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      Characterization of micronutrient supplements use by Brazilian children 6-59 months of age: Brazilian National Survey on Child Nutrition (ENANI-2019) Translated title: Caracterização do uso de suplementos de micronutrientes por crianças brasileiras de 6-59 meses de idade: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) Translated title: Caracterización del uso de suplementos de micronutrientes por niños brasileños de 6-59 meses de edad: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

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          Abstract

          This study aimed to characterize micronutrient supplements use among Brazilian children 6-59 months of age included in the Brazilian National Survey on Child Nutrition (ENANI-2019; n = 12,598). Micronutrient supplements use at the time of the interview and the 6 months prior to it was evaluated using a structured questionnaire. The following indicators were included: micronutrient supplement use; supplements containing a single micronutrient; supplements of the Brazilian National Iron Supplementation Program (PNSF); multivitamin supplements with or without minerals; multivitamin supplements with minerals; multivitamin supplements without minerals. The estimates and their respective 95% confidence intervals (95%CI) were calculated for Brazil and according to macroregion, educational level of the mother or caregiver, and type of health care service used, considering the sampling plan, weights, and calibration. In Brazil, the prevalence of micronutrient supplements use was 54.2% (95%CI: 50.5; 57.8), with the highest prevalence in the North Region (80.2%; 95%CI: 74.9; 85.6) and among children 6-23 months of age (69.5%; 95%CI: 65.7; 73.3). The prevalence of the use of supplements containing exclusively iron and exclusively vitamin A in Brazil was 14.6% (95%CI: 13.1; 16.1) and 23.3% (95%CI: 19.4; 27.1), respectively. The prevalence of the use of multivitamin with or without minerals in Brazilian children 6-59 months of age was 24.3% (95%CI: 21.4; 27.2). These results may help to understand the practice of supplements use among Brazilian children and support the proposal of national public policies for the prevention and control of micronutrient deficiencies.

          Translated abstract

          O objetivo deste estudo foi caracterizar o uso de suplementos de micronutrientes entre crianças brasileiras de 6-59 meses de idade incluídas no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019; n = 12.598). O uso de suplementos de micronutrientes no momento da entrevista e nos seis meses anteriores foi avaliado por meio de um questionário estruturado. Foram incluídos os seguintes indicadores: uso de suplemento de micronutrientes; suplementos contendo um único micronutriente; suplemento do Programa Nacional de Suplementação de Ferro (PNSF); suplementos multivitamínicos com ou sem minerais; suplementos multivitamínicos com minerais; suplementos multivitamínicos sem minerais. As estimativas pontuais e seus respectivos intervalos de 95% de confiança (IC95%) foram calculados para o Brasil e de acordo com a macrorregião, a escolaridade da mãe ou cuidadora e o tipo de serviço de saúde utilizado, considerando o plano, os pesos e a calibração amostral. No Brasil, a prevalência de uso de suplemento de micronutrientes foi de 54,2% (IC95%: 50,5; 57,8), com maior prevalência na Região Norte (80,2%; IC95%: 74,9; 85,6) e entre crianças de 6-23 meses de idade (69,5%; IC95%: 65,7; 73,3). A prevalência do uso de suplementos contendo apenas ferro e apenas vitamina A no Brasil foi de 14,6% (IC95%: 13,1; 16,1) e 23,3% (IC95%: 19,4; 27,1), respectivamente. A prevalência de uso de multivitamínicos com ou sem minerais em crianças brasileiras de 6-59 meses de idade foi de 24,3% (IC95%: 21,4; 27,2). Esses resultados podem auxiliar na compreensão da prática do uso de suplementos entre crianças brasileiras e apoiar a proposta de políticas públicas nacionais de prevenção e controle de deficiências de micronutrientes.

          Translated abstract

          El objetivo de este estudio fue caracterizar el uso de suplementos de micronutrientes entre niños brasileños con edades entre 6-59 meses incluidos en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019; n = 12.598). El uso de suplementos de micronutrientes en el momento de la entrevista y en los seis meses anteriores se evaluó mediante un cuestionario estructurado. Se incluyeron los siguientes indicadores: uso de suplementos de micronutrientes; suplementos que contienen un solo micronutriente; suplemento del Programa Nacional de Suplementación con Hierro (PNSF); suplementos multivitamínicos con o sin minerales; suplementos multivitamínicos con minerales; suplementos multivitamínicos libres de minerales. Se calcularon las estimaciones puntuales para Brasil y sus respectivos intervalos del 95% de confianza (IC95%) de acuerdo con la macrorregión, el nivel educativo de la madre/cuidador y el tipo de servicio de salud utilizado, considerando el plan, los pesos y la calibración de la muestra. En Brasil, la prevalencia del uso de suplementos de micronutrientes fue del 54,2% (IC95%: 50,5; 57,8), con mayor prevalencia en la Región Norte (80,2%; IC95%: 74,9; 85,6) y entre niños con edades entre 6-23 meses (69,5%; IC95%: 65,7; 73,3). Las prevalencias del uso de suplementos que contienen solo hierro o solo vitamina A en Brasil fueron del 14,6% (IC95%: 13,1; 16,1) y del 23,3% (IC95%: 19,4; 27,1), respectivamente. La prevalencia de uso de multivitamínicos con o sin minerales en niños brasileños de 6-59 meses de edad fue del 24,3% (IC95%: 21,4; 27,2). Estos resultados pueden ayudar a comprender la práctica de uso de suplementos entre los niños brasileños y apoyar la propuesta de políticas públicas para la prevención y control de la carencia de micronutrientes.

