DOCSLIB.ORG

Determinants of Adherence to Iron and Folate Supplementation Among

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Determinants of Adherence to Iron and Folate Supplementation Among Quality in Primary Care (2017) 25 (3): 157-163 2017 Insight Medical Publishing Group Research Article DeterminantsResearch Article of Adherence to Iron and FolateOpen Access Supplementation among Pregnant Women in West Iran: A Population Based Cross-Sectional Study Sina Siabani Kermanshah University of Medical Sciences, Kermanshah, Faculty of Veterinary medicine, Razi University, Iran Marjan Moeini Arya Kermanshah University of Medical Sciences, Kermanshah, Iran Maryam Babakhani School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran Fateme Rezaei Kermanshah University of Medical Sciences, Kermanshah, Iran Soraya Siabani School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran, University Technology Sydney, NSW, Australia ABSTRACT Background: Iron and/or folate deficiency are prevalent Findings: Participant's ages and their gestational ages health problems in pregnant women worldwide, especially in were (27.86 ± 5.54 years) (µ ± SD) and (23.29 ± 9.86 weeks), less developed countries. Although such a problem could be respectively. Adherence and on time, respectively, were prevented by an adequate prenatal care including providing 71.6%/28% for Iron, and 81.5%/40% for Folate. Most common iron and folate supplementation, adherence to the prescribed cause of non-adherence was forgetfulness and medical side- supplementations is still problematic in many nations. effects concerning. Educational status, age and history of anemia were significantly associated with adherence to Folate, Purpose: This study was aimed to assess adherence to Iron against, Iron with a positive association with educational status and Folate supplementation, and the associated factors, among only. pregnant women in western, Iran. Conclusion: Although adherence to iron and Folate Design/methodology/approach: This cross-sectional was relatively high, most women had not started taking the study conducted on 433 pregnant women selected randomly supplements at the correct time, mostly due to insensibleness among those (n=8500) attending 40 Health Care Centers in and fear of side effects which could be improved by educating west Iran (2015-2016). A validated questionnaire was used to women and providing a strategy remembering women to take gather data related to the aim of study including demographic their pills on time. characteristics, compliance to iron/folate and reasons for non-adherence. Using Chi-square, the relationships between Keywords: Compliance; Folic acid; Iron; Pregnancy; outcome variable and predicting variables were assessed. Prenatal care Introduction [5]. Overall, the causes for pregnancy anemia are nutritional deficiencies, incompatibility between needs and nutritional Pregnancy is a critical stage of women's life affecting in intakes, parasitic and bacterial diseases and hematological the next generation. During pregnancy, iron and folic acid disorders (e.g. thalassemia). It is estimated that 20% to 80% of requirements are enhanced due to physiological and hormonal female population in the world are suffering from anemia during changes in mother and high fetal demands hence, the probability pregnancy, the majority being due to iron deficiency [6] resulted of occurrence iron deficiency and acid folic deficiency is in a hypochromic and microcytic anemia. Anemia in pregnancy relatively high [1-3]. Iron deficiency anemia in pregnancy is a is aggravated by condition such as postpartum hemorrhage and significant health problem [1-4]. active hemorrhagic events associated with delivery. In addition According to the Centers for Disease Control and Prevention's to the general adverse effects of iron deficiency anemia, it approach, hemoglobin (Hb) levels less than 11 g/dl, during the increases the risk of maternal mortality [7], premature delivery, first and third trimesters and also Hb levels less than 10.5 g/dl intrauterine growth retardation and low birth weight (less in the second trimester is considered as anemia in pregnancy than 2500 g) [8,9]. The definitive diagnosis comes from a low 158 Soraya Siabani serum ferritin level or percent transferrin saturation (TSAT) may improve outcomes [13]. In Iran, where Iron and Acid Folic plus iron bound capacity [10]. Oral iron therapy is generally are provided by Primary health care centers for all pregnant effective and convenient to prevent and treat iron deficiency women freely, adherence to Iron/Folate supplements is not anemia [11]. In pregnant women suffering from gastric bypass, optimal. On the other hand, recently, a huge governmental uterine bleeding, inflammatory bowel disease and hereditary concerning about aging population and reducing fertility rate hemorrhagic telangiectasia or in those who oral iron is to be