Search Results (384)

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article

Background/Objectives: Anemia is a multifactorial condition influenced by nutritional deficiencies, chronic diseases, and inflammatory processes. These factors not only contribute to anemia but may also exacerbate oral conditions such as Oral Lichen Planus (OLP) by impairing epithelial integrity and immune function. By synthesizing published studies, this review seeks to clarify whether anemia is associated with OLP and to highlight biological mechanisms common to both conditions that could be relevant for future therapeutic development. Methods: A comprehensive literature search was conducted across the selected electronic databases: Medline/Pubmed, Scopus, and Cochrane. Methodological quality and potential bias of the included studies were evaluated using the Newcastle–Ottawa Scale (NOS), while the overall certainty of the evidence was appraised according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework. Forest plots were generated using the Cochrane RevMan software to evaluate and visually summarize the results of the included studies. Results: Application of the search strategy resulted in the identification of 549 articles; after applying exclusion and inclusion criteria, 11 papers were selected. The prevalence of anemia, iron deficiency, and folic acid deficiency was significantly increased in the study population (p < 0.05); whereas hemoglobin deficiency was observed exclusively in women with statistical significance (p < 0.00001), driven by a single large study. Conclusions: Patients with OLP show a higher prevalence of anemia and deficiencies in key hematologic micronutrients such as vitamin B12, folic acid, and iron. Routine laboratory evaluation is recommended to detect and manage these systemic alterations. In addition to corticosteroid therapy, micronutrient supplementation may serve as a useful complementary treatment approach. Full article

Maternal undernutrition remains a major modifiable risk factor for adverse pregnancy outcomes. Dietary supplements are widely used to bridge nutritional gaps, but their efficacy, safety, and quality control remain controversial. This review critically evaluates the mechanisms, clinical evidence, and quality assurance of key supplements (folic acid, iron, vitamin D, calcium, iodine, omega-3 PUFA, choline, and multiple micronutrients) specifically in pregnant and postpartum women. We highlight that while folic acid (400–800 µg/d) and iron supplementation reduce neural tube defects by >70% and maternal anaemia by 30–50%, respectively, high-dose antioxidant cocktails (vitamins C + E) have shown no benefit and potential harm in large RCTs. Up to 18–40% of commercially available prenatal supplements contain undeclared pharmaceuticals, heavy metals, or incorrect dosages, underscoring the urgent need for advanced analytical methods (LC-MS/MS, HRMS, NMR). We propose the GAPSS (Genotype–Analytics–Physiology–Safety–Sustainability) framework for future personalised maternal nutrition. Rigorous, pregnancy-specific quality control combined with biomarker-guided supplementation is essential to maximise benefits and minimise risks. Full article

Background: Folic acid supplementation (FAS) before and in early pregnancy prevents neural tube defects, but the benefits of extending FAS to late pregnancy on pregnancy outcomes remain unclear. We aimed to investigate the associations between duration of FAS and a spectrum of pregnancy outcomes, and to determine whether the associations were modified by maternal age or pre-pregnancy body mass index (BMI). Methods: This prospective multicenter study included 15,694 singleton pregnancies. We used mixed-effects log-binomial regression models to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for gestational diabetes mellitus (GDM), gestational hypertensive disorders (GHDs), pre-eclampsia, preterm birth, macrosomia, small (SGA) and large for gestational age (LGA), and the interaction effects of advanced maternal age and pre-pregnancy BMI. Results: Of 15,694 women, 4523 (28.8%) did not take FAS before or during pregnancy, 2854 (18.2%) took FAS only during peri-pregnancy, 921 (5.9%) took FAS from peri- to mid-pregnancy, and 7396 (47.1%) took it through late pregnancy. Compared with women without FAS, those supplemented until mid-pregnancy were associated with lower risks of GHDs (aRR 0.84, 95% CI 0.74, 0.96) and pre-eclampsia (aRR 0.81, 95% CI 0.67, 0.97). Supplementation until late pregnancy was associated with lower risks of preterm birth (aRR 0.67, 95% CI 0.59, 0.76), SGA (aRR 0.74, 95% CI 0.63, 0.87), and LGA (aRR 0.88, 95% CI 0.79, 0.97). Among women of advanced maternal age or with overweight/obesity, supplementation until mid-pregnancy was associated with higher risk of GDM. Conclusions: Extending FAS until mid-pregnancy is associated with lower risks of GHDs and preeclampsia, and extending it until late pregnancy is associated with lower risks of preterm birth, SGA, and LGA. However, women of advanced maternal age or with overweight/obesity should be cautious about prolonging FAS. Full article

