World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition.

The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.

Developing food supplements for moderately malnourished children: lessons learned from ready-to-use therapeutic foods.

Ready-to-use therapeutic foods (RUTFs) are solid foods that were developed by changing the formulation of the existing liquid diet, F-100, recommended by the World Health Organization (WHO) for the rapid catch-up phase of the treatment of children suffering from severe acute malnutrition (SAM). The resulting products proved highly effective in promoting weight gain in both severely and moderately wasted children and adults, including those infected with HIV. The formulation of the existing RUTFs, however, has never been optimized to maximize linear growth, vitamin and mineral status, and functional outcomes. The high milk content of RUTFs makes it an expensive product, and using lower quantities of milk seems desirable. However, the formulation of alternative, less expensive but more effective versions of RUTF faces difficult challenges, as there are uncertainties regarding the effect in terms of protein quality, antinutrient content, and flatulence factors that will result from the replacement of current dairy ingredients by less expensive protein-rich ingredients. The formulation of alternative RUTFs will require further research on these aspects, followed by efficacy studies comparing the future RUTFs to the existing formulations.

Evolution of nutritional management of acute malnutrition.

Wasting, kwashiorkor and stunting are not usually due to either protein or energy deficiency. Treatment based upon this concept results in high mortality rates, and failure of treated children to return physiologically to normal. They become relatively obese with insufficient lean tissue. Preventive strategies have also failed. Wasting and stunting are primarily due to deficiency of type II nutrients and kwashiorkor probably due to deficiency of several type I nutrients that confer resistance to oxidative stress. Modern dietary treatments are based upon the F75 formula whilst the child is sick without an appetite, followed by F100 for rapid gain of weight. Derivative, ready-to-use therapeutic foods (RUTF) allow treatment of large numbers of children at home, are preferred by mothers and dramatically improve coverage. Children are indentified by screening in the community and treated before complications arise, using simple protocols. Successful treatment of the sick children with severe malnutrition not only depends upon these products, but appropriate management of complications. The physiology of the malnourished child is completely different from the normal child and many drugs and treatments that are safe in children with normal physiology are fatal for the malnourished child. In particular, the diagnosis and management of diarrhea and dehydration is different in the malnourished child. Giving standard treatment frequently leads to circulatory overload and death from heart failure. The challenge now is to find successful local ways to prevent malnutrition and achieve nutritional security. Until prevention works, we have to rely on fortified foods for treatment and convalescence from illness.

Nutritional associations with bone loss during the menopausal transition: evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids.

BACKGROUND: The menopausal transition is characterized by rapid bone loss. Few data exist on the role of nutrition. OBJECTIVE: The objective of the study was to ascertain which dietary factors influence perimenopausal skeletal loss. DESIGN: A longitudinal study was conducted of 891 women aged 45-55 y at baseline and 50-59 y at follow-up 5-7 y later. Bone mineral density (BMD) was measured by using dual-energy X-ray absorptiometry at the lumbar spine and femoral neck (FN). Nutrient intakes were assessed after the baseline visit and 5 y later, by using the same food-frequency questionnaire. RESULTS: After adjustment for energy intake and other confounders, higher intakes of calcium were correlated with change in FN BMD (ie, reduced loss) (r = 0.073, P < 0.05), and the intake of modest amounts of alcohol was associated with less lumbar spine bone loss (P < 0.01 for quartile of alcohol intake). Greater FN BMD loss was associated with increased intake of polyunsaturated fatty acids (r = -0.110, P < 0.01), monounsaturated fatty acids (r = -0.069, P < 0.05), retinol (r = -0.067; P < 0.05), and vitamin E (r = -0.110; P < 0.01). The latter 2 nutrients were highly correlated with polyunsaturated fatty acids. For premenopausal women, calcium and nutrients found in fruit and vegetables (vitamin C, magnesium, and potassium) were associated with FN BMD, and calcium, vitamin C, and magnesium were associated with change in FN BMD. CONCLUSIONS: Although menopausal status and hormone replacement therapy use dominate women's bone health, diet may influence early postmenopausal bone loss. Fruit and vegetable intake may protect against premenopausal bone loss.