leading to encourage people to birth more child, may increases ineffective, the intravenous iron is prescribed [10]. pregnant women resulting in pregnancy-related issues. Iron/ Folate supplementation therapy and the associating factors Pregnancy-related Folate deficiency is often associated to non-adherence or poor adherence, therefore, must be with megaloblastic anemia, low birth weight (less than 2500 clarified to be addressed appropriately. This study was aimed g) and congenital anomalies (e.g. Neural tube defects) [12]. to assess factors associated with adherence to Iron and Folate NTDs are accounted as the second common group of congenital supplementation among pregnant women in Kermanshah, Iran anomalies [13]. NTDs arise because of the defect in neurulation 2015-2016. during embryogenesis, a process that occurs in 21-28 days after conception, often before women even know they are pregnant Materials and Methods [14-16]. The burden associated with NTDs is substantial, it is usually related with other congenital abnormalities and all these Setting lead to various disabilities and financial burden on the family Kermanshah, in western Iran, with 1952433 inhabitants of and society [15]. The evidence is strong that the administration whom 964419 are women, is a capital city in which many people of acid folic 3 months before and during conception can reduce are disadvantaged. In this city, more than 40 Primary Health the risk of NTDs by 75% [12,14,15,17]. Spinabifida and Care Centers (PHCC) provide people, especially children and anencephaly is the most common neural tube defects. A bout 0.3- women, with primary care services for free. One of care taker 0.4 million infants are affected by Spina bifida and anencephaly groups are pregnant women, therefore, a good setting for our yearly. The serious defects like anencephaly is incompatible study. with life and majority do not survive and the others live with a huge disability [15]. Study design and sampling Pregnant women living in low and middle income countries, In this cross-sectional study, 433 people among pregnant suffering from a base-line malnutrition, need more attention women attending in the PHCC in Kermanshah were selected about starting Iron and Folate supplementation therapy in an to participate in the study. A multi-stage sampling technique appropriate stage of their pregnancy [12]. The World Health (including cluster sampling, proportional and then randomized Organization (WHO) recommends that all pregnant women sampling) was used to select the samples. First, the 10 PHCC should take a daily dosage of 30-60 mg of elemental Iron1 and (clusters) were selected among 40 PHCC randomly. Then, 400 µg (0.4 mg) Acid Folic as a part of antenatal and neonatal samples size for each PHCC was considered based on its care program in order to improve pregnancy outcome and population coverage and the number of pregnant women taking prevent adverse effects of elemental deficiency [3,16]. This care there. In the last stage, the pregnant women registered to includes women with normal hemoglobin (Hb) as well as those each PHCC were selected randomly using Excel randomization. with anemia of iron deficiency, however the time for starting regular taking supplement is different for those with anemia in According to two similar previous studies reporting an whom anemia must be treated before getting pregnant, if not adherence rate of 50% [21] and 40% [1] and using a confidence possible anyway, taking extra dosage of supplements during level of 95% and marginal error of 5%, the computed sample pregnancy. size was 385. On the other hand, based on Cochran table for Nowadays, providing elemental Iron/Folate supplements by determining sample size, the minimum sample size was 379. health care systems in the most of countries across the world, However considering 10-15% nonresponse, a sample size of the major problem with Iron and Acid Folic deficiency is related 433 was considered to be enrolled in this study. to non-adherence or a poor adherence arise from personal Exclusion criteria behaviors, cultural issues, environmental factors, etc. [18,19]. Most common reason declared by evidence is lack of awareness, Participants were excluded from the study if be non- Sociodemographic factors, economic status, inadequate service residential and/or were in the last month of pregnancy and/or delivery and side effects [20]. For example, women taking Iron those who did not sign consent form to participate in the study. supplements, especially those with lower price, may experience unpleasant side effects such as constipation and sometimes Instrument used for data collection diarrhea, gastric cramping, a metallic taste and thick, green and The eligible pregnant women signed consent forms were tenacious stool
Load more

Recommended publications
  • Does Dietary Fiber Affect the Levels of Nutritional Components After Feed Formulation?
