The recognition that nutritional status plays a role in altering susceptibility to lead absorption and toxicity has triggered the development of this review. There has been a significant increase worldwide in awareness and concern about the effects of lead on human health and the environment over the last two decades. Both occupational and environmental exposures to lead remain a serious problem in many developing and industrialising countries, as well as in some developed countries. Port Pirie (South Australia) has the world's largest lead smelter and the surrounding population continues to be exposed to environmental lead. The increased awareness of the detrimental impacts of 100 years of smelting at Port Pirie led in 1984 to the development of the Lead Implementation Program, run by the Environmental Health Centre (EHC), Department of Human Services (DHS). The major focus of the program is to reduce household lead exposure for pregnant women and children below the age of five years. Despite intervention efforts by all stakeholders in Port Pirie, 55% of children less than 4 years old have blood lead levels above the National Health and Medical Research Council (NH&MRC) goal of 10µg/dl. The Port Pirie Lead Implementation Program includes components on nutrition education aimed at reducing lead absorption and toxicity. However, nutritional intake and nutritional status of Port Pirie residents, in particular children under five years, has not been evaluated. This review focuses on nutrition as a component of intervention in lead toxicity and it discusses the nutritional concerns in relation to lead exposure. Fortunately most food patterns that reduce susceptibility to lead toxicity are consistent with recommendations for a healthy diet. The relationship between nutritional status and lead uptake and toxicity is most clearly established for irregular food intake (i.e. periods of fasting), marginal calcium ingestion and (subtle) iron deficiency.
A micro level study on the haemoglobin status of 127 Munda (a tribe) and 174 Poundrakshatriya (Pod) (caste) women were conducted in the peri-urban area of Kolkata City, India. The two ethnic groups were selected in order to find out whether populations residing in the same habitat, with similar medical and health care facilities have similar haemoglobin status. Results indicate that there exists very high percentage of anaemia in both the ethnic groups and 100 percent anaemia was observed among the Munda. Mean haemoglobin level was higher among the women of both the ethnic groups, consuming calorie, protein, iron and folic acid, above the recommended value (Indian Council of Medical Research, 2000).25 Women below the age of 30 years were found to be more anaemic. Education (P <0.001), height (P <0.001) and weight (P <0.005) were significantly associated with the haemoglobin status of the Pod women. Haemoglobin level of both ethnic groups was found to increase with increase in Body Mass Index. Low socioeconomic condition, very low literacy rates, poverty and higher live births may have lowered the haemoglobin level of the women of the Munda population. However, women of both the ethnic groups were found to be anaemic in higher percentage than the state of West Bengal and all India (NFHS, 2000).26 Linear regression analysis indicated that expenditure on food had positive effect on the haemoglobin level (P <0.05) of the Munda adult women, possibly due to better buying capacity. However, negative effect of food expenditure on the haemoglobin level was noticed among the Pod women (P <0.05), which may be due to disparity in food sharing within the households. Thus populations residing with similar medical and health care facilities revealed differences in the haemoglobin level. Differential expenditure pattern and food sharing practice seems to be the major factors responsible for the differences in haemoglobin status among the adult women in this present study. Very low intake of iron and heavy workload may be the reasons for this high percentage of anaemia. Moreover, hookworm infections need to be analyzed, as its prevalence is very high in India and South Asia. One hundred percent anaemia among Munda women is also very alarming. The results suggest that government policies should be intensified further at problem specific areas for the more vulnerable populations and literacy and antenatal care (especially iron supplementation) at various growing periods among the women should be intensified to eradicate anaemia.
