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Do We Contribute to Women's Empowerment? Insights From a Nutrition-Sensitive Agriculture Project Implemented in Nong, Laos. 我们为妇女赋权做出贡献了吗?在老挝侬省实施的营养敏感型农业项目的启示。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-11-06 DOI: 10.1177/03795721241293547
Manon Gerber, Daniëlle M Bon, Bounthanom Bouahom, Jacqueline E W Broerse, Dirk Essink

Background: The gender-gap in power is still persistent around the globe. Nutrition-Sensitive Agriculture (NSA) interventions have been implemented to increase women's empowerment as a goal in itself, and as a pathway to food and nutrition security (FNS). However, contradicting evidence exists on whether the interventions, besides food security, realize women's empowerment. Furthermore, the concept of women's empowerment has different meanings across different cultures, regions, and countries.

Objective: To assess the understanding of, and perspectives on, women's empowerment among different stakeholders in the context of an NSA project in Laos, and to assess whether this project contributes to women's empowerment and FNS.

Methods: Semistructured interviews were conducted with local implementers of NSA interventions (n = 13) and senior program managers and advisors (n = 5). Six focus group discussions were conducted with community members (n = 46).

Results: Our findings reveal that community members had a materialistic understanding and local implementers an instrumental understanding, in contrast to senior program managers and advisors, who had an egalitarian understanding of women's empowerment. The level of women's empowerment in Nong was considered low by all respondents. Furthermore, respondents reported that the NSA interventions had a positive impact on FNS, but not on women's empowerment.

Conclusions: In a community in which both women's empowerment and FNS are low, working with women may contribute to FNS, but not necessarily contribute to women's empowerment. Nevertheless, from an emic perspective, women do feel more empowered as the interventions contributed to increased household capacity to address FNS.

背景:在全球范围内,权力方面的性别差距依然存在。营养敏感型农业(NSA)干预措施的实施,本身就是为了提高妇女的能力,并将其作为实现粮食和营养安全(FNS)的途径。然而,关于这些干预措施除粮食安全外是否还能实现妇女赋权,存在着相互矛盾的证据。此外,妇女赋权的概念在不同的文化、地区和国家有不同的含义:评估老挝 NSA 项目中不同利益相关者对妇女赋权的理解和观点,并评估该项目是否有助于妇女赋权和 FNS:对当地的消极安全保证干预措施实施者(n=13)以及高级项目经理和顾问(n=5)进行了半结构化访谈。对社区成员(n = 46)进行了六次焦点小组讨论:结果:我们的研究结果表明,社区成员对妇女赋权的理解是物质性的,当地执行者对妇女赋权的理解是工具性的,而高级项目经理和顾问对妇女赋权的理解是平等性的。所有受访者都认为农区的妇女赋权水平较低。此外,受访者报告称,国家体育局的干预措施对 FNS 有积极影响,但对妇女赋权没有影响:结论:在妇女赋权和 FNS 都较低的社区,与妇女合作可能有助于 FNS,但不一定有助于妇女赋权。尽管如此,从情感角度来看,由于干预措施有助于提高家庭应对 FNS 的能力,妇女确实感到自己的能力得到了增强。
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引用次数: 0
Exploring the FAO Minimum Dietary Diversity Indicator as a Suitable Proxy of Micronutrient Adequacy in Men and Women Across Reproductive and Non-reproductive Ages in 8 Latin American Countries. 探索粮农组织最低膳食多样性指标作为 8 个拉美国家男性和女性在生殖和非生殖年龄段微量营养素充足性的合适替代指标。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-28 DOI: 10.1177/03795721241242920
Georgina Gómez, Rafael Monge-Rojas, Rulamán Vargas-Quesada, Agatha Nogueira Previdelli, Dayana Quesada, Irina Kovalskys, Marianella Herrera-Cuenca, Lilia Yadira Cortes, Martha Cecilia Yépez García, Reyna Liria-Domínguez, Attilio Rigotti, Regina Mara Fisberg, Gerson Ferrari, Mauro Fisberg, Juan C Brenes

Background: Women's Dietary Diversity Score (WDDS) is an indicator of dietary diversity, a key component of diet quality in women of reproductive age (WRA). Limited information is available regarding its applicability in other population groups.