Comparison of antioxidant status during recovery from malnutrition on a corn oil- or coconut oil-based diet - abstract

Children recovering from malnutrition are given a high-energy diet during the "catch-up" phase. Corn oil, a poly-unsaturated fatty acid (PUFA) rich vegetable oil, is used to supply 60 per cent of the energy in the recovery diets. Previous work suggests that this high intake of corn oil may be associated with a deterioration of antioxidant status. A normal antioxidant status is essential for protection against cell damage. We therefore compared indices of antioxidant status (whole blood gluthathione, GSH; plasma vitamen E; and urinary mercapturic acid outputs (UMCA) in two groups of malnourished children who had recovered on isocaloric diets containing either PUFA rich, corn oil (Control group) or coconut oil (test group), which is rich in saturated fatty acids. Both groups showed an initial normalisation of GSH and vitamin E levels; whereas the test group maintained normal levels, the control group showed a progressive decrease of both indices during recovery. At discharge the test group had GSH (2.7 ñ 0.08 vs 2.44 ñ 0.88 mmol/Lrbc, mean ñ SEM) and vitamen E (8.44 ñ 1.21 vs 7.38 ñ 1.01 mg/l), levels that were significantly higher (p< 0.05) that in the Control group. Several children in the Control group had vitamen E levels that were below the accepted normal range. At recovery, UMCA outputs of the Control group (4.85 ñ 0.55 umol/kg/24 hr) were further increased, and as such were significantly higher (p < 0.05) than the admission mean (3.32 ñ 0.54 umol/kg/24 hr). In the test group, mean discharge UMCA output (1.98 ñ 0.44 umol/kg/24 hr) was significantly lower than admission values, as well as the mean discharge UMCA output of the Control group. This suggests that the body's burden of compounds that require detoxification is significantly increased when malnourished children are rehabilitated on a diet rich in corn oil. Following recovery on the coconut oil diet, plasma cholesterol levels (2.30 ñ 0.15 mmol) were similar to the pre-treatment mean (2.15 ñ 0.11 mmol). However, plasma levels of triglycerides fell significantly (p < 0.05) with treatment (pre: 1.23ñ0.14; post 0.88ñ0.08 mmol). When given a diet that is not rich in PUFA, malnourished children are able to maintain their antioxidant status within the normal range. It is suggested that coconut oil be used routinely in the formulation of recovery diets for malnourished children (AU)

Effect of zinc on lean tissue synthesis during recovery from malnutrition

During recovery from severe wasting, malnourished children gain weight at greatly accelerated rates. To determine if additional zinc added to their basal therapeutic diets increased the retention of lean tissue and stimulated protein metabolism, we studied three groups of children taking either the basal diet alone or the basal diet supplemented with either 76 mumol (5 mg) or 153 mumol (10 mg) Zn/kg diet. The zinc-supplemented children gained similar weight and consumed the same amount of diet as the unsupplemented children. Zinc supplementation resulted in a greater net absorption of nitrogen and a higher rate of protein turnover, as estimated from urinary ammonia 15N enrichment after oral [15N] glycine. We conclude that additional zinc affected the composition of newly synthesized tissue and intermediary nitrogen metabolism (AU)

Zinc intake and plasma insulin-like growth factor-I (IGF-I) in Jamaican malnourished children - abstract

The effect of zinc intake on plasma immunoreactive insulin-like growth factor-I (IR-IGF-1) was studied in 24 children (aged 3 to 24 mos) recovering from severe malnutrition. The children were randomly assigned to two groups for zinc supplementation. Twelve (Zn+) were given (2mg/kg/d) added to the recovery of diet, and 12 (ZN-) were not. There was no group difference in age, sex, anthropometric measurements or plasma IR-IGF-1 at baseline. Plasma IR-IGF-1 was significantly higher in the zinc supplemented children during recovery (p = 0.031). These results suggest that zinc intake stimulates IR-IGF-1 production. (AU)

Relationships among dietary quality, children's appetites, growth stunting and efficiency of growth in poor populations

