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Background: The Zanzibar Infant Nutrition Campaign is a large-scale randomised control trial investigating the effects of iron and zinc supplementation on the morbidity and mortality of infants and young children on Pemba Island, Zanzibar, Tanzania. The Child Development Study is a substudy of the larger ZINC control trial assessing the effects of 12 months of iron and zinc supplementation on motor and language development. The Caregiver-Infant Interaction Study is a substudy of the Child Development Study, assessing the effects of 1 to 3 months of iron and zinc supplementation on caregiver-infant interaction among 9-month-old dyads. This thesis reports on the dyads enrolled in the Caregiver-Infant Interaction Study. While not examining treatment effects1 • Formulate behavioural and developmental hypotheses specific to a population of 9-month-old caregiver-infant dyads affected by a history of IDA , hypothesised disturbances in the behaviour and development of infants affected by a history of iron deficiency anaemia (IDA) are examined. Objectives: • Develop a hypothesis-driven observational coding system and establish the psychometric properties of this measure • Test hypotheses about the relationship between a history of IDA and the behaviour and development of 9-month-old caregiver-infant dyads Rationale: Iron deficiency anaemia is the most common nutritional disorder in the world. Prevalence is especially high among women, young children and infants in developing countries. As a public health concern, the effects of IDA are various and insidious, however the relationship between IDA and infant behaviour and development is not known. The majority of studies concerned with the impact of IDA in infancy have relied on global developmental scales, such as the Bayley Scales of Infant Development (Bayley, 1969, 1993). While infants with IDA consistently score worse than non-anaemic comparisons on mental and motor subscales, the value of this form of assessment is known to be limited. Apart from being of questionable validity as indices of abilities or functions (e.g., Fagan & Singer, 1983), the scores and ratings produced by traditional developmental scales are not designed to assess the specific functions hypothesised to be affected by IDA (Lozoff, De Andraca, Castillo, Smith, Walter & Pino, 2003). Over-reliance on this kind of measure thus rules out meaningful hypothesis-driven research. Recently, malnutrition researchers have begun to made use of systematic behavioural observation as a means of assessment. While a promising approach, extant research is limited to only two studies (see Footnote 6), and both of these have been conducted by the same research group. Moreover, these studies have relied on fairly rudimentary behavioural coding to examine a version of the ‘Functional Isolation Hypothesis', originally proposed some time ago in the infrahuman literature (Levitsky & Barns, 1972, 1973). More sophisticated hypotheses are available, especially given the ready availability of insights from developmental psychobiology and cognitive science. Design: A correlational design was used to examine the behaviour and development of 9-month old caregiver-infant dyads with a history of IDA. Setting: Wete District, Pemba Island, Zanzibar, Tanzania. Participants: 160 Caregiver-infant dyads assessed observationally at 9-month of age. Main Outcome Measure: Systematic observational coding. Main Findings: Infants with a history of more severe IDA spent significantly less time in high energy states during free play, and their caregivers made less physically demanding requests. A history of IDA also correlated with developmental disturbances in postural control. Affectively, IDA infants were hypo-responsive, and caregivers showed more (overt) positive affect for healthy males, but not females. Caregivers coordinated actions and vocalizations less often during interaction with infants affected by a history of IDA. Conclusion: A history of IDA among 9-month old infants is related to behavioural and developmental disturbances in both motor and socio-cognitive domains. Note to reader: The present research was first submitted as a Masters dissertation in 2008. The author was subsequently offered the opportunity rather to upgrade to a Doctoral thesis and resubmit the work as PhD. Chronologically then, studies which did not inform the design and development of the coding system used for data collection, or which published findings after the first submission of the present work, are discussed in the final chapter. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

