Search Results (171)

Introduction: Asthma is the most common chronic inflammatory disease in childhood, with complex pathogenesis and heterogeneous clinical manifestations. Current efforts are focused on achieving remission through phenotyping and personalized therapy. Micronutrient deficiency is commonly observed in both children and adults, and current evidence points to their role in the pathogenesis of numerous acute and chronic conditions. Method: In this narrative review, we analyzed current information regarding the influence of micronutrient deficiencies on asthma control. The aim was to clarify the extent to which current knowledge provides evidence for implementing specific dietary measures in children with asthma to achieve disease control. We conducted a review of the literature covering the past 20 years to assess the impact of iron, vitamin D, and folic acid deficiency on asthma control. The research was performed in PubMed, Web of Science, Cochrane Library and Embase. Results: Vitamin D deficiency is associated with the frequency of asthma exacerbations in children. However, data regarding the severity of exacerbations, hospitalizations, or emergency department visits are not consistent across different studies. Vitamin D supplementation has controversial effects on disease control. Iron deficiency may contribute to the development of asthma, but there is no clear evidence. Observational studies have reported associations between iron deficiency, poorer asthma control, frequent exacerbations, and impaired lung function. An association between low folate levels and increased asthma risk and poorer asthma control was also reported. Conclusions: Assessing micronutrient status in children with asthma and the effect of correcting deficiencies as part of a personalized treatment plan to achieve symptom control remains a topic that requires further research. Full article

Anemia among adolescent girls remains a persistent public health challenge in Indonesia, driven by limited nutritional knowledge, poor dietary practices, and suboptimal adherence to iron supplementation programs. This study is grounded in the Social–Ecological Model (SEM), which frames health behaviors as shaped by individual, interpersonal, institutional, and community-level factors. This study aimed to explore students’ knowledge and dietary behaviors related to anemia, assess perceptions of existing supplementation programs, and examine teachers’ and students’ perspectives on school-based digital education for anemia prevention in Denpasar, Bali. A qualitative descriptive design was employed across eight public junior high schools. Participants included eight teachers and 40 female students (aged 13–15 years) selected via purposive sampling. Data were collected through semi-structured in-depth interviews, non-participant observations, and document analysis. Thematic analysis was conducted using Atlas.ti version 23, with trustworthiness ensured through triangulation, member checking, peer debriefing, and iterative saturation assessment. Four inter-related themes emerged: (1) students held superficial, menstruation-centric conceptualizations of anemia with limited understanding of iron deficiency as an underlying cause; (2) dietary patterns were dominated by low-iron foods with poor vegetable consumption; (3) adherence to the Weekly Iron and Folic Acid Supplementation (WIFAS) program was inconsistent, hindered by side effects, forgetfulness, and low perceived benefit; and (4) both teachers and students expressed strong interest in digital education tools while identifying infrastructure and training gaps as barriers. Anemia prevention in school settings requires a multi-level approach integrating knowledge improvement, dietary behavior support, and institutional reinforcement. School-based digital education represents a contextually appropriate, youth-aligned innovation with strong potential to bridge the gap between health information and sustained behavioral change. Full article

Background/Objectives: Pakistan has one of the highest burdens of adolescent anaemia in South Asia. A Weekly Iron-Folic Acid Supplementation (WIFAS) program for school-going adolescent girls aged 10–19 years was piloted in the Lodhran District, Punjab, Pakistan. Methods: A quantitative cross-sectional study was conducted among 750 girls, selected by multi-stage random cluster sampling from 50 public schools across Lodhran; qualitative data were generated through in-depth interviews and focus group discussions with 327 stakeholders. Quantitative data were analyzed using a chi-square test in SPSS. Qualitative data were analyzed in NVIVO using thematic analysis based on the Socio-Ecological Model, enabling environment and institutional systems, community engagement, behavior change and adolescent empowerment and agency. Coding was guided by overarching research questions of acceptability, feasibility and impact. Cases of anaemia averted were estimated using program data and outcome modeling. Qualitative findings were triangulated with quantitative results. Results: The program reached 30,506 girls and was estimated to have averted 5659 cases of anaemia. WIFAS coverage increased from 0% to 100%, with a high level of adherence (80%). Knowledge about anaemia, its signs/symptoms and preventative measures increased significantly at endline. Dietary practices showed positive changes, with significant increase in girls never skipping a meal. Stakeholders attributed success to the creation of an enabling environment through institutional alignment and multisectoral collaboration, culturally adapted, adolescent-friendly materials, and robust community mobilization that proactively addressed socio-cultural barriers. Conclusions: The school-based WIFAS program for reducing anaemia among adolescent girls was feasible and acceptable in a context where few nutrition services are available to girls. Full article

