between white and yellow cassava and indicated to prefer yellow cassava because of its soft texture, sweet taste and attractive color. Serum concentrations of retinol binding protein, transthyretin and C-reactive protein combined showed excellent diagnostic performance in estimating vitamin A deficiency in primary school children, with an area under the curve of 0.98. Adding yellow cassava to the diet as a school lunch improved the nutrient adequacy of the diet of schoolchildren, however, even with the addition of nutrient dense foods such as fish and oil, nutrient adequacy could not be ensured for fat, riboflavin, niacin, folate and vitamin A.
Conclusions: Consumption of yellow cassava is acceptable and improves the serum retinol concentrations of primary school children in Kenya. The combination of three proxy markers is a promising approach to measure vitamin A deficiency in a low resource setting. Yellow cassava contributes to a better nutrient adequacy but should be accompanied by additional dietary guidelines and interventions to fill the remaining nutrient gaps.
Effects of iodine supplementation in mild-to-moderately iodine-deficient pregnant women on thyroid function, pregnancy outcomes and newborn development in Thailand
Gowachirapant, S. - \ 2014
Wageningen University. Promotor(en): Michael Zimmermann, co-promotor(en): Alida Melse-Boonstra; P. Winichagoon. - Wageningen : Wageningen University - ISBN 9789462570290 - 162
jodium - voedingstoestand - sporenelementtekorten - minerale supplementen - zwangerschap - schildklierwerking - zuigelingenontwikkeling - thailand - iodine - nutritional state - trace element deficiencies - mineral supplements - pregnancy - thyroid function - infant development
Background: Iodine deficiency (ID) during pregnancy has been recognized as a major cause of hypothyroidism and adverse health consequences in both mothers and children. Although urinary iodine concentration (UIC) in school-aged children is recommended as an indicator to assess ID in the general population, it may not be a good surrogate for directly assessing iodine status in pregnant women. Iodine supplementation of mildly iodine-deficient pregnant women has been recommended worldwide; however, long-term benefit and safety of iodine supplementation in this group is uncertain. Finally, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) may negatively affect thyroid function and pregnancy outcomes.
Objectives: 1) to measure UIC in pairs of pregnant women and their school-aged children living in the same household; 2) to investigate the effects of iodine supplementation on maternal thyroid function, pregnancy and birth outcomes, and newborn development; 3) to evaluate the association between pre-pregnancy BMI and GWG with thyroid function and pregnancy outcomes.
Methods: 1) In a cross-sectional pilot study, UIC was measured in spot urine samples from pairs (n=302) of healthy pregnant mothers and their school-aged children in Bangkok; 2) Arandomized controlled trial was conducted with 200 µg iodine per day or placebo given to mildly ID pregnant Thai women from <14 weeks to term. Anthropometrics, maternal thyroid function, UIC and thyroid volume were measured at baseline, 2ndand 3rdtrimester, at delivery and 6-week postpartum. Birth outcomes were collected from hospital records. Neonatal thyroid function, UIC and thyroid volume were measured at delivery and 6 weeks after birth. The Neonatal Behavioral Assessment Scales (NBAS) was used to assess newborn development.
Results: 1) In the pilot study, median UIC in the pregnant women was 108 (11–558) µg/L and was lower than UIC in their school-aged children [200 (25–835) µg/L] (P<0.001); 2) In the RCT, medianUIC increased significantly from baseline in both groups, and the increase was higher in the iodine group (p<0.001). At 30 weeks of gestation, only 2% of the women in the placebo group and 7% in the iodine group reported a median UIC >500 µg/L. Maternal thyroid function, thyroid volume and the prevalence of all thyroid dysfunction subtypes did not differ significantly between treatment groups during the study (p>0.05). At 6-week postpartum, the prevalence of postpartum thyroiditis (hyperthyroidism) was significantly lower in the iodine group (3%) as compared to the placebo group (9%) (OR: 95%CI, 0.17: 0.04-0.70). There were no significant differences between newborn groups in thyroid function, thyroid volume, birth characteristics, UIC and NBAS score (p>0.05); 3) Pre-pregnancy BMI was a negative predictor of free thyroxine (fT4) (β=-0.20, P<0.001) in early gestation (<14 weeks). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08–6.37) (P<0.01). In addition, secondary data analysis showed that overweight women had an 11-fold higher risk of delivering a large for gestational age infant compared to normal weight women, while women who had excessive GWG were 5.6 times more likely to deliver a macrosomic infant compared to women with normal GWG.
Conclusion: 1) UIC in school-aged children should not be used as a surrogate for monitoring iodine status in pregnancy; 2) iodine supplementation (200 µg/d) in mildly iodine-deficient pregnant Thai women was effective in increasing iodine intakes into the adequate range but had no benefit on antenatal maternal thyroid function or newborn outcomes out to 6 weeks; however, it significantly reduced the risk of maternal postpartum thyroid dysfunction; 3) excess maternal body weight both before and during pregnancy may have adverse impacts on maternal thyroid function as well as birth weight. Therefore, maintaining normal body weight before and throughout pregnancy should be recommended.
