INCAP studies of kwashiorkor and marasmus.

This article summarizes thirty years of intensive clinical metabolic and therapeutic studies of the consequences of severe protein deficiency relative to calories, which results in kwashiorkor, and of a balanced deficiency of protein and calories that results in marasmus. Evidence is provided that these are two different metabolic diseases, but kwashiorkor is usually superimposed on some degree of chronic marasmus and hence most cases studied were marasmic kwashiorkor. The value of the creatinine/height index to indicate the degree of lean body cell mass with any disease is demonstrated.

INCAP studies of nutrition and infection.

As soon as the Institute of Nutrition of Central America and Panama (INCAP) began to study the poor nutritional status and stunting of children in the rural villages of Central America, it was apparent that infections, particularly diarrheas, were also a serious problem. Studies of kwashiorkor indicated that infections precipitated kwashiorkor and anemia in children who were already malnourished. In the 1940s there was almost no suggestion in the literature of a relation between nutrition and infection. INCAP gradually identified the mechanisms by which any infection worsens nutritional status and demonstrated that infections were more severe and more often fatal in malnourished children and adults. These studies ultimately led to the 1968 World Health Organization (WHO) monograph "Interactions of nutrition and infection" and widespread recognition by public health workers of the importance of this relationship for morbidity and mortality in poorly nourished populations.

INCAP studies of endemic goiter and its prevention.

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally. However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt. When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.

History and early development of INCAP.

Nevin Scrimshaw was the founding Director of the Institute of Nutrition of Central America and Panama (INCAP), serving as Director from 1949 to 1961. In this article, he reviews the history of the founding of INCAP, including the role of the Rockefeller and Kellogg Foundations, the Central American governments, and the Pan American Health Organization. The objectives pursued by INCAP in its early years were to assess the nutrition and related health problems of Central America, to carry out research to find practical solutions to these problems, and to provide technical assistance to its member countries to implement solutions. INCAP pursued a strategy of selecting promising Central Americans for advanced education and training in the US who assumed positions of leadership on their return. After this early phase, talented non-Central Americans of diverse origins were brought to INCAP, as well as additional researchers from the region. Growth of INCAP, as reflected in its annual budget and in the physical plant, was rapid and this was accompanied by high scientific productivity. Several field studies were launched that contributed impetus and design elements for the Oriente Longitudinal Study, which is the focus of this supplement.

Historical concepts of interactions, synergism and antagonism between nutrition and infection.

In the 1950s textbooks of nutrition made little or no mention of a relation to infection. The same was true for treatises on infectious disease. Relevant studies in experimental animals and a number of classical clinical observations were available pointing out the role of infection in precipitating nutritional disorders. However, clinicians and nutritionists did not recognize the importance of the relationship. The field and metabolic studies of the Institute of Nutrition of Central America and Panama (INCAP) in the 1950s demonstrated that malnutrition and infection in humans are generally synergistic. These studies stimulated the review of available evidence that resulted in the 1968 WHO monograph on "Interactions of Nutrition and Infection." It provided extensive evidence for the role of infections in precipitating clinical malnutrition and for the impact of malnutrition on morbidity and mortality from infection. The high frequency of diarrhea in underprivileged young children led to intensive studies in many countries of its effect on nutritional status and to recognition of the high prevalence of "weanling diarrhea." The effects of infection on nutritional status were then extensively and elegantly investigated at Fort Detrick, MD, and hormonal and cytokine mechanisms identified. The subsequent explosion in knowledge of cell-mediated immune mechanisms has led to an understanding of how malnutrition lowers this resistance. Today, recognition of the synergistic relationship between nutrition and infection influences most public health interventions to prevent malnutrition.

Tolerancia a la lactosa y el consumo de leche: mitos y realidades / Lactose tolerance and milk consumption: myths and facts

El disacárido lactosa, el principal carbohidrato de las leches de animales, requiere de la enzima lactasa para disociarse en glucosa y galactosa. La lactosa no digerida pasa al colon, en donde por fermentación se produce hidrógeno y ácidos grasos de cadena corta que pueden producir distensión abdominal, dolor, y algunas veces, diarrea. La persistencia de lactasa intestinal después de la niñez temprana, se hereda como característica genética autosómica dominante y altamente penetrante. En base a la revisión de más de 560 referencias, todos los datos disponibles en lo que a la pérdida primaria de lactasa intestinal en poblaciones latinoamericanas se refiere, se presentan en forma tabulada. La prevalencia de maldigestores de lactosa en poblaciones latinoamericanas varía de 45% a 100%. No obstante, éste no es un predictor confiable de la aceptabilidad de la leche y de los productos lácteos que contienen lactosa. La leche está siendo utilizada con éxito a nivel mundial, para la alimentación suplementaria de niños, y la mayoría de maldigestores de lactosa pueden tolerar cuando menos, 240 ml de leche o el equivalente de lactosa de otros productos. La mala digestión de la lactosa no interfiere con la absorción de la proteína y micronutrientes esenciales de la leche. Se proporciona información referente al contenido de lactosa de la leche y productos lácteos, sobre el consumo usual de leche de poblaciones latinoamericanas, y sobre observaciones experimentales y de campo a través del mundo...

Guías de alimentación: bases para su desarrollo en América Latina: informe de la reunión / Dietary guide: the basics for their development in Latin America: meeting report

El objetivo de la Reunión fue efectuar una revisión y actualización de los principios nutricionales que deben orientar la alimentación de los pueblos de la Región, y ofrecer ciertas recomendaciones que permitan a los Gobiernos de América Latina, elaborar e implementar "Guías de Alimentación" dirigidas a sus respectivas poblaciones...El Grupo discutió una amplia agenda apoyada por numerosas ponencias preparadas por los mismos participantes. A la luz de los conocimientos actuales, se analizaron las recomendaciones internacionalese, las metas nutricionales que es deseable alcanzar para América Latina y los criterios que deben tener en cuenta los Gobiernos de los países en la elaboración de sus Guías Nacionales de Alimentación. Este Informe, al que llamaremos "Informe de Caracas" , recoge las conclusiones del grupo de participantes, quienes analizaron los principios científicos pertinantes y propusieron una serie de medidas para estimular la elaboración y aplicación de Guías de Alimentación.

Efecto de la yodación de la sal sobre la prevalencia de bocio endémico en niños escolares de Guatemala / Effect of salt iodization on the prevalence of endemic goiter in school children in Guatemala

Successive surveys in school children in Guatemala show that a progressive reduction in endemic goiter prevalence has been achieved through the salt iodization programs. The results indicate that the initial prevalence of 37 percent in 1951-1952 dropped to 15 percent in 1962 and to 7 percent in 1964. Moreover, whereas in 1951-1952 the reports showed figures of 10 percent for Grade 2 goiter and 2 percent for Grade 3, these forms of the disease had virtually disappeared by 1962 and were no longer found among school children in the 1964 surveys. These findings clearly indicate the advisability of undertaking iodization programs in all areas where endemic goiter is present, and they show also that beneficial results can be achieved even when it is not possible to iodize the entire amount of salt produced

El sindrome pluricarencial de la infancia y su respuesta a una dieta heperproteica

Publicado en ingles en The Jounal of the american Medical Association, 164:555-561, 1957

Problemas nutricionales en niños de Centro America y Panama

Publicado en ingles en Pediatrics, 16:378-397, 1955