Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Background: The high prevalence of iron deficiency and anaemia among South African children highlights the need for iron fortification, especially with a highly bioavailable iron compound. Fortification of staple foods is an adequate strategy to provide additional iron to populations at risk. In South Africa it is mandatory to fortify maize meal and wheat flour with iron, as well as other micronutrients. Elemental iron, specifically electrolytic iron, is currently the preferred choice but other compounds that might be more effective in alleviating iron deficiency are under consideration. Objectives: The objective of this study was to provide information about the bioavailability of ferrous fumarate and NaFeEDTA from maize meal porridge in young children, which would assist in selecting a bioavailable alternative to electrolytic iron in the South African National Food Fortification Programme, Methods: A randomized parallel study design was used, with each of the 2 groups further randomised to receive either one of two test regimens in a crossover design in which each child acted as his/her own control. Iron bioavailability was measured with a stable-isotope technique based on erythrocyte incorporation 15 days after intake. Results: The mean absorption of iron from NaFeEDTA and ferrous fumarate from the maize porridge meal was 11.5% and 9.29% respectively. NaFeEDTA and ferrous fumarate are both sufficiently bioavailable from a maize based meal rich in phytates. Conclusion: Both NaFeEDTA and ferrous fumarate would provide a physiologically important amount of iron should they replace electrolytic iron as fortificant in maize flour fortification. The final choice between ferrous fumarate and NaFeEDTA as when it comes to finding the alternative iron fortificant will depend on factors such as technical compatibility, bioavailability, relative cost and organoleptic characteristics. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Background: The high prevalence of iron deficiency and anaemia among South African children highlights the need for iron fortification, especially with a highly bioavailable iron compound. Fortification of staple foods is an adequate strategy to provide additional iron to populations at risk. In South Africa it is mandatory to fortify maize meal and wheat flour with iron, as well as other micronutrients. Elemental iron, specifically electrolytic iron, is currently the preferred choice but other compounds that might be more effective in alleviating iron deficiency are under consideration. Objectives: The objective of this study was to provide information about the bioavailability of ferrous fumarate and NaFeEDTA from maize meal porridge in young children, which would assist in selecting a bioavailable alternative to electrolytic iron in the South African National Food Fortification Programme, Methods: A randomized parallel study design was used, with each of the 2 groups further randomised to receive either one of two test regimens in a crossover design in which each child acted as his/her own control. Iron bioavailability was measured with a stable-isotope technique based on erythrocyte incorporation 15 days after intake. Results: The mean absorption of iron from NaFeEDTA and ferrous fumarate from the maize porridge meal was 11.5% and 9.29% respectively. NaFeEDTA and ferrous fumarate are both sufficiently bioavailable from a maize based meal rich in phytates. Conclusion: Both NaFeEDTA and ferrous fumarate would provide a physiologically important amount of iron should they replace electrolytic iron as fortificant in maize flour fortification. The final choice between ferrous fumarate and NaFeEDTA as when it comes to finding the alternative iron fortificant will depend on factors such as technical compatibility, bioavailability, relative cost and organoleptic characteristics. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Elevated plasma total homocysteine (ptHcy) or hyperhomocysteinemia (hHcy) independently predicts cardiovascular disease in predialysis chronic kidney disease (pCKD). Folate status is one of the known nutritional determinants of ptHcy. In the era of folic acid food fortification, this cross-sectional study aimed to describe in pCKD subjects (n=48): 1) Prevalence of hHcy. 2) Intake and status of nutrients involved in homocysteine metabolism. 3) Determinants of ptHcy. The prevalence of hHcy was 93.8% (95% CI: 81.8 to 98.4). Median (25th, 75th percentile) total folate intake from food and supplements was 389 (282,640) µg DFE/d. No subject was folate deficient (red blood cell < 317 nmol/L). Red blood cell folate (r = - 0.406, p=0.004) and energy-protein undernutrition (r = 0.357, p=0.013) independently predicted ptHcy. To conclude, total folate intake among subjects with pCKD was sufficient to prevent folate deficiency but not able to prevent a high prevalence of hHcy.