Bones, brains and B-vitamins : the impact of vitamin B12, folate and homocysteine on bone health and cognitive function in elderly
Wijngaarden, J.P. van - \ 2013
Wageningen University. Promotor(en): Lisette de Groot, co-promotor(en): Rosalie Dhonukshe-Rutten. - Wageningen : Wageningen UR - ISBN 9789461737151 - 192
botontkalking - kenvermogen - ouderen - beenderen - vitamine b12 - foliumzuur - homocysteïne - vitaminetoevoegingen - botbreuken - voedingstoestand - osteoporosis - cognition - elderly - bones - vitamin b12 - folic acid - homocysteine - vitamin supplements - bone fractures - nutritional state
An elevated homocysteine level has been indicated as a risk factor for cardiovascular disease, cognitive decline, and fractures. Supplementation of vitamin B12 and folic acid in order to normalize homocysteine levels might be of substantial public health importance as this might reduce the risk for several age-related conditions. This thesis focuses on two health outcomes frequently associated with elevated homocysteine levels and low levels of vitamin B12 and folate: osteoporosis and cognitive decline later in life.
Findings are presented in the context of a model which links dietary intake to biomarkers of nutritional status and subsequently to health outcomes. Two systematic reviews with meta-analyses investigated the current status of knowledge about the association of vitamin B12 intake and status with cognitive function, and the association of homocysteine, vitamin B12 and folate status with bone health. Baseline data of the B-PROOF study were used to assess 1) the association of vitamin B12 intake with status according to four biomarkers (vitamin B12, holotranscobalamin (holoTC), methylmalonic acid (MMA) and homocysteine), 2) the mutual association among these four vitamin B12 biomarkers and 3) the association between homocysteine, vitamin B12 biomarkers, folate and cognitive function. The effect of 2-year daily vitamin B12 (500 μg) and folic acid (400 μg) supplementation on fracture risk was assessed in the B-PROOF study, a large (N=2919) randomized controlled trial in elderly people (aged ≥65 years) with an elevated homocysteine level (≥12.0 µmol/L).
The systematic review of the literature showed no or inconsistent associations of vitamin B12 intake with cognitive function. Furthermore, serum vitamin B12 was not associated with risk of dementia, global cognition or memory. Studies on MMA and holoTC reported significant associations with risk of dementia, Alzheimer’s disease and global cognition. A meta-analysis showed that serum/plasma vitamin B12 per 50 pmol/L was borderline significantly associated with a lower fracture risk (RR=0.96, 95% CI = 0.92-1.00) and that homocysteine was significantly associated with a higher fracture risk (RR=1.04, 95% CI = 1.02-1.07). Meta-analyses regarding vitamin B12, folate and homocysteine levels and BMD did not show significant associations.
In the B-PROOF study a doubling of vitamin B12 intake was associated with 9% higher levels of vitamin B12, 15% higher holoTC, 9% lower MMA and 2% lower homocysteine, saturation of biomarkers occurs with dietary intakes of >5 μg B12. Levels of MMA and homocysteine were higher when vitamin B12 levels were below 330 pmol/L and when holoTC levels were below 100 pmol/L, with a steep elevation when levels of vitamin B12 and HoloTC were below 220 and 50 pmol/L respectively. At baseline, levels of vitamin B12 and holoTC were not associated with cognitive function in any cognitive domain. Levels of homocysteine (β= -0.009), folate (β= 0.002), MMA (β= -0.163) and the wellness score – a vitamin B12 biomarker combination score - (β= 0.048) were significantly associated with the domain of episodic memory. Additionally, homocysteine (β= -0.015) and the wellness score (β= 0.103) were significantly associated with the domain information processing speed.
The B-PROOF intervention did not lower the risk of fracture in the total population (HR=0.84, 95% CI = 0.58-1.22). Per protocol subgroup analysis of elderly aged >80 years, showed a lower risk of fracture in the intervention group (HR=0.28, 95% CI 0.10-0.74). We observed more cancer cases in the intervention group (HR=1.55, 95% CI = 1.04-2.30) compared to the placebo group. We cannot rule out the possibility of accelerated cancer progression as a possible negative side effect.
Our literature reviews and observational data confirm an association of levels of homocysteine, vitamin B12 and folate with cognitive function and fracture risk in elderly. Supplementation with vitamin B12 and folic acid did not lower the risk of fracture in the total study population. Though positive effects on fracture incidence emerged in elderly aged >80 years, these benefits should be weighed against potential risks.
Socioeconomic differences in micronutrient intake and status in Europe
Novakovic, R.N. - \ 2013
Wageningen University. Promotor(en): Pieter van 't Veer; Lisette de Groot, co-promotor(en): Anouk Geelen; M. Gurinovic. - [S.l. : S.n. - ISBN 9789461735775 - 154
sporenelementen - voedingsstoffenopname (mens en dier) - voedingstoestand - sociale economie - sociaal-economische positie - europa - vitaminen - trace elements - nutrient intake - nutritional state - socioeconomics - socioeconomic status - europe - vitamins
The aim of this thesis was to evaluate micronutrient intake and status of socioeconomic disadvantaged populations, such as from Central and Eastern European (CEE) as compared to other European populations, and low socioeconomic status (SES) groups as compared to high SES groups within European countries. We addressed the micronutrients that have been prioritized because of their relevance for nutritional health by the EC-funded EURRECA Network of Excellence. Moreover, we assessed the association between folate intake and status which can be used in the process of setting folate DRVs.