Anemia affects nearly half of all pregnant and lactating women in India. Suboptimal compliance is often due to lack of awareness on effective management of perceived side effects, issues in ensuring regular last mile availability for distribution to beneficiaries owing to challenges in timely and adequate procurement supply chain management issues, family and household dynamics, lack of support for maternal nutrition. Implementation research was conducted in two states of India to deliver a package of interventions with the objective of preventing and managing anemia and improving health by increasing compliance with IFA and calcium supplements among pregnant and lactating women. Method: A quasi-experimental approach with a non-equivalent control group was adopted to assess the effectiveness of the model in a pragmatic setup across two blocks in each of the two states, divided into intervention and control arms (2007 pregnant and 2117 lactating women). Both arms continued with the standard government programs. Health systems interventions like supply chain strengthening, capacity building, behavior change were designed and delivered to ensure availability, accessibility and utilization of IFA and calcium by the beneficiaries in the intervention arm. The primary outcome was compliance with IFA among pregnant women. Secondary outcomes were compliance with calcium among pregnant women and IFA and calcium among lactating women. Difference-in-difference (DID) analysis was conducted, and logistic regression identified contributing factors. Results: The intervention package resulted in 26% improved compliance (DID: 8.1% vs. 1.5%) with IFA among pregnant women in the intervention arm compared to baseline. Similarly, compliance with IFA in lactating women increased by 49.2%. The attributable fraction was greatest (24.4%) for ‘proper instructions’ given. Compliance with calcium increased by 59% among pregnant women in one state, where the baseline parameters were lagging and interventions were initiated early within the stipulated time. Standardized ANC services and provision of proper instructions were consistently found to be associated with improved compliance. Interventions led to improved supply chain management, distribution of IFA and calcium in adequate quantities, increased awareness in the community, and better access to services. Conclusions: The intervention model was found to be effective in improving compliance with IFA in pregnant and lactating women. It is concluded that provision of proper instructions while distributing supplements seemed to have the greatest impact in improving compliance. State-specific variations highlight the need for tailored approaches. Scaling up such models, with emphasis on systemic and behavioral enablers, could strengthen India’s anemia control efforts. Full article

Background: Adequate nutrition during pregnancy is essential for maternal health, pregnancy outcomes, and foetal development. However, general awareness of healthy eating may not translate into detailed nutritional knowledge or appropriate dietary practices. This study assessed nutritional knowledge and selected dietary behaviours among pregnant women from urban and rural areas of the Pomeranian Voivodeship, Poland, in two periods: 2008–2010 and 2017–2019. Methods: A repeated cross-sectional questionnaire study was conducted among 938 pregnant women, including 630 respondents surveyed in 2008–2010 and 308 in 2017–2019. The original questionnaire assessed sociodemographic characteristics, nutritional knowledge, dietary behaviours, sources of information, supplementation practices, and selected health-related behaviours. Internal consistency was good (Cronbach’s alpha = 0.88). Results: Most respondents were aged 25–34 years, married, and had normal pre-pregnancy or early-pregnancy BMI. Compared with 2008–2010, women surveyed in 2017–2019 more often had higher education and more frequently reported income above the predefined questionnaire threshold. Although general awareness of healthy nutrition during pregnancy was high, detailed knowledge of key nutrients remained insufficient. Correct knowledge of the role of folic acid was reported by 58% of respondents, iron by 36%, vitamin D by 29%, iodine by 21%, and calcium by 18%. Prenatal supplement use was common, but only 39% reported supplementation based on medical recommendations. Frequently reported dietary problems included irregular meals, low fish consumption, frequent sweets intake, insufficient water intake, and low vegetable and fruit consumption. Knowledge of selected nutrient-rich foods was higher in 2017–2019, particularly for omega-3 fatty acid and vitamin D sources. Conclusions: Nutritional knowledge was heterogeneous, and practical gaps in dietary behaviours persisted, supporting the need for accessible and individualized prenatal nutrition education. Full article