    fibers Article Does Dietary Fiber Affect the Levels of Nutritional Components after Feed Formulation? Seidu Adams 1 ID , Cornelius Tlotliso Sello 2, Gui-Xin Qin 1,3,4, Dongsheng Che 1,3,4,* and Rui Han 1,3,4 1 College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China; [email protected] (S.A.); [email protected] (G.-X.Q.); [email protected] (R.H.) 2 College of Animal Science and Technology, Department of Animal Genetics, Breeding and Reproduction, Jilin Agricultural University, Changchun 130118, China; [email protected] 3 Key Laboratory of Animal Production, Product Quality and Security, Jilin Agricultural University, Ministry of Education, Changchun 130118, China 4 Jilin Provincial Key Laboratory of Animal Nutrition and Feed Science, Jilin Agricultural University, Changchun 130118, China * Correspondence: [email protected]; Tel.: +86-136-4431-9554 Received: 12 January 2018; Accepted: 25 April 2018; Published: 7 May 2018 Abstract: Studies on dietary fiber and nutrient bioavailability have gained an increasing interest in both human and animal nutrition. Questions are increasingly being asked regarding the faith of nutrient components such as proteins, minerals, vitamins, and lipids after feed formulation. The aim of this review is to evaluate the evidence with the perspective of fiber usage in feed formulation. The consumption of dietary fiber may affect the absorption of nutrients in different ways. The physicochemical factors of dietary fiber, such as fermentation, bulking ability, binding ability, viscosity and gel formation, water-holding capacity and solubility affect nutrient absorption. The dietary fiber intake influences the different methods in which nutrients are absorbed.
    [Show full text]
  • Co-Administration of Iron and a Bioavailable Curcumin Supplement Increases Serum BDNF Levels in Healthy Adults
    antioxidants Article Co-Administration of Iron and a Bioavailable Curcumin Supplement Increases Serum BDNF Levels in Healthy Adults 1, 1, 1,2 3 Helena Tiekou Lorinczova y, Owen Fitzsimons y, Leah Mursaleen , Derek Renshaw , Gulshanara Begum 1 and Mohammed Gulrez Zariwala 1,* 1 School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK; [email protected] (H.T.L.); [email protected] (O.F.); [email protected] (L.M.); [email protected] (G.B.) 2 The Cure Parkinson’s Trust, 120 New Cavendish St, Fitzrovia, London W1W 6XX, UK 3 Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Priory St, Coventry CV1 5FB, UK; [email protected] * Correspondence: [email protected]; Tel.: +44-20-7911-5000 (ext. 65086) These authors contributed equally to this work. y Received: 19 June 2020; Accepted: 16 July 2020; Published: 22 July 2020 Abstract: Brain-derived neurotrophic factor (BDNF) is key for the maintenance of normal neuronal function and energy homeostasis and has been suggested to improve cognitive function, including learning and memory. Iron and the antioxidant curcumin have been shown to influence BDNF homeostasis. This 6-week, double blind, randomized, placebo-controlled study examined the effects of oral iron supplementation at low (18 mg) and high (65 mg) ferrous (FS) iron dosages, compared to a combination of these iron doses with a bioavailable formulated form of curcumin (HydroCurcTM; 500 mg) on BDNF levels in a healthy adult cohort of 155 male (26.42 years 0.55) and female ± (25.82 years 0.54) participants.