Micronutrient intake and status of CEE countries versus other European countries
CEE countries have recently experienced rising income inequalities over a period of economic transition. There is some evidence that these reforms have been accompanied by health inequalities. Inadequacy in micronutrient intake and status may contribute to these inequalities. Because in more affluent Western European countries wide ranges in micronutrient intake and status are observed, we studied if low micronutrient intake and status levels are prevailing in CEE. The findings from this thesis signal no differences in micronutrient intake and status between CEE populations in comparison to those of other European regions with the exception of calcium intake in adults and iodine status in children that were lower in CEE than in other European regions. Since data from Western Europe indicate that inadequacies do exist among SES strata, more insight in the nutritional situation of lower SES populations in CEE and an understanding of both its determinants and consequences is needed. It is important to mention that evidence from grey literature added to that from open access sources. Fundamental to further studying of nutritional health in CEE, is suitable data. We underline the necessity for conducting nutritional surveillances on micronutrient intake and status in CEE as we have identified significant knowledge gaps for many life-stage groups.
Differences in micronutrient intake between SES groups
Considering that not enough studies have addressed the relationship between SES and micronutrient intake and status in their analyses of nutritional health, we performed a systematic review on this topic and we used data from the large European EPIC cohort to address that issue.
To be able to conclude on socioeconomic, i.e. educational, occupational and income, inequalities associated with intake and status of prioritized micronutrients for all life stages in Europe, substantial knowledge gaps should be filled. Currently, data are mostly available for the intake of calcium, vitamin C and iron as collected from adults in Western European countries. When either of the above mentioned SES indicators was applied to estimate relative differences in micronutrient intake and status between the lowest and the highest SES category within one study, the results often, but not consistently, indicated a lower intake and/or status in low versus high SES groups. For example, in eight out of ten studies a lower intake for calcium intake was found with relative differences ranging from -2 to -14%. Similar patterns were found for vitamin C and iron: in eleven out of twelve studies relative differences ranged from -5 to -48% for vitamin C, whereas in nine of ten studies on iron relative differences went up to -14%. Studies on intake and/or status of folate, vitamin B12, zinc, iodine, and intake of vitamin D, selenium and copper were limited. Still, when differences were observed, it appeared that lower intake in low than in high SES groups was found except for vitamin B12 and zinc for which the findings were inconsistent.
Furthermore, using education as a proxy for SES, we assessed differences in micronutrient intake between educational levels using the individual-participant data on European adults and elderly from the EPIC cohort. Based on data from 10 Western European countries it appeared that intake of calcium (except in France and a distinctive ‘health-conscious’ group in the UK), folate (except in Greece), and vitamin C was lower in the lowest than in the highest education groups: relative differences ranged up to 12, 13 and 23%, respectively. The intake of iron differed marginally, whereas the variation in intake of vitamins D and B12 was inconsistent. The observed association between educational level and intake of micronutrients was the same for men and women. Furthermore, differences in micronutrient intake were found to be larger between countries than between SES groups.
With respect to SES differences in micronutrient intake and status, there are significant gaps in the open source literature for many life-stage groups in Europe, but particularly in CEE countries. There is a clear need for cross-country and within country comparative research and for the monitoring of trends in dietary intake across different SES groups and European countries.
Relationship between folate intake and status to add complementary evidence for deriving folate dietary reference values (DRVs)
DRVs are under continuous review and periodic revision as the cumulative evidence base and body of knowledge evolve. Folate is considered a public health priority micronutrient for which re-evaluation of DRVs is needed. For this micronutrient, a systematic review of observational studies on the relationship between intake and status was done followed by meta-analysis. The intake of folate was significantly associated with markers of folate status. The results of our meta-analysis showed that an average person with a folate intake of 100 µg/day has a serum/plasma folate status concentration that is 26% higher and a red blood cell folate status that is 21% higher than a person who has a folate intake of 50 µg/day; plasma homocysteine was found to be 16% lower. The difference between natural food folate and that from supplements and fortified foods (folic acid) significantly influenced the estimated relationship between folate intake and serum/plasma status. Associations were stronger when assessed as folate from the diet than as folate from diet and supplements. Dietary assessment method did not significantly influence the association, although pooled estimates were somewhat higher when FFQs were used as compared to 24-hour recalls combined with food records. To focus on the impact of poor intakes on related health outcomes, data modelling can be conducted to produce estimates for Average Nutrient Requirements. For this analysis datasets and statistical models developed within the EURRECA NoE are available and can be used.
Overall, further research would benefit from methodologically comparable data on food intake in all age ranges, especially on so far understudied CEE populations. Both intakes obtained through diet and from supplements and fortified foods should be assessed. Monitoring of trends across SES strata should be done with standardized SES measurements that would also facilitate cross-country comparative research. The findings on the level and distribution of micronutrient intake and status could be used for development of food based dietary guidelines. To make them effective in meeting populations’ micronutrient needs, they should be created accounting for the country specific dietary patterns giving consideration to the socioeconomic context.