Background/Objectives: Chronic undernutrition in the first 1000 days continues to be a significant public health concern in Ecuador. This study examined associations between infant feeding practices, maternal supplementation, socioeconomic factors, and stunting in the first two years of life using explainable machine-learning methods. Methods: The analysis was based on 8613 eligible children aged 0–23 months from the Ecuadorian National Child Malnutrition Survey (Encuesta Nacional sobre Desnutrición Infantil, ENDI) 2023–2024, of whom 8344 had non-missing stunting status and were included in the final modelling sample. Results: Among the children included in the modelling sample, stunting was observed in 18.7%. Maternal iron and folic-acid supplementation were associated with lower stunting prevalence, while breastfeeding and complementary feeding indicators showed weak linear associations but contributed to model predictions in explainability analyses. SHapley Additive exPlanations (SHAP) additionally highlighted geographic and socioeconomic variation, with province, area of residence, and socioeconomic indicators ranking among the features contributing to model prediction. Predictive performance was modest to moderate across models, with area under the receiver operating characteristic curve (AUC) values ranging approximately from 0.62 to 0.66 across the main model specifications. Model performance remained stronger for the majority non-stunted class than for the minority stunted class, highlighting the challenge of detecting stunted children in an imbalanced analytic ENDI sample. Conclusions: Overall, the results suggest that stunting in the analytic sample was represented by multidimensional predictive patterns involving prenatal, nutritional, socioeconomic, and geographic factors, and illustrate the potential value of explainable machine learning for identifying multidimensional risk patterns in child nutrition research. Full article

Background: The United Nations International Multiple Micronutrient Antenatal Preparation of a multiple micronutrient supplement (UNIMMAP MMS or MMS) is replacing iron and folic acid supplementation (IFAS) in antenatal care (ANC) in low- and middle-income countries (LMICs). An investigation into determining how to secure a sustainable supply of MMS began in response to the Indonesian Ministry of Health (MOH)’s decision to introduce MMS into its national health services. Objective: We aimed to identify and test sustainable strategies for securing MMS supplies. Methods: A three-phase implementation science framework was applied to (1) foster an enabling environment for securing MMS supplies, (2) undertake implementation research (IR) to compare sourcing strategy options, and (3) plan and execute actions to scale MMS supply availability and distribution. The MOH assumed ownership of the initiative and guided policy, procurement, and program decisions. Results: (1) Landscaping resulted in recommendations that triggered supply-related policies, an accommodating regulatory framework, integration of MMS into key government support systems (i.e., budget, finance, procurement, and distribution), and identification of supply strategy options. (2) IR resulted in the selection of a local manufacturing and sourcing strategy for acquiring a sustainable supply of high-quality MMS product while retaining an option to import a limited supply of MMS during scaling. (3) A multi-year plan was developed to scale MMSs within ANC services. Conclusions: Applying implementation science provided an evidence-based framework with which to identify, establish, and test a sustainable strategy for securing MMS supplies and yielded insights useful for other countries introducing MMS into their national health systems. Full article

Despite declining malaria transmission, maternal anaemia and low birthweight (LBW) remain high in Ghana, suggesting that non-malarial determinants now dominate these outcomes. A cohort of 5197 pregnant women was enrolled at eight health facilities across Ghana’s Ashanti and Volta regions. Independent predictors of anaemia at term and LBW were identified by multivariable logistic regression using multiple imputation by chained equations. Anaemia at term prevalence was 60.57% and LBW was 11.54%. No intestinal helminths were detected. Anaemia at antenatal care (ANC) booking was the strongest predictor of anaemia at term (aOR 3.98; absolute risk increase of 31.4 percentage points). Three or more iron and folic acid doses and eight or more ANC contacts each reduced risk by only four to six percentage points. For LBW, household poverty (absolute risk increase 8.8%), short maternal stature, and male foetal sex dominated. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine–pyrimethamine (aOR 0.65) remained protective despite booking parasitaemia being non-significant. The Volta region had higher anaemia (71.1%vs. 47.7%) but lower LBW (9.6%vs. 14.4%) than Ashanti, with markedly higher parasite densities among infected women, consistent with waning naturally acquired immunity. Persistent anaemia and LBW reflect nutritional depletion, structural poverty, and increased malaria vulnerability under declining transmission. Pre-conception nutrition, social protection, and sub-microscopic malaria surveillance must complement clinic care. Full article