This cross-sectional study investigated the prevalence of anaemia and vitamin A deficiency (VAD) among pregnant women in a poor urban population of Bangladesh. It also examined the association of various socio-economic and dietary factors with anaemia and vitamin A status. A maternal and child health clinic in Dhaka city, Bangladesh was used to obtain the sample. Three hundred and eighty three pregnant women, aged 20-30 years, of 20-30 weeks gestation were randomly selected from women on their first presentation for antenatal care. Socio-economic, pregnancy related information, usual dietary pattern and anthropometric data were collected. Blood haemoglobin and serum retinol (vitamin A) concentrations were determined. About 40% of the pregnant women were anaemic (haemoglobin <11.0 g/dl) and 45% had low serum vitamin A levels (<30 mg/dl); with 8.6% having sub-clinical VAD (serum retinol <20 mg/dl). The women with low serum vitamin A levels had 1.8 times greater risk of being anaemic than did the women with normal vitamin A status. Food frequency data revealed that a large proportion of these women did not consume egg (49%), milk (25%), meat (31%), liver (83%), large fish (32%), small fish (39%) and sweet pumpkin (52%) at all; while about 25% of the women reported consuming dark green leafy vegetables (DGLV) and 64% reported an intake of fruit at least four servings a week. The pregnant women who were either illiterate or received only informal education (up to grade ten) had significantly lower haemoglobin and serum vitamin A levels compared to those who completed at least a secondary school certificate. The women whose husbands were illiterate or received only informal education had significantly (P=0.01) lower serum vitamin A levels than those whose husbands had received at least a secondary school certificate. The women who came from families with a per-capita income below the poverty line had significantly lower haemoglobin and serum vitamin A levels compared to those who came from families with a per-capita income above the poverty line. The women who consumed three servings or less of DGLV and fruit per week had significantly lower haemoglobin and serum vitamin A levels than those who consumed four or more servings a week. The women who never consumed large fish had significantly lower haemoglobin compared to those who reported at least one serving a week. Furthermore, the women who never consumed sweet pumpkin had significantly lower serum vitamin A than the women who ate at least one serving a week. By multiple regression analysis, intake of meat, DGLV and fruit, and serum vitamin A levels were found to have a significant independent relationship with haemoglobin. The overall F-ratio (9.9) was highly significant (P=0.000), the adjusted R-square was 0.086 (multiple R =0.309). Multiple regression analysis for serum vitamin A also revealed a significant independent relationship with per capita income, haemoglobin levels, intakes of DGLV and sweet pumpkin. The overall F-ratio (10.2) was highly significant (P=0.000), the adjusted R-square was 0.10 (multiple R =0.312). In conclusion, anaemia and vitamin A deficiency were highly prevalent among poor urban pregnant women in Bangladesh. Various socio-economic and dietary factors may influence the anaemia and vitamin A status of these women. The present study emphasizes the need for a comprehensive intervention strategy, which include both nutritional and environmental factors, to improve the nutritional status of this population.
Our understanding of the influence of nutrition on bone health is limited because most studies concentrate on the role of calcium and protein, while other nutrients receive less attention. Recent evidence shows a positive link between fruit and vegetable consumption and bone health. In the present study, the relationships of dietary intakes of preformed retinol and carotenoids, one group of phytonutrients abundant in fruit and vegetables, were examined in an Anglo-Celtic Australian population of 68 men and 137 women. Bone mass of total body and lumbar spine were positively related to lycopene intake in men, and to lycopene and lutein/zeaxanthin intake in premenopausal women. In addition, a positive association of lumbar spine bone mass with dietary b-carotene intake was observed in postmenopausal women. No relationship was found between dietary retinol intake and bone mineral status. The finding of the present study suggests a beneficial effect of fruit and vegetable consumption, as indicated by dietary carotenoid intake, on bone health, possibly via an antioxidant mechanism.
Saffron (dried stigmas of Crocus sativus L.), was evaluated in the mouse bone marrow micronucleus test for its possible protective effects against chromosomal damage induced by cisplatin (CIS), mitomycin-C (MMC) and urethane (URE). Three doses of saffron (25, 50 and 100 mg/kg body weight) were orally administered to mice for five consecutive days prior to administration of genotoxins under investigation. From the results obtained, it was evident that the administration of 50 and 100 mg saffron/kg body weight could significantly inhibit the in vivo genotoxicity of these genotoxins. However, all the three doses of saffron were effective in exerting a protective effect against urethane.