A universal HPLC method with diode array detection was developed for the separation and determination of the lactone and acid forms of monacolin K in the presence of other active ingredients (vitamins B₁, B₆, B₁₂, and folic acid) found in selected dietary supplements. The method also enables the quantitative determination of citrinin in monacolin K. Chromatographic separation was performed on an ACE 5 C18-PFP column (250 × 4.6 mm) thermostated at 25 °C. The mobile phase consisted of 0.005 M phosphate buffer (pH 2.60) and acetonitrile under linear gradient elution conditions. Detection was carried out spectrophotometrically at 230 nm for monacolin K and 325 nm for citrinin. The total run time was 28 min. The method was validated and met the acceptance criteria for specificity, linearity, sensitivity, accuracy, and precision. Linearity was achieved over a broad concentration range: 12.48–37.44 μg·mL⁻¹ for MK and 3.48–5.22 μg·mL⁻¹ for CTN. The method is sufficiently sensitive, with LOD and LOQ values of 0.91–2.85 μg·mL⁻¹ and 2.18–3.48 μg·mL⁻¹ for MK and CTN, respectively. Good precision (RSD < 0.70%) and intermediate precision (RSD < 1.33%) were observed. The accuracy of the method, expressed as percentage recovery at three concentration levels, ranged from 98.73% to 100.64%. The analysis revealed that the monacolin K content in randomly selected dietary supplements did not comply with the manufacturer’s declaration in any case. Full article

Background/Objectives: Micronutrient deficiencies during infancy remain a major public health concern, particularly in developing countries. Although exclusive breastfeeding is the optimal source of nutrition for infants up to six months of age, limited studies have simultaneously evaluated multiple micronutrient statuses in this population. This study aimed to assess the levels of vitamin D, iron, and other micronutrients—including vitamins A, E, B12, folic acid, zinc, and copper—in exclusively breastfed infants. Methods: This cross-sectional study was conducted between 2022 and 2024 at a university well-child clinic in İzmir, Turkey. A total of 132 healthy, exclusively breastfed six-month-old infants were included. Blood samples were analyzed for hemogram, serum iron, ferritin, 25(OH)D, vitamins A, E, B12, folic acid, zinc, and copper. Sociodemographic data and supplementation practices were recorded. Deficiency cut-offs were defined according to WHO and national guidelines. Results: Among the infants, 40.2% had iron deficiency or anemia, and 14.4% had vitamin D deficiency. Vitamin B12, A, E, zinc, and copper deficiencies were identified in 29.5%, 2.4%, 4%, 7.4%, and 6.6% of infants, respectively. Regular vitamin D and iron supplementation were significantly associated with lower deficiency rates (p < 0.05). Maternal education level, dressing style, and smoking status were significantly related to infant vitamin D status. Conclusions: Despite national supplementation programs, iron and vitamin D deficiencies remain common in exclusively breastfed infants. Routine and regular supplementation should be emphasized, and subclinical deficiencies—particularly vitamin B12—should be considered. Broader studies evaluating maternal nutritional factors and socioeconomic determinants are warranted to guide preventive strategies. Full article

Background: Adequate folate intake before and during early pregnancy is essential for neural tube defect (NTD) prevention. In 2023, the Polish Society of Gynecologists and Obstetricians updated national recommendations, emphasizing the use of L-5-methyltetrahydrofolate (5-MTHF). Evidence on women’s awareness of these guidelines is limited. Methods: This cross-sectional online survey (2025) included 188 Polish women aged 18–45 years who were currently pregnant or had been pregnant within the previous 12 months. Knowledge, attitudes, and supplementation practices were compared between women with (n = 94) and without infertility (n = 94). Group differences were assessed using χ² tests, and predictors of 5-MTHF use were examined with multivariable logistic regression. Results: General awareness of folate recommendations was high (98.9%). However, detailed knowledge varied substantially. Women with infertility more frequently recognized different folate forms (87.2% vs. 72.3%; p = 0.018), knew the role of the MTHFR gene (77.7% vs. 39.4%; p < 0.001), and initiated supplementation ≥3 months before conception (88.3% vs. 47.9%; p < 0.001). Overall, 66% reported using 5-MTHF. Independent predictors of choosing 5-MTHF included awareness of folate forms, MTHFR knowledge, and awareness of emerging considerations related to folic acid metabolism. Infertility status was not an independent predictor. Conclusions: Although folate supplementation was nearly universal in this selective sample, more advanced knowledge—particularly regarding folate forms and genetic aspects of folate metabolism—remained limited. Higher awareness among women with infertility likely reflects greater exposure to medical supervision rather than inherent differences between groups. These findings may represent early signals of how the 2023 Polish recommendations are disseminating among women who are more engaged with health information, highlighting the need for continued public and professional education to support informed use of folate supplements. Full article