Objective: To examine the ability of the Minimum Dietary Diversity for Women (MDD-W) of 5-food groups cutoff to predict micronutrient adequacy in men and women 15 to 65 years old from 8 Latin American countries.

Methods: We used a 24-hour recall from 9216 participants in the Latin American Study on Nutrition and Health (ELANS) to determine Dietary Diversity Score (DDS) based on the consumption of 10 food groups. The Mean Probability of Adequacy (MPA) was associated with DDS for the overall sample, for men, WRA, and women of nonreproductive age (WNRA). Sensitivity and specificity analyses were performed to determine if the 5-food groups cutoff point for MDD can be used to correctly identify men, WRA, and WNRA with adequate micronutrient adequacy (MPA ≥ 0.70).

Results: We found a mean DDS of 4.78 ± 1.33 and an MPA of 0.64 ± 0.16, with 59% of participants showing a diverse diet (DDS ≥ 5). The 5-food groups-cutoff point showed a better balance between sensitivity and specificity predicting an MPA ≥0.70 in men, WRA, and WNRA. MPA was significantly associated with DDS in WRA and for men and WNRA, as well.

Conclusion: The 5-food group MDD, originally intended to be used in WRA, performed equally well in predicting MPA ≥0.70 in men, WRA, and WNRA, and can be used as a proxy of micronutrient adequacy in Latin American population.

背景:妇女膳食多样性评分(WDDS)是育龄妇女(WRA)膳食多样性的一个指标,也是膳食质量的一个关键组成部分。有关该指标在其他人群中的适用性的资料有限:目的:研究拉丁美洲 8 个国家 15 至 65 岁男性和女性的 5 种食物组最低膳食多样性(MDD-W)临界值预测微量营养素充足性的能力:我们对 9216 名拉丁美洲营养与健康研究(ELANS)参与者进行了 24 小时回忆,根据 10 种食物的摄入量确定了膳食多样性得分(DDS)。平均充足概率 (MPA) 与总体样本、男性、WRA 和非育龄女性 (WNRA) 的 DDS 相关。我们对敏感性和特异性进行了分析,以确定是否可以使用5类食物的MDD临界点来正确识别微量营养素充足的男性、WRA和WNRA(MPA≥0.70):我们发现,平均 DDS 为 4.78 ± 1.33,MPA 为 0.64 ± 0.16,59% 的参与者饮食多样化(DDS ≥ 5)。在男性、WRA 和 WNRA 中,5 种食物组别分界点在预测 MPA ≥0.70 的灵敏度和特异性之间显示出更好的平衡。在 WRA 中,MPA 与 DDS 显著相关,在男性和 WNRA 中也是如此:五种食物组 MDD 原本用于 WRA,在预测男性、WRA 和 WNRA 的 MPA ≥0.70 方面表现同样出色,可用作拉丁美洲人群微量营养素充足性的替代指标。
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引用次数: 0
Introduction and Executive Summary for the Supplement Micronutrients in Latin America: Current State and Research. 拉丁美洲微量营养素补充剂》导言和执行摘要:现状与研究。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-18 DOI: 10.1177/03795721241254610
María J Soto-Méndez, Erick Boy
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引用次数: 0
Perspective on Emerging Micronutrient Deficiencies in Latin America and the Caribbean. 透视拉丁美洲和加勒比地区新出现的微量营养素缺乏症。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-04 DOI: 10.1177/03795721241257008
Noel W Solomons

The moral imperative of public health systems is to maximize the health and welfare of the population to the extent possible. Constraints often include a lack of resources, political will, popular acceptance, or an acceptable safety margin. Major agencies have established iron, iodine, and vitamin A as the principal elements for micronutrients, with folate and zinc on the second plane. As the armamentarium of interventions to favor micronutrient nutrition, for example, preventive health measures, dietary improvement, forms of fortification, and nutrient supplements, is offered in public health policy. The utility of their merger with other nutrients, emergent nutrients, has been considered. The Latin America and Caribbean Region has unique characteristics. The scientific and epidemiology considerations for action in the Region's health concern on 4 emergent nutrient deficiencies of public health-vitamins D and E, essential fatty acids, and choline-are reviewed.