Monotonous diets prevail among the poor in developing countries. In Jamaica, small children do not eat a variety of foods and the foods they do eat has a low energy density and is low in protein. Further, infants receive sweetened maize meal porridge and infant formula in a bottle. Older children eat a thicker porridge and rarely eat meats. Yet these children are content with small infrequent feedings. They often have infections which further diminishes their appetite resulting in weight loss. Their weight often does not catch up between infections. Gaseous intestinal distention, foul feces, and anorexia (indicative of small bowel anaerobic overgrowth) are common symptoms of undernutrition. Further anorexia is also a symptom of zinc, potassium, and phosphorous deficiencies. 17 percent of children <5 years old in Jamaica weighed <80 percent of the NCHS standard for age. Among 11-17 year old boys, the height of low income boys in Jamaica was much shorter (by 9 cm) than that of middle income Jamaican boys and the NCHS standards. This shows that earlier, chronic, environmental stress results in stunting. Further childhood undernutrition can also impair mental development. Food supplements do not always result in weight or height gain, however. Yet essential minerals and vitamins are not included in food supplements, but are included in animal feed. Lean tissues and adipose tissue synthesis are needed for normal growth each of which requires different diets. An optimal balance of amino acids and essential elements known as type II nutrients (potassium, magnesium, calcium, phosphorus, and zinc) are needed for lean tissue synthesis while adipose tissue synthesis needs energy for storage. Jamaican children who quickly improve after malnutrition become fat indicating that muscle synthesis lags behind adipose tissue synthesis. In conclusion, to prevent growth failure, nutritionists should concentrate on nutrient balance and nutrient intake in the diets and supplements of children.(AU)

Vitamin E status in oedematous and non-oedematous malnourished children - abstract

The antioxidant function of vitamin E is essential for maintaining the integrity of cell membranes. During the early phase of recovery from severe malnutrition, we measured the plasma levels of Vitamin E in 58 children on admission (A), and after metabolic recovery (B). A total of 19 marasmic children, and 34 with oedematous malnutrition (19 with marasmic-kwashiorkor and 15 with kwashiorkor) were studied. A further group of 5 oedematous children who were clinically assessed as extremely sick received daily vitamin E supplements. The children were all fed on the same dietary regimen. The results indicated that although vitamin E intake was greater in the non-oedematous (marasmic) children, the rate of change of concentration in the plasma did not differ between the two groups. This could possibly be attributed to a difference in the absorption or utilization of the vitamin between the groups. In the group receiving supplements, there was a significant increase in plasma vitamin E concentration between A and B. However, the rate of increase and the concentration at B did not differ from that in the two groups of unsupplemented children. We conclude that in malnourished children: (1) plasma viatmin E levels are low on admission, (2) values normalize by time B, and (3) supplementation with alpha-tocopherol in oil did not affect the rate of increase in plasma vitamin E. The supplement did not seem to be bioavailable (AU)

Plasma iron, transferrin and transferrin saturation of severely malnourished Jamaican children - abstract

Mortality amongst severely malnourished children is often associated with an unusually high hepatic store of iron (Fe). Indeed, this excess Fe has been implicated in the aetiology of kwashiorkor. In order to examine the possibility that unbound Fe may be present in the plasma of malnourished Jamaican children, Fe and its transport protein, transferrin were measured. Transferrin saturation ( percentTS) was calculated from plasma Fe and transferrin levels. The measurements were also carried out in a control group of 23 healthy children who had presented for elective minor surgery. Plasma Fe levels (fg/dl) in children with marasmic-kwashiorkor (MK; n = 59. 69ñmeanñ), kwashiorkor (K, n = 37; 76ñ) and in those who died (D;n = 24: 111ñ) were not significantly different from the control group (C; 79ñ). In the marasmic group Fe levels (M;n = 63: 66ñ g/dl) were significantly lower than (p<0.05) than normal. In malnutrition, transferrin levels (mg/dl) were significantly lower (p<0.001) than normal: C - 232ñM - 170ñn = 66: MK - 110ñn = 61: K - 84ñn = 41: D - 77ñn = 24. In the marasmic group transferrin levels were significantly higher (p<0.001) than the other malnourished groups. percentTS was lowest in the marasmic group and highest in the group of children who died. At a percentTS of 30 percent, mortality was 5 per cent compared with a mortality of 24 per cent when percentTS was >90 per cent. It is concluded that oedematous malnourished Jamaican children have normal plasma levels of iron, but significantly reduced levels of circulating transferrin. The latter were more severely decreased in children with kwashiorkor and those who died. Elevated percentTS was associated with increased mortality. It is recommended that iron supplements be witheld during the early stages of resuscitation of the malnourished child (AU)

