Effect of vitamin A, calcium and vitamin D fortification and supplementation on nutritional status of women: an overview of systematic reviews

Rajwar, Eti; Parsekar, Shradha S; Venkatesh, Bhumika T; Sharma, Zinnia

doi:10.1186/s13643-020-01501-8

Cited by 11 publications

(11 citation statements)

References 41 publications

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“…The documented evidence of the effects of calcium food fortification seems scarse, despite the existance of many calcium fortified foods in the market. This is in agreement with other recent reviews on the topic [ 54 ]. Food fortification strategies have been implemented for more than 80 years and have contributed to an improvement in health [ 55 ].…”

Section: Discussionsupporting

confidence: 94%

Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis

et al. 2021

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Calcium supplementation and fortification are strategies widely used to prevent adverse outcome in population with low-calcium intake which is highly frequent in low-income settings. We aimed to determine the effectiveness and cost-effectiveness of calcium fortified foods on calcium intake and related health, or economic outcomes. We performed a systematic review and meta-analysis involving participants of any age or gender, drawn from the general population. We searched PubMed, Agricola, EMBASE, CINAHL, Global Health, EconLit, the FAO website and Google until June 2019, without language restrictions. Pair of reviewers independently selected, extracted data and assessed the risk of bias of included studies using Covidence software. Disagreements were resolved by consensus. We performed meta-analyses using RevMan 5.4 and subgroup analyses by study design, age group, and fortification levels. We included 20 studies of which 15 were randomized controlled trials (RCTs), three were non-randomised studies and two were economic evaluations. Most RCTs had high risk of bias on randomization or blinding. Most represented groups were women and children from 1 to 72 months, most common intervention vehicles were milk and bakery products with a fortification levels between 96 and 1200 mg per 100 g of food. Calcium intake increased in the intervention groups between 460 mg (children) and 1200 mg (postmenopausal women). Most marked effects were seen in children. Compared to controls, height increased 0.83 cm (95% CI 0.00; 1.65), plasma parathyroid hormone decreased −1.51 pmol/L, (−2.37; −0.65), urine:calcium creatinine ratio decreased −0.05, (−0.07; −0.03), femoral neck and hip bone mineral density increased 0.02 g/cm2 (0.01; 0.04) and 0.03 g/cm2 (0.00; 0.06), respectively. The largest cost savings (43%) reported from calcium fortification programs came from prevented hip fractures in older women from Germany. Our study highlights that calcium fortification leads to a higher calcium intake, small benefits in children’s height and bone health and also important evidence gaps for other outcomes and populations that could be solved with high quality experimental or quasi-experimental studies in relevant groups, especially as some evidence of calcium supplementation show controversial results on the bone health benefit on older adults.

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Section: Discussionsupporting

confidence: 94%

Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis

et al. 2021

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“…So far, there have been no studies that show unquestionably that a vitamin A supplementation program benefits maternal mortality rates and neonatal weight or reduces preterm deliveries. Administration of vitamin A during pregnancy is needed to maintain the serum retinol levels of women residing in areas where vitamin A deficiency is a public health concern, but we cannot identify strong evidence of a general benefit of vitamin A supplementation during pregnancy [39]. The evidence is not conclusive to support the prescribing of vitamin A supplements during pregnancy.…”

Section: Vitamin Amentioning

confidence: 93%

Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review

Ballestín

Campos

Ballestín³

et al. 2021

Nutrients

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Introduction: Proper nutrition during pregnancy is important to prevent nutritional imbalances that interfere with pregnancy. Micronutrients play critical roles in embryogenesis, fetal growth, and maternal health, as energy, protein, vitamin, and mineral needs can increase during pregnancy. Increased needs can be met by increasing the intake of dietary micronutrients. Severe micronutrient deficiency or excess during pregnancy can have negative effects on fetal growth (intrauterine growth retardation, low birth weight, or congenital malformations) and pregnancy development (pre-eclampsia or gestational diabetes). We investigate whether it is necessary to continue micronutrient supplementation during pregnancy to improve women’s health in this stage and whether this supplementation could prevent and control pathologies associated with pregnancy. Aim: The present review aims to summarize evidence on the effects of nutritional deficiencies on maternal and newborn morbidity. Methods: This aim is addressed by critically reviewing results from published studies on supplementation with different nutrients during pregnancy. For this, major scientific databases, scientific texts, and official webpages have been consulted. PubMed searches using the terms “pregnancy” OR “maternal-fetal health” AND “vitamins” OR “minerals” OR “supplementation” AND “requirement” OR “deficiency nutrients” were performed. Results: There are accepted interventions during pregnancy, such as folic acid supplementation to prevent congenital neural tube defects, potassium iodide supplementation to correct neurodevelopment, and oral iron supplementation during the second half of pregnancy to reduce the risk of maternal anemia and iron deficiency. A number of micronutrients have also been associated with pre-eclampsia, gestational diabetes mellitus, and nausea and vomiting in pregnancy. In general, experimental studies are necessary to demonstrate the benefits of supplementation with different micronutrients and to adjust the recommended daily doses and the recommended periconceptional nutrition for mothers. Conclusions: Presently, there is evidence of the benefits of micronutrient supplementation in perinatal results, but indiscriminate use is discouraged due to the fact that the side effects of excessive doses are not known. Evidence supports the idea that micronutrient deficiencies negatively affect maternal health and the outcome of pregnancy. No single micronutrient is responsible for the adverse effects; thus, supplementing or correcting one deficiency will not be very effective while other deficiencies exist.

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“… 57 There was no empirical evidence for the nutritional advantages of fortification of food with vitamin A, vitamin D and calcium for reproductive-age women, necessitating the need for future quality study on food fortification. 58 …”

Section: Resultsmentioning

confidence: 99%

Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective

Haridas

Ramaswamy

Natarajan

et al. 2022

Health Promot Perspect

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Background: Micronutrient deficiency has long been recognized as a public health problem, particularly among vulnerable groups such as children, adolescents, pregnant and lactating women. Micronutrient deficiency could not be ruled out in spite of the implementation of various intervention strategies. Different interventions are being used to prevent and treat micronutrient deficiencies at the national and global level. The aim of this study is to systematically review the intervention strategies among different vulnerable age groups in India. Methods: The review was focused on identifying various interventions published based on the internet databases and the peer-reviewed papers from 2011 to 2021, on the predefined inclusive/exclusive criteria. The major intervention strategies implemented in India were recognized and evaluated based on dietary supplementation, micronutrient supplementation, knowledge interventions and food fortification among various age groups. Results: The results show that there are still considerable gaps in identifying the effective intervention strategies, research initiatives, programs and policies addressing to tackle micronutrient deficiencies in India. Multiple interventions are effective that could lead the road to innovations in approaches with diverse dietary intake, developing multiple micronutrient supplements, fortifying foods and nutrition interventions to address calcium, zinc, iodine, vitamin D and vitamin A deficiencies among the vulnerable population. Conclusion: Evidence-based multiple intervention studies covering a large population, in the long term cross-sectional, is the need for the hour to design policies and programs for improving the micronutrient status of vulnerable population in the community.

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Effect of vitamin A, calcium and vitamin D fortification and supplementation on nutritional status of women: an overview of systematic reviews

Cited by 11 publications

References 41 publications

Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis

Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis

Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review

Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective

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