Efficacy of iron fortified cowpea flour in improving iron status of schoolchildren in malaria endemic rural Ghana
Abizari, A.R. - \ 2013
Wageningen University. Promotor(en): Michael Zimmermann, co-promotor(en): Inge Brouwer; M. Armar-Klemesu. - S.l. : s.n. - ISBN 9789461735263 - 191
vignameel - fortificatie - ijzer - ijzergebrekanemie - voedingstoestand - schoolkinderen - ghana - schoolmaaltijden - edta - biologische beschikbaarheid - voedingsprogramma - malaria - voedselsoevereiniteit - cowpea meal - fortification - iron - iron deficiency anaemia - nutritional state - school children - school meals - bioavailability - nutrition programmes - food sovereignty
Children in sub-Saharan Africa are more likely to have survived the critical first 1000 days of life carrying along unresolved micronutrient deficiencies into the school-age. Iron-deficiency is the most prevalent micronutrient problem affecting school-age children in sub-Saharan Africa and yet the most difficult to resolve. It is necessary to ensure an adequate iron intake through the diet of school-age children and school-based feeding intervention may be a way to improve iron intake of schoolchildren. Such a feeding intervention would be more sustainable if it relies on locally produced food(s) with the potential to support food sovereignty. In this context, this thesis investigated whether foods based on cowpeas, an indigenous legume crop originating from Africa, can be used in a school feeding setting to improve iron status of school-age children in Ghana.
The investigations in this thesis comprised cross-sectional dietary and iron status assessment of schoolchildren (n=383), cowpea acceptability among schoolchildren (n=120 mother-child pairs), chemical analysis of cowpea landraces (n=14), an in vivo iron bioavailability among young women (n=16) and a randomized cowpea intervention trial (n=241) conducted mainly in Tolon-Kumbungu district of Ghana.
The results indicated that iron-deficiency and iron-deficiency anaemia affect 8 and 7 out of every 10 schoolchildren respectively. It also showed that the probability of adequate dietary iron intake is 0.32 but much larger (~0.90) if schoolchildren benefitted from a school feeding programme. Mothers/caregivers intended to give cowpeas to their schoolchildren 2–3 times per week. The positive attitudes of mothers towards cowpea predicted their intention to give them to their schoolchildren but they were worried about the cost, long cooking time and the discomfort their children may suffer after consuming cowpeas. The chemical analysis showed that cowpeas contain appreciable amounts of iron (4.9–8.2 mg/ 100 gd.w) and zinc (2.7–4.1 mg/100 gd.w) but also high amounts of inhibitory phytate (477–1110 mg/100 gd.w) and polyphenol (327–1055 mg/100 gd.w). Polyphenol concentration in particular was higher (P<0.05) in coloured compared to white landraces. Iron bioavailability from red and white cowpeas were 1.4 and 1.7%, respectively, in NaFeEDTA-fortified meals and 0.89 and 1.2%, respectively, in FeSO4-fortified meals. Compared with FeSO4, fortification with NaFeEDTA increased the amount of iron absorbed from white and red cowpea meals by 0.05 and 0.08 mg (P < 0.05) respectively. Irrespective of the fortificant used, there was no significant difference in the amount of iron absorbed from the 2 varieties of cowpea. Finally the results from the intervention trial showed that fortification of whole cowpea flour with NaFeEDTA resulted in improvement of haemoglobin (P<0.05), serum ferritin (P<0.001) and body iron stores (P<0.001), and reduction in transferrin receptor concentration (P<0.001). Fortification also resulted in 30% and 47% reduction in the prevalence of iron-deficiency (ID) and iron-deficiency anaemia (IDA) (P<0.05), respectively.
Overall, this thesis has shown that in a malarious region with high iron-deficiency like (northern) Ghana, iron status of schoolchildren can be improved through the consumption of cowpeas within a school feeding programme. The improvement in iron status is however unlikely to result from the usual/conventional consumption of cowpeas but through fortification of whole cowpea flour with a highly bioavailable iron compound. This thesis has also shown that the most suitable iron compound for such whole cowpea flour fortification is NaFeEDTA irrespective of whether the cowpea has high or low concentration of polyphenols.
Micronutrient status and effects of supplementation in anemic pregnant women in China
Ma, A. - \ 2013
Wageningen University. Promotor(en): Evert Schouten; Frans Kok. - S.l. : s.n. - ISBN 9789461734938 - 148
ijzergebrekanemie - zwangerschap - vitaminetoevoegingen - minerale supplementen - voedingstoestand - china - iron deficiency anaemia - pregnancy - vitamin supplements - mineral supplements - nutritional state
Iron deficiency anemia (IDA) is a major nutrition related problem in China, especially affecting pregnant women,like in most developing countries. Deficiencies of vitamins also play an important role, such that iron, retinol and riboflavin deficiencies tend to coexist in anemic pregnant women. However, vitamin and/or mineral supplements are not routinely used by pregnant women at or below low income levels. Besides being an essential trace element, iron plays a central role in oxygen radical generation, whereas susceptibility during pregnancy is elevated. There is evidence that both iron deficiency and excess may result in free radical damage.
Based on this background, objectives of this thesis were to investigate the current prevalence of anemia among pregnant women in different sites of China, and todescribe the micronutrient status of anemic and non-anemic pregnant women in China. In addition, in anemic pregnant women, the effect of retinol and riboflavin supplementation on top of iron plus folic acid on anemia and changes in hematological status wasassessed. Also oxidative stress and erythrocyte membrane fluidity were evaluated. Finally, we compared the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA) and ferrous sulfate on hemoglobin (Hb), iron bioavailability and oxidative stress.