Motivation: A variety of factors including food shortage, poor hygiene and low education levels affects the nutritional status of black women. Women also have a high risk for the development of iron deficiency because they lose iron through menstruation, the birth process and a low intake of iron containing foods. All of these factors contribute to an increased risk for the development of iron deficiency anaemia in women. Objectives: The primary purpose of the study was to investigate the association between tea consumption and iron status of African females in the North West Province. To reach this purpose the specific aims were to (1) assess the iron status of women, (2) determine tea intake, and (3) determine the relationship between tea consumption and iron status, taking into account inhibiting and enhancing factors of iron absorption. Methods: A cross-sectional sample of apparently healthy females was taken from five different strata of urbanisation. The subjects were then further divided into two groups, namely younger women (younger than 45.9 years) and older women (older than 46 years). A sample of 920 subjects was used. Data were obtained from dietary, demographic and additional questionnaires, as well as from the taking of blood samples. This study was a sub-study of the THUSA study. Results: A total of 920 subjects participated of which 69.24% were younger women and 30.76% were older women. Due to missing data, the number of subjects for each parameter differed. The mean serum ferritin as well as haemoglobin concentrations were within normal ranges for both groups. The mean dietary iron intake for both groups was below recommendations. No significant correlations were found between serum ferritin or haemoglobin and total tea intake as well as a variety of other dietary factors. The low haemoglobin concentration group of the younger and older women combined had a slightly higher intake of animal protein and ascorbic acid than the high haemoglobin concentration group. On the other hand, the high serum ferritin concentration group had a significantly higher intake of animal protein than the low serum ferritin concentration group. Conclusion: The results of this study indicated that tea does not have an inhibitory effect on the iron status of the female population of the North West Province. However, the investigation of other studies conducted on the same topic had mixed results. Two of seven studies investigated and this study indicated that tea had no inhibitory effect on iron absorption. These two studies, as well as this study were not done in a controlled environment where certain factors can be controlled for, for example, time of tea intake and milk consumption with tea. The other five studies were, however, conducted in an environment where subjects were given test meals, time of tea consumption was regulated and milk consumption with tea was recorded. The conclusion can, therefore, be made that further studies on the South African population in a controlled environment are necessary to give accurate recommendations to the population. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

The thesis is comprised of a comparative study of iron metabolism with particular reference to iron deficiency in the Indian and the African; Europeans were included when naterlal was available. Fifty four patients with iron deficiency anaemia were studied. There ware 43 Indians as compared with 11 Africans although the overall proportion of Indians to Africans admitted to the same ward was 1 : 4. Amongst the Indians the commonest cause of anaemia from blood loss was peptic ulceration (6 patients); while 3 had cirrhosis of the liver, one had hookworm anaemia and one was a case of ulcerative colitis. Gynaecological lesions were found in 2 patients, one had a proliferative endometrium and the other had endometrial polypi. Idiopathic iron deficiency anaemia was found in 60.5% of the Indian patients (both male and female). Amongst the Africans on the other hand, there were 2 cases of hookworm anaemia and 2 of cirrhosis of the liver while peptic ulceration was suspected in one patient who alao had amoebic dysentery and urinary hllharsiesis. None of the Africans had Idiopathic iron deficiency anaemia with the possible exception of one who had 4 Caesarean sections in rapid succession. There were 175 Indians, 175 Africans and 139 Europeans who were studied haematologlcally during pregnancy. The Incidence of iron deficiency anaemia among them was 26.7%, 2% and 4% respectively. The third aspect of the thesis is confined to an analysis of necropsy materiel for iron stores. Two hundred Africans and 58 Indians were studied. It was found that the incidence of *siderosis" in the African was high. There was a significant difference in the iron concentrations in the stores of the 2 racial groups. It was concluded that iron deficiency anaemia is common in the Indian. Diet appears to play an important role in its production. / Thesis (M.D.)-University of Natal, Durban, 1963.

