The use of changes in hair root morphology in the assessment of protein-calorie malnutrition.

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of Black West Indian children. Significant differences in mean shaft diameter, mean % anagen, and mean % telogen were found only between the well-nourished and the severely malnourished groups. No significant differences in mean % atrophy, and in mean diameter of anagen bulbs were found among well-nourished children, children with mild-moderate PCM, severely malnourished children, and children hospitalized for conditions with a secondary effect on nutritional status. The method was found to be time consuming; it can be used only for differentiating well-nourished from severely malnourished children; and it cannot be used for determining the prevalence of the different degrees of PCM. For these reasons, the method is not recommended for use in the field assessment of PCM.

The menstrual cycle's effect on the reliability of bioimpedance measurements for assessing body composition.

We examined the reliability of resistance (R) and body composition estimates measured by bioelectrical impedance analysis (BIA) in 25 women during their menstrual cycle. Weight and bioimpedance were measured daily for one cycle and sodium intake was assessed. The precision of bioimpedance measures was examined and subjects' average resistance, weight, Na intake, and calculated body composition during the four phases of menses were compared by using paired t tests. Significant differences were observed between phases 1 and 2 for R (p less than 0.001), weight (p less than 0.05), and fat-free mass (p less than 0.05) and differences were observed between phases 2 and 4 for R (p less than 0.05) and weight (p less than 0.05); no significant differences were observed for percent body fat. Changes in body weight (p less than 0.001) associated with Na intake explained a significant proportion of error in resistance measures. These data suggest the reliability of the BIA body composition approach during menses; small weight changes related to hydration status may, however, be a confounding influence.

The prevalence and the etiology of the nutritional anemias in Guyana.

A survey was carried out in Guyana to determine the prevalence and the etiology of the nutritional anemias among both sexes, in various age groups, and in pregnant and lactating women. The sample consisted of 590 subjects drawn from 103 households selected by multistage cluster sampling. Anthropometric and hematological measurements and stool investigations for intestinal parasites were carried out in each subject. Socioeconomic and other demographic data were obtained for each household. High prevalences of anemia, although of a relatively mild degree, were found among all age groups especially among pregnant and lactating women. The major factors related to Hb levels were found to be inadequate consumption of food rich in the erythropoietic nutrients, iron deficiency, age, sex, pregnancy, household income, and percentage of household income spent on food. A number of socioeconomic and other demographic variables were associated with anemia. More anemia was found in urban than in rural areas.

Factors affecting riboflavin requirements of oral contraceptive users and nonusers.

Riboflavin depletion has been identified in women on oral contraceptives (OC) but change in riboflavin nutriture has not been consistently demonstrated in all OC user groups studied. Discrepant findings in reports have been attributed to differences of pill formulation or riboflavin intake. Aims of this study were to compare the riboflavin requirements of healthy OC users and nonusers on diets prepared in a metabolic unit. A single daily menu and meal pattern was used. The basic diet providing riboflavin at a level of 0.6 mg/1000 kcal was used in the period of acclimation and period 1. In periods 2 and 3, the riboflavin content of the diet was increased to 0.8 and 1.0 mg/1000 kcal, respectively. The riboflavin status of subjects was monitored by erythrocyte glutathione reductase assay and urinary riboflavin excretion. Eight women on OC and 10 nonusers participated. Erythrocyte glutathione reductase assay values and urinary riboflavin excretion showed intersubject and interperiod differences but no significant group differences (OC versus non-OC) in erythrocyte glutathione reductase values or in urinary riboflavin per g creatinine. It was concluded that when dietary intake is controlled, OC do not significantly influence riboflavin status. Riboflavin needs were related to energy requirements of the subjects.

An evaluation of the use of changes in hair root morphology in the assessment of protein-calorie malnutrition.

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of black West Indian children. The following five hair root characteristics were measured: percentage of anagen (the growing phase), percentage of telogen (the resting phase), percentage of atrophy, diameter of anagen bulbs, and shaft diameter. Significant differences in shaft diameter, percentage of anagen, and percentage of telogen were found only between well-nourished and severely malnourished children. Significant correlation coefficients were obtained between both bulb diameter and percentage of atrophy and muscle circumference. No significant differences in any of the hair root characteristics were obtained between children with nutritional marasmus and those with kwashiorkor. The method was found to be time-consuming; it can be used for differentiating well-nourished children only from those with severe PCM; and it is unsuitable for determining the prevalence of the three degrees of PCM. For these reasons, the method is not recommended for use in the field assessment of protein-calorie malnutrition.

Ultraviolet light-induced reductions in plasma carotenoid levels.

