Large marine protected areas represent biodiversity now and under climate change.

Large marine protected areas (>30,000 km2) have a high profile in marine conservation, yet their contribution to conservation is contested. Assessing the overlap of large marine protected areas with 14,172 species, we found large marine protected areas cover 4.4% of the ocean and at least some portion of the range of 83.3% of the species assessed. Of all species within large marine protected areas, 26.9% had at least 10% of their range represented, and this was projected to increase to 40.1% in 2100. Cumulative impacts were significantly higher within large marine protected areas than outside, refuting the critique that they only occur in pristine areas. We recommend future large marine protected areas be sited based on systematic conservation planning practices where possible and include areas beyond national jurisdiction, and provide five key recommendations to improve the long-term representation of all species to meet critical global policy goals (e.g., Convention on Biological Diversity's Aichi Targets).

Dietary habits of the Somali population in Liverpool, with respect to foods containing calcium and vitamin D: a cause for concern?

BACKGROUND: A large percentage of Liverpool Somalis have vitamin D deficiency and low calcium excretion. The dietary habits of Liverpool Somalis were investigated with respect to food items containing calcium and vitamin D. METHODS: A questionnaire, administered by a Somali field worker, assessed the intake of food of 60 adult (45 females and 15 males; mean age 42 years) and 10 child (seven females and three males; mean age 10 years) Somali volunteers. Questions concerned personal details, health (bone and muscle problems) and dietary habits including the frequency of consumption of food items containing substantial amounts of calcium and vitamin D. Results Most subjects reported bone and muscle pain. Eating habits reflected traditional customs. Foods containing substantial amounts of calcium and vitamin D were consumed infrequently. Milk was only consumed in tea. Those self-reporting bone pain consumed eggs, cheese and beans rarely. CONCLUSION: The food choices of these individuals with regard to bone health is a cause for concern and indicates a likelihood of low calcium and vitamin D intake.

The cost of infant feeding in Liverpool, England.

OBJECTIVE: To investigate feeding practices in infants under the age of 4 months in Liverpool, England with particular reference to the cost of infant feeding. DESIGN: A cross-sectional survey consisting of self-completion questionnaires and interviews. SETTING: Subjects' homes within Central and South Liverpool Primary Care Trust areas. SUBJECTS: One hundred and forty-nine women (aged 18 to 43 years) and their infants (mean age 13 weeks). RESULTS: The average weekly cost of breast-feeding was 11.58 pounds sterling compared with 9.60 pounds sterling for formula-feeding. Many breast- and formula-feeding women spent money however on items that were not needed or used only once or twice. This was especially true of first-time mothers. Characteristics significantly associated with higher spending were: feeding method - mothers that had or were partially breast-feeding (P=0.001), education - those educated to degree level (P=0.028), socio-economic status - those in social classes I and II (P=0.002) and age - those aged 30 years and over (P=0.003). CONCLUSIONS: This study demonstrates that while breast-feeding is often promoted as being free, this is not the case. Better information needs to be given to parents to avoid wasting money on items that are unnecessary, or where cheaper alternatives are available.

The effect of a dietary preload on estimation of usual food portion size by photograph in female volunteers.

BACKGROUND: The aim of this study was to investigate whether a subject's level of satiety influences perception of their usual portion size. METHODS: A total of 62 school children were recruited for the pilot study. Half of the group assessed food photographs for their usual portion size before lunch, and half after lunch. For the main study, 55 female students were recruited to test within-subject variation in perception of usual portion size before and after consuming a preload. RESULTS: Significant differences in perception of portion size were found for four of the six foods used. CONCLUSION: Some subjects' perception of their usual portion size was influenced by their level of satiety. Further study is needed to investigate this using a wider variety of food photographs and an alternative preload.

The estimation of food portion sizes: a comparison between using descriptions of portion sizes and a photographic food atlas by children and adults.

BACKGROUND: Food Photographs and standard portion sizes have been used with adults to assess portion size when recording dietary intake. The effectiveness of these methods may be reduced when memory/recall is required and children may have problems using these techniques. METHODS: Adults (47) and children (37) were recruited from amongst university personnel, their children and children's friends to assess portion sizes of nine self-served amounts of selected food items using food photographs and standard descriptions of portion sizes. Portion sizes were estimated directly after self-serving and three - 4 days later. RESULTS: Substantial differences in the estimate of portion sizes were observed for most foods regardless of the method used or the age of the subjects, median difference range: -52-100%. For children there were greater errors using both methods than for adults. Significant differences were found between the two methods of estimating weight. The food atlas provided higher median estimated weights for the majority of the food items. There were very few differences in the estimation of portion sizes between the two testing periods. CONCLUSION: The findings would suggest that either an alternative method or a modification of the methods used here for estimating portion sizes in young subjects, for example standard food portion sizes for children of different ages such as those that are being developed by the Food Standards Agency, would be more appropriate.