Motivation: A variety of factors including food shortage, poor hygiene and low education levels affects the nutritional status of black women. Women also have a high risk for the development of iron deficiency because they lose iron through menstruation, the birth process and a low intake of iron containing foods. All of these factors contribute to an increased risk for the development of iron deficiency anaemia in women. Objectives: The primary purpose of the study was to investigate the association between tea consumption and iron status of African females in the North West Province. To reach this purpose the specific aims were to (1) assess the iron status of women, (2) determine tea intake, and (3) determine the relationship between tea consumption and iron status, taking into account inhibiting and enhancing factors of iron absorption. Methods: A cross-sectional sample of apparently healthy females was taken from five different strata of urbanisation. The subjects were then further divided into two groups, namely younger women (younger than 45.9 years) and older women (older than 46 years). A sample of 920 subjects was used. Data were obtained from dietary, demographic and additional questionnaires, as well as from the taking of blood samples. This study was a sub-study of the THUSA study. Results: A total of 920 subjects participated of which 69.24% were younger women and 30.76% were older women. Due to missing data, the number of subjects for each parameter differed. The mean serum ferritin as well as haemoglobin concentrations were within normal ranges for both groups. The mean dietary iron intake for both groups was below recommendations. No significant correlations were found between serum ferritin or haemoglobin and total tea intake as well as a variety of other dietary factors. The low haemoglobin concentration group of the younger and older women combined had a slightly higher intake of animal protein and ascorbic acid than the high haemoglobin concentration group. On the other hand, the high serum ferritin concentration group had a significantly higher intake of animal protein than the low serum ferritin concentration group. Conclusion: The results of this study indicated that tea does not have an inhibitory effect on the iron status of the female population of the North West Province. However, the investigation of other studies conducted on the same topic had mixed results. Two of seven studies investigated and this study indicated that tea had no inhibitory effect on iron absorption. These two studies, as well as this study were not done in a controlled environment where certain factors can be controlled for, for example, time of tea intake and milk consumption with tea. The other five studies were, however, conducted in an environment where subjects were given test meals, time of tea consumption was regulated and milk consumption with tea was recorded. The conclusion can, therefore, be made that further studies on the South African population in a controlled environment are necessary to give accurate recommendations to the population. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

Os indicadores brasileiros de anemia ferropriva são alarmantes. Para colaborar com a redução deste quadro, o governo brasileiro adotou a fortificação das farinhas de trigo com ferro. Nesta pesquisa, profissionais dos moinhos de trigo brasileiros foram questionados, sobre suas percepções da Resolução ANVISA nº 344/02, que obrigou a fortificação das farinhas. As respostas dos entrevistados permitiram construir Discursos do Sujeito Coletivo (DSC) e interpretar alguns de seus aspectos com o objetivo de avaliar a aceitação e a adoção das determinações da legislação. Os DSC são redações organizadas, pelo pesquisador, das informações qualitativas obtidas nas entrevistas, contendo as principais idéias e expressões verbais que revelam as percepções dos entrevistados. Os resultados obtidos permitem afirmar que esses concordam com a legislação, porém questionam sua forma de apresentação, autoritária e pouco participativa da categoria que, a princípio, deixou o setor arredio e exigente de uma contrapartida pelo governo de um programa de educação ao consumidor e também desconfiado se a estratégia atingirá a população pobre, devido ao preço dos derivados do trigo. A coletividade afirma que cumpre a legislação apesar das deficiências tecnológicas do setor, que têm sido contornadas com a escolha de qualificados fornecedores de micronutrientes