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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EMicronutrients including vitamins, trace elements, and other compounds are important for brain development and the proper functioning of organs. Depending on the organ, age, and micronutrient, too little or too much of a micronutrient can be deleterious. The consequences may persist and can hinder physical and mental development.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eiron\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edeficiency\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egrowth and development\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emicronutrients\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emonitoring\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eparenteral nutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurodevelopment\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EA deficiency or excess of micronutrients, including vitamins, trace elements, and other compounds can be deleterious to organ development and function prior to birth and throughout life. The effects can be temporary or long-lasting and may not resolve with resolution of the deficiency.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMichael K. Georgieff, MD, University of Minnesota, Minneapolis, Minnesota, USA, discussed the significance of iron in early neurodevelopment. Iron is required for the proper development and function of every cell and organ, including the brain. Cognitive and motor problems related to a lack of available iron can be temporary or long-lasting, even after sufficient iron levels are restored. The timing of iron deficiency during brain development is crucial concerning the type and degree of brain dysfunction [Lozoff B et al. \u003Cem\u003ENutr Rev\u003C\/em\u003E. 2006]. Because the brain is not homogeneous in structure and development, the effects of nutrient deprivation can vary, depending on when the deprivation occurs and how long it lasts. For example, sensory perception is hard-wired by birth, but cognitive functions continue to be established for over a decade after birth.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIron is required for the proper function of various enzymes and hemoproteins in myelin production, neuronal\/glial energy status, and neurotransmitter and receptor manufacture. According to Dr Georgieff, the influence of iron deficiency is especially profound during fetal development and soon after birth (when 60% of the body\u2019s oxygen demand is due to the brain), from 6 months to 2.5 years of age, and in female adolescents. Neonates, infants, and children up to 2.5 years can experience long-term deficits despite iron repletion.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIron deficiency in the mother or fetus has been linked with increased risks of schizophrenia [Insel BJ et al. \u003Cem\u003EArch Gen Psychiatry\u003C\/em\u003E. 2008], autism [Schmidt RJ et al. \u003Cem\u003EAm J Epidemiol\u003C\/em\u003E. 2014], delayed cognition [Riggins T et al. \u003Cem\u003EDev Neuropsychol\u003C\/em\u003E. 2009], and poorer reflexes. These may indicate persistent hippocampus dependent circuitry and myelin impairments.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EIn infants and children (aged 6-24 months), iron status is governed by factors including the iron reserve at birth, requirement for iron, available iron, lost iron, and other factors (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Iron deficiency in infants and children can lead to behavioral abnormalities and cognitive delays [Lozoff B et al. \u003Cem\u003EJ Pediatr\u003C\/em\u003E. 2008; Lozoff B et al. \u003Cem\u003ENutr Rev\u003C\/em\u003E. 2006] and electrophysiologic abnormalities associated with defective myelination [Algar\u00edn C et al. \u003Cem\u003EPediatr Res\u003C\/em\u003E. 2003].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/27\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Factors Determining Infant Iron StatusAdapted with permission of American Society for Nutrition, from Lozoff B et al. Iron deficiency in infancy: applying a physiologic framework for prediction. Am J Clin Nutr. 2006;84:1412-1421.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2073480503\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Factors Determining Infant Iron StatusAdapted with permission of American Society for Nutrition, from Lozoff B et al. Iron deficiency in infancy: applying a physiologic framework for prediction. \u0026amp;lt;em\u0026amp;gt;Am J Clin Nutr.\u0026amp;lt;\/em\u0026amp;gt; 2006;84:1412-1421.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/27\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/27\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/27\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16135\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EFactors Determining Infant Iron Status\u003C\/p\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EAdapted with permission of American Society for Nutrition, from Lozoff B et al. Iron deficiency in infancy: applying a physiologic framework for prediction. \u003Cem\u003EAm J Clin Nutr.\u003C\/em\u003E 2006;84:1412-1421.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EHuman fetuses contain levels of iron that are higher than the typical levels present after the first several years of life. In the fetus, iron is sequestered mostly in red blood cells. When the mother is iron deficient or when iron availability is limited by decreased placental iron transfer or pregnancy-associated diabetes mellitus, the available iron is increasingly shunted to the red blood cells at the expense of the brain and other organs.