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Abstracts of selected current articles in food and nutrition

"Changes in the Nutritional Status of the Lactating Wom- an during Exclusive Lactation.". A. Arteaga, S. Díaz, M. Villalon, M. Valenzuela, A.M. Cubillos. Arch. Latinoamer. Nutr. 31 (4): 766 (1981).

In order to evaluate the influence of breast-feeding upon selected nutritional parameters of lactating women, several anthropometric and biochemical measurements were performed during the interval between 40 and 180 postpartum days in 54 women in full and satisfactory nursing. Only one significant change was detected in measurements done for nutritional assessment: loss of body weight. No changes were detected in haemoglobin levels or in serum protein and albumin. There was high variability in body weight changes with a mean loss of 1.5 kg due especially to loss in lean body mass. The mean food intake did not change during the observation period. The mean caloric intake was 2,771 car/day at the beginning and 2,737 cal/ day at the end of the study. A significant correlation was established between the individual energy intake and the body weight changes of lactating women. The allowance of 2,750 car/day suggested by FAO/WHO for lactating women seems adequate for the health of women in a normal nutritional condition, but apparently insufficient to overcome under-nutrition in women who initiate lactation with this condition. In spite of the small nutritional impact observed, our results support the need for food supplementation programs directed to lactating women, with special orientation to undernourished women of low socioeconomic level. (In Spanish.)

"Nutritonal Status in a Healthy Elderly Population: Vitamin C." P.J. Garry, J.S. Goodwin, W.C. Hunt, and B.A. Gilbert. Am. J. Clin Nutr. (36) (2): 332 (1982).

Vitamin C status in 270 free-living and healthy elderly was determined from dietary intakes and plasma levels of ascorbic acid. Mean dietary intake for women (n = 145) was 137 and 142 mg/day for men (n=125). The median intake of supplemental ascorbic acid for women was 355 mg/day (n = 85) and 500 mg/day (n = 70) for men. The mean plasma ascorbic acid level for women was 1.30 mg/dl and was significantly higher than for men, 1.13 mg/dl. Less than 2% were at risk for developing clinical symptoms of hypovitaminosis-C. It was estimated that intakes needed to maintain a plasma ascorbic acid level of 1.0 mg/ day would be 75 mg/day for women and 150 mg/day for men. Our data suggest that a different recommended dietary allowance for ascorbic acid should be considered for men and women.

"Riboflavin Status in Infants Born in Rural Gambia, and the Effect of a Weaning Food Supplement." C.J. Bates, A.M. Prentice, A.A. Paul, A. Prentice, B.A. Sutcliffe, and R.G. Whitehead. Trans. Roy. Soc. Trop. Med. Hyg. 76 (2): 253 (1982).

Riboflavin status was measured in infants between birth and two years of age, by the erythrocyte glutathione reductase [NAD (P)H2: glutathione oxidoreductase, EC] test on finger-prick blood samples. The infants were living in three rural Gambian villages: Keneba, Manduar, and Kanton Kundar; those in Keneba were receiving a weaning food supplement between three and 12 months, which provided 0.15 to 2.0 mg riboflavin per day, in addition to their normal intake from breast-milk and locally available weaning foods, which provided 0.13 to 0.21 mg/ day over the same age range. On the basis of currently accepted criteria of biochemical normality, the unsupplemented infants were born deficient and, in the absence of a supplement, remained so throughout their first two years of life, with only a minor, shortlived improvement during the first few months. In the supplemented group, however, riboflavin status fell within normal limits for the duration of the supplement, but rapidly deteriorated again once the supplement was withdrawn. It is concluded that infants born to deficient mothers are usually deficient at birth, and remain so throughout suckling and weaning on to locally available foods The daily requirement, to achieve satisfactory biochemical status, is thus greater than 0.12 to 0.21 mg/day, and probably approaches 0.4 mg/day, for most individuals up to the age of one year.

"Zinc, Copper and Iron Content of Milk from Mothers of Preterm and Full-Term Infants." R.A. Mendelson, G.H. Anderson, and M.H. Bryan. Early Hum. Dev. 6 (2): 145 (1982).