The effects of ultraviolet (UV) irradiation on plasma levels of carotenoids and vitamin A in human subjects were investigated in two crossover trials. UV exposures were given on 11 r 12 days of a 2-wk period. The 12 female and 12 male subjects received mean cumulative UV-A (320-400 nm) doses of 17.8 +/- 1.9 J/cm2 and 21.0 +/- 3.3 J/cm2 to the anterior and posterior sides of the body, respectively. UV-B (280-320 nm) doses were equivalent to 10% of UV-A doses given. Significant reductions in plasma total carotenoid levels were observed in both female (p less than 0.004) and male (p less than 0.05) subjects after repeated irradiation. There was no significant effect on plasma vitamin A levels. It was concluded that UV treatment can reduce plasma carotenoid levels in vivo.

Effects of aerobic exercise and weight loss on riboflavin requirements of moderately obese, marginally deficient young women.

In a previous study, exercise was shown to increase riboflavin requirements of active, normal weight young women. The present study examined the effect of exercise and weight loss on riboflavin status of moderately overweight women. The experiment was designed as a two-period cross-over with an initial base-line period and two 5-wk metabolic periods. The basic diet contained 1200 kcal with a riboflavin concentration of 0.8 mg/1000 kcal. Exercise consisted of a program of dance exercise. Riboflavin depletion, as measured by increased erythrocyte glutathione reductase activity coefficients and decreased urinary excretion of riboflavin, occurred during both nonexercise and exercise periods. Erythrocyte glutathione reductase activity coefficients increased from a base-line mean of 1.28 +/- 0.11 to 1.40 +/- 0.12 during nonexercise and to 1.49 +/- 0.16 during exercise. Urinary excretion of riboflavin fell from 48 +/- 12% of intake during base-line to 30 +/- 13% during nonexercise and to 19 +/- 6% during exercise. Riboflavin depletion was not related to the rate or composition of weight loss or to change in aerobic capacity.

Effect of beta-carotene supplementation on photosuppression of delayed-type hypersensitivity in normal young men.

The aim of this study was to examine whether beta-carotene protects against the immunosuppression seen with long-wave ultraviolet-light (UV-A) exposure. Free-living, healthy men, aged 19-39 y received 30 mg beta-carotene/d or a placebo while on a single-menu, low-carotenoid diet. After 28 d all subjects received 12 exposures to a UV-A/B light source over a 16-d period. The total UV-A dose received ranged from 15.9 to 19.3 J/cm2. The total shorter-wave ultraviolet-light (UV-B) dose varied from 1.59 to 1.96 J/cm2. Follow-up continued for 21 d. Carotenoid assays and delayed-type hypersensitivity (DTH) tests were performed at baseline, pre-UV, post-UV, and after follow-up. The DTH-test responses were significantly suppressed in the placebo group after UV treatments. The suppression was inversely related to plasma beta-carotene concentrations in this group. There was no significant suppression of DTH test responses in the beta-carotene group. It is concluded that beta-carotene protects against photosuppression of immune function.

Dietary fat and the regulation of energy intake in human subjects.

The role of dietary fat in the regulation of energy intake was assessed by manipulating a conventional diet and measuring spontaneous food consumption. Twenty-four women each consumed a sequence of three 2-wk dietary treatments in which 15-20%, 30-35%, or 45-50% of the energy was derived from fat. These diets consisted of foods that were similar in appearance and palatability but differed in the amount of high-fat ingredients used. Relative to their energy consumption on the medium-fat diet, the subjects spontaneously consumed an 11.3% deficit on the low-fat diet and a 15.4% surfeit on the high-fat diet (p less than 0.0001), resulting in significant changes in body weight (p less than 0.001). A small amount of caloric compensation did occur (p less than 0.02), which was greatest in the leanest subjects (p less than 0.03). These results suggest that habitual, unrestricted consumption of low-fat diets may be an effective approach to weight control.

Accuracy of heart-rate monitoring and activity diaries for estimating energy expenditure.

The accuracy of heart-rate monitoring and activity diaries for measuring energy expenditure in free-living individuals was studied in 12 women. Estimates of energy expenditure were calculated from heart-rate monitoring by use of four different prediction equations to describe the relationship between heart rate and energy expenditure. Estimates of energy expenditure from activity diaries were calculated using both individually measured and published values for the energy cost of activities. Energy intake adjusted for changes in body-energy stores was used as a reference. Heart-rate monitoring overestimated group energy expenditure from 2 to 9% and the errors in estimating individual energy expenditure ranged from -53 to 67%. Activity diaries underestimated group energy expenditure by 2-6% and the errors in estimating individual energy expenditure ranged from -39 to 56%. Heart-rate monitoring and activity diaries may prove useful for estimating the energy expenditure of groups but not individuals.

Effects of exercise on riboflavin requirements of young women.