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EEdward Saltzman, MD, Tufts University, Boston, Massachusetts, USA, discussed how patients who undergo bariatric surgery can also experience micronutrient deficiency. According to Yanoff and colleagues, obesity is associated with abnormal iron deficiency in the blood [\u003Cem\u003EInt J Obes (Lond).\u003C\/em\u003E 2007]. Sleeve gastrectomy is a weight loss measure for obese patients, in which a substantial portion of the stomach is removed. Factors that influence the risk for this micronutrient deficiency after sleeve gastrectomy include preoperative deficiency, inadequate nutrient intake following surgery, changes in digestion and absorption that result from reduced stomach volume, and inadequate nutrient intake following surgery. Bioavailability of iron is also diminished in obese patients due to the decreased tissue absorption of iron. This occurs because of the increased production of the liver peptide hormone hepcidin, which regulates iron absorption [Ganz T, Nemeth E. \u003Cem\u003EAnnu Rev Med\u003C\/em\u003E. 2011]. The persistent vomiting and inadequate food intake that can occur can provoke thiamine deficiency [Aasheim ET. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EA study of morbidly obese women who received a sleeve gastrectomy or Roux-en-Y gastric bypass documented marked reductions in heme and nonheme iron after both surgeries, with greater reductions in sleeve gastrectomy recipients [Ruz M et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E. 2012]. While many nutritional consequences can resolve with dietary supplementation, some will persist [Moiz\u00e9 Vet al. \u003Cem\u003EJ Acad Nutr Diet\u003C\/em\u003E. 2013]. Bariatric surgery can also disrupt bone homeostasis, which can lead to increased resorption [Folli F et al. \u003Cem\u003EInt J Obes (Lond)\u003C\/em\u003E. 2012]. Following bariatric surgeries, the intake and absorption of a variety of micronutrients can be diminished. The monitoring of micronutrient concentrations following surgery and adherence to dietary supplementation are both prudent to maintain physiologic levels of various micronutrients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EAnother population at risk of altered micronutrient intake and absorption is the gut failure group who requires parenteral nutrition (PN) to meet all or most of their nutrient requirements. Gut failure is characterized by malabsorption resulting from inadequate bowel length or functional disability of available bowel. Carol J. Rollins, MS, RD, PharmD, The University of Arizona, Tucson, Arizona, USA, discussed the monitoring of micronutrients in patients receiving long-term PN.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003ERequirements for micronutrients depend on age, the disease, and the surgical history. Both the lack of micronutrients and toxic excess can be problematic. Problems may manifest as changes in physical appearance of skin, hair, and nails and altered gait. Biochemical changes can also occur. Deficiencies in essential fatty acids present signs and symptoms including alopecia, heightened fragility of capillaries, poor wound healing, and retarded growth in children. In patients with an inflammatory response, knowing the degree of the response is important in judging plasma micronutrient levels (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Duncan A et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E. 2012].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16136\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16136\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16136\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EEffect of Systemic Inflammation Response on Micronutrients\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EUse of multiple component additives, such as multi\u2013trace element solution, in PN can produce deficiencies in some trace elements including copper, manganese, selenium, and zinc. Manganese deficiency is rare, while zinc deficiency is one of the more common micronutrient abnormalities and is a great concern in neonates. Toxicity due to excessive levels of some trace elements can occur during PN therapy. For example, manganese accumulates in the brain and can attain toxic levels. Toxicity has also been reported in high doses of zinc. Thus, it is wise to monitor patients during PN therapy for signs and symptoms of trace element deficiency and toxicity. To date, no evidence-based guidelines have been established concerning trace element monitoring during PN therapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EDeficiency in L-carnitine is also a concern since this affects energy production by mitochondria. Deficiency is primarily genetic and secondarily due to low production or excessive loss in pregnancy, chronic kidney disease, malnutrition, or a diet high in protein or fat.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003ETo conclude, there is a risk of micronutrient abnormalities in patients with long-term PN. If therapy continues for a year, this is almost assured. As a result, periodic monitoring is prudent.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/3\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}