The incidence of dieting amongst adolescent girls: a question of interpretation?

AIM: It is the intention of this study establish the extent of dieting practices amongst adolescent girls and identify their perceptions with regard to 'dieting' and 'healthy eating'. METHODS: A total of 140 girls, aged 12-13 years, were recruited from two schools. A self-reported questionnaire, which determined the incidence of dieting and sought to identify the girls' perceptions of 'dieting' and 'healthy eating', was used to collect data. RESULTS: Out of the total group, 33.6% reported that they had dieted at some time and 15.8% were presently dieting. The most popular definition of dieting amongst the dieters was 'eating less/cutting down'; however, the second most popular answer was 'eating healthy food' which was the most popular answer amongst the non-dieters. The most popular definition of healthy eating was 'increasing fruit/ veg/salads', which is similar to how many girls perceived dieting, i.e. eating healthy food (fruit/veg/salads). CONCLUSION: Establishing the actual incidence of dieting amongst adolescent girls is not a clear-cut issue as it can be interpreted in many different ways, depending on the perceptions of the individual. The results of this study showed that in many cases 'dieting' and 'healthy eating' were perceived in a similar light, concluding that the dietary intake of dieters may be similar to that of non-dieters with both groups being at risk from any related health problems.

Dieting behavior among 11-15-year-old girls in Merseyside and the Northwest of England.

PURPOSE: To examine the general dieting behavior and characteristics of adolescent girls in the United Kingdom, and in particular, the Northwest of England. METHODS: A total of 569 girls, ages 11-15 years, from six schools in the Merseyside and Lancashire area, representing a cross-section of social status, completed a nonstandardized questionnaire concerning general dieting behavior. Data were analyzed using SPSS (p < .05 was considered significant). RESULTS: The incidence of dieting was 35.3%. The earliest reported age of starting to diet was 8 years. Significantly more girls from the independent schools (45.2%) had started to diet by the age of 10 years, compared to girls from the comprehensive schools (24%) (p = .03). Of those who had dieted, 30.3% had dieted up to two times during the previous 12 months, 17.4% had dieted up to four times, and 6% had dieted for most of the time. Most girls (33%) dieted for 2-4 weeks at a time, and 66% thought that dieting was good for their health. Only 52% said their parents did not approve of them dieting. Most girls (42.1%) dieted because they felt they were too fat. CONCLUSION: This study has shown that many young girls are engaging in potentially harmful dieting practices from a very early age, and are of the opinion that dieting is a healthy activity. This would suggest that many misconceptions are held with regard to nutritional advice and education, and that such information should be reviewed and changed accordingly.

Aflatoxins in autopsy kidney specimens from children in Nigeria.

Autopsy kidney specimens from 24 children with kwashiorkor and 21 with other miscellaneous diseases, at the Obafemi Awolowo Teaching Hospital Complex, Ile-Ife, Nigeria, were analyzed for the presence of aflatoxins using high-performance liquid chromatography. Aflatoxins were detected in 14 children who died of kwashiorkor and in 13 of those who died from miscellaneous diseases. Aflatoxicol was detected in 10 specimens, 7 of which had severe gastroenteritis. Seven kidney specimens demonstrated the presence of more than one type of aflatoxin; four of these were kidneys of patients with kwashiorkor and the remaining three died from renal failure. No difference was found between the frequency of detection, type of aflatoxin detected, or mean concentrations of total aflatoxins in the kidney specimens of the kwashiorkor children when compared to the kidney specimens of children who died from miscellaneous diseases. These findings demonstrate that aflatoxins can be detected in the kidneys of children exposed to aflatoxins.

Aflatoxins in the lungs of children with kwashiorkor and children with miscellaneous diseases in Nigeria.