com serviços analíticos agregados. A sobredosagem de micronutrientes tem sido praticada para contornar problemas tecnológicos e a falta de um controle laboratorial adequado. O composto de ferro mais empregado para fortificar farinhas de uso doméstico é o ferro reduzido e, para as de uso industrial, o composto de ferro varia conforme as necessidades dos clientes. Na percepção da coletividade dos moinhos de trigo, a problemática da fortificação obrigatória das farinhas é menos tecnológica e mais política e administrativa. A fortificação obrigatória foi uma grande conquista que pode ser melhorada com a fiscalização dos processos industriais e dos produtos. Deveria ser tratada como um programa, que educasse a população por mídia de massa e incluísse gestores capazes de mediar as ações, que envolvem setores com interesses distintos, como o governo, a indústria e a sociedade. / Anemia caused by iron deficiency is very prevalent in Brazil. To decrease it, the Brazilian government established that wheat flour must be fortified with iron and folic acid. This work presents the perceptions of the wheat flour milling professionals on the Brazilian law - Resolução ANVISA nº 344/2002, which has obligated the flour fortification. The answers of the interviewed professionals were used to writing the Collective Discourses of the Subjects. Some aspects of them were interpreted with the objective of evaluating the acceptance of the law by the milling community. Collective Discourses of the Subjects are wordings organized and written by the researcher using the information obtained with the interviewers, and contains the main ideas and verbal expressions which reveal the interviewers perceptions. The results allow to concluding the wheat mills community agree with the law, however it argues with its authoritarian way of dealing, without the participation of the milling fellows, who became strayed and distrust, and asking the government for an advertising campaign of consumer´s education. The milling fellows distrust if the poor population will be reached by the measure, because of the prices of the products derived from wheat. The collective subject says he is fulfilling the law, besides the technological deficiencies of the milling companies, which have been solved with good suppliers of micronutrients who includes lab services. Over dosage of micronutrients has been used to avoiding technological issues, and the lack of rapid lab analysis results. Between the interviewers, reduced iron is the most used iron compound to fortify wheat flour for domestic usage, and the source of iron for the flour for industrial purposes varies depending on the customer. The perception of the milling professionals reveals the fortification issues are more administrative and political, than technological. The fortification should be improved with the govern enforcement and should be seen like a program, which would include educational advertising to the population and should be managed by professionals able to mediate government, industry and society interests.

A deficiência de ferro é o resultado de um longo período de balanço negativo do ferro, culminando na exaustão do estoque de ferro do organismo. Isto é revelado quando a concentração de hemoglobina declina para valores abaixo dos limites normais e então aparece a anemia, que ocorre devido à deficiente síntese de hemoglobina, com diminuição da proliferação eritrocitária. A anemia ferropênica é considerada o maior problema de saúde no idoso e está associada com várias complicações, incluindo doença cardiovascular, disfunção cognitiva, aumento no risco de morte, e principalmente tem um significante efeito na qualidade de vida. Estudos revelam que a anemia por deficiência de ferro causa maior susceptibilidade aos agentes oxidantes. Utilizando técnica espectrofotométrica, foram determinadas as atividades das enzimas antioxidantes catalase (CAT), glutationa peroxidase (GPx) e superóxido dismutase (SOD) e quantificada a glutationa total (GSH) nos eritrócitos dos pacientes. Também determinou-se o dano oxidativo nas proteínas plasmáticas e no hemolisado celular pelo método do carbonil a 360 nm. Os níveis da peroxidação lipídica (MDA) e da vitamina C foram determinados por cromatografia líquida de alta performance (HPLC). Os participantes da pesquisa foram selecionados de Ambulatórios de Atenção Básica de Saúde da Região Norte do Rio Grande do Sul, sendo que 17 indivíduos apresentaram anemia ferropênica e