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            The Epidemiology of Global Micronutrient Deficiencies

            Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.
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              A Review of Micronutrients and the Immune System–Working in Harmony to Reduce the Risk of Infection

              Immune support by micronutrients is historically based on vitamin C deficiency and supplementation in scurvy in early times. It has since been established that the complex, integrated immune system needs multiple specific micronutrients, including vitamins A, D, C, E, B6, and B12, folate, zinc, iron, copper, and selenium, which play vital, often synergistic roles at every stage of the immune response. Adequate amounts are essential to ensure the proper function of physical barriers and immune cells; however, daily micronutrient intakes necessary to support immune function may be higher than current recommended dietary allowances. Certain populations have inadequate dietary micronutrient intakes, and situations with increased requirements (e.g., infection, stress, and pollution) further decrease stores within the body. Several micronutrients may be deficient, and even marginal deficiency may impair immunity. Although contradictory data exist, available evidence indicates that supplementation with multiple micronutrients with immune-supporting roles may modulate immune function and reduce the risk of infection. Micronutrients with the strongest evidence for immune support are vitamins C and D and zinc. Better design of human clinical studies addressing dosage and combinations of micronutrients in different populations are required to substantiate the benefits of micronutrient supplementation against infection.
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                Author and article information

                Contributors
                Role: contributed to the study conception, design, executionRole: the article’s writing and revision
                Role: contributed to the study conception, design, executionRole: the article’s writing and revision
                Role: contributed to the study conception, design, execution, performed the statistical analysisRole: the article’s writing and revision
                Role: contributed to the study executionRole: the article’s writing and revision
                Role: contributed to the study executionRole: the article’s writing and revision
                Role: contributed to the study executionRole: the article’s writing and revision
                Role: performed the statistical analysisRole: contributed to the article’s writing and revision
                Role: contributed to the study conception, design, executionRole: the article’s writing and revision
                Journal
                Cad Saude Publica
                Cad Saude Publica
                csp
                Cadernos de Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
                0102-311X
                1678-4464
                28 August 2023
                2023
                : 39
                : Suppl 2
                : e00085222
                Affiliations
                [1 ] Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
                [2 ] Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
                [3 ] Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
                [4 ] Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Marabá, Brasil.
                Author notes
                [Correspondence ] G. Kac Departamento de Nutrição Social e Aplicada, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Centro de Ciências da Saúde, Bloco J, 2° andar, sala 29, Rio de Janeiro, RJ 21941-902, Brasil. gilberto.kac@ 123456gmail.com

                Additional information: ORCID: Maiara Brusco de Freitas (0000-0003-1737-8918); Inês Rugani Ribeiro de Castro (0000-0002-7479-4400); Raquel Machado Schincaglia (0000-0002-8450-6775); Letícia B. Vertulli Carneiro (0000-0003-0832-2293); Nadya Helena Alves-Santos (0000-0002-0098-6047); Paula Normando (0000-0002-6443-7733); Pedro Gomes Andrade (0000-0002-3964-6787); Gilberto Kac (0000-0001-8603-9077).

                Other members of the Brazilian Consortium on Child Nutrition: Cristiano Siqueira Boccolini, Dayana Rodrigues Farias, Elisa Maria de Aquino Lacerda, Luiz Antonio dos Anjos, Neilane Bertoni, Talita Lelis Berti.

                Author information
                http://orcid.org/0000-0003-1737-8918
                http://orcid.org/0000-0002-7479-4400
                http://orcid.org/0000-0002-8450-6775
                http://orcid.org/0000-0003-0832-2293
                http://orcid.org/0000-0002-0098-6047
                http://orcid.org/0000-0002-6443-7733
                http://orcid.org/0000-0002-3964-6787
                http://orcid.org/0000-0001-8603-9077
                Article
                05001
                10.1590/0102-311XEN085222
                10545133
                37646722
                ff38557a-4409-4aa4-8aa4-2760437d94e9

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 09 May 2022
                : 31 August 2022
                : 27 September 2022
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 56
                Categories
                Article

                dietary supplements,vitamins,minerals,preschool children,suplementos nutricionais,vitaminas,minerais,pré-escolar,suplementos dietéticos,minerales,preescolar

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