    [Show full text]
  • L-Carnitine, Mecobalamin and Folic Acid Tablets) TRINERVE-LC
    For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only (L-Carnitine, Mecobalamin and Folic acid Tablets) TRINERVE-LC 1. Name of the medicinal product Trinerve-LC Tablets 2. Qualitative and quantitative composition Each film- coated tablets contains L-Carnitine…………………….500 mg Mecobalamin……………….1500 mcg Folic acid IP…………………..1.5mg 3. Pharmaceutical form Film- coated tablets 4. Clinical particulars 4.1 Therapeutic indications Vitamin and micronutrient supplementation in the management of chronic disease. 4.2 Posology and method of administration For oral administration only. One tablet daily or as directed by physician. 4.3 Contraindications Hypersensitivity to any constituent of the product. 4.4 Special warnings and precautions for use L-Carnitine The safety and efficacy of oral L-Carnitine has not been evaluated in patients with renal insufficiency. Chronic administration of high doses of oral L-Carnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), since these metabolites are normally excreted in the urine. Mecobalamin Should be given with caution in patients suffering from folate deficiency. The following warnings and precautions suggested with parent form – vitamin B12 The treatment of vitamin B12 deficiency can unmask the symptoms of polycythemia vera. Megaloblastic anemia is sometimes corrected by treatment with vitamin B12. But this can have very serious side effects. Don’t attempt vitamin B12 therapy without close supervision by healthcare provider. Do not take vitamin B12 if Leber’s disease, a hereditary eye disease.
    [Show full text]
  • Iron and Physical Activity: Bioavailability Enhancers, Properties of Black Pepper (Bioperine®) and Potential Applications
    nutrients Review Iron and Physical Activity: Bioavailability Enhancers, Properties of Black Pepper (Bioperine®) and Potential Applications Diego Fernández-Lázaro 1,* , Juan Mielgo-Ayuso 2 , Alfredo Córdova Martínez 2 and Jesús Seco-Calvo 3 1 Department of Cellular Biology, Histology and PHArmacology, Faculty of Health Sciences, University of Valladolid, Campus de Soria, 42003 Soria, Spain 2 Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, University of Valladolid, Campus de Soria, 42003 Soria, Spain; [email protected] (J.M.-A.); [email protected] (A.C.M.) 3 Institute of Biomedicine (IBIOMED), Physiotherapy Department, University of Leon, Visiting Researcher of Basque Country University, Campus de Vegazana, 24071 Leon, Spain; [email protected] * Correspondence: [email protected]; Tel.: +34-975-129-185 Received: 17 April 2020; Accepted: 22 June 2020; Published: 24 June 2020 Abstract: Black pepper (Piper nigrum L.) has been employed in medicine (epilepsy, headaches, and diabetes), where its effects are mainly attributed to a nitrogen alkaloid called piperidine (1-(1-[1,3-benzodioxol-5-yl]-1-oxo-2,4 pentenyl) piperidine). Piperine co-administered with vitamins and minerals has improved its absorption. Therefore, this study aimed to describe the impact of the joint administration of iron (Fe) plus black pepper in physically active healthy individuals. Fe is a micronutrient that aids athletic performance by influencing the physiological functions involved in endurance sports by improving the transport, storage, and utilization of oxygen. Consequently, athletes have risk factors for Fe depletion, Fe deficiency, and eventually, anemia, mainly from mechanical hemolysis, gastrointestinal disturbances, and loss of Fe through excessive sweating.