Subjects and Methods
A total of 6413 women in their third trimester of pregnancy were recruited from five rural areas in China (years 2000~2003) for screening anemia or iron deficiency. A random subset was selected for measuring micronutrient status. In three supplementation trials, effects of iron, folic acid, retinol and riboflavin were assessed among anemic pregnant women. Outcomes included hematological status, micronutrient status and parameters of oxidative stress. Samples of fasting blood were collected from subjects before and at the end of the interventions for measurements.
The overall prevalence of anemia was 58.6%, ranging between 48.1%~70.5% in the five areas. Serum concentrations of micronutrients were significantly lower in anemic women than non-anemic women. After the 2-mo intervention, the increase of Hb concentration in the group, supplemented with iron and folic acid combined with retinol and riboflavin, was 5.4g/L greater than in the group with iron and folic acid only (p<0.001). The reductions in the prevalence of anemia (Hb<110g/L) and iron deficiency anemia were significantly greater in the groups supplemented with retinol and/or riboflavin than in the iron and folic acidgroup. Riboflavin and/or retinol supplementation significantly improved gastrointestinal symptoms and well-being. In addition, supplementation of iron combined with retinol and riboflavin significantly decreased levels of serum malondialdehyde, and increased activities of glutathione peroxidase and erythrocyte membrane fluidity as well. NaFeEDTA supplementation showed superior effectiveness.
Conclusion and recommendations
Deficiency of iron and micronutrients in combination appears to contribute to the high prevalence of anemia in pregnant women in rural China. Supplementation with iron, particularly in combination with vitamins improved hematologic status as well as oxidative stress. NaFeEDTA performed better than ferrous sulfate. Multi-micronutrient supplementation may be worthwhile for pregnant women in rural China. Further studies on food-based or supplement-based approaches are warranted to decrease anemia of Chinese pregnant women in the third trimester.
Zinc intake and dietary pattern in Jiangsu Province, China: consequences of nutrition transition
Qin, Y. - \ 2012
Wageningen University. Promotor(en): Frans Kok; Michael Zimmermann, co-promotor(en): Alida Melse-Boonstra; J.K. Zhao. - S.l. : s.n. - ISBN 9789461733740 - 133
zink - voedingstoestand - fortificatie - dieet - hypertensie - obesitas - china - zinc - nutritional state - fortification - diet - hypertension - obesity
Background: Jiangsu Province is an economically booming area in East China, where soil zinc concentrations are low. Nutrition transition to a dietary pattern with more animal source foods may have improved zinc intake in this area. However, such a transition may also have increased the burden of non-communicable diseases (NCDs), such as hypertension and obesity. Investigation of dietary patterns in relation to undernutrition and overnutrition could help to better address both problems.
Objectives: The first aim of this thesis was to assess zinc status in Jiangsu Province using dietary zinc intake, serum zinc and stunting as indicators, as well to investigate the potential of biofortified rice to improve zinc intake. The second aim was to investigate the association between dietary patterns and high blood pressure, taking obesity into account.
Methods:Data from the 2002 National Nutrition and Health Survey in Jiangsu Province were used to assess zinc intake in the population aged 4-89 years (n=3,867). Primary school children (n=2,268) were selected from three counties in the Province with relatively low soil zinc for assessment of stunting. Serum zinc was measured among children in the county where stunting was highest (n=297). Thirteen women were recruited in the same county for three test rounds with rice meals (zinc biofortified rice, zinc extruded fortified rice and control rice). Fractional zinc absorption (FAZ) was measured with the use of the double isotope tracer ratio method. Effect of biofortified rice with zinc, at a level of 2.7 and 3.8 mg/100g, on zinc intake was simulated in adults (n=2.819). For adults, four distinct dietary patterns were identified, named “traditional”, “Macho”, “sweet tooth” and “healthy” pattern. Associations were assessed between the four dietary patterns and blood pressure in adults (n=2,518) by using Poisson regression analysis.
Results:The overall prevalence of insufficient intake of zinc was 22.9%, with a higher prevalence in children (64.6%) and adolescents (64.9%), and in those with low socio-economic status (27.3%). Around 4% of the primary school children were stunted, and the prevalence of zinc deficiency measured by serum and hair zinc was 0.7%, and 15.2%, respectively. Biofortified 70Zn enriched rice with an intrinsic label was found to have higher fractional zinc absorption (FAZ) than extrinsically labeled fortified extruded rice. However, FAZ could not be accurately quantified because we could not determine the exact amount of isotope infused to subjects due to adhesion of zinc to the vial. When simulating zinc intake by replacing normal rice with zinc biofortified rice with either 2.7 and 3.8 mg/100g of zinc, the prevalence of insufficient zinc intake decreased from 15.4% to 6.5% and 4.4%, respectively. The “traditional” dietary pattern in Jiangsu Province was most strongly associated with high blood pressure (P for trend = 0.005). This pattern is characterized primarily by consumption of rice and fresh vegetable; secondary of pork and fish; and lastly of root vegetable and wheat flour, but also by high salt intake. Subjects with overweight and obesity were more likely to have high blood pressure than those with normal weight.