hipertensão primária e 18 apenas hipertensão primária devido à dificuldade de selecionar pacientes sem nenhuma patologia associada. Todos os indivíduos assinaram o termo de consentimento livre e esclarecido. Os dados obtidos foram expressos como médias ± desvio padrão e analisados utilizando-se o Teste t-Student. Os resultados do trabalho mostram que os indivíduos com anemia ferropênica apresentam atividade significativamente elevada da SOD e da CAT em relação aos indivíduos controle, mas não apresentaram diferença na atividade da GPx nem da GSH. Observamos também, dano oxidativo em proteínas plasmáticas, mas não no hemolisado celular. Os pacientes com anemia ferropênica mostraram dano oxidativo em proteínas plasmáticas significativamente maiores, assim como um aumento significativo da produção de MDA no soro, como um indicativo do aumento da auto-oxidação dos lipídios sob condições de estresse oxidativo. Os níveis séricos da vitamina C não mostraram diferença significativa entre os grupos. Estes dados revelam o envolvimento de espécies reativas de oxigênio no agravamento da anemia carencial. Sendo assim, reforça-se a necessidade de diagnosticar e tratar esses pacientes precocemente, diminuindo a magnitude dos efeitos da anemia na saúde do idoso. / Iron deficiency is the outcome of a long period of negative iron balance, culminating in exhaustion of the body’s iron stores. This is revealed when hemoglobin concentration declines to values below normal levels and anaemia is detected, due to a deficient synthesis of hemoglobin, with decrease in eritrocitary proliferation. Iron deficiency anaemia is considered the most important health problem in elderly and it is associated with various complications, including cardiovascular disease, cognitive dysfunction, increased risk of death and, mostly, it has a meaningful effect in the quality of life. Studies reveal that iron deficiency anaemia cause higher susceptibility to oxidant agents. Using spectrophotometric techniques, the activities of antioxidant enzymes, catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) and total glutathione (GSH) were quantified in the erythrocytes of the patients. We also determined oxidative damage of plasma proteins and in hemolysate using the carbonyl assay at 360 nm. The levels of lipid peroxidation (MDA) and vitamin C were determined by highperformance liquid chromatography (HPLC). Participants in this study were selected in Ambulatories of Basic Health Attention in the North of the State of Rio Grande do Sul. 17 individuals presented iron deficiency anaemia and primary hypertension and 18 only primary hypertension, because it was difficult to select patients without any associated deficiency. All individuals signed the term of free and clarified consent to participate in this study. Data were analyzed using t- Student Test. Results show that individuals with iron deficiency anaemia show significantly higher activity of SOD and CAT when compared with those from the control group, but they do not show difference in the activity of GPx or GSH. Oxidative damage was also observed in plasma proteins, but not in the cellular hemolysate. Patients with iron deficiency anaemia showed oxidative damage in plasma proteins significantly higher when compared with the control group. And they also showed a significant increase in the production of MDA in the serum as an indicative of the increased auto-oxidation of lipids under oxidative stress. Serum vitamin C levels did not show significant difference between the groups. These data reveal the involvement of the reactive oxygen species in carential anaemia. Therefore, we reinforce the need to diagnose and treat these patients early to reduce the magnitude of the effects of anaemia on the heath of the elderly.

A deficiência de ferro é o resultado de um longo período de balanço negativo do ferro, culminando na exaustão do estoque de ferro do organismo. Isto é revelado quando a concentração de hemoglobina declina para valores abaixo dos limites normais e então aparece a anemia, que ocorre devido à deficiente síntese de hemoglobina, com diminuição da proliferação eritrocitária. A anemia ferropênica é considerada o maior problema de saúde no idoso e está associada com várias complicações, incluindo doença cardiovascular, disfunção cognitiva, aumento no risco de morte, e principalmente tem um significante efeito na qualidade de vida. Estudos revelam que a anemia por deficiência de ferro causa maior susceptibilidade