Elevated plasma total homocysteine (ptHcy) or hyperhomocysteinemia (hHcy) independently predicts cardiovascular disease in predialysis chronic kidney disease (pCKD). Folate status is one of the known nutritional determinants of ptHcy. In the era of folic acid food fortification, this cross-sectional study aimed to describe in pCKD subjects (n=48): 1) Prevalence of hHcy. 2) Intake and status of nutrients involved in homocysteine metabolism. 3) Determinants of ptHcy. The prevalence of hHcy was 93.8% (95% CI: 81.8 to 98.4). Median (25th, 75th percentile) total folate intake from food and supplements was 389 (282,640) µg DFE/d. No subject was folate deficient (red blood cell < 317 nmol/L). Red blood cell folate (r = - 0.406, p=0.004) and energy-protein undernutrition (r = 0.357, p=0.013) independently predicted ptHcy. To conclude, total folate intake among subjects with pCKD was sufficient to prevent folate deficiency but not able to prevent a high prevalence of hHcy.

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

Objetivo: Verificar se há diferença entre o consumo habitual de folato entre mães de crianças com Síndrome de Down e mães de crianças sem malformações. Métodos: Foi realizado um estudo de caso-controle, com um total de 100 mães das quais 50, incluídas no grupo caso, apresentavam filhos com Síndrome de Down e 50, consideradas grupo controle,tinham filhos sem malformações congênitas. Aplicou-se um questionário de consumo habitual de alimentos contendo questões relativas à classificação sócio-econômica e ao consumo de alimentos-fonte e alimentos fortificados com esta vitamina. Todas participantes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Entre as variáveis analisadas, somente a quantidade de ácido fólico consumida habitualmente e a idade no momento do nascimento do filho, diferiram-se significantemente entre os grupos. Mães caso consumiram em média 359,1 μg/dia (dp ± 91,9) de folato, enquanto as mães do grupo controle, 425,5 μg/dia (dp± 104,3), (p=0,001). A idade que tiveram seus filhos foi no grupo caso 27, 5 anos (dp± 4,8) de e no grupo controle de 25,4 (dp ±5,3), (p=0,042). Somente 3,4% das entrevistadas relataram uso de ácido fólico ou polivitamínicos de forma periconcepcional ou em algum momento da gestação. Conclusões: Embora pelo presente estudo tenha havido diferença significativa entre o consumo de folato no grupo caso e no controle é importante que não se descarte possíveis fatores bioquímicos envolvidos e aqui não avaliados. / Objective: Check if exists difference between the usual consumption of folate in mothers of children with Down Syndrome and in mothers of children without congenital abnormalities. Methods: A case-control study was accomplished, with a sample of 100 mothers from which, 50 had children with Down Syndrome and 50, considered group control, children without congenital abnormalities. A questionnaire of quantitative frequency was applied containing questions related to the socioeconomic class and the food-source consumption, and foods fortified with folic acid. All participants signed the Informed Consent Form. Results: Among the variables in analysis, only the daily amount of folic acid consumed and the age that the mothers had their babies were significant different between the two groups. Mothers of children with Down Syndrome consumed 359,1 μg/day (dp ± 91,9) of folate, while the mothers of control group consumed, 425,5 μg/day (dp± 104,3), (p=0,001). The age that they had their babies were in group case 27, 5 years (dp± 4,8) and in the control group, 25,4 (dp ±5,3), (p=0,042). Only 3,4% of the interviewee related use of folic acid or others vitamines before or during the pregnancy. Conclusion: Although in the present study has been a significant difference between the consumption of folate in the case group and in the control, is important not to discard possible biochemical factors involved and here not evaluated.