Conclusion: Children and adolescents had low dietary zinc intake, in Jiangsu Province, where the soil is also deficient in zinc. However, these findings did not match with the low prevalence of stunting and zinc deficiency based on serum zinc concentrations in primary school children from three rural areas of the Province. Zinc appears to be better absorbed from biofortified rice than from control rice or from extruded fortified rice, which needs further investigation. Simulated zinc intake from biofortified rice with zinc at a level of 2.7 mg/kg has the potential to significantly improve zinc intake, especially in the “traditional” dietary pattern. However, this pattern is also related to high blood pressure, which may be due to high salt intake. High blood pressure is also positively and independently related to obesity. Nutrition education is required to improve knowledge and awareness of healthy diets in Jiangsu Province.
Probiotics, calcium and acute diarrhea : a randomized trial in Indonesian children
Agustina, R. - \ 2012
Wageningen University. Promotor(en): Frans Kok; A. Firmansyah, co-promotor(en): I.M.J. Bovee-Oudenhoven. - S.l. : s.n. - ISBN 9789461733726 - 174
probiotica - calcium - diarree - ademhalingsziekten - peuters en kleuters - indonesië - voedingstoestand - probiotics - diarrhoea - respiratory diseases - preschool children - indonesia - nutritional state
Fonio (Digitaria exilis) as a staple food in Mali : an approach to upgrade nutritional value
Fanou-Fogny, N.M.L. - \ 2012
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Inge Brouwer; R.A.M. Dossa. - S.l. : s.n. - ISBN 9789461732927 - 188
digitaria exilis - mali - ijzer - fortificatie - ijzerabsorptie - voedingstoestand - sporenelementtekorten - voedingswaarde - vrouwen - iron - fortification - iron absorption - nutritional state - trace element deficiencies - nutritive value - women
Conclusions and recommendations
Multi-micronutrient supplementation in HIV-infected South African children : effect on nutritional s tatus, diarrhoea and respiratory infections
Mda, S. - \ 2011
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Joop van Raaij; F.P.R. de Villiers. - [S.l.] : S.n. - ISBN 9789085858577 - 168
voedselsupplementen - minerale supplementen - vitaminetoevoegingen - humane immunodeficiëntievirussen - hiv-infecties - voedingstoestand - diarree - ademhalingsziekten - kinderen - zuid-afrika - food supplements - mineral supplements - vitamin supplements - human immunodeficiency viruses - hiv infections - nutritional state - diarrhoea - respiratory diseases - children - south africa
Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and increased risk of diarrhoea and respiratory infections. Micronutrient deficiencies are common in HIV-infected children. The poor growth, diarrhoea and respiratory infections seen in HIV-infected children may be partly due to micronutrient deficiencies. The studies in this thesis had two main objectives: (1) to evaluate the effect of short-term (during hospitalization) and long-term (6 months) multi-micronutrient supplementation on episodes of diarrhoea and respiratory infections in HIV-infected children who are not yet on antiretroviral therapy (ART), and (2) to assess the effects of long-term multi-micronutrient supplementation on appetite and growth performance of HIV-infected who are not on ART.
Methods and results: Four studies were conducted. Initially a cross-sectional study was performed in which the duration of hospitalization, weight, length, micronutrient status and appetite of HIV-infected children admitted with diarrhoea or pneumonia was compared with the results of HIV-uninfected children. Duration of hospitalization was 2.8 days (52%) longer in HIV-infected children. Appetite as measured by amount of test food eaten (g per kg body weight) was 26% poorer in HIV-infected children. Mean length-for-age Z-scores were lower in HIV-infected children; there was no difference in level of wasting.
Subsequently multi-micronutrient supplementation studies were performed, one short-term and two long-term studies. The effect of supplementation on the duration of hospitalization in HIV-infected children with diarrhoea or pneumonia was assessed in the short-term study. One long-term study assessed the supplement’s impact on growth and frequency of episodes of diarrhoea and of pneumonia in HIV-infected children. The other evaluated the effect of the supplement on the appetite of these children. The supplement contained vitamins A, B complex, C, D, E and folic acid, and the minerals copper, iron, selenium and zinc at levels based on recommended dietary allowances.
In the short-term supplementation study HIV-infected children aged 4-24 months who were hospitalized with pneumonia or diarrhoea received the supplement or a placebo until discharge from hospital. The duration of hospitalization was 1.7 days (19%) shorter in the supplement group.
Long-term multi-micronutrient supplementation improved the weight-for-age and weight-for-height Z-scores of HIV-infected children aged 4-24 months by 0.4 over the 6-month period. There was no improvement in stunting. Children in the supplement group had substantially fewer episodes of respiratory symptoms per month than the placebo group (0.66 ± 0.51) per month vs (1.01 ± 0.67) (P < 0.05) and marginally fewer episodes of diarrhoea per month (0.25 ± 0.31) vs (0.36 ± 0.36) (P = 0.09). There was no effect on CD4 lymphocytes. Long-term supplementation with micronutrients had benefits on the appetite of HIV-infected children aged 6-24 months as well. Improvements in amount of test food eaten over the 6-month period were much higher among children who received the supplement (4.7 ± 14.7 g/kg body weight) than the changes in those who received the placebo (-1.4 ± 11.6 g/kg body weight).