Background/Objectives: In Pakistan, 41.7% of women of reproductive age and 53.7% of children aged 6–59 months are anaemic. This study aimed to evaluate the effectiveness of a nutritional supplementation programme, underpinned with behaviour change communication and implemented through Lady Health Workers (LHWs), in reducing anaemia among pregnant and lactating women as well as 6–59-month-old children. Methods: This study used a quasi-experimental design with an intervention and a control group. A total of 2821 and 2410 pregnant and lactating women and 3397 and 3277 children aged 6–59 months participated in the baseline and endline surveys, respectively. The study areas were matched for demographic and economic characteristics, and both had routine public-sector health and nutrition programmes, including iron–folic acid supplementation during pregnancy. The participants in the intervention group received additional nutritional support. Throughout the pregnancy and in the first six months of exclusive breast feeding, women were provided 5 kg (165 g/day) of wheat soya blend (WSB) per month. Children aged 6–23 months received lipid-based nutrient supplements (LNS), and those aged 24–59 months received micronutrient powder. We applied a difference-in-difference (DID) analysis with kernel propensity score matching to assess the impact on anaemia, a secondary outcome of a stunting prevention programme. Results: Maternal anaemia (both pregnant and breastfeeding women) declined substantially in the intervention areas from 80.4% to 62.6% compared with a smaller reduction in the control areas (80.0% to 72.9%). The DID estimate showed a 10.7-percentage-point (pp) greater decline in maternal anaemia (p ≤ 0.001). Both pregnant and lactating women benefited, with DID reductions of 16.7 pp (p ≤ 0.001) and 9.4 pp (p = 0.005), respectively. The largest gains occurred among women in higher-wealth quintiles, with reductions up to 22.6 pp (p ≤ 0.001). In contrast, childhood anaemia showed no overall significant difference between intervention and control areas (DID = −0.7 pp, p = 0.73). However, significant improvements were observed among male children (DID = −10.3 pp, p = 0.001) and those in higher-wealth quintiles (DID = −15.0 pp, p = 0.002). Conclusions: Overall, the findings suggest that LHWs can effectively reduce maternal anaemia when iron–folic acid supplementation is complemented with WSB and targeted behaviour change communication. Full article

The Polish dietary supplement market is undergoing rapid development, driven by an increasing societal interest in preventative healthcare and the utilisation of products that have demonstrated efficacy. Poland is a leading European dietary supplement market, driven by a number of factors, including increased nutritional awareness, an ageing population, and intensive marketing efforts by manufacturers. In this study, the elemental composition of 24 dietary supplements containing iron, folic acid, and other vitamins and essential macro- and micronutrients was examined using CV AAS, F AAS, and ICP-OES techniques. The samples analysed included supplements intended for pregnant and breastfeeding women, supplements for individuals struggling with anaemia, and multivitamin supplements containing a complete set of both vitamins and minerals. In order to ensure the accuracy of the product, the mineral doses listed in the package inserts were also verified. The study’s findings revealed significant discrepancies between the doses declared by manufacturers and the doses obtained through analysis, particularly with regard to iron and zinc. Furthermore, an inconsistency was observed between the mineral doses and the values recommended by Polish law. Full article

Objectives: The purpose of this study is to observe the preventive effect of folic acid (FA) combined with melatonin (MLT) on high-fat diet (HFD)-induced hepatic steatosis and to explore its potential mechanism. Methods: Fifty male C57BL/6J mice were randomized into five groups: control group (CN), high-fat diet group (HD), FA supplementation group (HF), MLT supplementation group (HM), and FA combined with MLT supplementation group (HFM). The experiment lasted for 10 weeks. Results: FA combined with MLT effectively inhibited HFD-induced increases in liver index, hepatic TG levels, and serum TG levels. Histological examination revealed that FA combined with MLT significantly reduced the area of hepatic steatosis and the accumulation of lipid droplets (LD). Western blot analysis showed FA combined with MLT activated AMPK, inhibiting the expression of ERS-related proteins, thereby reducing the expression of LD lipolysis-associated proteins. Conclusions: FA combined with MLT might prevent HFD-induced hepatic steatosis by attenuating ERS and subsequently promoting LD lipolysis. Full article