    [Show full text]
  • Ferronyl™ Iron Supplement
    ™ ferronyl iron supplement introduction Iron deficiency continues to be a concern around benefits of ferronyl™ the world, especially in women and children, often iron supplement resulting in anemia.1 One approach to prevent iron deficiency is supplementation of food, vitamins, ¢ low use levels and nutritional products.2 When selecting an iron ¢ higher bioavailabilty source for supplementation it is important to consider ¢ easy to formulate bioavailability, toxicity, potential side effects, iron ¢ generally recognized as safe (GRAS) content, taste and ease of formulation. Ferronyl™ iron supplement is an ideal source of essentially pure iron with minimal metallic taste and excellent bioavailability demonstrated in preclinical studies.3,4,5 Thus, it is the physical and chemical properties 6,7 better choice for iron supplementation formulators. product description Ferronyl™ iron supplement powder is elemental iron (Fe) Ferronyl™ iron supplement is elemental iron with high (> 98%) iron content. High iron content enables manufactured by the chemical decomposition of iron lower use levels to achieve the same daily intake levels pentacarbonyl. The resulting iron particles are small, compared with ferrous (Fe2+) salts (e.g., ferrous sulfate, uniform spheres of high purity with only traces of carbon, ferrous fumarate or ferrous gluconate). This is important oxygen and nitrogen. in multivitamin formulations where smaller tablets are preferred to encourage consumer use, but are often chemical description elemental iron difficult to achieve with the
    [Show full text]
  • Guidelines on Food Fortification with Micronutrients
    GUIDELINES ON FOOD FORTIFICATION FORTIFICATION FOOD ON GUIDELINES Interest in micronutrient malnutrition has increased greatly over the last few MICRONUTRIENTS WITH years. One of the main reasons is the realization that micronutrient malnutrition contributes substantially to the global burden of disease. Furthermore, although micronutrient malnutrition is more frequent and severe in the developing world and among disadvantaged populations, it also represents a public health problem in some industrialized countries. Measures to correct micronutrient deficiencies aim at ensuring consumption of a balanced diet that is adequate in every nutrient. Unfortunately, this is far from being achieved everywhere since it requires universal access to adequate food and appropriate dietary habits. Food fortification has the dual advantage of being able to deliver nutrients to large segments of the population without requiring radical changes in food consumption patterns. Drawing on several recent high quality publications and programme experience on the subject, information on food fortification has been critically analysed and then translated into scientifically sound guidelines for application in the field. The main purpose of these guidelines is to assist countries in the design and implementation of appropriate food fortification programmes. They are intended to be a resource for governments and agencies that are currently implementing or considering food fortification, and a source of information for scientists, technologists and the food industry. The guidelines are written from a nutrition and public health perspective, to provide practical guidance on how food fortification should be implemented, monitored and evaluated. They are primarily intended for nutrition-related public health programme managers, but should also be useful to all those working to control micronutrient malnutrition, including the food industry.
    [Show full text]
  • DRIDIETARY REFERENCE INTAKES Thiamin, Riboflavin, Niacin, Vitamin
    Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline http://www.nap.edu/catalog/6015.html DIETARY REFERENCE INTAKES DRI FOR Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients Food and Nutrition Board Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline http://www.nap.edu/catalog/6015.html NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was funded by the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion, Contract No. 282-96-0033, T01; the National Institutes of Health Office of Nutrition Supplements, Contract No. N01-OD-4-2139, T024, the Centers for Disease Control and Prevention, National Center for Chronic Disease Preven- tion and Health Promotion, Division of Nutrition and Physical Activity; Health Canada; the Institute of Medicine; and the Dietary Reference Intakes Corporate Donors’ Fund.
    [Show full text]
  • Does Dietary Melatonin Play a Role in Bone Mineralization?
    Syracuse University SURFACE Theses - ALL January 2017 Does Dietary Melatonin Play a Role in Bone Mineralization? Martha Renee Wasserbauer Syracuse University Follow this and additional works at: https://surface.syr.edu/thesis Part of the Medicine and Health Sciences Commons Recommended Citation Wasserbauer, Martha Renee, "Does Dietary Melatonin Play a Role in Bone Mineralization?" (2017). Theses - ALL. 120. https://surface.syr.edu/thesis/120 This Thesis is brought to you for free and open access by SURFACE. It has been accepted for inclusion in Theses - ALL by an authorized administrator of SURFACE. For more information, please contact [email protected]. ABSTRACT Introduction: Melatonin is generated as a product of normal circadian rhythm and is also is thought to play an important role in maintaining bone mineral density (BMD) by reducing chronic inflammation. Postmenopausal women are at an elevated risk of BMD loss due to declining estrogen and a natural decrease in melatonin synthesis with increasing age. Endogenous melatonin production is largely influenced by exposure to external light cues, but recent research has indicated that serum melatonin may be increased by the consumption of melatonin-rich foods. The purpose of this study was to quantify dietary-derived melatonin and examine its effects on inflammation, BMD, and sleep in a sample of postmenopausal women. Methods: Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) was conducted to examine differences in melatonin consumption, BMD, and sleep in postmenopausal women with chronic and low-level inflammation indicated by level of C-reactive protein (CRP). Data from the years 2005-2010 was included in this study.