We set out to compare the effect of diets containing intact seeds as food ingredients on colon function and fermentation-dependent events. Using a randomized cross over design, twelve healthy adults were recruited and required to consume an experimental diet containing intact or ground seeds for 7-days then after returning to their usual diet for 21-days to consume the second experimental diet for 7-days. All foods consumed during the experimental dietary periods were supplied by the researchers. Stools passed on three consecutive days on the usual diet prior to commencement and on days 5, 6 and 7 during each experimental diet, were collected. Outcome measures were whole gut transit time, 24 h stool output, faecal pH, particle size, and short chain fatty acid content. Seeds recovered from stools were examined by scanning electron microscopy. Nine of the twelve subjects completed all aspects of the study. Consumption of intact seeds compared to ground seeds increased 24 h faecal wet weight (mean 258g ± 123g and 170g ± 63g, respectively; P=0.005) and dry weight (78g ± 34g and 46g ± 28g, respectively; P=0.003). Whole gut transit times and moisture content of stools were not different. There was a trend for stools from the whole seed diet to be more acidic than those from the ground seed diet (pH 6.2 ± 0.3 and pH 6.6 ± 0.3, respectively; P = 0.06) and they contained more short chain fatty acids (35 ± 5.2 and 30 ± 10.5 mmol/kg, respectively; P=0.05). Large amounts of apparently whole seeds were recovered from stools, but internally the endosperm was often eroded and coated with bacteria. Intact seeds as food ingredients bring about changes to the colonic environment and to faecal composition that may reduce the risk of colon cancer.
Ramadan fasting is a unique model that is associated with restriction of the timing of food and fluid intake food from dawn to sunset and reduction in meal frequency and sleep duration. Leptin levels are thought to play a role in long-term regulation of caloric intake and fat deposition. However, the long-term changes in leptin levels during this pattern of fasting are not known. The study was conducted on lean (N=26, BMI = 22.5 ± 0.4) and obese (N=18, BMI=33.1±1.0) healthy female volunteers. Fasting serum levels of leptin, insulin and glucose were estimated at baseline (day 1), days 14 and 28 of the month of Ramadan and 2 weeks after Ramadan. Baseline serum levels of leptin were significantly higher in obese (13.5 ± 1.96µg/L, P<0.05) compared with lean subjects (9.60 ± 0.80 µg/L) and correlated positively with body fat (r = 0.82, P = 0.0004). Serum leptin levels exhibited a significant and comparable increase by 39% and 37% throughout the month in lean and obese subjects, respectively. In addition, a significant correlation (r = 0.52, P = 0.003)) was found between changes in serum leptin and serum insulin levels. We conclude that chronic diurnal fasting is associated with significant elevations in serum leptin. These elevations appear to be mediated by changes in serum levels of insulin. These data support the role of insulin in the long-term regulation of leptin secretion during chronic diurnal fasting followed by nocturnal eating during the month of Ramadan.
We investigated the chemopreventive effect of S-allylcysteine (SAC), a water-soluble garlic constituent against gastric carcinogenesis induced in male Wistar rats by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and saturated sodium chloride (S-NaCl). The animals were divided into four groups of six animals. Rats in groups 1 and 2 were administered MNNG (200 mg/kg body weight) on days 0 and 14 as well as S-NaCl (1mL/rat) three days during weeks 0 to 3, and thereafter placed on basal diet until the end of the experiment. Rats in group 2 in addition received SAC (200 mg/kg body weight) three times per week starting on the day following the first exposure to MNNG and continued until the end of the experimental period. Group 3 animals were given SAC alone as in group 2. Group 4 animals received basal diet and tap water throughout the experiment and served as the untreated control. The animals were sacrificed after an experimental period of 21 weeks. Measurement of lipid peroxidation and antioxidants of the glutathione redox cycle in the stomach tissue, liver and venous blood was used to monitor the chemopreventive potential of SAC. All animals that received MNNG and S-NaCl alone, developed tumours, identified histologically as squamous cell carcinomas. In the tumour tissue, diminished lipid peroxidation was accompanied by increase in reduced glutathione (GSH) and GSH-dependent enzymes, whereas in the liver and circulation, enhanced lipid peroxidation was associated with antioxidant depletion. Administration of SAC suppressed the incidence of MNNG+S-NaCl-induced gastric tumours as revealed by the absence of carcinomas. SAC ameliorated MNNG-induced decreased susceptibility of the gastric mucosa to lipid peroxidation, whilst simultaneously increasing the antioxidant status. In the liver and blood, SAC reduced the extent of lipid peroxidation and significantly enhanced antioxidant activities. We suggest that SAC exerts its chemopreventive effects by modulating lipid peroxidation and enhancing GSH-dependent antioxidants in the target organ as well as in the liver and blood.
