It has been estimated that over 700 million people still do not have enough food to eat on a daily basis and that more than 2 billion are subsisting on diets that lack the essential vitamins and minerals required for normal growth and development and to prevent premature death and disabilites such as blindness and mental retardation. At the same time, millions more suffer from chronic diseases caused by excessive and unbalanced diets. At the International Conference on Nutrition (ICN), held in Rome in 1992 and sponsored by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) of the United Nations system, 159 nations endorsed a World Declaration that included recognition of the need for national plans of action for nutrition/national food and nutrition policies. Specific objectives that the delegates agreed should be achieved were a reinforcement of earlier goals agreed to at the World Summit for Children 1990. Political will is an essential prerequisite for successful national food and nutrition policies and plans. These must also be realistic, well-conceived and effective at all levels, especially where devolution is taking place. Over the last two decades there has been an evolution in the issues that policies address, as well as changes in the expectations of them. Virtually all countries have agreed to 'establish appropriate national mechanisms to prioritize, develop, implement and monitor policies and plans to improve nutrition within designated time-frames, based on national and local needs, and to provide appropriate funds for their functioning'. Worldwide, over 120 member states of the United Nations (UN) have finalized, strengthened or have under way, national plans of action for nutrition. The policy decisions being made in order to implement more of these plans over the remainder of the decade and beyond, are already providing invaluable experience and data. Evaluation should provide even more in the future.
A longitudinal study was conducted over the period August 1993 to August 1994 on 217 children from a fishing community of Visakhapatnam, Andhra Pradesh. The subjects were aged between 7 and 13 years. Children were screened for Ascaris lumbricoides, Trichuris trichiura and hookworm. Intensity of infection was estimated by the formalin-ether sedimentation technique. Simultaneously, blood samples ware also collected for estimation of hemoglobin and serum proteins using standard techniques. Blood parameters and ova count were monitored both prior to and following treatment with albendazole, administered at a single oral dose of 400 mg/child in November 1993. Post-treatment recordings were done at the end of the second, fourth and fifth months while hemoglobin estimation was also monitored at the ninth month. Study showed a prevalence of 82% with intestinal helminths and a mean hemoglobin level of 9.7 g/dL + 1.7 (513 g/dL), with 88% of the children being anemic. Total serum protein level was normal (8.61 ± 1.03 g/dL), with an elevated serum globulin response (4.63 ± 0.88). Post-treatment observations showed the complete expulsion of worms with the significant lowering of globulin levels. However, moderate anemia persisted in the population with gradual improvement by the ninth month. Significant increase in weight was not registered at the end of the fifth month probably coinciding with the rapid establishment of infection. Sex-wise there was no significant deviation from the general trend.
The effect of treatment for helminth infections on growth, appetite, and physical activity was investigated in Indonesian schoolchildren with Ascaris and Trichuris infections. Groups of schoolboys were selected for this substudy from a large study in which two groups received a single dose of 400 mg albendazole (AL, n = 86) and one group received an identical placebo (PL, n = 43). All boys were measured for parasitic infection, growth, appetite, and physical activity at baseline and 6 months after treatment. At baseline, all variables measured were not significantly different. After 6 months of treatment, the prevalence of Ascaris and Trichuris infections did not change significantly for both groups but the intensity of Ascaris and Trichuris infections significantly reduced in both groups (P < 0.05) except for Trichuris in the PL group. Increases in mid-arm circumference and height-for-age, after treatment, in the AL group were significantly greater than in the PL group (P < 0.05). In addition, appetite scores were higher in the AL group than in the PL group (P = 0.014). Free play activity, measured by Caltrac accelerometers, increased by 28% in the AL group after treatment (P = 0.004) and did not change in the PL group. We conclude that treatment with a single dose of albendazole may improve growth, appetite, and activity in areas with a high transmission of helminth infections.
Balanced diet fed (BDF) rats injected with Salmonella typhi 'H' antigen showed an initial suppression of an immunomodulatory bone marrow cytokine Frl (BM-Frl) followed by stimulation, whereas the cytokine secretory pattern showed only stimulation in immunized vitamin B complex malnourished rats. This nutritional-dependent differential response of a bone marrow cytokine to antigen is similar to that observed previously in brain adenosine triphosphatase (ATPase) function following immunization. An improvement in antibody response to S. typhi (P < 0.01) and neutrophil function (P < 0.05) was observed in cytokine-treated malnourished immunosuppressed rats further strengthening our previous observations that BM-Frl modulates both specific and non-specific immune systems. No significant change was observed in BDF animals indicating that malnourished rats gain more from cytokine therapy, whereas a negative feedback system might be present in BDF animals.