Background/Objectives: Heart transplant recipients are particularly at risk for micronutrient deficiencies due to chronic immunosuppression, metabolic disorders, gastrointestinal absorption disorders, and increased postoperative demand. Despite a growing body of evidence suggesting their clinical relevance, the prevalence, characteristics, and consequences of these deficiencies remain poorly defined. The aim of this review was to assess of selected micronutrient deficiencies in personnel after heart vaccination and risk factors for their control. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute’s scope review methodology and presented in accordance with the PRISMA-ScR guidelines. A systematic search of PubMed, Scopus, EBSCO, Web of Science, Google Scholar, and Cochrane Library (January–February 2026) identified studies assessing micronutrient deficiencies in adult heart transplant recipients. Original publications, meta-analyses, and reviews available in full text in English were eligible for the review. Data extraction was carried out independently by two reviewers; using the PCC (Population–Concept–Context) model. Results: Of the 35 pre-identified records, 12 studies met the inclusion criteria. The most commonly reported deficiencies included iron, vitamin D, and B vitamins, and their incidence varied widely due to heterogeneous diagnostic criteria. Iron deficiency—both absolute and functional—was common and often associated with inflammation and impaired hepcidin regulation. Vitamin D deficiency persisted before and after transplantation and was associated with impaired bone health, inflammation, and a potentially increased risk of infection. Elevated homocysteine levels associated with low levels of folic acid and vitamin B6 have been identified as potential contributing factors to atherosclerotic and thrombotic complications. Limited evidence also points to deficiencies in iodine, zinc, and other trace elements. Conclusions: Micronutrient deficiencies are common among heart transplant recipients and can adversely affect immune system function, cardiovascular risk, and overall clinical outcomes. Routine evaluation and targeted correction of deficiencies should be considered in post-transplant care. Further prospective, multicenter, and interventional studies are needed to establish standardized diagnostic criteria and evidence-based supplementation strategies. Full article

Background/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron–folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and as part of a broader implementation research project, this study examines MMS acceptability, pregnant women (PW)’s adherence practices and experiences, and facilitators and barriers to acceptability, adherence, and provision of MMS within public ANC services in Pakistan and Nigeria. Methods: Following introduction of MMS by the Government of Pakistan in April 2022 (Swabi District) and the Government of Nigeria in December 2023 (Bauchi State), mixed-methods research was conducted using cross-sectional surveys (one in each country), focus group discussions (6 in Pakistan, 9 in Nigeria), and in-depth interviews (7 in Pakistan, 10 in Nigeria) with PW, family members, and facility- and community-based healthcare providers (HCPs). Results: Findings in both settings showed that MMS is widely accepted, and almost all women (>97%) started consuming the MMS they received. Adherence levels, assessed using both pill-count and self-reported measures, exceeded 70%. In both countries, perceived benefits were identified as a key enabler to MMS acceptability and adherence among PW, whereas perceived negative effects acted as a barrier. Facilitators of MMS provision included trusting relationships between PW and HCPs, while delayed antenatal care (ANC) initiation, anemia screening, and limited agency of PW were identified as barriers. Conclusions: This study provides findings to inform MMS scale-up across public ANC platforms in two low- and middle-income countries and contributes to global evidence on context-specific considerations for MMS implementation. Full article