Low-carbohydrate diets for weight loss are receiving a lot of attention of late. Reasons for this interest include a plethora of low-carbohydrate diet books, the over-sensationalism of these diets in the media and by celebrities, and the promotion of these diets in fitness centres and health clubs. The re-emergence of low-carbohydrate diets into the spotlight has lead many people in the general public to question whether carbohydrates are inherently 'bad' and should be limited in the diet. Although low-carbohydrate diets were popular in the 1970s they have resurged again yet little scientific fact into the true nature of how these diets work or, more importantly, any potential for serious long-term health risks in adopting this dieting practice appear to have reached the mainstream literature. Evidence abounds that low-carbohydrate diets present no significant advantage over more traditional energy-restricted, nutritionally balanced diets both in terms of weight loss and weight maintenance. Studies examining the efficacy of using low-carbohydrate diets for long-term weight loss are few in number, however few positive benefits exist to promote the adoption of carbohydrate restriction as a realistic, and more importantly, safe means of dieting. While short-term carbohydrate restriction over a period of a week can result in a significant loss of weight (albeit mostly from water and glycogen stores), of serious concern is what potential exists for the following of this type of eating plan for longer periods of months to years. Complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities can all be linked to long-term restriction of carbohydrates in the diet. The need to further explore and communicate the untoward side-effects of low-carbohydrate diets should be an important public health message from nutrition professionals.
In the past decade of economic growth, Vietnam has achieved an impressive rate of socioeconomic development. However, the rate of improvement in child malnutrition lags far behind that of most other health indicators. This study examines factors other than income that might affect this inability to reduce rapidly child malnutrition by exploring the socioeconomic factors that explain the high rates of stunting and underweight status of many Vietnamese children. A nationally representative survey of Vietnamese households, the 1997-98 Vietnam Living Standards Survey (VLSS) is used. Multivariate logit is used for regression analysis. The key parameters are household poverty status, total expenditure level, rural residence, and minority status with controls for many key socio-demographic measures. Children from rural households, poor households, and ethnic minority backgrounds are significantly more likely to be malnourished (with a 17.6%, 10.9%, and 14.1%, respectively, greater prevalence of malnutrition) than are urban residents, non-poor households, and the majority Kinh population. These results suggest that economic improvements in Vietnam have, for the most part, bypassed the rural poor and minorities and that targeting economic resources towards these groups will be most critical for reducing undernutrition in Vietnam.
The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI ³25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2 as a referent, subjects with BMI of 23 kg/m2 and 27 kg/m2 had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of ³90 cm in men and ³85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.
Lifestyle programmes provide the greatest opportunity to stem the developing epidemic of type 2 diabetes. This is especially relevant to indigenous people worldwide, and to Maori in New Zealand. The shift from traditional diets and activities to a westernised energy dense diet and a sedentary lifestyle has precipitated the rapid increase in Maori developing type 2 diabetes in New Zealand. Attendance of Maori to mainstream health clinics or programmes has been poor, and a unique approach developed specifically for Maori is required if Maori are going to attend and benefit from lifestyle programmes. We describe the process involved in developing a successful community programme for Maori and outline the novel aspects of the programme which contribute to its acceptability and success in the local community.