The riboflavin requirement of young women during periods of sedentary living and exercise was determined during a 12-wk metabolic study. The study was divided into a 6-wk no exercise period followed by a 6-wk exercise period in which subjects jogged around a track for 20 to 50 min/day. Twelve subjects, aged 19 to 27 yr, were fed a basic diet containing 0.6 mg riboflavin/1000 kcal of intake. Riboflavin intake was increased by 0.2 mg/1000 kcal increments by provision of riboflavin in a glucose polymer mixture. Linear regression analysis was used to estimate the riboflavin intake required for an erythrocyte glutathione reductase activity coefficient of 1.25 during both the no exercise and exercise periods. Individual riboflavin requirements ranged from 0.62 to 1.21 mg/1000 kcal before exercise and 0.63 to 1.4 mg/1000 kcal during the exercise periods. Riboflavin requirement could not be related to the kilocalorie intake or lean body mass of the subjects. It is concluded that healthy young women require more riboflavin to achieve biochemical normality than the 1980 Recommended Dietary Allowances and that exercise increases riboflavin requirements.

Riboflavin requirements and exercise adaptation in older women.

The effects of exercise training on riboflavin requirements and of riboflavin intake on endurance were examined in 14 women, 50-67 y of age, who participated in a 10-wk, two-period crossover exercise study at two riboflavin intakes, 0.15 micrograms/kJ (0.6 micrograms/kcal) and 0.22 micrograms/kJ (0.9 micrograms/kcal). Subjects exercised 20-25 min/d, 6 d/wk, for 4-wk periods on a cycle ergometer at 75-85% of their maximal heart rate. Riboflavin status was assessed by measuring the erythrocyte glutathione reductase activity coefficient (EGRAC) and urinary riboflavin excretion. Physical performance was evaluated by using a walking treadmill test to determine maximal oxygen capacity (VO2max) and anaerobic threshold by gas exchange (ATGE). Exercise significantly affected riboflavin status as EGRAC increased (P less than 0.001) and riboflavin excretion decreased (P less than 0.01) in both groups. VO2max increased significantly with exercise (P less than 0.01). However, changes in VO2max (L/min) and ATGE with exercise training were not different in the two groups. Riboflavin requirements of older women increased with exercise training, but increased riboflavin intake did not enhance improvements in endurance.

Effects of exercise on riboflavin requirements: biological validation in weight reducing women.

The present study was designed to evaluate our previous estimates for riboflavin requirement, 0.96 mg/1000 kcal during nonexercise and 1.16 mg/1000 kcal during exercise in overweight women. Two groups of 6 weight reducing women consumed either 1.16 mg riboflavin/1000 kcal (HR) or 0.96 mg/1000 kcal (MR). The study was two, 3 period by 2 treatment (exercise or nonexercise) crossover designs, one design at each level of riboflavin. Erythrocyte glutathione reductase activity coefficients (AC) significantly increased in both groups from 1.16 +/- .02 to 1.20 +/- .03 in group HR and from 1.31 +/- .04 to 1.36 +/- .02 in the MR group during nonexercise and exercise, respectively. ACs increased in the HR group due to an increase in total enzyme activity while ACs increased in the MR group due to a decrease in basal enzyme activity reflecting decreased flavin availability. There were no differences in aerobic capacity, weight loss, nor change in lean body mass between the two groups. Thus, 0.96 mg/1000 kcal was not adequate during either nonexercise or exercise periods while the 1.16 mg/1000 kcal was adequate.

Effect of psyllium gum and wheat bran on spontaneous energy intake.

Energy intake, fecal energy output, and gastrointestinal symptoms were measured in 12 females who consumed either approximately 23 g/d supplementary fiber or a 4 g/d fiber control. Fiber supplements were crackers containing psyllium gum, wheat bran, or a combination of the two fiber sources. After 1 wk on the control cracker, subjects consumed the three high-fiber crackers and the control cracker for 2-wk periods in a balanced design. Gum and combination supplements gave increased bloating and flatulence. Increase in abdominal pain was reported with gum supplement. Mean daily fecal energy was 96 kcal/d with control crackers and was increased by 63 kcal with high-fiber crackers. Gum and combination supplements significantly decreased intake of digestible energy by 153 and 115 kcal/d, respectively. This suppression was not dependent upon fiber intolerance. Wheat bran supplement had no effect on energy intake.

Body composition and energy intake: do overweight women overeat and underreport?

The relationship between energy consumption and body composition was evaluated in 63 women by use of energy-intake values that were precisely measured in a metabolic unit and corrected for deviations from energy balance. Energy requirement for the maintenance of body weight was not significantly correlated with adiposity expressed as percent body fat. However, energy requirement was positively associated with lean mass (p less than 0.0001) whereas fat mass added no predictive value to the same multivariate regression equation. Self-reported energy intake (before the experiments) was not correlated with lean mass and was underestimated by lean subjects at least as much as by obese subjects. Discrepant findings in the literature concerning relationships between obesity and energy intake may be explained by reporting error and by the relative lean mass of obese vs nonobese women but not by systematic underreporting unique to obese subjects.