Complete 24-hour expressions of milk were collected over the first month of lactation from mothers giving birth at term (FT) and prematurely (PT). Samples were analyzed for Cu. Fe, and Zn concentration. Composition of PT and FT milks was similar during the first four weeks of lactation, but the concentrations of each mineral were higher during the first week than during the fourth week. From these data, the intakes of premature infants fed their own mother's milk were estimated and the proportion wich must be absorbed and retained in order to accumulate the amounts laid down in utero were predicted. On the basis of these estimates, preterm infants who retain 25% of the Zn and 35% of the Cu in PT milk would approximate in utero accumulations. However the Fe content of PT milk is inlikely to provide for in utero accretion rates, even if 100% absorption is achieved.

"Standards for Nutritional Adequacy of the Diet: European and WHO/FAO Viewpoints." A. Wretlind. Am. J. Clin. Nutr. 36 (2): 366 (1982).

The dietary recommendations of FAO/WHO and of the various European nations differ in several ways. There are two types of dietary recommendations or standards. The first is related to the recommended daily intake of nutrient and the second refers to the nutrient content of the diet expressed either as percentage of total energy (energy % or cal %) derived from protein, fat, and carbohydrate or as the amounts of nutrients in relation to units of energy, the so-called nutrient concentration or nutrient density (weight per 1,000 kcal, per 1 MJ, or per 10 MJ). The numbers of recommended nutrients vary between 8 and 28. The recommendations are given for individuals of different age, sex, and physiological status. The highest number of subgrouping is 41 and the lowest 11. The ranges of recommended values are sometimes very wide, but all seem acceptable from the nutritional point of view. There are many good reasons for this situation, such as cultural background, food tradition, food production, and availability

"Kwashiorkor in a Child in Central Pennsylvania A SevenYear Follow-up." C. M. Berlin, Jr. and D.E. Tinker. Am. J. Dis Child. 136 (9): 822 (1982).

Follow-up of a child who had severe protein malnutrition from the ages of 3 to 6 2 months demonstrated intellectual and social functioning within normal range seven years after diagnosis and treatment. Treatment consisted of peripheral alimentation, followed by an elemental infant formula (lactosefree), with nutritional education of the family.

"Osteomalacia, Vitamin D Deficiency and Cholestasis in Chronic Liver Disease." J. B. Dibble, P. Sheridan, R. Hampshire, G. J. Hardy, and M. S. Losowsky. Quart. J. Med. 51 (201): 89 (1982).

Twenty-nine patients with chronic liver disease, nine of whom had symptoms suggesting bone disease, were studied by bone histology, Nine had osteomalacia, six associated with cholestatic liver disease and three with primarily hepatocellular disease. Two of these had clinical and biochemical features of cholestasis for at least a year and the other had alcoholic cirrhosis associated with severe malnutrition. Excluding the latter patient, histological osteomalacia was significantly associated with presence and duration of cholestasis. Plasma 25-hydroxy-vitamin D was low and fasting urine hydroxyproline/ creatinine ratio was high in all patients with osteomalacia but were abnormal also in some patients who did not have histological osteomalacia. Serum calcium, phosphate, alkaline phosphatase, vitamin D-binding protein, and radiology were unhelpful in many patients with osteomalacia. Vitamin D deficiency correlated significantly with deficiency of other fat-soluble vitamins and those patients with rachitic levels of plasma 25-hydroxy-vitamin D showed no seasonal variation, suggesting a combination of malabsorption of vitamin D and reduced sunlight exposure. We suggest that patients with chronic liver disease with cholestasis for at least a Year are at risk from osteomalacia and that those likely to have this complication may be identified by plasma 25-hydroxyvitamin D and/or fasting urine hydroxyproline/creationine ratio measurements. The diagnosis can only be made with certainty by bone biopsy.

"Malnutrition, Liver Damage, and Cancer." P. Grasso. Nutr. Cancer 3 (2): 103 (1981).