    [Show full text]
  • Identification of Folates by Iodine Oxidation at Acid, Neutral and Alkaline Ph
    Coppell et at.: Identification of folates by iodine oxidation 155 Pteridines Vo!' 1, 1989, pp. 155 - 157 Identification of Folates by Iodine Oxidation at Acid, Neutral and Alkaline pH By A . D . Coppell, R . J. Leeming!) Haematology Department, The General Hospital, Steelhouse Lane, Birmingham B4 6NH, Great Britain J. A. Blair Biology Division, Aston University, Birmingham B4 7ET, Great Britain (Received March 1989) Summary Oxidation by iodine at pH 1.5, pH 7.0 with and without catalase and at pH 12.5, differentiated folic acid, 5- methyltetrahydrofolic acid, 10-formylfolic acid, 10-formyltetrahydrofolic acid and 5-formyltetrahydrofolic acid, when the products were assayed with Lactobacillus casei. This method is proposed as an alternative to differential microbiological assay for identifying folates. Introduction Blakley (7). 5-Methyltetrahydrofolic acid (5- The methods commonly used for measuring folates CH3THF) was obtained from Eprova, Switzerland. in biological material a re microbiological (1) or radio­ 5-Formyltetrahydrofolic acid (5-CHOTHF) was a gift isotope dilution assays (2). The identification of in­ from Lederle. 10-Formyltetrahydrofolic acid (10- dividual folates is carried out using differential mi­ CHOTHF) was prepared by acidifying 5-CHOTHF, crobiological assays with L. casei, P. cerevisiae and leaving for one hour at 25 "C in the dark then return­ S.faecalis (3). This process is time consuming, re­ ing to neutral pH. Tetrahydrofolic acid (THF) was quiring the maintenance of three stock cultures in obtained from Eprova. The iodine solution was pre­ appropriate culture media. High performance liquid pared by saturating a 2 gi l potassium iodide solution chromatography (HPLC) using electrochemical de­ with crystalline iodine.
    [Show full text]
  • Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: a Literature Review
    medical sciences Review Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review Sachin Relia 1,* and Vijayabharathi Ekambaram 2,* 1 Department of Psychiatry, University of Tennessee Health Sciences Center, 920, Madison Avenue, Suite 200, Memphis, TN 38105, USA 2 Department of Psychiatry, University of Oklahoma Health Sciences Center, 920, Stanton L Young Blvd, Oklahoma City, OK 73104, USA * Correspondence: [email protected] (S.R.); [email protected] (V.E.); Tel.: +1-901-448-4266 (S.R.); +1-405-271-5251 (V.E.); Fax: +1-901-297-6337 (S.R.); +1-405-271-3808 (V.E.) Received: 15 August 2018; Accepted: 17 October 2018; Published: 25 October 2018 Abstract: Autism is a developmental disability that can cause significant emotional, social and behavioral dysfunction. Sleep disorders co-occur in approximately half of the patients with autism spectrum disorder (ASD). Sleep problems in individuals with ASD have also been associated with poor social interaction, increased stereotypy, problems in communication, and overall autistic behavior. Behavioral interventions are considered a primary modality of treatment. There is limited evidence for psychopharmacological treatments in autism; however, these are frequently prescribed. Melatonin, antipsychotics, antidepressants, and α agonists have generally been used with melatonin, having a relatively large body of evidence. Further research and information are needed to guide and individualize treatment for this population group. Keywords: autism spectrum disorder; sleep disorders in ASD; medications for sleep disorders in ASD; comorbidities in ASD 1. Introduction Autism is a developmental disability that can cause significant emotional, social, and behavioral dysfunction. According to the Diagnostic and Statistical Manual (DSM-V) classification [1], autism spectrum disorder (ASD) is characterized by persistent deficits in domains of social communication, social interaction, restricted and repetitive patterns of behavior, interests, or activities.