Background: Cancer patients often use natural health products (NHPs) during chemotherapy without medical supervision. We have previously described the clinical cases of two patients taking capecitabine in combination with folate supplements who suffered from severe diarrhoea and hand-foot syndrome, emphasising that the combination of NHPs with chemotherapeutic agents such as fluoropyrimidines (FPs) can lead to life-threatening events. Although the potential harmful interaction between folate supplements and capecitabine is reported in the summary of product characteristics for this FP, it remains unclear, and evidence regarding interactions with other NHPs is even more limited. Objectives/Methods: This narrative review aimed to provide an update on the literature regarding the effects of combining NHPs and FPs, describing the results of randomised clinical trials and observational studies to provide a critical analysis of the factors influencing the clinical outcomes of cancer patients following this therapeutic approach. Results: Herbal supplements belonging to traditional Chinese medicine and other NHPs, including polyunsaturated fatty acids and probiotics, may reduce the incidence and severity of gastrointestinal, haematological, and skin toxicities related to FPs. In addition to potential safety benefits, NHPs may improve the efficacy of FP-based therapy. Folate supplements appear to improve efficacy outcomes, such as disease-free survival and overall survival, but have also been associated with serious FP-related adverse events. However, the results are mixed, partly because they are influenced by the patient’s genetic background. Conclusions: Overall, the available data are inconclusive and do not support the introduction of natural products as complementary therapy in cancer patients undergoing FP-based chemotherapy, highlighting the need for further investigation. Full article

Background: Preconception care (PCC) is a key element of preventive reproductive health, aiming to optimise maternal and child outcomes by addressing biomedical, behavioural, psychosocial, and genetic risks before conception. International frameworks provide clear guidance, yet implementation in many low- and middle-income countries remains inconsistent. Methods: A structured narrative review was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on literature published between 2010 and 2025. Eligible sources included empirical studies, clinical guidelines, policy documents, and high-quality grey literature from health authorities. Quality, relevance, and applicability were assessed, with particular emphasis on European and Bulgarian contexts. Results: Evidence from diverse settings demonstrates that PCC interventions—such as chronic disease management, vaccination, lifestyle optimisation, and expanded carrier screening (ECS)—can reduce adverse pregnancy outcomes and prevent severe genetic disorders. Effective international models integrate PCC into primary care, leverage digital health tools, and ensure equitable access through public funding. In Bulgaria, PCC remains underdeveloped: genetic screening is not part of routine care, there are no national guidelines or surveillance systems, and only ~4% of women initiate folic acid supplementation before pregnancy. NGOs and EU-funded digital initiatives provide partial outreach but cannot replace state-supported services. Conclusions: Bulgaria urgently requires a coordinated national PCC strategy, incorporating standardised guidelines, provider training, digital platforms, and phased ECS introduction. Strengthening PCC delivery can reduce preventable maternal and neonatal morbidity, advance reproductive justice, and enhance the long-term sustainability of public health systems. These findings support the development of a publicly funded, guideline-driven national PCC strategy with phased introduction of expanded carrier screening under NHIF to improve equity and long-term system sustainability. Full article

Objectives: Maternal folic acid supplementation is recommended to prevent neural tube defects (NTDs), yet its influence on offspring neurodevelopmental disorders (NDDs) remains uncertain. This umbrella review aims to evaluate whether maternal folic acid supplementation before and/or during pregnancy affects the risk of NDDs. Methods: We conducted a systematic search in MEDLINE, Cochrane Library, EMBASE, PubMed, and Web of Science from inception to 30 June 2025, to identify systematic reviews (SRs) and meta-analyses (MAs) that synthesized evidence from non-randomized studies on maternal folic acid supplementation and NDDs. Methodological quality was assessed using the AMSTAR-2 assessment and evidence certainty using the GRADE framework. Results: A total of 23 SRs/MAs were included, of which 14 did not perform meta-analysis. Most included SRs/MAs were methodologically limited, with 50.00% rated as very low quality and only 36.37% achieving high or moderate quality. MAs indicated a protective effect of supplementation, with odds ratio (OR) of 0.66 (95% confidence interval (CI): 0.55–0.79) for autism spectrum disorder (ASD), 0.86 (95% CI: 0.78–0.95) for attention-deficit/hyperactivity disorder (ADHD), and 0.75 (95% CI: 0.63–0.91) for behavioral problems. No significant associations were found for motor, intellectual/cognitive, or language development. SRs reported inconsistent conclusions across most outcomes. Conclusions: In summary, maternal folic acid supplementation may reduce the risk of ASD, ADHD, and behavioral problems in offspring. Although the current evidence is of low quality, supplementation guidelines are justified by the well-established benefits for NTDs. Further research is required to address remaining uncertainties. Full article