Increase in hepatic gamma-glutamyltransferase (GGT) activity following chronic ethanol intake in combination with a high fat diet.

Increased hepatic gamma-glutamyltransferase (GGT) activity following chronic ethanol consumption has been attributed to enzyme induction, dietary carbohydrate imbalance, and/or to hepatic cell damage. In this study, hepatic GGT activity was increased in rats consuming ethanol (35% of kcals) in a high fat (35% of kcals) diet compared to pair fed and ad lib. fed high fat controls (P less than or equal to 0.01), but no enhancement of activity was observed in those rats consuming ethanol on low fat (11% of kcals) diets. The high-fat-ethanol group also had increased hepatic lipid (P less than or equal to 0.01) and decreased glutathione levels (P less than or equal to 0.05) compared to their ad lib. fed control group. In rats that had ethanol removed from their diet for the final 4 weeks of the 12-week dietary treatment period, levels of GGT, lipid or glutathione were not different from control values. Histochemical evaluation of hepatic GGT activity showed increases associated with centrolobular lipid accumulation in ethanol-fed rats consuming a high fat diet. The cause of the increase in hepatic GGT activity could not be determined from this experiment. However, increased microsomal enzyme activity did not appear to be related to GGT activity. It is suggested that cellular damage following increased lipid accumulation, depletion of hepatic glutathione, or changes in biliary flow may be associated with the increased GGT activity.

Development and current status of home-delivered meals programs in the United States: are the right elderly served?

Federal home-delivered meals programs for the frail elderly began in the United States in the 1970s, and during the 1980s the provision of meals to the homebound elderly has been expanded through development of state-funded meals programs. The time has now come to pose two questions relative to coverage and program impacts. These questions are whether the program serves those who are currently most needy and whether the meals programs reduce the need for higher levels of care. Information available suggests that the elderly most served are those with socioeconomic problems that reduce their ability to obtain regular meals. Medical disability as a criterion for program eligibility or priority is less often used. The new finding that provision of home-delivered meals reduces hospitalization rates has to be re-examined, to ask the key question of whether the medically needy are actually kept out of the hospital by being provided with home-delivered meals.

Nutritional concerns in the alcoholic.

In summary, nutritional concern of alcoholics as viewed by the patient differ from the concern of his/her nutrition and health advisers. Between alcoholics, nutritional concerns differ with age, sex, and life style. Caloric excess, obesity, nutrient overload, and a whole spectrum of nutritional deficiencies are found in alcoholics. Causes of malnutrition are complex. Malnutrition is commonly associated with prior alcoholic damage to tissues. Vulnerability for specific syndromes of nutritional deficiency is dependent on genetic predisposition. Optimal response to nutritional rehabilitation requires abstinence, as no nutrient or combination of nutrients will protect tissues from alcoholic damage. However, moderate intake of alcoholic beverages may offer some protection against coronary heart disease.

Therapeutic effects of drug-nutrient interactions in the elderly.

The elderly are the major drug users both because they need specific prescription drugs for control of chronic diseases and because they make excessive use of over-the-counter (OTC) drugs. Therapeutic drugs that are required may be discontinued because the individuals suffer side effects or because the drug is ineffective. Adverse drug reactions in the elderly may result from drug overuse or misuse, slowed drug metabolism or elimination secondary to aging or to age-related chronic disease, intake of alcohol, food-drug incompatibilities, or nutrient-drug interactions. The timing of drug intake in relation to food intake is an important determinant of therapeutic efficacy in the elderly. Food-drug interactions in the gastrointestinal tract may reduce drug absorption. Enteral formula feeding may also interfere with drug absorption. Conversely, absorption of certain drugs (e.g., thiazides) may be promoted by meal-induced slowing of gastric emptying time. Therapeutic diet prescription can influence drug responses in the elderly because the protein composition of the diet influences the rate of drug metabolism. Nutrient depletion secondary to the effect of drugs may be recognized as an important and often avoidable type of adverse drug reaction.

Effect of fiber supplements on the apparent absorption of pharmacological doses of riboflavin.

The effect of dietary fiber from wheat bran and psyllium gum on the apparent absorption of riboflavin was studied in 12 healthy women. The test fiber was consumed in crackers that contained approximately 7.5 gm fiber from psyllium gum, wheat bran, or a combination of the two sources. Each subject was given a riboflavin load test after consuming one of the three different fiber supplements or a control supplement that contained 1.3 gm fiber. Fractional urine collections were made for 24 hours, and riboflavin was measured by fluorometric techniques. The psyllium gum and combination supplements reduced the 24-hour apparent absorption of riboflavin from 31.8% to 25.4% and 26.1%, respectively (p less than .01). No effect of the wheat bran supplement on riboflavin was detected.