Autopsy lung specimens from 20 children with kwashiorkor and 20 with other miscellaneous diseases, at the Obafemi Awolowo Teaching Hospital complex, Ile-Ife, Nigeria, were analyzed for the presence of aflatoxin using high-performance liquid chromatography. Aflatoxins were detected in 18 children who died from kwashiorkor but only in 13 of those who died from miscellaneous diseases. Of the 10 children, 5 in each group, who died with pneumonia, all had detectable levels of aflatoxins in their lungs. The two children with congestive cardiac failure, one secondary to pneumonia and the other secondary to tuberculous pericarditis, had more than two detectable aflatoxins in their lungs. These findings demonstrate that Nigerian children are exposed to aflatoxins and that high levels can accumulate in lung tissue.

Aflatoxins and ochratoxin A in the weaning food of Nigerian children.

A total of 48 samples of maize-based gruels, used as weaning food for children, were taken daily from hospital meals and from patients' mothers while their children were on admission at the Wesley Guild Hospital, Ilesha, Nigeria. These samples were analysed for aflatoxins and ochratoxin A. Twelve samples (25%) were positive for aflatoxins (concentration range 2-19,716 pg/g) but only four (8%) were positive for ochratoxin (concentration range 142-6516 pg/g). In the majority, the concentrations were relatively low, only two having aflatoxin and one ochratoxin A levels greater than 1000 pg/g. It is concluded that, unlike aflatoxin, ochratoxin A contamination is unlikely to present a major health hazard to the newly weaned child in this area of Nigeria.

PIP: Ochratoxin A is a toxic compound commonly produced by Penicillium verrucosum and Aspergillus ochraceus, two species of fungi. Ochratoxin A may play a role in the irreversible and fatal kidney disease known as Balkan endemic nephropathy. The compound also has potent carcinogenic effects and is known to be capable of causing liver damage. Aflatoxins form another group of mycotoxins produced by certain strains of Aspergillus flavus and related fungi, and are common contaminants of a wide variety of foods in tropical countries. The authors investigated whether the weaning diets of children in Ilesha, Nigeria, are contaminated by aflatoxins and/or ochratoxin A. 48 samples of maize-based gruels, used as weaning food for children, were taken daily from hospital meals and from patients' mothers while their children were admitted at the Wesley Guild Hospital. The samples were then analyzed for the presence of aflatoxins and ochratoxin A. 12 tested positive for aflatoxins and 4 were positive for ochratoxin. The concentrations were relatively low among the majority, with only two having aflatoxin and one having ochratoxin A levels greater than 1000 pg/g.

Two unusual cases of kwashiorkor: can protein deficiency explain the mystery?

Two children with unusual features of kwashiorkor are reported. One, an exclusively breastfed 7-month-old girl, had been admitted earlier, treated for pneumonia and discharged 3 weeks before she presented with kwashiorkor. The other was an identical twin who was admitted for kwashiorkor and gastro-enteritis. The twin sister was underweight but relatively well. Both children died. Potent aflatoxins were detected in the organs of these children on post-mortem examination. The occurrence of kwashiorkor in a fully breastfed infant and in an identical twin does not accord with the extant belief that the aetiology of kwashiorkor is wholly nutritional, but suggests a disease probably of multifactorial origin.

Ochratoxin A and aflatoxins in breast milk samples from Sierra Leone.

Breast milk from 113 mothers in two 'Under-Five Clinics' in the Southern Province of Sierra Leone, namely, Njala and Bo, were examined for their mycotoxin content. Only 10 were mycotoxin-free. Eighty-eight per cent of samples contained various aflatoxins and 35% contained ochratoxin A (OTA). Few samples (15%) had a single mycotoxin. Thirty-six (32%) had two mycotoxins and 50 (40%) had three or more. The occurrence of OTA in combination with various aflatoxins was recorded. It is concluded that infants in Sierra Leone are exposed to OTA and aflatoxins at levels which in some cases far exceed those permissible in animal feed in developed countries.

Protecting adolescent girls against tetanus.

PIP: An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.^ieng

Neonatal jaundice, aflatoxins and naphthols: report of a study in Ibadan, Nigeria.