There is no clear indication that malnutrition, per se, is a principal cause of cancer in man, but the prevalence of liver cancer in areas where malnutrition exists supports this hypothesis. Liver damage and liver cancer have been induced in laboratory rats by diets consisting of peanut meal and proteins deficient in some essential amino acids. However, liver damage, but not cancer, was produced when the diets contained no peanut meal but consisted of a mixture of amino acids deficient in methionine and cysteine, so that it is possible that aflatoxin, a contaminant of peanut meal, may have been responsible for the malignancies seen in the earlier experiments. Liver cancer develops in a high proportion of mice allowed to feed ad libitum or given a diet containing a high proportion of fat {groundnut oil) or protein (casein). Dietary restriction reduced the incidences of this cancer. This finding lends some support to current thinking that diet may be a factor in the development of cancer in man.

"Diet Survey Based on Family Food Consumption: The Case of Ilheus, Bahia, in 1979." M. R. Homer, J. G. Dorea, M. G. Pereira, V L. Bezerra, and J. B. Salomon. Arch. Latinoamer. Nutr. 31 (4): 726 (1981).

A simplified method was used to analyze the diets of 31 poor families in the city of Ilheus, Bahia, Brazil. The results are presented in terms of frequency of foods consumed, nutritional density and theoretical adequacy of the diet. Intrafamilial distribution of food intake was not considered in the analysis. Results show that the home diet was very limited in variety; only 8 of the 46 items in the dietary frequency were consumed by 50% or more of the sample. Nutrient density was low for calcium, riboflavin, vitamin A, and zinc. Energy density, as measured by the ratio of fat calories to protein calories (G/P) was 1.0, a value considered nutritionally inadequate. Protein provided 16 % of the energy and, of all nine nutrient analyzed, presented the highest levels of intake compared to recommended amounts. Theoretically, the groups at greater nutritional risk were women and children. (In Spanish.)

"Worker Productivity and the Nutritional Status of Kenyan Road Construction Laborers." J. C. Wolgemuth, M. C. Latham, A. Hall, A. Chesher, and D. W. Crompton. Am. J. Clin. Nutr. 46 (1): 68 (1982).

The effects of energy supplementation (group I received 200 kcal/day and group 11 received 1,000 kcal/day) were examined on road workers in Kenya. Anthropometric, dietary, worker productivity, clinical haematology, and parasitology data were collected from 224 workers of both sexes, or subsamples of these workers at base-line, midpoint, and final measurement periods. Sixty-seven per cent of the work force was less than 85% of weight for height. Females tended to be better nourished than males. Multiple regression analysis showed that increases in arm circumference and Hb levels were associated with significant productivity gains of about 4 %. At the midpoint, group 11 males gained 1.10 kg (p<0.0003) while group I males showed no change. Weight loss during the latter part of the study resulted in no significant final weight change for males. "Successful" supplementation was weakly associated with productivity increase for group 11 workers of 12.5% (p <0.10)

"Relation between Mineral Fertilization and Supply of Potassium, Calcium, Magnesium and Phosphorus to the Population under Conditions of Intensive Plant Production in East Germany." W. Romer and W. Merbach. Nahrung 26 (2): 135 (1982).

In the past 25 years, mineral fertilization increased considerably in the GDR in the course of the intensification of plant production. This happened on the basis of computerassisted advice on mineral fertilizing and resulted in the improvement of the mineral contents of the soil and also in a considerable increase in crop yields, the mineral contents typical of the respective plants remaining mostly unchanged or being in part increased. During the same period, the proportion of vegetable foods in the mineral supply to man decreased due to changes in food habits. Nevertheless, most of the P. K, and Mg consumed in the nutrition still originates from vegetable products; only in the case of Ca, milk is the main source. In the course of this development, the amounts of P. K, and Ca consumed in the human nutrition increased, whereas the amount of Mg remained almost unchanged. There is some evidence of the (at least potential) danger of an insufficient supply of Ca and Mg. As the intensive plant production in the GDR furnishes highmineral crops in sufficient quantity, a better supply of these minerals might be realized by reducing the losses due to processing (extraction rate of cereals, preservation) and by changing the food habits (more vegetable foods, greens). (In German.)

"Protein Requirements of Preschool Children: Obligatory Nitrogen Losses and Nitrogen Balance Measurements Using Cow's Milk." B. Torún, M. i. Cabrera-Santiago, and F. E. Viteri. Arch. Latinoamer. Nutr. 31 (3): 571 (1981).