Lipoprotein(a) (Lp(a)) and apolipoprotein(a) (apo(a)) phenotypes as genetic markers for coronary heart disease (CHD) have been the focus of great interest in recent times. Included in this study were four Australian populations comprising 348 Anglo-Celtic Melburnians (157 men and 191 women), 339 Chinese Melburnians (169 men and 170 women), 402 South Asian Melburnians (216 men and 186 women) and 394 Aboriginal Australians from Western Australia (175 men and 219 women). Plasma Lp(a) concentrations were more highly skewed towards the lower range in the Chinese and Aboriginal groups than in the Anglo-Celtics and South Asians. Approximately 33% of Anglo-Celtics, 20% Aboriginals, 13% Chinese and 44% South Asians had plasma Lp(a) levels above the generally accepted risk threshold values of 300 mg/L. In Aboriginals and Chinese, the S4 apo(a) phenotype predominated while in Anglo-Celtics and South Asians, the highest frequency occurred in the S3 phenotype. In the S4 phenotype, Lp(a) values varied between the four populations but there was no significant difference in concentration between gender.
L-carnitine plays an important role as a factor necessary for the transport of long-chain fatty acids into the mitochondria. A random double blind study was designed to investigate the effects of L-carnitine treatment (12 weeks, 3 g/d) on lipid metabolism and the fat content of the body in the patients with non-insulin-dependent diabetes mellitus. The study details 46 patients, randomly assigned into L-carnitine and placebo groups (23 patients in each group). Patients received either L-carnitine or placebo for 12 weeks. The results revealed that L-carnitine had significant effects on reducing the waist to hip ratio (0.99 ± 0.18 vs 0.95 ± 0.16, P < 0.01), and percentage of body fat (35.4 ± 7.1% vs 32.9 ± 6.9%, P < 0.01). It also lowered plasma triglyceride (4.0 ± 1.6 mmol/L vs 2.6 ± 1.2 mmol/L, P < 0.05), but there were no significant changes in body weight, high density lipoprotein cholesterol, apolipoprotein A or apolipoprotein B. These findings suggest that L-carnitine treatment may promote body fat utilization and result in reduced percentage of body fat and in lower serum triglyceride.
Intestinal helminth infections may reduce nutrient availability and thereby impair cognitive growth and other functions. Certain nutrients such as fatty acids may also modulate inflammation and the immune response and, thus, the severity of helminth infection. Fatty acid status may, therefore, both be affected by and affect helminth infection. Rural school-children in South Africa with a 35% helminth infestation rate were assessed for serum total fatty acid status. With hookworm, a higher percentage total n-3 fatty acids were found with functional implications.
In order to better define the trends and patterns of growth for children of Asian refugee families residing in the USA, we studied the anthropometric data from 12 states collected by the Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance System (PedNSS) from 1979 to 1993. The Asian refugee children under 5 years of age showed a progressive and significant decline in the prevalence of low height-for-age and low weight-for-age, while those nutritional indices remained stable for low income white children and black children. By 1993, the growth status of Asian refugee children was comparable with that of other ethnic groups. This marked improvement over a short period strongly suggests that the poor growth status earlier observed among recently immigrated Asian children was due to nutritional and health factors related to socioeconomic conditions, rather than to genetic factors, as is often suggested. Detailed analysis of each birth cohort born at different time periods found that low anthropometry during infancy is a strong predicator of smaller body size later in childhood.
This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed the impact on these patterns of the following socio-demographic characteristics: gender, age, educational achievement, and gross household income. Food intake by category, food variety and meal patterns were assessed using a 156-item food frequency questionnaire. It was found that gender and age were the most important factors to influence food consumption patterns. Men consumed more wheat products, red meat and tea, whereas women consumed more vegetables, fruit, nuts, fish, eggs and milk. Women also tended to consume a wider variety of food than did men. Furthermore, it was found that younger and more educated people tended to consume a wider variety of food. Age also had an important influence on the food intake. Younger and generally more educated adults tended to consume foods associated with affluence: meats, soft drinks and beer, while the older population tended to consume more vegetables (women only), milk and tea in their diets. Because education is closely correlated with age in this Beijing Chinese population, it appeared to have little effect on the food intake patterns, after adjusting for age. The older members of this population, who probably have a decreased functional reserve of nutrients, and the less educated, appeared not to be taking advantage of the availability of a wide variety of food, further increasing the risk of nutrient deficiency. On the other hand, the younger and more educated, who tended to consume a wide variety of foods, were more likely to maintain adequate nutritional standards. However, their tendency to consume food associated with affluence, such as meat and beer, may point toward an increased risk of those diseases prevalent in affluent societies, such as obesity, diabeties, cardiovascular disease, certain cancers and osteoporosis. Ongoing nutrition surveillance and appropriate nutrition education will be required increasingly for Beijing Chinese and similar communities.