This study set out to investigate the prevalence of naphthols and aflatoxins in the sera of babies with neonatal jaundice and their mothers in order to determine whether they contribute to the occurrence of unexplained neonatal jaundice in Ibadan. Blood was obtained from 327 jaundiced neonates and 80 of their mothers, and 60 non-jaundiced controls and seven of their mothers admitted to hospital between April 1989 and April 1991. Blood group, bilirubin concentration, erythrocyte G6PD status, aflatoxin and naphthol concentrations in blood were measured. Altogether, 30.9% of the jaundiced neonates were G6PD-deficient, compared with 13.3% of controls (chi 2 = 6.88; p = 0.009). Aflatoxins were detected in 27.4% of jaundiced neonates, 17% of their mothers, 16.6% of controls and 14.4% of control mothers. Naphthols were detected in 7.2% of jaundiced babies, 6.3% of their mothers, 6.25% of control babies and 14.4% of their mothers. Analysis of the data revealed that either G6PD deficiency or the presence of any serum aflatoxin is a risk factor for neonatal jaundice; odds ratio were 2.97 (95%) confidence intervals (CI): 1.31-6.74) and 2.68 (CI: 1.18-6.10), respectively. This study demonstrates that G6PD deficiency and/or the presence of serum aflatoxins are risk factors for neonatal jaundice in Nigeria. Aflatoxins are an additional risk factor not previously reported.

Salivary sampling for hepatitis B surface antigen carriage: a sensitive technique suitable for epidemiological studies.

Vertical transmission from mothers to infants of hepatitis B infection result in a high incidence of carriage in children with long-term consequences, and is the focus of current immunization strategies. The use of saliva for hepatitis B surface antigen (HBsAg) screening in a country with an intermediate to high prevalence of chronic carriage was investigated. We recruited 88 Thai women with known HBsAg status (44 positive, 44 negative) who were attending an antenatal clinic. The collection of saliva was acceptable to all patients. Aspects of technique regarding collection and handling in a tropical setting are discussed. Comparing the detection of HBsAg in saliva to serum using a commercially available serological test kit without modification, the sensitivity was 92.0% (95% CI 84.8-99.5) and the specificity was 86.8% (95% CI 76.0-97.6). Population acceptability and safety advantages along with a high sensitivity strongly support the use of salivary sampling for epidemiological surveillance of hepatitis B virus.

Neonatal jaundice with reference to aflatoxins: an aetiological study in Zaria, northern Nigeria.

Two prospective studies were undertaken to determine a possible relationship between perinatal aflatoxin exposure and neonatal jaundice. First, cord blood samples from 37 neonates who subsequently developed jaundice and from 40 non-jaundiced (control) babies were analysed for six major aflatoxins and aflatoxicol. Peripheral blood samples of both groups were also analysed postnatally for aflatoxins. In a second study, serum aflatoxin levels of 64 jaundiced neonates admitted from outside the hospital were compared with levels in 60 non-jaundiced control babies. Aflatoxins were detected in 14 (37.8%) cord blood samples of jaundiced neonates and in nine (22.5%) of the controls. The mean cord aflatoxin concentration was highest in jaundiced neonates with septicaemia, but the difference was not statistically significant. The frequency of detection of aflatoxins in peripheral blood was not significantly different in jaundiced and non-jaundiced babies. Aflatoxins were detected in the blood of over 50% of neonates with jaundice of 'unknown' aetiology. There was no correlation between severity of hyperbilirubinaemia and serum aflatoxin levels. Further studies are needed to determine the extent of pre- and postnatal exposure to aflatoxin in Nigerian infants and the effects of such exposure on fetal and neonatal health.

Human fetal exposure to ochratoxin A and aflatoxins.

Analysis of 64 cord blood samples from pregnant women in Sierra Leone revealed the presence of ochratoxin A (OTA) and aflatoxins in 25% and 58% of samples, respectively. Of the eight maternal blood samples collected during delivery, one contained OTA and aflatoxins were detected in six. There was no relationship between mycotoxins in maternal and cord blood. The effect these toxins might have had on the birthweight of infants is discussed.

Low birthweight: a 10-year outcome study of the continuum of reproductive casualty.

Disability rates among low-birthweight infants, particularly those related to congenital abnormality and cerebral palsy, are high. Both prenatal and perinatal factors are likely to be involved in the aetiology of most types of disability. IQ tends to be lower among low-birthweight infants, but does not appear to be closely related to birthweight alone. The confounding effect of social class should be considered when assessing aetiology and outcome. The long-term outcome for the increasing number of low-birthweight infants who survive and receive intensive neonatal care requires to be continually assessed; however, studies should not be confined to the very- and extremely-low-birthweight infant requiring prolonged intensive care, but should include abortions, stillbirths and neonatal deaths. As disability in survivors can relate to preterm birth but not perinatal complications, all low-birthweight infants require to be studied if selective bias is to be solved.