aos agentes oxidantes. Utilizando técnica espectrofotométrica, foram determinadas as atividades das enzimas antioxidantes catalase (CAT), glutationa peroxidase (GPx) e superóxido dismutase (SOD) e quantificada a glutationa total (GSH) nos eritrócitos dos pacientes. Também determinou-se o dano oxidativo nas proteínas plasmáticas e no hemolisado celular pelo método do carbonil a 360 nm. Os níveis da peroxidação lipídica (MDA) e da vitamina C foram determinados por cromatografia líquida de alta performance (HPLC). Os participantes da pesquisa foram selecionados de Ambulatórios de Atenção Básica de Saúde da Região Norte do Rio Grande do Sul, sendo que 17 indivíduos apresentaram anemia ferropênica e hipertensão primária e 18 apenas hipertensão primária devido à dificuldade de selecionar pacientes sem nenhuma patologia associada. Todos os indivíduos assinaram o termo de consentimento livre e esclarecido. Os dados obtidos foram expressos como médias ± desvio padrão e analisados utilizando-se o Teste t-Student. Os resultados do trabalho mostram que os indivíduos com anemia ferropênica apresentam atividade significativamente elevada da SOD e da CAT em relação aos indivíduos controle, mas não apresentaram diferença na atividade da GPx nem da GSH. Observamos também, dano oxidativo em proteínas plasmáticas, mas não no hemolisado celular. Os pacientes com anemia ferropênica mostraram dano oxidativo em proteínas plasmáticas significativamente maiores, assim como um aumento significativo da produção de MDA no soro, como um indicativo do aumento da auto-oxidação dos lipídios sob condições de estresse oxidativo. Os níveis séricos da vitamina C não mostraram diferença significativa entre os grupos. Estes dados revelam o envolvimento de espécies reativas de oxigênio no agravamento da anemia carencial. Sendo assim, reforça-se a necessidade de diagnosticar e tratar esses pacientes precocemente, diminuindo a magnitude dos efeitos da anemia na saúde do idoso. / Iron deficiency is the outcome of a long period of negative iron balance, culminating in exhaustion of the body’s iron stores. This is revealed when hemoglobin concentration declines to values below normal levels and anaemia is detected, due to a deficient synthesis of hemoglobin, with decrease in eritrocitary proliferation. Iron deficiency anaemia is considered the most important health problem in elderly and it is associated with various complications, including cardiovascular disease, cognitive dysfunction, increased risk of death and, mostly, it has a meaningful effect in the quality of life. Studies reveal that iron deficiency anaemia cause higher susceptibility to oxidant agents. Using spectrophotometric techniques, the activities of antioxidant enzymes, catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) and total glutathione (GSH) were quantified in the erythrocytes of the patients. We also determined oxidative damage of plasma proteins and in hemolysate using the carbonyl assay at 360 nm. The levels of lipid peroxidation (MDA) and vitamin C were determined by highperformance liquid chromatography (HPLC). Participants in this study were selected in Ambulatories of Basic Health Attention in the North of the State of Rio Grande do Sul. 17 individuals presented iron deficiency anaemia and primary hypertension and 18 only primary hypertension, because it was difficult to select patients without any associated deficiency. All individuals signed the term of free and clarified consent to participate in this study. Data were analyzed using t- Student Test. Results show that individuals with iron deficiency anaemia show significantly higher activity of SOD and CAT when compared with those from the control group, but they do not show difference in the activity of GPx or GSH. Oxidative damage was also observed in plasma proteins, but not in the cellular hemolysate. Patients with iron deficiency anaemia showed oxidative damage in plasma proteins significantly higher when compared with the control group. And they also showed a significant increase in the production of MDA in the serum as an indicative of the increased auto-oxidation of lipids under oxidative stress. Serum vitamin C levels did not show significant difference between the groups. These data reveal the involvement of the reactive oxygen species in carential anaemia. Therefore, we reinforce the need to diagnose and treat these patients early to reduce the magnitude of the effects of anaemia on the heath of the elderly.