Conclusion: Multi-micronutrient supplementation reduces the duration of diarrhoea and of pneumonia and incidence of diarrhoea and of respiratory symptoms in HIV-infected children who are not yet on ART. Multi-micronutrient supplementation also improves appetite and weight in these children but not height. The results of these studies indicate that multi-micronutrient supplementation should be considered in HIV-infected infant and young children who have not commenced ART.
Bio-impedantiemeting in de eerste lijn: geschikt of ongeschikt?
Hulshof, P.J.M. ; Weijs, P. - \ 2010
Nederlands Tijdschrift voor Voeding en Dietetiek 65 (2010)1. - ISSN 1875-9955 - p. 26 - 27.
impedantie - lichaamsgewicht - lichaamssamenstelling - voedingstoestand - impedance - body weight - body composition - nutritional state
Is het gebruik van bio-impedantiemeting in de eerstelijnsgezondheidszorg geschikt of ongeschikt? Paul Hulshof, universitair docent afdeling Humane Voeding, Wageningen Universiteit en Peter Weijs, Lector Gewichtsmanagement en coördinator onderzoek Diëtetiek en Voedingswetenschappen, VU medisch centrum, geven over deze kwestie hun mening
|Het meten van lichaamssamenstelling in de eerstelijnszorg : bio-impedantie steeds populairder, maar op individueel niveau niet betrouwbaar
Hulshof, P.J.M. - \ 2009
Nederlands Tijdschrift voor Voeding en Dietetiek 64 (2009)5. - ISSN 1875-9955 - p. 7 - 10.
voedingstoestand - lichaamssamenstelling - lichaamsgewicht - diëtisten - lichaamsvet - impedantie - nutritional state - body composition - body weight - dietitians - body fat - impedance
Lichaamssamenstelling is een maat voor de voedingstoestand. Een groot scala aan methoden staat ter beschikking om lichaamssamenstelling te meten. Sommige van deze methoden zijn geschikt voor toepassing in de eerste lijn, zoals antropometrie en bio-impedantie. Andere, meer kostbare en geavanceerde technieken - zoals MRI, CT, DEXA en isotopen-verdunningsmethoden - zijn geschikter voor toepassing in een onderzoeksomgeving. Met name bio-impedantie wordt steeds populairder
Mogelijkheden voor reductie van medicijngebruik door gezonde voeding(sproducten) in zorginstellingen
Sluis, A.A. van der; Peppelenbos, H.W. ; Witkamp, R.F. ; Rompelberg, C.J.M. ; Jong, N. de; Verhagen, H. - \ 2009
Wageningen : AFSG - 29
verpleeghuizen - geneesmiddelen - voedingsstof-geneesmiddel interacties - voeding en gezondheid - gezondheidszorginstellingen - ouderen - voedingstoestand - nursing homes - drugs - nutrient drug interactions - nutrition and health - health maintenance organizations - elderly - nutritional state
De nadruk van dit rapport ligt op de volgende twee vragen: 1) In hoeverre kan voeding het gebruik van geneesmiddelen in het algemeen in verpleeghuizen beïnvloeden? Hierbij valt onderscheid te maken in: a) Wat is de rol van omgevingsinvloeden (sociale context)? b) Voedingsproducten: welke specifieke producten kunnen medicijngebruik verminderen? 2) Wat is de kostenefficiëntie van de vervanging van medicijnen door gezonde voedingsproducten? In hoeverre betekent investeren in voeding een besparing op medicijnen of verpleging?
Nectar exploitation by herbivores and their parasitoids is a function of flower species and relative humidity
Winkler, K. ; Wäckers, F.L. ; Kaufman, L.V. ; Larraz, V. ; Lenteren, J.C. van - \ 2009
Biological Control 50 (2009)3. - ISSN 1049-9644 - p. 299 - 306.
diadegma-insulare hymenoptera - diamondback moth lepidoptera - biological-control - nutritional state - floral resources - field conditions - honeydew sugars - aphid honeydew - longevity - ichneumonidae
In conservation biological control, diversification of the agro ecosystem with flowering vegetation is seen as an important tool to support the broad range of predators and parasitoids that require nectar and pollen sources to survive and reproduce. In order to identify flowering plants that provide suitable food sources for natural enemies without supporting the pest species, we analyzed the exploitation of 19 flowering plants by two important lepidopteran cabbage pests, Pieris rapae and Plutella xylostella, and their hymenopteran parasitoids, Cotesia glomerata and Diadegma semiclausum. The experiments were conducted at 90% r.h., while Pieris rapae was tested both at 45% r.h. and at 90% r.h. At 45 ± 5% r.h., corresponding with field conditions at which P. rapae is predominantly active, the butterfly was unable to feed on a number of exposed floral nectar sources whose nectar was successfully exploited at 90% r.h. The broader nectar exploitation by P. rapae at the high humidity is presumably explained by the resulting decrease in nectar viscosity. When comparing D. semiclausum and its herbivorous host P. xylostella, the herbivore exploited a broader range of plants. However, those plants that benefited both the parasitoid and the herbivore had a much stronger effect on the longevity of the parasitoid. The results from the accessibility bioassay suggest that flowers where nectar is not accessible can have a negative impact on insect survival presumably by stimulating foraging without providing accessible nectar. Our results underline the importance of considering species-specific environmental conditions when fine-tuning the choice of nectar sources to be used in conservation biological control programs.