公共卫生系统在道义上的当务之急是尽可能最大限度地增进人民的健康和福祉。制约因素通常包括缺乏资源、政治意愿、大众接受度或可接受的安全系数。主要机构已经将铁、碘和维生素 A 确定为微量营养素的主要元素,叶酸和锌位于第二位。公共卫生政策提供了有利于微量营养素营养的干预措施,如预防性保健措施、膳食改善、营养强化和营养素补充剂等。它们与其他营养素、新兴营养素合并的效用也得到了考虑。拉丁美洲和加勒比地区具有独特的特点。针对该地区对公共卫生的 4 种新出现的营养素缺乏症--维生素 D 和 E、必需脂肪酸和胆碱--所采取的行动,对科学和流行病学方面的考虑进行了审查。
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引用次数: 0
Considerations for Correction of Micronutrient Deficiencies Through Supplementation in Pregnant Women and Children Under-5 in Latin America. 通过补充剂纠正拉丁美洲孕妇和 5 岁以下儿童微量营养素缺乏症的考虑因素。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2024-01-07 DOI: 10.1177/03795721231219824
Ana C Fernández-Gaxiola, Lynnette M Neufeld, Armando García-Guerra

Background: Micronutrient deficiencies in Latin America are a public health concern, nonetheless, lack of information still exists in many countries, so that the true magnitude of the problem remains uncertain.

Objective: To summarise experiences that can inform the development of policies and programs to address micronutrient deficiencies throung supplementation in pregnant women and chlidren under five years of age in Latin American.

Methods: Review of the most evidence on the effects of micronutrients supplementation, focusing on pregnant women and children under five years of age.

Results: Certain population groups, as women of reproductive age and children under 2 years of age, are at increased risk for deficiency due to their high micronutrient requirements. This is compounded by the limited access to micronutrient-rich foods for many people living in vulnerable situations. Micronutrient supplementation is an effective intervention to prevent and treat deficiency and to mitigate its adverse effects on health, nutrition, and pregnancy outcomes in micronutrient-deficient populations. The potential benefits of supplementation programs, however, are realized only when they reach those who have the potential to benefit, that is, with inadequate intakes of micronutrients from dietary sources, and when the quality of design and delivery of the programs aresufficient to reach that population timely, regularly, and effectively to enable and motivate consumption.

Conclusions: Several resources and experiences exist that can help favor the development of programs that can realize this biological and programmatic potential. There is need for continuous efforts to augment coverage and achieve results that can translate into economic benefits for individuals, families, and nations.

背景:拉丁美洲的微量营养素缺乏症是一个公共卫生问题,但许多国家仍然缺乏相关信息,因此这一问题的真正严重程度仍不确定:总结经验,为制定政策和计划提供信息,以解决拉丁美洲孕妇和五岁以下儿童微量营养素缺乏问题:方法:回顾有关补充微量营养素效果的大多数证据,重点关注孕妇和五岁以下儿童:某些人群,如育龄妇女和两岁以下儿童,由于对微量营养素的需求量大,缺乏微量营养素的风险也就更大。许多生活在脆弱环境中的人只能获得有限的富含微量营养素的食物,这使问题更加复杂。补充微量营养素是一种有效的干预措施,可以预防和治疗微量营养素缺乏症,并减轻其对微量营养素缺乏人群的健康、营养和妊娠结果的不利影响。然而,只有当补充计划惠及那些有可能从中受益的人群(即从膳食中摄入微量营养素不足的人群),并且计划的设计和实施质量足以及时、定期、有效地惠及这些人群,从而促进和激励他们摄入微量营养素时,补充计划的潜在益处才能实现:现有的一些资源和经验有助于制定能实现这一生物和计划潜力的计划。有必要继续努力扩大覆盖面,取得成果,为个人、家庭和国家带来经济效益。
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引用次数: 0
Persistent Challenges of Micronutrient Deficiencies in Latin America Need Action. 拉丁美洲微量营养素缺乏的长期挑战需要采取行动。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-31 DOI: 10.1177/03795721241262136
A C Fernández-Gaxiola, A García-Guerra, L M Neufeld