Zinc and muscle growth during recovery from malnutrition - abstract

During recovery from severe malnutrition, muscle gain is slow relative to overall weight gain. We postulated that this might be due to an inadequate supply of zinc. We therefore compared nitrogen (N) balance and protein synthesis rates (as estimates of muscle gain) during early, mid and late recovery in children fed 3 different levels of dietary zinc (Low Zn gp.n = 4; Moderate Zn gp.n = 4; High Zn gp.n = 3). N intake was similar in the 3 Zn groups throughout recovery. N net absorption and N retention were also similar in early recovery. Later, both increased in the moderate and high Zn groups only: so also did the N retention /g wt gained. By late recovery, they were each significantly higher in the high Zn gp than in the low Zn gp. Thus, Zn supplementation of the relatively low Zn recovery diet resulted in synthesis of tissue richer in N - and therefore, by implication, having a higher proportion of muscle. Protein synthesis rates were calculated from the 15N enrichments of urinary urea and ammonia at plateau, obtained during a constant nasogastric infusion of 15N labeled glycine. Overall, the results using the 2 different end products were not different. However, there was a difference among the Zn gps in the 15N ammonia enrichments. From these values, protein synthesis rates were significantly higher than in the high Zn gp than in the low Zn gp by late recovery (table included). These data are consistent with the N balance data in that they indicate increased muscle protein metabolism with Zn supplementation (AU)

Plasma zinc levels throughout pregnancy: a study in Jamaican women with relevant aspects of nutrition - abstract

In a prospective study, plasma zinc levels were determined by atomic absorption spectrophotometry in 135 Jamaican women over a two-year period. A total of 1,237 such determinations were made at fixed intervals throughout pregnancy. Zinc being an essential trace element with a wide physiological role in many aspects of metabolism, supplementary studies on the relationship between zinc, folic acid, vitamin A and dietary intake in general were undertaken. Results (Table) show that plasma zinc levels were lowered during pregnancy, moreso during the second trimester: the levels rise significantly during labour and then fall rapidly towards normal during the puerperium. Daily dietary zinc intake was of the order of 8-10 mg/day (the RDA for pregnancy being 15 mg/day) while protein intake averaged 67 gm/day (the RDA for protein being 80-90 gm/day). Clinical and laboratory investigations revealed no signs of any dietary deficiency among the patients. Average weight gain in pregnancy was 12 kg. Plasma, vitamin A and red cell folate levels were within normal ranges in all patients, indicating that there was no state of zinc deficiency interfering with the absorption of these vitamins. Viewed together, all the facts of this study suggest that the pattern of the fall of plasma zinc in pregnancy is a normal physiological change not related to socio-economic status, parity or age. It is concluded that the lowered plasma zinc observed in pregnancy does not reflect a state of true deficiency nor even a state of inadequate dietary zinc intake; it is most likely due to the heavy demand for zinc in the developing foetal tissues and by the expanding maternal blood volume (AU)