A deficiência de ferro é o resultado de um longo período de balanço negativo do ferro, culminando na exaustão do estoque de ferro do organismo. Isto é revelado quando a concentração de hemoglobina declina para valores abaixo dos limites normais e então aparece a anemia, que ocorre devido à deficiente síntese de hemoglobina, com diminuição da proliferação eritrocitária. A anemia ferropênica é considerada o maior problema de saúde no idoso e está associada com várias complicações, incluindo doença cardiovascular, disfunção cognitiva, aumento no risco de morte, e principalmente tem um significante efeito na qualidade de vida. Estudos revelam que a anemia por deficiência de ferro causa maior susceptibilidade aos agentes oxidantes. Utilizando técnica espectrofotométrica, foram determinadas as atividades das enzimas antioxidantes catalase (CAT), glutationa peroxidase (GPx) e superóxido dismutase (SOD) e quantificada a glutationa total (GSH) nos eritrócitos dos pacientes. Também determinou-se o dano oxidativo nas proteínas plasmáticas e no hemolisado celular pelo método do carbonil a 360 nm. Os níveis da peroxidação lipídica (MDA) e da vitamina C foram determinados por cromatografia líquida de alta performance (HPLC). Os participantes da pesquisa foram selecionados de Ambulatórios de Atenção Básica de Saúde da Região Norte do Rio Grande do Sul, sendo que 17 indivíduos apresentaram anemia ferropênica e hipertensão primária e 18 apenas hipertensão primária devido à dificuldade de selecionar pacientes sem nenhuma patologia associada. Todos os indivíduos assinaram o termo de consentimento livre e esclarecido. Os dados obtidos foram expressos como médias ± desvio padrão e analisados utilizando-se o Teste t-Student. Os resultados do trabalho mostram que os indivíduos com anemia ferropênica apresentam atividade significativamente elevada da SOD e da CAT em relação aos indivíduos controle, mas não apresentaram diferença na atividade da GPx nem da GSH. Observamos também, dano oxidativo em proteínas plasmáticas, mas não no hemolisado celular. Os pacientes com anemia ferropênica mostraram dano oxidativo em proteínas plasmáticas significativamente maiores, assim como um aumento significativo da produção de MDA no soro, como um indicativo do aumento da auto-oxidação dos lipídios sob condições de estresse oxidativo. Os níveis séricos da vitamina C não mostraram diferença significativa entre os grupos. Estes dados revelam o envolvimento de espécies reativas de oxigênio no agravamento da anemia carencial. Sendo assim, reforça-se a necessidade de diagnosticar e tratar esses pacientes precocemente, diminuindo a magnitude dos efeitos da anemia na saúde do idoso. / Iron deficiency is the outcome of a long period of negative iron balance, culminating in exhaustion of the body’s iron stores. This is revealed when hemoglobin concentration declines to values below normal levels and anaemia is detected, due to a deficient synthesis of hemoglobin, with decrease in eritrocitary proliferation. Iron deficiency anaemia is considered the most important health problem in elderly and it is associated with various complications, including cardiovascular disease, cognitive dysfunction, increased risk of death and, mostly, it has a meaningful effect in the quality of life. Studies reveal that iron deficiency anaemia cause higher susceptibility to oxidant agents. Using spectrophotometric techniques, the activities of antioxidant enzymes, catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) and total glutathione (GSH) were quantified in the erythrocytes of the patients. We also determined oxidative damage of plasma proteins and in hemolysate using the carbonyl assay at 360 nm. The levels of lipid peroxidation (MDA) and vitamin C were determined by highperformance liquid chromatography (HPLC). Participants in this study were selected in Ambulatories of Basic Health Attention in the North of the State of Rio Grande do Sul. 17 individuals presented iron deficiency anaemia and primary hypertension and 18 only primary hypertension, because it was difficult to select patients without any associated deficiency. All individuals signed the term of free and clarified consent to participate in this study. Data were analyzed using t- Student Test. Results show that individuals with iron deficiency anaemia show significantly higher activity of SOD and CAT when compared with those from the control group, but they do not show difference in the activity of GPx or GSH. Oxidative damage was also observed in plasma proteins, but not in the cellular hemolysate. Patients with iron deficiency anaemia showed oxidative damage in plasma proteins significantly higher when compared with the control group. And they also showed a significant increase in the production of MDA in the serum as an indicative of the increased auto-oxidation of lipids under oxidative stress. Serum vitamin C levels did not show significant difference between the groups. These data reveal the involvement of the reactive oxygen species in carential anaemia. Therefore, we reinforce the need to diagnose and treat these patients early to reduce the magnitude of the effects of anaemia on the heath of the elderly.