|Aanwijzingen voor effecten op functionele eindpunten : vitaminesuppletie voeding van ondervoede ouderen
Groot, C.P.G.M. de - \ 2009
VoedingsMagazine 2009 (2009)6. - ISSN 0922-8012 - p. 16 - 18.
vitaminetoevoegingen - ondervoeding - ouderen - voedingstoestand - ouderenvoeding - voeding en gezondheid - vitamin supplements - undernutrition - elderly - nutritional state - elderly nutrition - nutrition and health
Protein or energy supplementation of the diet of malnourished older people leads to body weight gain and an improved nutritional status. There are no indications for an effect on functional endpoints. In contrast, according to Prof. Lisette de Groot (Wageningen University), vitamin supplementation reportedly leads to functional improvements
Dietary patterns, biological risk factors and survival in elderly European men and women
Knoops, K.T.B. - \ 2007
Wageningen University. Promotor(en): Wija van Staveren; Daan Kromhout, co-promotor(en): Lisette de Groot. - [S.l.] : S.n. - ISBN 9789085046912 - 208
dieet - risicofactoren - risicoschatting - mortaliteit - overleving - voedingstoestand - voeding - ouderen - ouderdom - verouderen - europa - diet - risk factors - risk assessment - mortality - survival - nutritional state - nutrition - elderly - old age - aging - europe
Background: The percentage of the population aged 65 and over, which started to rise sharply in the last decades of the past century, is continuing to rise. However, up until now, little is known about dietary factors and diet-related biological factors in elderly in relation to survival in old age. Aim: The aim of this thesis is to investigate the associations between dietary patterns, diet-related biological risk factors and survival. Study population: Data from two prospective studies were used, the Healthy Ageing: a longitudinal study in Europe (HALE) and the Normative Aging Study (NAS). The HALE project which involves individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women in 11 European Countries, aged 70 to 90 years at baseline and who were followed for 10 years. The NAS is a longitudinal study which started in 1963 by recruiting men, 21 to 80 years of age and free of heart disease and other major health problems, around Boston. Data collected in 1993 and later were used. Results: We observed that after fortification with folic acid, folate intake and plasma folate concentration increased significantly in three groups with different dietary patterns, derived by cluster analysis. Homocysteine tended to decrease in the group with a relatively high alcohol consumption, low fruit and vegetable dietary pattern in the NAS study. Dietary patterns defined by three European indexes were significantly associated with all-cause mortality in the HALE project. A Mediterranean type of diet was associated with an approximately 20 % lower mortality rates in both apparently healthy elderly and in post-myocardial infarction patients. Healthy lifestyle factors (moderate alcohol consumption, being physically active and non-smoking) were also inversely associated with all-cause mortality. Weight loss was significantly associated with increased all-cause mortality in the study centres of Northern Europe while weight gain was weakly associated with increased mortality in these centres in the FINE study. HDL-cholesterol was inversely associated with mortality from cardiovascular diseases and all-causes in the HALE project. Associations between HDL and mortality were strongest in women. Conclusion: A healthy diet is associated with lower mortality risk in elderly. Besides a healthy diet, it is important for elderly people to be physically active, use alcohol in moderation and quit smoking. It is also important to maintain constant body weight and to keep blood cholesterol at a desirable level, especially to keep HDL-cholesterol high.
Towards a food-based approach to improve iron and zinc status of rural Beninese children: enhancing mineral bioavailability from sorghum-based food
Mitchikpe, C.E.S. - \ 2007
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Joop van Raaij; E.A.D. Ategbo; R.A.M. Dossa. - [S.l.[ : S.n. - ISBN 9789085046431 - 152
voedingstoestand - zink - ijzer - biologische beschikbaarheid - sorghum - tropisch voedsel - mineraaltekorten - kinderen - benin - nutritional state - zinc - iron - bioavailability - tropical foods - mineral deficiencies - children
The growth performance, food pattern, and iron and zinc status of 80 rural Beninese school-age children were assessed in a post-harvest and in a pre-harvest season. The foods as eaten by the children were analysed chemically with special reference to iron, zinc, and phytate contents. The children show a poor growth performance and many of them can be classified as stunted (small for height). This suggests that the children suffer from a long-term marginal food intake, quantitatively and qualitatively. This is confirmed by the food intake and food analysis results which underline that the iron and zinc bioavailability is poor because of the presence of high levels of antinutritional factors as phytate. The low iron bioavailability is undoubtedly one of the causes of the high prevalence of anaemia among these children. To improve iron and zinc status of children, more attention should be given to improving bioavailability of these minerals.
Voeding versus veroudering
Groot, C.P.G.M. de - \ 2006
VoedingsMagazine 19 (2006)3. - ISSN 0922-8012 - p. 8 - 10.
humane voeding - ouderen - ouderenvoeding - gezondheid - voedingstoestand - verouderen - organisatie van onderzoek - human feeding - elderly - elderly nutrition - health - nutritional state - aging - organization of research
In her inaugural speech when accepting the office of professor by special appointment at Wageningen University, Lisette de Groot unfolds her intentions. Research on all levels (from descriptive research on a population level and individual interventions to studies on a cellular level) should bring a bit closer the target goal of curbing functional decline as a consequence of ageing processes