The use of eggs in the assessment of selenium status of a community - abstract

Selenium (Se) deficiency appears to play a part in the development of oedematous malnutrition. It occurs in regions where soil Se availability is low. This is likely in wet, tropical limestone-based regions, such as in much of Jamaica. In high Se regions in Venezuela, Se status of the inhabitants and Se concentrations in the locally produced eggs were high. The present study explored the potential use of egg Se concentrations as a monitor for low Se areas in Jamaica. Six areas were selected, three of which were expected to be low Se areas. Homes were visited and free range hens' eggs, soil samples and hair samples were collected. Se concentrations of the sample were measured. For each area, the mean concentrations in ppm dry weight were: Glengoffe, Haynes, E. St. Thomas, Porus, Mavis Bank, Lluidas Vale; YOLK - 1.3, 2.1, 2.2, 1.8, 1.2, 1.6 respectively Total mean is 1.8; WHITE - 1.5, 3.0, 4.4, 2.4, 1.6, 2.1 Total mean is 2.7; SOIL - 0.7, 0.6, 1.1, 1.8, 0.4, 1.9 respectively Total mean is 1.2; HAIR - 0.5, 0.6, 0.6, 0.8, 0.5, 0.5 respectively Total mean is 0.6. In many of the soil samples, the values found were lower than the accepted normal range. However, in egg and hair samples, they were mostly within the normal (literature) range. There were no very low values. There was a linear correlation between egg white and egg yolk concentrations (n=101, r=0.84, p<0.001) and between egg yolk and soil concentration (n=102, r=0.20, p<0.05). Overall, however, egg Se concentration did not reflect closely either soil or hair Se concentration, and therefore is unlikely to be a useful index of Se status of a community (AU)

The excretion of taurine in severe malnutrition - abstract

Taurine may be a conditionally essential nutrient in man. Diets lacking taurine have resulted in reduced body and urinary taurine and in the development of abnormal retinograms, which were reserved with taurine supplementation. Malnourished children are often fed diets low in taurine and other sulphur amino acids, particularly cow's milk-based diets. It is therefore possible that their taurine body pools and hence excretion are low. Urinary taurine was measured, by spectrophotometry, in 37 malnourished children, aged 3-24 months, on admission to hospital and when recovered. Four normals, aged 60-96 months, were also studied. Taurine in the urine of the normals, expressed as uM/d, was about 6 times that of the malnourished children on admission and on discharge respectively. The difference was even greater when expressed per body weight. The values were also low when compared with published values for normals. The children were rehabilitated on a cow's milk-based diet. Thus, the over-all low levels most likely resulted from low dietary taurine and reduced synthesis. Urinary taurine can serve as a crude index of taurine status, suggesting that the children were at risk of developing abnormal retinograms. The lowest values were from the oedematous children. This observation could be important in terms of new data showing that taurine protects cell membranes by attenuating toxic compounds. Taurine supplementation might beneficial in severe malnutrition (AU)

Zinc absorption in malnutrition - abstract

Malnourished children are often zinc-deficient. Net intestinal absorption (NA) of zinc is the main factor controlling zinc status: NA = TA - ES, where TA is total intestinal absorption, and ES is endogenous secretion of zinc into the intestine. In order to investigate factors affecting zinc homeostasis, we have measured NA and TA in 7 severely malnourished and in 10 recovered (weight-for-height) children, 8 to 18-months-old. NA was calculated as the difference between feed zinc intake and faecal zinc output over a 3-day period. TA was calculated as the difference between feed intake and faecal output of the stable isotope, 70Zn, given over the first 6 hours of the balance. Eight of the recovered children, the control group, were given a standard cow's milk-based infant formula at 'maintenance energy' intake. TA of zinc was 25ñ7 percent of zinc intake (meanñSD); it increased significantly with the age and weight of the child, and insignificantly with the weight gain (RWG). NA of zinc, 19ñ8 percent of zinc intake, was not related to age, weight or RWG. ES of zinc varied from 0 to 22 percent of zinc intake. The other 2 recovered children were given a low protein formula, also at 'maintenance energy' intake. Of them, 4 non-oedematous children had RWG similar to the recovered children but NA of zinc (8ñ4 percent of intake) was lower than in the recovered children. TA (32ñ1 percent of intake) was lower than in the 2 recovered children on the same formula. The 3 oedematous children were sicker than the others; two were anorectic and therefore fed by nasogastric tube throughout their balances. TA were 5 and 9 percent in the tube fed and 21 percent in the other child. NA of zinc was -28, +2 and -14 percent. Thus 2 children had a high ES of zinc while the other child had a low ES Zn; he was the only one with profuse diarrhoea. The very low TA Zn and negative NA in two of the three children show that zinc homeostasis was markedly deranged and that zinc deficiency was probably present. This is consistent with our previous finding of low plasma zincs in oedematous malnourished children. The findings imply the need for zinc supplementation of severely malnourished children, in particular those with oedema. They also imply that factors affecting zinc absorption include the child's age and/or weight, and the dietary zinc and/or protein content. This study was supported by the Medical Research Council and the Wellcome Trust (AU)