Severe browning often occurs in Multivitamin Iron Oral Solution during storage, which directly leads to the decline of product quality. To clarify the main mechanism of browning in this preparation, the contents of 5-hydroxymethylfurfural (5-HMF) and carbohydrates, as well as the relevant characteristic parameters such as color and fluorescence, were determined at different storage times in this study. Subsequently, four reaction models, namely sucrose-lysine, sucrose-citric acid, sucrose-niacin, and sucrose-folic acid, were constructed according to the formulation of the preparation to systematically investigate the effects of each system on browning. The results showed that the sucrose-lysine model was the main color-forming reaction system of the preparation. Citric acid could significantly promote the hydrolysis of sucrose to produce two reducing sugars, glucose and fructose, which not only provided sufficient substrates for the Maillard reaction (MR), but also led to the massive accumulation of 5-HMF. Further analysis revealed that heating temperature and heating time were significantly positively correlated with the contents of 5-HMF, browning index (BI), color density (CD), and reducing sugars in the solution, while significantly negatively correlated with sucrose content (p < 0.05). Two fractions, P1 and P2, were isolated by Sephadex LH-20 column chromatography. Among them, P1 with a molecular weight of 61,660 Da was identified as the key fluorescent color-forming component, whose ultraviolet and fluorescence characteristics were basically consistent with those of Multivitamin Iron Oral Solution. Ultra-performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS) analysis confirmed that P1 contained characteristic fragments of conjugated unsaturated structure, which was the key chromophore responsible for its fluorescence properties. In summary, this study explored the main browning mechanism of Multivitamin Iron Oral Solution. It was found that after citric acid catalyzed the hydrolysis of sucrose, the generated reducing sugars underwent Maillard reaction with lysine to produce fluorescent color-forming substances, and heat treatment significantly aggravated the browning process. The results of this study not only provide a solid theoretical basis for optimizing the preparation process and improving the storage stability of Multivitamin Iron Oral Solution, but also offer an important reference for the research on the browning mechanism and stability of other sugar-containing liquid preparations. Full article

Background/Objectives: Metabolic bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk of postoperative nutritional deficiencies. This study aimed to assess the impact of adherence to the Mediterranean diet on selected laboratory parameters and excess weight loss after bariatric surgery. Methods: Eighty adults with obesity were evaluated before and 6 months after surgery. Based on dietary questionnaires, patients were classified as adhering to the Mediterranean diet (n = 32) or not adhering (n = 48). Laboratory parameters, including vitamin D, vitamin B12, folic acid, iron, ferritin, calcium, hemoglobin, and total protein, were assessed pre- and postoperatively. Excess weight loss percentage (EWL%) was calculated using standard methodology. Results: Postoperatively, vitamin D and total protein levels increased in both groups, with median increases of 9.45 ng/mL and 1.1 g/dL, respectively. A significant increase in iron concentration was observed only in Mediterranean diet adherents (median +24 µg/dL), while a decrease was noted in non-adherent patients (−4 µg/dL). Iron deficiency and iron-deficiency anemia occurred exclusively in the non-Mediterranean diet group (10.4% vs. 0%). Median EWL% was higher in Mediterranean diet adherents (44% vs. 31%), although the difference was not statistically significant. Conclusions: Adherence to the Mediterranean diet may reduce the risk of iron deficiency after bariatric surgery, whereas total protein concentration alone appears insufficient for assessing nutritional status or weight loss effectiveness. Full article

Background: Low birth weight (LBW) is one of the most significant health issues worldwide, especially in countries with fewer resources. No systematic reviews or meta-analyses on LBW have been conducted in Sudan, the third largest African country. Methods: A systematic review and a meta-analysis were conducted to assess the pooled prevalence of LBW in Sudan and the associated factors. PubMed, Google Scholar, and ScienceDirect were searched for studies on LBW in Sudan. The meta-analysis was performed by calculating the pooled prevalence of LBW. The meta package in R was used for statistical analysis. Results: The final sample comprised 10 studies, with 10,043 neonates enrolled. The overall pooled prevalence of LBW was 13.0% (95% CI [13.0, 14.0]; I² = 47.0%, p = 0.05), without significant heterogeneity. Primiparity (adjusted odds ratio [AOR] = 1.4, 95% CI [1.1, 2.1]), a short interpregnancy interval, lack of iron–folic acid supplementation (AOR = 3.33, CI [1.47, 5.88]), a low level of antenatal/perinatal care (AOR = 2.10, 95% CI [1.30, 3.57]), maternal undernutrition (AOR = 1.66, 95% CI [1.09, 2.53]), and decreasing gestational age of pregnancy (AOR = 0.80, 95% CI [0.66, 0.96]) were associated with LBW in different studies. In three studies, anemia was associated with LBW. Conclusions: This review reveals a high prevalence of LBW in Sudan. The factors identified in this review may help health planners and policymakers design and implement preventive interventions for LBW. Full article