Obligatory N losses through faeces (FN) and urine (UN) were measured in five children and N balance was measured in them and in five others (23 - 4 months old) using four levels of cow's milk intake. FN, UN, and FN + UN were 19.5 ± 6.9, 34.0 ± 5.3, and 53.7± 8.1 mg N/kg/day, respectively. The rations of FN, UN, and total obligatory losses (FN + UN + sweat and integumental N) to basal energy expenditure were 0.38, 0.64, and 1.11 mg N/basal kcal, respectively. The two latter values are 32% and 45% lower than the 1971 FAO/WHO estimates. Mean N requirement determined by factorial calculations using a correction factor of 1.3 and by N balance techniques was 98 mg N or 0.61 9 milk protein/ kg/day, which is 33% lower than the FAO/WHO estimates. Depending on the allowances made for inter-individual variability, safe levels of protein intake ranged from 0.79 to 0.94 g/kg/day, 33% to 21 % lower than FAO/ WHO recommendations. Apparent and "true" milk protein digestibilities were 80 + 4% and 94 + 4%, respect lively.

"Lymphocyte Subpopulations and Antibody Levels in Immunized Malnourished Children." L.S., Salimonu, A. O. Johnson, A. I. Williams, G. I. Adeleye, and B. O. Osunkoya. Brit J. Nutr. 48 (1): 7 (1982).

1. The proportions of Iymphocyte subpopulations (by rosette tests) and the serum antibody levels (using haemagglutination techniques) were estimated in malnourished and well fed Nigerian children before and up to 21 days after immunization with tetanus toxoid or measles virus vaccine

2. Significantly diminished (p < 0.01) mean percentage T Iymphocyte levels and considerably higher mean percentage null cell levels were observed in the malnourished children before immunization with either of the vaccines.

3. There were comparable in vivo increases in percentage T Iymphocytes in malnourished and control children following administration of each antigen.

4 The mean percentage B Iymphocyte levels were similar in the control and malnourished children before and after the immunization.

5. There was a slight depression in the tetanus antibody levels (p > 0.2) but a significant diminution (p < 0.01) in measles virus antibody concentrations in the malnourished children.

6. Rise in mean percentage T Iymphocytes corresponded with the elevation in mean tetanus antibody levels in both malnourished and control children following tetanus toxoid immunization. This was, however, not the situation in the malnourished children following immunization with measles virus.

7. The observed depressed T Iymphocyte number in malnourished children may, in practice, affect their handling of antigens such as measles virus in vivo.

"Effect of Moderate Malnutrition on Immediate Hypersensitivity and Immunoglobulin E levels in Asthamatic Children." M. A. Reyes, N. G. Saravia, R. R. Watson, and D. N. McMurray. J. Allergy Clin. Immunol. 70 (2): 94 (1982).

Dermal reactions and lgE levels were compared in 51 asthmatic Colombian children identified on the basis of anthropometric measurements as nutritionally normal (25) or mildly (16) or moderately (10) undernourished. Twenty-five non-atopic children served as controls. Total serum lgE concentrations were significantly elevated in the asthmatic group as a whole. Moderately malt nourished (grade II) asthmatic children had more than twice as much serum lgE as normal or mildly malnourished (grade I) asthmatic subjects and seven times more than non-atopic children. Intestinal parasitism did not appear to contribute to these differences in lgE levels. Serum levels of lgA and lgD were similarly elevated in grade II asthmatics. Concentrations of serum lgG, lgM, and C3 and C4 complement were unaffected by nutritional or allergic status. Eosinophilia in nasal mucus was significantly reduced in grade I and grade II malnourished asthmatic children. Among asthmatics, the most frequent dermal reactions were to mite antigens (96%), house dust (67%), and grass pollens (35%). Significant levels of specific lgE were detected by the RAST to two species of mites in nearly all atopic children. There was no apparent influence of nutritional status on the distribution or reactivity on specific lgE assay. The clinical significance of hyperimmunoglobulin E in atopic, moderately malnourished children remains to be elucidated,

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