The effects of iodized salt use on the quality of processed Philippine food products were evaluated. Samples for the study included dried-salted and smoked fish products, nitrite-cured pork, and fermented plain and flavored shrimp pastes. Generally, no significant differences were detected between the physicochemical, microbiological and sensory characteristics of the test products prepared with iodized and unfortified NaCl salts. The salting process in each food operation significantly increased the iodine content of the test products. However, subsequent losses in the absorbed iodine were recorded due to the boiling, smoking, drying, fermenting and heating processes in the different operations. It was recommended that studies be undertaken on the addition of iodine to semi-processed or completely processed food products to lessen iodine losses.
Papua New Guinea (PNG) is among those areas of the world where soils lack iodine. Iodine deficiency leads to a number of disorders including goitre and cretinism. The PNG government has chosen to promote the consumption of adequately iodised salt as one of its intervention programmes to eradicate the iodine deficiency disorders. A study was undertaken to assess the iodine content of salt in the distribution chain in Lae, as well as to assess the per capita salt consumption in the city. It was found that the average salt consumption was 6.59 g/d. However, not all the Lae population were consuming adequately iodised salt. Only 48% of salt samples from one school were adequately iodised. The percentage of wholesale salt samples containing more than the standard 30 p.p.m. iodine increased from 61.5% in 1996 to 90.9% in 1997. The iodine content of the retail samples were 73.5% and 87.1% in 1996 and 1997, respectively. Stricter, sustained and systematic monitoring of the quality of iodised salt procured and distributed in Lae is called for to ensure consumption of adequately iodised salt.
The possibility of improving iodine deficiency disorder (IDD) in school children in Khon Kaen province was investigated during the period of 1 year, using an operational research approach. Four schools in Pupaman and Srichompu districts, namely Ban Khoa Wong, Na Fai Witaya, Ban Pa Num Tieng and Ban Non Khom, were selected for this study. Ban Non Khom served as the control school. Different methods were used for iodine fortification. Iodized salt was used for the children of the Ban Khoa Wong school, iodized water was used for Na Fai Witaya school and iodized fish sauce was used for Ban Pa Num Tieng school. The iodized salt, water and fish sauce were provided with the help of the school teachers under the supervision and advice of the team of investigators. Urine iodine excretion as well as palpation of the thyroid gland and the thyroid hormones T4, T3 and TSH were selected for monitoring and evaluation. The proportion of children with low urine iodine excretion, indicated by a cut-off point suggested by the WHO/ICCIDD/UNICEF working group, decreased during the course of the project in all schools receiving iodine supplementation as well as in the control school. However, the decrease was less in the control school in comparison with the implementation schools. Furthermore, the goitre rate decreased in all schools under investigation. The decrease of the goitre rate for the children of the control school might have been due to the activities of a village health volunteer from a nearby village who was using iodized salt for IDD control according to the ongoing national programme initiated by the Ministry of Public Health. No significant difference in the level of thyroid hormones was detected before or at the end of the supplementation for either the experimental schools or the control school. The results from the determination of thyroid hormone serum levels could not be used for assessing the outcome of the project. The measuring of urinary iodine excretion might be helpful in monitoring the iodine intake during the intervention phase. Long-term effects of iodine fortification could be seen best by the declining proportion of children with goitre. However, an observation of 1 year might not have been enough to clearly see the outcome of the project. The other possible contributing error to this study is intra-observer variation of the palpation technique when the sample size was not big enough. Goitrogens in this area might be another risk factor for the high prevalence rate of goitre. Further study in this field should be encouraged. The results of the study indicate that iodine fortification of salt and fish sauce is more effective than iodine fortification of drinking water. Due to the local preference of adding fish sauce (nam pla) instead of salt to almost all dishes, fish sauce proved to be the best vehicle for iodine fortification. The success of the project depended heavily on the understanding and cooperation of the school teachers and the school children. Major constraints in conducting this project were the insufficient distribution of iodized salt and potassium iodide solution for the fortification of drinking water, and the inconsistency of iodide concentration in the salt after fortification.
