Implications of the Central America-Dominican Republic-Free Trade Agreement for the nutrition transition in Central America

OBJECTIVES: To identify potential impacts of the Central America-Dominican Republic-Free Trade Agreement (CAFTA-DR) on food consumption patterns associated with the nutrition transition, obesity, and diet-related chronic diseases. METHODS: Examination of CAFTA-DR agreement to identify measures that have the potential to affect food availability and retail prices. RESULTS: CAFTA-DR includes agreements on tariffs, tariff-rate quotas (TRQs), and sanitary and phytosanitary regulations with direct implications for the availability and prices of various foods. Agreements on investment, services, and intellectual property rights (IPR) are also relevant because they create a business climate more conducive to long-term investment by the transnational food industry. Trade liberalization under CAFTA-DR is likely to increase availability and lower relative prices of two food groups associated with the nutrition transition: meat and processed foods. These outcomes are expected to occur as the direct result of increased imports from the United States and increased production by U.S. companies based in Central America, and the indirect result of increased domestic meat production (due to increased availability of cheaper animal feed) and increased production of processed foods by domestic companies (due to a more competitive market environment). CONCLUSIONS: CAFTA-DR is likely to further the nutrition transition in Central America by increasing the consumption of meat; highly processed foods; and new, non-traditional foods. The public health community should be more aware of the implications of trade agreements for dietary health. Governments and related stakeholders should assess the coherence between changes fostered by specific trade agreements with national policies on diet and nutrition.

The appropriateness of the current antibiotic empiric therapy based on the bacteria isolated from severely malnourished Jamaican children

We performed a retrospective audit of antimicrobial sensitivities of bacteria isolated from children admitted with a diagnosis of malnutrition to the Tropical Metabolism Research Unit (TMRU), University of the West Indies, between January 1995 and December 1999. There were 150 admissions for severe malnutrition to the TMRU during this period, which was approximately 50 percent fewer than in a previous TMRU study done ten years ago, between 1984 and 1989. In the present study, bacteraemia was documented in 10 percent of 150 severely malnourished children between 1 and 31 months of age. The most common organism isolated were coagulase-negative Staphylococci, which represented 40 percent of the total isolates. The micro-organism grown were most likely to be sensitive to amoxycillin/clavulanic acid. The current TMRU treatment protocol for severe malnutrition recommends use of crystalline penicillin plus gentamicin as empirical antibiotic therapy. This study has provided valuable information suggesting that the current empiric antibiotic therapy may be inappropriate. (AU)

Nutritional status of children under 5 years of age in three hurricane-affected areas of Honduras

Hurricanes and other natural disasters can produce crop destruction, population displacement, infrastructure damage, and long-term public health consequences that include increased malnitrition among the affected populations. This paper presents the results of anthropometric measurements taken of 295 children under 5 years of age from three regions of Honduras that were affected by Hurricane Mitch, a major storm that struck Central America in the fall of 1998. The children in our study were sampled in three shelters in the capital city of Tegucigalpa; in the resettlement zone of Nueva Choluteca, Choluteca; and in the small urban area of Catacamas, Olancho. Our data indicated that, in comparison to the period before the hurricane, there was an elevated prevalence of wasting in all three of the study areas, and that there were also high levels of underweight in the Tegucigalpa and Nueva Choluteca study areas. There were statistically significant differences between the mean values of malnutrition indicators for Catacamas and those for the Tegucigalpa and Nueva Choluteca settlements. These differences suggest that resettled families were confronting a nutritional crisis in July and August of 1999, some 9 months after the hurricane struck (AU)

The nutritional status of the elderly residents at the Golden-Age Home, Kingston

The elderly group has been acclaimed as the fastest growing worldwide, with the most increase taking place in the developing countries. Due to this increase in the elderly population and importance of good nutrition which is the possibility of a more vigorous and abundant life, there is need for more research on this group of individuals especially as it relates to their nutrition. This study is aimed at assessing the nutritional status of the elderly residents at the Golden Age Home, Kingston, a government institution; and the relationship between nutritional status and state of health. This study involved 96 elderly resident at the institution aged 60 years and above. It was conducted in two phases; the first phase involved administration of a questionnaire to assess their demographic characteristics, dietary habits, functional status and state of health as reported by the individuals. The second phase involved taking anthropometric measurements and blood samples from each of the respondents to assess their nutritional status. Findings revealed that the majority (55.2 percent) of the respondents were males compared to 44.8 percent females, with mean age 77.2 ñ 8.9 years. The gender difference was statistically significant (t=3.19, p<0.01). Majority, (80.2 percent) was functionally independent and ambulant. Chronic illnesses prevalent among this group were hypertension, arthritis and diabetes. Nutritional status revealed malnutrition at different levels (36.5 percent) and high incidence of anaemia (52.1 percent), but this was higher in males than females (20 males compared to 15 females malnourished and 54.7 percent males compared with 48.8 percent females with anaemia). Overweight/obesity was more prevalent among the females (32.6 percent) compared to males (11.3 percent). Underweight/different levels of malnutrition were however more prevalent among males. Most of these elderly were involved in one form of physical activity or the other, with more males than females engaging in physical activities. Different sources of support were revealed but this needs to be improved. There was no significant relationship between nutritional status and state of health. Recommendations were made for improving the quality of the diets of the elderly residents at institutions to improve their nutritional status and addressing factors that affect nutrition ... (AU)