Objetivo: Verificar se há diferença entre o consumo habitual de folato entre mães de crianças com Síndrome de Down e mães de crianças sem malformações. Métodos: Foi realizado um estudo de caso-controle, com um total de 100 mães das quais 50, incluídas no grupo caso, apresentavam filhos com Síndrome de Down e 50, consideradas grupo controle,tinham filhos sem malformações congênitas. Aplicou-se um questionário de consumo habitual de alimentos contendo questões relativas à classificação sócio-econômica e ao consumo de alimentos-fonte e alimentos fortificados com esta vitamina. Todas participantes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Entre as variáveis analisadas, somente a quantidade de ácido fólico consumida habitualmente e a idade no momento do nascimento do filho, diferiram-se significantemente entre os grupos. Mães caso consumiram em média 359,1 μg/dia (dp ± 91,9) de folato, enquanto as mães do grupo controle, 425,5 μg/dia (dp± 104,3), (p=0,001). A idade que tiveram seus filhos foi no grupo caso 27, 5 anos (dp± 4,8) de e no grupo controle de 25,4 (dp ±5,3), (p=0,042). Somente 3,4% das entrevistadas relataram uso de ácido fólico ou polivitamínicos de forma periconcepcional ou em algum momento da gestação. Conclusões: Embora pelo presente estudo tenha havido diferença significativa entre o consumo de folato no grupo caso e no controle é importante que não se descarte possíveis fatores bioquímicos envolvidos e aqui não avaliados. / Objective: Check if exists difference between the usual consumption of folate in mothers of children with Down Syndrome and in mothers of children without congenital abnormalities. Methods: A case-control study was accomplished, with a sample of 100 mothers from which, 50 had children with Down Syndrome and 50, considered group control, children without congenital abnormalities. A questionnaire of quantitative frequency was applied containing questions related to the socioeconomic class and the food-source consumption, and foods fortified with folic acid. All participants signed the Informed Consent Form. Results: Among the variables in analysis, only the daily amount of folic acid consumed and the age that the mothers had their babies were significant different between the two groups. Mothers of children with Down Syndrome consumed 359,1 μg/day (dp ± 91,9) of folate, while the mothers of control group consumed, 425,5 μg/day (dp± 104,3), (p=0,001). The age that they had their babies were in group case 27, 5 years (dp± 4,8) and in the control group, 25,4 (dp ±5,3), (p=0,042). Only 3,4% of the interviewee related use of folic acid or others vitamines before or during the pregnancy. Conclusion: Although in the present study has been a significant difference between the consumption of folate in the case group and in the control, is important not to discard possible biochemical factors involved and here not evaluated.

Objetivo: Verificar se há diferença entre o consumo habitual de folato entre mães de crianças com Síndrome de Down e mães de crianças sem malformações. Métodos: Foi realizado um estudo de caso-controle, com um total de 100 mães das quais 50, incluídas no grupo caso, apresentavam filhos com Síndrome de Down e 50, consideradas grupo controle,tinham filhos sem malformações congênitas. Aplicou-se um questionário de consumo habitual de alimentos contendo questões relativas à classificação sócio-econômica e ao consumo de alimentos-fonte e alimentos fortificados com esta vitamina. Todas participantes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Entre as variáveis analisadas, somente a quantidade de ácido fólico consumida habitualmente e a idade no momento do nascimento do filho, diferiram-se significantemente entre os grupos. Mães caso consumiram em média 359,1 μg/dia (dp ± 91,9) de folato, enquanto as mães do grupo controle, 425,5 μg/dia (dp± 104,3), (p=0,001). A idade que tiveram seus filhos foi no grupo caso 27, 5 anos (dp± 4,8) de e no grupo controle de 25,4 (dp ±5,3), (p=0,042). Somente 3,4% das entrevistadas relataram uso de ácido fólico ou polivitamínicos de forma periconcepcional ou em algum momento da gestação. Conclusões: Embora pelo presente estudo tenha havido diferença significativa entre o consumo de folato no grupo caso e no controle é importante que não se descarte possíveis fatores bioquímicos envolvidos e aqui não avaliados. / Objective: Check if exists difference between the usual consumption of folate in mothers of children with Down Syndrome and in mothers of children without congenital abnormalities. Methods: A case-control study was accomplished, with a sample of 100 mothers from which, 50 had children with Down Syndrome and 50, considered group control, children without congenital abnormalities. A questionnaire of quantitative frequency was applied containing questions related to the socioeconomic class and the food-source consumption, and foods fortified with folic acid. All participants signed the Informed Consent Form. Results: Among the variables in analysis, only the daily amount of folic acid consumed and the age that the mothers had their babies were significant different between the two groups. Mothers of children with Down Syndrome consumed 359,1 μg/day (dp ± 91,9) of folate, while the mothers of control group consumed, 425,5 μg/day (dp± 104,3), (p=0,001). The age that they had their babies were in group case 27, 5 years (dp± 4,8) and in the control group, 25,4 (dp ±5,3), (p=0,042). Only 3,4% of the interviewee related use of folic acid or others vitamines before or during the pregnancy. Conclusion: Although in the present study has been a significant difference between the consumption of folate in the case group and in the control, is important not to discard possible biochemical factors involved and here not evaluated.