Micronutrient deficiencies affect growth and development and are critical for maintaining health at all ages. Their critical role in exacerbating complications of infections and chronic diseases continues to impact morbidity, mortality, and quality of life for many. Raising awareness and advocating for micronutrient deficiencies in Latin America is urgent to reduce this preventable burden. Globally, an estimated 372 million preschool-aged children and 1.2 billion non-pregnant women of reproductive age suffer deficiency from 1 or more micronutrient. Data is limited and often old, and the true burden of problem in the region remains unclear. There are also limited data on dietary intake and on the double burden of malnutrition. Latin America has been a leader in the design and implementation of innovative and effective actions to reduce excess energy intake and curb the consumption of unhealthy Actions to address deficiency have been implemented in many countries in the region over the years, but current evidence suggests that micronutrient deficiencies have fallen off the public health agenda in Latin America. Effective programming can be developed / appropriately adapted only with knowledge of the current burden. Such data can also help guide and predict future areas of risk and priorities to missing upcoming nutrition issues in the population. Renewed commitment to quantify and monitor micronutrient deficiencies in the region is essential. Abundant evidence and guidance exist to inform effective program selection, design and implementation to address this public health problem.

微量营养素缺乏会影响生长发育,对维持各年龄段的健康至关重要。它们在加剧感染和慢性疾病并发症方面的关键作用,继续影响着许多人的发病率、死亡率和生活质量。在拉美地区提高对微量营养素缺乏症的认识并进行宣传,对于减轻这一可预防的负担迫在眉睫。全球估计有 3.72 亿学龄前儿童和 12 亿非怀孕育龄妇女缺乏一种或多种微量营养素。数据有限,而且往往是陈旧的数据,该地区问题的真正负担仍不清楚。关于膳食摄入量和营养不良双重负担的数据也很有限。多年来,该地区许多国家都采取了解决营养缺乏问题的行动,但目前的证据表明,微量营养素缺乏问题已经淡出了拉丁美洲的公共卫生议程。只有了解当前的负担,才能制定/适当调整有效的计划。这些数据还有助于指导和预测未来的风险领域和优先事项,以解决人口中即将出现的营养问题。再次承诺量化和监测该地区的微量营养素缺乏症至关重要。现有的大量证据和指导可为有效选择、设计和实施计划提供信息,以解决这一公共卫生问题。
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引用次数: 0
A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition. 拉丁美洲 8 个国家 15 至 65 岁城市人口微量营养素膳食摄入情况:拉丁美洲健康与营养研究》的结果。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2023-12-19 DOI: 10.1177/03795721231215267
Rafael Monge-Rojas, Rulamán Vargas-Quesada, Agatha Nogueira Previdelli, Irina Kovalskys, Marianella Herrera-Cuenca, Lilia Yadira Cortés, Martha Cecilia Yépez García, Reyna Liria-Domínguez, Attilio Rigotti, Regina Mara Fisberg, Gerson Ferrari, Mauro Fisberg, Georgina Gómez

Background: Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients.

Objective: This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries.

Method: Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method.

Results: In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status.