Birth weight may influence susceptibility to oedematous forms of severe protein-energy malnutrition [abstract]

OBJECTIVE: To determine whether an association exists between reported birth weight and oedematous forms of severe protein energy malnutrition (PEM). METHODS: Severe PEM continues to be a major public health problem worldwide. However, the causes of oedematous PEM (OPEM) have not yet been elucidated. Recently, birth weight was reported to be associated with risk of ischaemic heart disease and Type 2 diabetes mellitus in adults. It is possible that the examination of the relationship between birth weight and OPEM in children may give clues, not only about the mechanisms underlying the developing of OPEM, but also about the mechanism by which associations between birth weight and adult disease may arise. As part of a larger project to create a database containing information on children admitted to the ward of the Tropical Metabolism Research Unit, the authors reviewed the clinical records of 884 children. Children were categorised as having either OPEM or non-OPEM. Multiple logisitic regression was used to examine the relationship between reported birth weight and the odds ratio (OR) for having OPEM. RESULTS: In this sample of children, the OR for having OPEM was 1.40 (95 percent CI 1.15 - 1.70) for each increase of 1 pound in birth weight. Birth weight remained significant even after inclusion of gender, mother's age and birth rank in the mutliple logistic regression model. CONCLUSION: These results suggest that among children with severe PEM, higher birth weights are associated withan increased risk of oedematous malnutrition. Replication of this result in a large sample is required.(Au)

Primary malnutrition - can we always tell?

OBJECTIVE: To determine if there was a decrease in admissions for primary malnutrition and an increase in those for initially undiagnosed secondary malnutrition over the period January 1, 1990 to October 31, 1999 at the Tropical Metabolism Research Unit (TMRU). DESIGN AND METHODS: A retrospective review of all admissions, for treatment of malnutrition, to TMRU using admission books and patient records was done. Children were classified with secondary malnutrition if diagnosed after admission with illnesses known to cause malnutrition. Those known to have such conditions on admission or who were over 10 years old were eliminated. Nutritional diagnosis according to the Wellcome classification, age at presentation, sex and birth weight were reviewed. RESULLTS: A total of 411 patients were admitted to the TMRU during this 10-year period and 23 of these had secondary malnutrition have increased, especially since 1998. Children with secondary malnutrition were usually marasmic (78 percent), had low normal birth weight (2.8kg) and presented at a later age (15.3 months). The most common secondary cause of malnutrition was HIV infection (56 percent). CONCLUSION: There has been an increase in initially undiagnosed secondary malnutrition seen at TMRU over the last ten years even with a decrease in admissions for primary malnutrition. This may be due to subtlety of presentation and indicates a need for increased vigilance in assessment by health professionals in order to optimize management.(Au)

Metabolic handling of different fatty acids during rehabilitation from childhood malnutrition

The gastrointestinal handling and post absorptive metabolism of [1, 1, 1-13 C] triolein (TO) and [1, 1, 13 C] tripalmitin (TP) were studied in two groups of eight severely malnourished children (5-0 months): on admission (Phase 1), during rapid-catch up growth (Phase 2) and when weight for height had reached 90 percent of the reference (Phase 3). Total excretion of 13 C label in stool (over 3 days) and breath as 13 CO 2 (over 24 hours) were analysed by isotope radio mass spectrometry. Stool 13 C excretion at admission was approximately 10 percent of the administered dose for both trials but varied markedly between subjects, was significantly reduced during rehabilitation in the TO trial (Phase 2:0.5 +or- 1.0; Phase 3: 1.3 +or- 0.9; p<0.05) and tended to decline on the P trial. ANOVA analysis of the magnitude and time course of 13 C excretion in breath (from area under the curve), excretion tended to decrease during rehabilitation in the TO trial but remained unchanged on the TP trial. These results suggest that the efficiency with which dietary triacylglycerol is handled within the gastrointestinal tract is generally impaired in severely malnourished children at admission but improves during rehabilitation.(Au)

Linamarin levels in economically important yam varieties and implications for health