Lifestyle programmes have been shown to reduce the risk of type 2 diabetes in European populations. The participation of Maori in many mainstream health programmes is poor. This study evaluates a lifestyle intervention programme which is acceptable to Maori and which has objective outcome measures to determine the effectiveness of the programme. Thirty six Maori men and women were recruited for a 4 month programme involving modification of diet and exercise. Insulin sensitivity was measured using a euglycaemic insulin clamp, body composition using dual-energy-absorptiometry and fitness using a submaximal exercise test. Secondary outcome measures included anthropometry, blood pressure, fasting glucose and insulin levels, and lipid profiles. There was a 24% improvement in insulin sensitivity (from 5.1 to 6.3 G/mIU/L, P=0.03, N=29). This was associated with a reduction of 3.1 kg in weight (95%CI -4 to -2) and a reduction of 7mmHg in systolic blood pressure (95%CI -13, -1). This approach successfully reduced risk for type 2 diabetes and cardiovascular disease in New Zealand Maori in the short term.
This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural aras. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.
The co-existence of under-and overnutrition in developing countries might be the resultant factor of a marked shift in dietary and lifestyle practices of people, especially in urban areas. The eating of high fat, high caloric diets, the presence of inactive entertainment devices and mechanized labour influence patterns of food demand and physical activity. This study identified factors associated with the occurrence of under/overweight or normal/normal nutritional status of child-mother pairs in one household. This study was conducted in two phases. The first phase was a survey of 376 child-mother pairs. The children aged 33-83 months were attending classes in government day care centres. Anthropometric indices: weight-for-age Z score (WAZ) < -2SD was used to classify underweight in children. WAZ+1 to -1SD was used to indicate normal nutritional status in children, specifically for this study, in order to establish a more homogenous group. Body mass index (BMI) ³ 25 kg/m2 was used to measure overweight among mothers. Results showed that about 59% of the child-mother pairs were suffering from two different types of malnutrition. From this, 31 (8.2%) child-mother pairs in the same household were experiencing underweight/overweight: the child was underweight and the mother was overweight. The second phase of the study was an in-depth study of these 31 under/overweight child-mother pairs and 30 randomly selected normal/normal pairs. Pre-tested questionnaires were used to gather socio-economic-demographic data; 3 day 24-h food recall for dietary intake and 24-h activity recall for physical activity. Results showed that the different factors associated with the existence of underweight child/overweight mother (UC/OM) or normal child/normal mother (NC/NM) in this study were: mother's educational level, mother's occupation, and number of children in the household; energy intake, the preference of meats, sweets and sugars among children or meats and fried foods among mothers; and mother's perception on body size. Physical activity of both mothers and children was higher in the UC/OM than in the NC/NM group. The problem of undernutrition and overnutrition in one household poses enormous challenges. Although this study cannot make an inference to the whole population, the results indicate that there is a need to consider whether public health programs should focus on healthy diet and lifestyle patterns that will lead to optimal health outcomes at both ends of the spectrum of nutritional status.
The findings of a negative association between past maize (Zea mays) production and current Parkinson's disease mortality by each prefecture in Japan tends to support the hypothesis that the nutritional condition that causes niacin deficiency might protect people from Parkinson's disease. Specifically, the negative association between both the area planted for dried corn in 1960, 1970 or 1977 and the area planted for sweet corn in 1960 and age-adjusted death rates for Parkinson's disease is ecological evidence supporting the hypothesis. Extending the analysis to other cultivated crops, even stronger negative associations of age-adjusted death rates for Parkinson's disease and cultivation of rice and soybeans were found, but associations were not significant for a large variety of vegetables. The findings for soybean and rice are attributed to the correspondence (co-linearity) of cultivation of these other two seed-crops with maize. Hence, further testing of the theory of niacin deprivation and prevention of Parkinson's disease finds some circumstantial support in the cultivation patterns of a grain of poor niacin and tryptophan availability.