Effect of glycine supplementation on the pyroglutamic aciduria during recovery from severe malnutrition - abstract

We have previously demonstrated that as benzoic acid conjugates with endogenous glycine to form hippuric acid, the resulting glycine debt is associated with an increased pyroglutamic acid (PGA) excretion. We concluded that PGA could be used as an index of glycine insufficiency. Glycine is a substrate for glutathione (GSH) synthesis and PGA is an intermediate of the gamma-glutamyl cycle in which GSH is formed. As demand for glycine is enormous during periods of rapid growth, we supplemented glycine (127 mg/kg/d) to five rapid growing children (weight gain > 10g/kg/d) during recovery from severe malnutrition. Urinary PGA and blood GSH were measured before and after supplementation. SUBJECT 1: Diagnosis - kwashiorkor, Age - 18, Wt - 7.34, Change PGA - -73, Change GSH - +6.6; SUBJECT 2: Diagnosis - Mar/kwash, Age - 23, Wt - 6.55, Change PGA - -233, Change GSH - +7.6; SUBJECT 3: Diagnosis - mar/kwash, Age - 10, Wt 7.89, Change PGA - -55, Change GSH - +10.4; SUBJECT 4: Diagnosis - undernourished, Age - 14, Wt - 7.93, Change PGA - -53, Change GSH - +8.2; SUBJECT 5: Diagnosis - marasmus, Age - 12, Wt - 6.39, Change PGA - 0, Change GSH - + 4.9; SUBJECT 6: Diagnosis - kwashiorkor, Age - 14, Wt - 7.89, Change PGA - +245, Change GSH - -8.7. In four of the subjects, PGA decreased after supplementation while there was a concomitant increase in GSH. One showed no change in PGA excretion and had stopped growing. The other child showed the opposite result. PGA is usually associated with a deficiency of the enzyme GSH synthetase which is reponsible for the synthesis of GSH from glycine and glutamylcysteine. Our results support the hypothesis that if the availability of glycine were low then the reaction catalysed by GSH synthetase would be reduced because of limited substrated, and that the mechanism is effectively the same as with an absence of the enzyme - that is an increased PGA excretion. In this case, glycine corrects the defect. Furthermore, the data provide evidence that rapidly growing children may have an increased requirement for glycine (AU)

Selenium status during recovery from malnutrition: effects of selenium supplementation - abstract

It was previously shown that malnourished Jamaican children often had evidence of selenium deficiency, viz. low erythrocyte glutathione peroxidase (RBC GSH Px) activity that correlated inversely with cardiothoracic ratio, and was particularly low in children who died. In this study, RBC GSH Px activity, plasma GSH Px activity and plasma selenium concentration were measured in 41 malnourished children on admission to hospital, and after recovery in weight-for-height. Plasma GSH Px activity and selenium concentrations were also measured longitudinally throughout recovery in a group of 24 initially selenium-deficient children, 17 of whom were given oral selenium supplements for the first 3 weeks. RBC GSH Px activity was low in all malnourished children, whether oedematous or not (Table). It did not change with recovery. Plasma GSH Px activity and plasma selenium concentration were low only in oedematous malnourished children. PEM GROUPS: control, marasmus, oedematous; ERYTHROCYTE GSH Px (U/gHb)- *36ñ2, 24ñ4, 21ñ3 respectively; PLASMA GSH Px act. (U/L) - 140ñ9, 142ñ15, 98ñ8 respectively, PLASMA SE CONCN. (æg/e) - 86ñ4, 76ñ12, 53ñ5. *meanñSEM. Selenium was associated with a rapid rise in both plasma GSH Px activity and plasma selenium concentration. The increase in plasma selenium was more dramatic (44 up to 144 æg/e in 6 days): the variability in plasma GSH Px activity was much greater, and they remained within the control range. The changes were sustained after supplementation ceased. We conclude that (1) selenium deficiency in malnourished Jamaican children is not reversed during 'recovery' on the conventional 'high energy' diet, (2) plasma selenium concentration responds rapidly to changes in selenium intake, and is a useful measure of selenium status, and (3) oral selenium supplements improve selenium status in children recovering from malnutrition (AU)