Background/Objectives: Zinc deficiency remains a public health concern in South Asia but is rarely studied through gestation to infancy. Methods: We identified maternal and infant factors related to plasma zinc of 3 mo old Bangladeshi infants (n = 317) in the context of a trial of a daily antenatal to 3 mo postpartum multiple micronutrient supplementation (MMS) with 15 vitamins and minerals, including 12 mg zinc, versus iron–folic acid (IFA). Factors explored included maternal age, parity, and plasma zinc in early (pre-supplementation) and late pregnancy, at 3 months postpartum, and in milk; cord blood zinc (n = 83); birth outcomes; and infant feeding and biomarkers. Consequently, infant zinc was explored with 3 mo anthropometry and growth rates. Results: Mean ± SD infant plasma zinc was 15.63 ± 6.65 µmol/L, with 10.1% deficiency (<9.9 µmol/L). In adjusted analyses, infant zinc was positively associated with maternal age [20–30 years +0.11 µmol/L (p = 0.018) and ≥30 years +0.28 µmol/L (p = 0.003) relative to <20 years], maternal early pregnancy zinc (+0.01 µmol/L per 1 µmol/L maternal zinc, p = 0.011), and infant ferritin (+0.001 µmol/L per 1 µg/L, p = 0.007); conversely, infant zinc was −0.13 µmol/L lower (p = 0.013) with maternal parity ≥2 versus 0–1 and with partial versus exclusive breastfeeding (−0.15 µmol/L, p = 0.038). Relationships with MMS, maternal later pregnancy, postpartum, milk, and cord blood zinc were absent. Length-for-age (+0.02 per µmol/L, p = 0.047) but not weight-for-length Z-scores at 3 months were associated with infant zinc. Conclusions: Thus, infant zinc was associated with pre- but not post-MMS maternal zinc, age and parity, feeding style, and infant iron status. Infant length but not weight was associated with plasma zinc. Full article

Sepsis remains one of the major challenges in modern intensive care, characterized by high mortality and complex metabolic and immunological disturbances. Given the limited effectiveness of current therapeutic strategies, increasing attention has been directed toward supportive interventions aimed at restoring metabolic homeostasis. Particular interest has been focused on selected vitamins that exhibit pleiotropic biological effects. Thus, we summarized the current evidence on the role of selected vitamins (C, D, B1, B9, B12) in the treatment and supportive management of sepsis, highlighting their mechanisms of action, potential clinical benefits, and limitations derived from available studies. A comprehensive analysis of the literature was performed, including clinical trials and meta-analyses evaluating the efficacy of vitamin supplementation in sepsis, with particular emphasis on combined interventions and randomized controlled trials in severe sepsis and septic shock. Vitamin D might demonstrate the greatest therapeutic potential, particularly in patients with severe sepsis and respiratory failure, with benefits associated with achieving appropriate therapeutic concentrations. Thiamine (vitamin B1) appears to provide potential advantages primarily in deficient patients, improving mitochondrial function and reducing the risk of renal failure. Evidence regarding folic acid (vitamin B9) and cobalamin (vitamin B12) remains inconclusive, as both deficiency and elevated serum levels have been linked to adverse outcomes. Vitamin C, despite its well-documented antioxidant and microcirculatory effects, has not yet shown consistent evidence of mortality reduction. In conclusion, current evidence suggests that vitamin supplementation might represent an adjunct to standard sepsis therapy, particularly within a personalized approach that considers nutritional status and metabolic phenotype. The development of standardized dosing protocols and well-designed clinical trials is essential to determine the efficacy and safety of phenotype-driven individualized approaches in sepsis management. Full article