    [Show full text]
  • Vitamin B12 Deficiency ROBERT C
    Vitamin B12 Deficiency ROBERT C. OH, CPT, MC, USA, U.S. Army Health Clinic, Darmstadt, Germany DAVID L. BROWN, MAJ, MC, USA, Madigan Army Medical Center, Fort Lewis, Washington Vitamin B12 (cobalamin) deficiency is a common cause of macrocytic anemia and has been implicated in a spectrum of neuropsychiatric disorders. The role of B12 deficiency O A patient informa- in hyperhomocysteinemia and the promotion of atherosclerosis is only now being tion handout on vita- min B12 deficiency, explored. Diagnosis of vitamin B12 deficiency is typically based on measurement of written by the authors serum vitamin B12 levels; however, about 50 percent of patients with subclinical dis- of this article, is pro- ease have normal B12 levels. A more sensitive method of screening for vitamin B12 defi- vided on page 993. ciency is measurement of serum methylmalonic acid and homocysteine levels, which are increased early in vitamin B12 deficiency. Use of the Schilling test for detection of pernicious anemia has been supplanted for the most part by serologic testing for pari- etal cell and intrinsic factor antibodies. Contrary to prevailing medical practice, studies show that supplementation with oral vitamin B12 is a safe and effective treatment for the B12 deficiency state. Even when intrinsic factor is not present to aid in the absorp- tion of vitamin B12 (pernicious anemia) or in other diseases that affect the usual absorption sites in the terminal ileum, oral therapy remains effective. (Am Fam Physi- cian 2003;67:979-86,993-4. Copyright© 2003 American Academy of Family Physicians.) itamin B12 (cobalamin) plays manifestations (Table 1).It is a common cause an important role in DNA of macrocytic (megaloblastic) anemia and, in synthesis and neurologic func- advanced cases, pancytopenia.
    [Show full text]
  • Circulatory and Urinary B-Vitamin Responses to Multivitamin Supplement Ingestion Differ Between Older and Younger Adults
    nutrients Article Circulatory and Urinary B-Vitamin Responses to Multivitamin Supplement Ingestion Differ between Older and Younger Adults Pankaja Sharma 1,2 , Soo Min Han 1 , Nicola Gillies 1,2, Eric B. Thorstensen 1, Michael Goy 1, Matthew P. G. Barnett 2,3 , Nicole C. Roy 2,3,4,5 , David Cameron-Smith 1,2,6 and Amber M. Milan 1,3,4,* 1 The Liggins Institute, University of Auckland, Auckland 1023, New Zealand; [email protected] (P.S.); [email protected] (S.M.H.); [email protected] (N.G.); [email protected] (E.B.T.); [email protected] (M.G.); [email protected] (D.C.-S.) 2 Riddet Institute, Palmerston North 4474, New Zealand; [email protected] (M.P.G.B.); [email protected] (N.C.R.) 3 Food & Bio-based Products Group, AgResearch, Palmerston North 4442, New Zealand 4 High-Value Nutrition National Science Challenge, Auckland 1023, New Zealand 5 Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand 6 Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore 117609, Singapore * Correspondence: [email protected]; Tel.: +64-(0)9-923-4785 Received: 23 October 2020; Accepted: 13 November 2020; Published: 17 November 2020 Abstract: Multivitamin and mineral (MVM) supplements are frequently used amongst older populations to improve adequacy of micronutrients, including B-vitamins, but evidence for improved health outcomes are limited and deficiencies remain prevalent. Although this may indicate poor efficacy of supplements, this could also suggest the possibility for altered B-vitamin bioavailability and metabolism in older people.
    [Show full text]