Background/Objectives: Multiple micronutrient supplements (MMS) are more effective in improving maternal and birth outcomes compared to iron and folic acid (IFA) supplementation during pregnancy. High adherence to MMS is critical to achieving all the anticipated health benefits. Therefore, to ensure successful program implementation of transitioning to MMS in Cambodia, implementation research has been prioritized. The objective of this study was to assess the relevance, acceptability, utility and short-term, exploratory adherence outcomes of three behavioral interventions designed to support adherence to daily MMS intake and to promote healthy pregnancy practices. Methods: This mixed-methods study, conducted in four provinces in Cambodia, involved 12 focus group discussions (FGD) with 36 pregnant women who were exposed to three distinct behavioral interventions (family support, a tracking calendar, and educational videos). FGDs were held after three weeks of exposure to each intervention. Data was analyzed using a COM-B model, with inductive codes added to capture emerging themes. Results: Family support emerged as the most preferred and perceived as the most effective intervention, with participants consistently valuing the presence, encouragement, and practical assistance offered by husbands and other close family members. The second most preferred were educational videos, which were perceived to effectively convey key messages in an engaging, relatable way, overcoming literacy barriers. Finally, the calendar supported habit formation and appealed to first-time mothers but posed challenges for low-literacy users. Across interventions, findings reflect participants’ perceived effectiveness and preferences rather than comparative efficacy. Conclusions: This study provided insights into Cambodian women’s preferences and experiences with three distinct interventions designed to improve adherence over a short-term, 3-week exposure period per intervention. An integrated, multilevel approach that combines family-focused, educational, and system-level strategies is recommended for further piloting and scale-up, with longer-term studies needed to assess comparative efficacy for adherence and health outcomes. Full article

Oxaliplatin (OXA) is a chemotherapeutic agent that suffers from poor pharmacokinetics and off-target toxicity. To enable controlled OXA release, we engineered a multi-functional iron oxide nanoparticle (IONPs) drug delivery system, based on pH-responsive mesoporous Fe₃O₄ (Fe₃O₄@MSN-NH₂) nanoparticles (NPs), conjugated with folic acid (FA) for receptor-mediated targeting and guided by a magnetic robot platform (MRP) under simulated physiologically relevant dynamic circulation/flow system. For FA-conjugated NPs (Fe₃O₄@MSN-NH₂/FA), ~29.73% OXA loading was achieved compared to ~10.3% in controls (Fe₃O₄@MSN-NH₂/OXA), quantified by ICP-OES. Under dynamic circulation flow over 48 h, MRP enhanced pH-responsive OXA release (quantified by HPLC-UV), reaching ~92% and 88% (Fe₃O₄@MSN-NH₂/OXA and Fe₃O₄@MSN-NH₂/FA, respectively) at pH 5, versus 47% and 40% (Fe₃O₄@MSN-NH₂/OXA and Fe₃O₄@MSN-NH₂/FA, respectively) without MRP, demonstrating precise control in acidic tumor-mimicking conditions. MRI relaxometry exhibited strong T2-weighted contrast (T2 = 0.015 s at 50 μg/mL for Fe₃O₄@MSN-NH₂/FA/OXA), confirming theranostic potential. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) studies revealed variable Folate receptor alpha (FOLR1) expression among colorectal cancer cell lines (Caco2, SW620, SW48, and T84), with Caco2 demonstrating high levels. MTT assays indicated selective targeting of FOLR1-positive cells by FA-functionalized NPs (Fe₃O₄@MSN-NH₂/FA). This multi-functional drug delivery system integrates targeted delivery, MRP release, and real-time imaging, offering a promising technique for precision oncology. Full article