Superoxide dismutase in red cell fractions in severe malnutrition - abstract

When fed a milk-based diet, the red cell superoxide dismutase activity (CuSODA) of malnourished children decreased. Copper supplementation prevented the decrease. This led to the suggestion that red cell CuSODA represented recent copper intake. By separating red blood cells (RBC) into fractions of different ages and measuring the CuSODA of each, it should be possible to obtain an estimate of the copper status over the life span of the RBC. There is a strong correlation between the age of RBCs and their destiny: young cells being less dense than old cells. Percoll was used to develop a method to separate cells iospycnically. Thirteen fractions were prepared with densities between 1.076 g/ml. RBCs from malnourished and healthy children were fractionated by this method, and each fraction assayed for haemoglobin and CuSODA. The total CuSODA of whole blood from each subject was also measured. Mean (and standard error) whole blood CuSODA of 15 malnourished children on admission was 3,284ñ132 i.u./gm Hb. This correlated well (r=0.69) with the sum of CuSODA in the fractions of cells (3,187ñ112). In malnourished children, there was a preponderance of heavy (old) cells. However, there was no difference in the CuSODA between the different fractions. There was a slight decrease in the CuSODA with increasing density in blood taken from three healthy children. The control children had higher CuSODA in their lighter cells. This study has shown that severely malnourished children have a preponderance of heavy (old) cells. The fact that young, less dense cells had the same CuSODA as old (more dense) cells suggests that there is no change in the copper status of severely malnourished children in the four-month (120 days) period prior to their admission to hospital (AU)

Dietary patterns with respect to iron intake in the Turks and Caicos Islands - abstract

Cohen et al (1974) found a high prevalence of anaemia amongst 0-13 year-old children in the Turks and Caicos Islands. There was a marked inter-island variation with 69 percent of 5-year-old children on Middle Caicos and 28 percent on Grand Turk being anaemic. They ascribed this anaemia as probably being due to iron deficiency. A food frequency questionnaire was designed and weighted so that household iron consumption could be computed as a score. The method was pretested and the score calibrated against 24-hr recalls for three days in 10 individuals: a correlation coefficient of r=0.93 was obtained between the two methods. The questionnaire was administered to the female household head of 144 households on Grand Turk (48), Provodentiales (46) and Middle Caicos (50), selected at random from the register of voters. The foods consumed formed a series of Guttman scales for each of the eight food groups. Chicken, fish, rice, bread and evaporated milk were most frequently consumed. The dietaries were very restricted on each island, with Middle Caicos only having eight major items consumed more than three times per week, by more than 25 percent of households. The households were divided into low, medium and high iron intake categories based on iron scores which correspond to ó7.5, 7.6 to 12.9 and o13mg Fe/d. Grand Turk and Provodentiales were similar with 1 percent of families in the low iron group and 76 percent in the high group. In contrast, 20 percent of families in Middle Caicos were in the low, and only 44 percent in the high iron intake group. The iron equivalent of the overall scores for the three islands were 15.2ñ2.1, 14.6ñ1.7 and 11.8ñ2.7mg/d respectively. The mean RDA for iron for this population's age/sex structure is 10.1 mg/d. When the contributions to the total iron intake from each food group were calculated, Middle Caicos households had significantly lower intakes in each category. These data add support to the hypothesis that dietary iron deficiency is responsible for the high prevalence of anaemia in the Turks & Caicos Islands. Bread and rice were consumed more than 3 times weekly by 98 and 93 percent of households on each island: these were the only items which would be suitable for iron fortification. As the flour and rice are entirely imported from the U.S.A., in relatively small quantities (total population 7,700), it is probably more cost-effective to distribute prophylactic iron supplements than to fortify a dietary constituent (AU)