Conclusions: There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

背景拉丁美洲国家已经从富含微量营养素的传统饮食转变为富含高能量高密度食物和低微量营养素的西方化饮食:本研究旨在确定 8 个拉美国家城市人口微量营养素摄入充足的普遍程度:2014年9月至2015年8月,研究人员收集了9216名生活在8个拉美国家城市人口中、年龄在15.0岁至65.0岁之间的男性和女性的微量营养素膳食摄入数据。膳食摄入量是通过非连续两天的 24 小时回忆收集的。微量营养素摄入量是否充足采用估计平均需要量截断法进行计算:一般来说,硫胺素、核黄素、烟酸、叶酸、钴胺素、铁、磷、铜和硒摄入不足的比例从 0.4% 到 9.9% 不等。相比之下,吡哆醇、锌、维生素 C 和维生素 A 的不足率介于 15.7% 到 51.5% 之间。摄入不足率最高的营养素是镁(80.5%)、钙(85.7%)和维生素 D(98.2%)。教育程度低、超重/肥胖的参与者和男性的营养素摄入不足率最高,并因社会经济地位而异:拉丁美洲急需制定直接的区域行动和战略,通过主食强化计划、农艺生物强化或食品政策,促进经济上获得富含微量营养素的食品,从而提高微量营养素的充足性。
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引用次数: 0
Micronutrient Deficiencies in Older Adults in Latin America: A Narrative Review. 拉丁美洲老年人微量营养素缺乏症:叙述性综述。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-09-01 Epub Date: 2023-12-25 DOI: 10.1177/03795721231214587
Vanessa De la Cruz-Góngora, Rosa Palazuelos-González, Omar Domínguez-Flores

Background: The population in Latin America and Caribbean (LAC) has experienced a major demographic transition with increased numbers of older adults (OA). This change brings opportunities in the public health sector to implement health prevention interventions and delay the onset of geriatric syndromes. Micronutrients play an important role in the maintenance of biological function which contributes to longevity. Micronutrient deficiencies (MD) in OA increase the risk for onset of chronic comorbidities and geriatric syndromes.

Aim: To review and summarize the existing data on micronutrient status in OA in the LAC region and discuss the gaps and challenges in public health approaches to address deficiencies.

Methods: Literature review in Medline for records describing nutritional biomarkers in older adults (≥ 60y) from community dwelling and population-based studies in LAC.

Results: Few countries (including Chile, Ecuador, Costa Rica, Brazil, and Mexico) have documented one or more nutritional deficiencies for OA in national health surveys, however across the entire region, evidence of micronutrient levels is scarce. Some surveys have documented a high prevalence and large heterogeneity in the prevalence of vitamin D followed by B12 deficiency, being the 2 MDs most studied due their effects on cognition, frailty, and bone mineral density in the OA population. Other MD including C, E, A, copper, zinc, iron, and selenium have also been reported.

Conclusion: Information on the micronutrient status in OA from LAC is poorly documented. Research and capacity building initiatives in the region are crucial to develop tailored strategies that address the specific nutritional needs and challenges faced by the ageing population in Latin America.

背景:拉丁美洲和加勒比地区(LAC)的人口经历了重大的人口结构转型,老年人(OA)的数量不断增加。这一变化给公共卫生部门带来了实施健康预防干预措施和延缓老年综合症发病的机会。微量营养素在维持生物功能方面发挥着重要作用,有助于延年益寿。微量营养素缺乏症(MD)会增加慢性并发症和老年综合症的发病风险。目的:回顾和总结拉丁美洲和加勒比地区有关微量营养素缺乏症的现有数据,并讨论解决微量营养素缺乏症的公共卫生方法中存在的差距和挑战:方法:在Medline上对拉丁美洲和加勒比地区社区居民和人群研究中描述老年人(≥60岁)营养生物标志物的记录进行文献综述:少数国家(包括智利、厄瓜多尔、哥斯达黎加、巴西和墨西哥)在全国健康调查中记录了一种或多种OA营养缺乏症,但在整个地区,有关微量营养素水平的证据很少。一些调查记录了维生素 D 和 B12 缺乏的高患病率和巨大的异质性,这两种微量营养素因其对 OA 人口的认知、虚弱和骨矿物质密度的影响而被研究得最多。其他微量营养素包括C、E、A、铜、锌、铁和硒也有报道:拉丁美洲和加勒比地区有关OA微量营养素状况的资料很少。该地区的研究和能力建设活动对于制定有针对性的战略以解决拉丁美洲老龄人口的特殊营养需求和面临的挑战至关重要。
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引用次数: 0
In Memoriam: Dr. Noel W. Solomons (1940–2024) 悼念诺埃尔-索洛蒙斯博士(1940-2024)
IF 1.9 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-08-01 DOI: 10.1177/03795721241261216
Manuel Ruz
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引用次数: 0
A Brief Overview of the Diagnosis and Treatment of Cobalamin (B12) Deficiency. 钴胺素(B12)缺乏症的诊断和治疗简介。
IF 1.8 4区 医学 Q3 FOOD SCIENCE & TECHNOLOGY Pub Date : 2024-06-01 DOI: 10.1177/03795721241229500
Bruce H R Wolffenbuttel, Andrew McCaddon, Kourosh R Ahmadi, Ralph Green