There are over 600 species of Dioscorea of which some 50 are eaten worldwide. World production is estimated at some 20 million tonnes annually. In tropical and subtropical countries such as West and East Africa, the Caribbean, South America, India, and South East Asia, yam tubers constitute an economically important food crop. In some of these countries yam constitutes an important part of the daily staple, serving as an ideal source of calories and contributing vitamins and minerals vital to health. Antinutritional components are however also a part of the total compostion, one class among these being the cyanoglucosides. This study centers on the extraction, quantification and identification of the cyanoglucosides in economically important yam varieties. High Performance Liquid Chromatography Studies on purified extracts of cyanoglucosides in different varieties of four Dioscorea species - namely D alata, D cayenensis, D esculenta and D rotundata - have confirmed linamarin as the main cyanoglucoside in yams. Among the twelve cultivars studied, linamarin levels varied from 573.7 ñ 193.6 ppm for D cayenensis cv. roundleaf to 165.7 ñ 17.5 ppm for D rotundata cv lucea. This result could be of revelance in appropriate selectively in the promotion of desirable cultivars of yam for the food and health industries, since cyanide from linamarin, apart from interfering with oxidative processes of metabolism, also produces pancreatic damage by free radical mechanisms reactions and is therefore thought to be a factor in malnutrition related diabetes. This effect is most likely when there is ingestion of cyanide containing food coupled with low protein intake. There is a definite coincidence of malnutrition related diabetes and the consumption of staples containing cyanide yielding substances. Against their background, cultivars with low enough levels of cyanoglucoside should be favoured, since there are safe limits for cyanide ingestion.(AU)

Caribbean Christmas Beverages

The warning signs of poor nutritional health are often overlooked. For your guidance, this issue of Nyam News provides information on how changes in the different parts of your body may be related to certain nutrients in your diet.

Chronic diseases: the new epidemic

Mortality statistics show that there has been a significant change in the leading causes of death in Jamaica over the last 50 years, characterized by a decrease in the infectious diseases and those due to undernutrition and an increase in the non-communicable disease. The various patterns of this epidemiological transition worldwide are outlined and the characteristics of this "new" epidemic are discussed. Data are presented from the findings of the recent multi-country study of hypertension and diabetes, including Jamaica, which shows that as the body mass index (BMI) increases across the African diaspora, so does the prevalence of hypertension and diabetes. Among the Jamaican population studied, the prevalence of hypertension was 19.1 percent among males and 28.2 percent among females. Reported prevalence of previously diagnosed diabetes was 5.3 percent in men and 10.4 percent in females. The gender differences are in part explained by the differences in mean BMI which were 23.8 and 27.9, respectively, for males and females. 30.6 percent of males and 64.7 percent of females were either overweight or obese, with obesity prevalent in 7.2 percent of the males and 31.5 percent of the females studied. The increasing prevalence of obesity across the Caribbean is cause for concern as it significantly impacts on the demand for health and medical care. The identification of these reversible risk factors should be used to inform public policy to tackle what will be a growing concern.(AU)

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

OBJECTIVE: We investigated whether there was a growth or morbidity response to zinc supplementation. DESIGN: The study was randomized, placebo-controlled, and double-blind. SETTING: Children were recruited at clinics in Kingston, Jamaica, and supplemented at home. SUBJECTS: Children selected were singletons aged 6-24 months, and stunted (< -2.0 s.d. length for age, NCHS references). They were stratified by sex and age and randomly assigned to receive zinc supplement (n = 31) or placebo (n = 30). Four children were excluded because of hospitalization; all others had all measurements. Adequately nourished children (n = 24) were recruited from a well-baby clinic. INTERVENTIONS: The supplement provided 5 mg elemental zinc in a syrup daily for 12 weeks; the placebo comprised the syrup only. MAIN OUTCOME MEASURES: Caretakers were interviewed to obtain social background data, number of clinic visits and hospitalizations. Anthropometric measurements were done on enrolment, and after 6 weeks, 12 weeks and 12 months. Children's health was determined by weekly questionnaire to caretakers of the undernourished groups during the supplementation period. RESULTS: The supplemented and placebo groups were similar on enrolment. The adequately nourished children were from significantly better socio-economic circumstances. Mean initial hair zinc content was 5.5 +/- 4.8 mumol/g (supplemented group) and 6.7 +/1 12.1 mumol/g (placebo) (n.s.). Regression analyses showed that there were no significant effects of supplementation on length, height or head circumference, nor on the incidence of any morbidity symptom. Mean duration of the episodes was significantly shorter for skin rashes in the supplemented group compared with the control group (ANCOVA, P = 0.02), and longer for vomiting (P = 0.02). The incidence of hospitalization was significantly greater in the control group (Fisher's exact test, P = 0.02). CONCLUSIONS: Zinc supplementation reduced the hospitalizations which probably reflect severity of morbidity, but did not improve growth.(Au)

Emerging evidence of the effectiveness of nutrition services

Despite lack of uniformity of data, emerging evidence of the effictiveness of nutrition services in outpatient services , prenatal services, among diabetic and hypertensive patients indicate that nutrition services can lead to dietary change and subsequently to improved health outcomes and ultimately to decreased health care costs