In order to study the effect of levothyroxine in the treatment of endemic goitre, a longitudinal study was conducted among the Aborigines in Lanai Post and Sinderut Post, situated in an iodine-deficient area located in the district of Kuala Lipis, Pahang. All subjects in the treatment group (Lanai Post) were given 100 µg of levothyroxine per day and were followed for 1 1/2 years. A total of 311 subjects were examined at baseline, 323 on the first, 256 on the second, 239 on the third and 184 on the fourth visit following levothyroxine supplementation. Goitre prevalence, thyroid hormones, thyroid volume, nutritional status, urinary iodine levels, arterial blood pressure and mental performance were determined. Following the intervention, goitre prevalence was significantly reduced in the treatment group (baseline 42.8% vs final visit 13.0%, P < 0.0001); however, no significant difference was noted in the control group. Total T4 levels were increased in the treatment group (P < 0.0001), while a significant reduction was noted in the control group (P < 0.0001). Thyroid-stimulating hormone levels increased significantly in the treatment group following 1 year of intervention, while no significant changes were observed in the control group. As for the thyroid volume, both groups showed a significant increment following the intervention (P < 0.0001). With respect to the nutritional status, the treatment group showed a significant increase in body weight following the intervention (P < 0.05). In addition, the mid-arm circumference and body mass index also increased after 1 year of intervention. However, the control group showed a reduction in the waisthip ratio (P < 0.0001). Although there was no statistical difference in the waisthip ratio in the treatment group, there has been a significant reduction observed after 1 year of intervention. At 1 year, a reduction in skinfold thickness was noted in the treatment group while only the triceps and subscapular were increased in the control group. The body fat was decreased in the treatment group following 1 year of intervention (P < 0.0001). No particular trend was noted in the urinary iodine excretion in the treatment group, but surprisingly, the levels were increased in the control group (P < 0.0001). A significant increase in both systolic and diastolic blood pressures was observed in the treatment group following 1 year of intervention, but the controls showed a reduction in the systolic blood pressure (P < 0.0001). Both groups showed a remarkable increase in mental performance, with a more pronounced effect in the treatment group (P < 0.05). The correction of iodine deficiency by levothyroxine supplementation has a short-term beneficial effect in reducing the prevalence of goitre and improving the mental ability among the Aborigines in endemic areas; however, proper monitoring and close supervision are needed to maintain compliance.
The objective of this study was to determine the zinc and copper status in hair of a group of Indonesian infants aged 05 months, a period when growth faltering in this population is known to occur, and to determine the daily zinc and copper availability in the habitual diet. A mixed cross-sectional longitudinal design was used. Infants 03 months of age were recruited in two villages on the south coast of the island of Madura, Indonesia and followed up to the age of 5 months. All newborns during the study period were included. Hair samples were collected between the ages of 0 and 5 months at monthly intervals. Zinc and copper concentrations were determined by flame atomic absorption spectrophotometry and compared with a sample of Belgian controls, recruited cross-sectionally. Zinc and copper content of the habitual diet was calculated on the results of a food intake study previously performed in the same community. For the 42 Madurese infants recruited, 107 hair zinc and 96 hair copper concentrations were determined. Belgian infants (15 boys, 15 girls) served as controls. One Madurese infant died during the study and six moved from the area. Hair zinc concentrations were found to decrease with age in both populations, while the zinc and copper values did not differ from the Belgian controls. Hair zinc values were not correlated with growth performance. The boys had lower hair zinc values than did the girls. Copper values among the Indonesian infants did not show a trend over time; however, the Belgian children showed an increase towards the age of 12 months, although this was not significant. The mean daily zinc and copper availability in the habitual diet was less than half of the recommended daily allowance for adult women. The situation was much worse for lactating women given that the availability of these elements increased very little. The hair zinc and copper values indicate that they are not responsible for the early onset of linear growth retardation. The lower zinc values in boys might be an indication of a marginal deficiency. The very low zinc content of the diet consumed in this population could be an indication of a zinc and copper deficit in the Madurese population, although this needs to be confirmed.
Comparison of conjunctival impression cytology (CIC) with ocular signs and vitamin A levels was done based upon a national nutrition survey involving 427 randomly selected subjects aged 6 months to 6 years. Medical nutritionists looked for ocular signs and performed conjunctival impressions. Imprints were submitted to the Institute of Ophthalmology, University of the PhilippinesPhilippines General Hospital, for analysis. Fixing, staining and reading of all imprints was performed in accordance with the procedures of the International Centre for Epidemiologic and Preventive Ophthalmology (ICEPO). Comparison of the biochemical determination of serum vitamin A (SVA) with CIC results revealed that irrespective of SVA levels, more than 50% of the subjects were noted to have abnormal CIC results. The highest proportion of abnormal imprints was seen among those with low SVA. The relationship, however, was found not to be significant. Of the 247 subjects examined, 95% had a normal clinical and biochemical assessment of vitamin A; of these, 50.2% had abnormal cytology imprints while 45.3% had normal imprints. Using sensitivity and specificity analyses, CIC was compared with SVA levels. The computed sensitivity, specificity and positive predictive value (PPV) were 60.5, 45.2 and 60.0%, respectively. The lack of significant difference in mean serum retinol levels between normal and abnormal CIC groups may partly explain the low sensitivity and PPV of the CIC. In this study population, CIC failed to identify children with subclinical vitamin A deficiency as established by biochemical examination.