Os indicadores brasileiros de anemia ferropriva são alarmantes. Para colaborar com a redução deste quadro, o governo brasileiro adotou a fortificação das farinhas de trigo com ferro. Nesta pesquisa, profissionais dos moinhos de trigo brasileiros foram questionados, sobre suas percepções da Resolução ANVISA nº 344/02, que obrigou a fortificação das farinhas. As respostas dos entrevistados permitiram construir Discursos do Sujeito Coletivo (DSC) e interpretar alguns de seus aspectos com o objetivo de avaliar a aceitação e a adoção das determinações da legislação. Os DSC são redações organizadas, pelo pesquisador, das informações qualitativas obtidas nas entrevistas, contendo as principais idéias e expressões verbais que revelam as percepções dos entrevistados. Os resultados obtidos permitem afirmar que esses concordam com a legislação, porém questionam sua forma de apresentação, autoritária e pouco participativa da categoria que, a princípio, deixou o setor arredio e exigente de uma contrapartida pelo governo de um programa de educação ao consumidor e também desconfiado se a estratégia atingirá a população pobre, devido ao preço dos derivados do trigo. A coletividade afirma que cumpre a legislação apesar das deficiências tecnológicas do setor, que têm sido contornadas com a escolha de qualificados fornecedores de micronutrientes com serviços analíticos agregados. A sobredosagem de micronutrientes tem sido praticada para contornar problemas tecnológicos e a falta de um controle laboratorial adequado. O composto de ferro mais empregado para fortificar farinhas de uso doméstico é o ferro reduzido e, para as de uso industrial, o composto de ferro varia conforme as necessidades dos clientes. Na percepção da coletividade dos moinhos de trigo, a problemática da fortificação obrigatória das farinhas é menos tecnológica e mais política e administrativa. A fortificação obrigatória foi uma grande conquista que pode ser melhorada com a fiscalização dos processos industriais e dos produtos. Deveria ser tratada como um programa, que educasse a população por mídia de massa e incluísse gestores capazes de mediar as ações, que envolvem setores com interesses distintos, como o governo, a indústria e a sociedade. / Anemia caused by iron deficiency is very prevalent in Brazil. To decrease it, the Brazilian government established that wheat flour must be fortified with iron and folic acid. This work presents the perceptions of the wheat flour milling professionals on the Brazilian law - Resolução ANVISA nº 344/2002, which has obligated the flour fortification. The answers of the interviewed professionals were used to writing the Collective Discourses of the Subjects. Some aspects of them were interpreted with the objective of evaluating the acceptance of the law by the milling community. Collective Discourses of the Subjects are wordings organized and written by the researcher using the information obtained with the interviewers, and contains the main ideas and verbal expressions which reveal the interviewers perceptions. The results allow to concluding the wheat mills community agree with the law, however it argues with its authoritarian way of dealing, without the participation of the milling fellows, who became strayed and distrust, and asking the government for an advertising campaign of consumer´s education. The milling fellows distrust if the poor population will be reached by the measure, because of the prices of the products derived from wheat. The collective subject says he is fulfilling the law, besides the technological deficiencies of the milling companies, which have been solved with good suppliers of micronutrients who includes lab services. Over dosage of micronutrients has been used to avoiding technological issues, and the lack of rapid lab analysis results. Between the interviewers, reduced iron is the most used iron compound to fortify wheat flour for domestic usage, and the source of iron for the flour for industrial purposes varies depending on the customer. The perception of the milling professionals reveals the fortification issues are more administrative and political, than technological. The fortification should be improved with the govern enforcement and should be seen like a program, which would include educational advertising to the population and should be managed by professionals able to mediate government, industry and society interests.