Background: An increasing number of adult individuals are at risk of vitamin B12 deficiency, either from reduced nutritional intake or impaired gastrointestinal B12 absorption.

Objective: This study aims to review the current best practices for the diagnosis and treatment of individuals with vitamin B12 deficiency.

Methods: A narrative literature review of the diagnosis and treatment of vitamin B12 deficiency.

Results: Prevention and early treatment of B12 deficiency is essential to avoid irreversible neurological consequences. Diagnosis is often difficult due to diverse symptoms, marked differences in diagnostic assays' performance and the unreliability of second-line biomarkers, including holo-transcobalamin, methylmalonic acid and total homocysteine. Reduced dietary intake of B12 requires oral supplementation. In B12 malabsorption, oral supplementation is likely insufficient, and parenteral (i.e. intramuscular) supplementation is preferred. There is no consensus on the optimal long-term management of B12 deficiency with intramuscular therapy. According to the British National Formulary guidelines, many individuals with B12 deficiency due to malabsorption can be managed with 1000 µg intramuscular hydroxocobalamin once every two months after the initial loading. Long-term B12 supplementation is effective and safe, but responses to treatment may vary considerably. Clinical and patient experience strongly suggests that up to 50% of individuals require individualized injection regimens with more frequent administration, ranging from daily or twice weekly to every 2-4 weeks, to remain symptom-free and maintain a normal quality of life. 'Titration' of injection frequency based on measuring biomarkers such as serum B12 or MMA should not be practiced. There is currently no evidence to support that oral/sublingual supplementation can safely and effectively replace injections.

Conclusions: This study highlights the interindividual differences in symptomatology and treatment of people with B12 deficiency. Treatment follows an individualized approach, based on the cause of the deficiency, and tailored to help someone to become and remain symptom-free.

背景:越来越多的成年人因营养摄入减少或胃肠道对 B12 的吸收障碍而面临维生素 B12 缺乏的风险:本研究旨在回顾当前诊断和治疗维生素 B12 缺乏症患者的最佳实践:方法:对维生素 B12 缺乏症的诊断和治疗进行叙述性文献综述:预防和早期治疗 B12 缺乏症对于避免不可逆转的神经系统后果至关重要。由于症状多种多样,诊断方法的性能差异明显,二线生物标志物(包括全反式钴胺素、甲基丙二酸和总同型半胱氨酸)不可靠,因此诊断通常比较困难。如果膳食中的 B12 摄入量减少,就需要口服补充剂。在 B12 吸收不良的情况下,口服补充很可能是不够的,最好是进行肠外(即肌肉注射)补充。关于肌肉注射疗法治疗 B12 缺乏症的最佳长期疗法,目前还没有达成共识。根据《英国国家处方集》(British National Formulary)指南,许多因吸收不良导致 B12 缺乏症的患者在初次摄入 1000 微克羟钴胺后,可每两个月肌注一次。长期补充 B12 既有效又安全,但治疗效果可能会有很大差异。临床和患者经验强烈表明,多达 50% 的患者需要个性化的注射方案和更频繁的给药次数,从每天或每周两次到每 2-4 周一次,以保持无症状和正常的生活质量。不应根据血清 B12 或 MMA 等生物标志物的测量结果来 "调整 "注射频率。目前没有证据支持口服/舌下补充剂可以安全有效地替代注射:本研究强调了 B12 缺乏症患者在症状和治疗方面的个体差异。治疗应根据缺乏症的病因采取个体化的方法,量体裁衣,帮助患者摆脱症状并保持无症状状态。
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引用次数: 0
期刊
Food and Nutrition Bulletin
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