Anemia in the elderly: a public health crisis in hematology.

Over 3 million people in the United States aged 65 years and older are anemic. This condition is associated with significant functional impairment and, perhaps, increased mortality. In March 2004, the American Society of Hematology (in conjunction with the National Institute of Aging) convened a "blue ribbon" panel of twenty physicians who are experts on various aspects of this topic. This paper highlights important consensus concepts resulting from that meeting. In particular, four areas of thought are shared. First, the epidemiology of anemia in the elderly is reviewed, including its definition, its expression in different racial groups, and its wide-ranging manifestations. Second, the pathophysiology of anemia in the elderly is reviewed as pertains to three general etiological categories (nutritional, chronic diseases, and so-called "unexplained" anemias). Particular emphasis is given to pathophysiologic mechanisms of anemia that are potentially unique to this age group. Third, a practical approach to the diagnosis and management of anemia for this patient population for the practicing hematologist is provided. Finally, the public health implications of anemia in the elderly for key stakeholder constituencies will be discussed in the oral presentation.

Micronutrient deficiencies and gender: social and economic costs.

Vitamin and mineral deficiencies adversely affect a third of the world's people. Consequently, a series of global goals and a serious amount of donor and national resources have been directed at such micronutrient deficiencies. Drawing on the extensive experience of the authors in a variety of institutional settings, the article used a computer search of the published scientific literature of the topic, supplemented by reports and published and unpublished work from the various agencies. In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that: (1) micronutrient deficiencies affect global health outcomes; (2) micronutrient deficiencies incur substantial economic costs; (3) health and nutrition outcomes are affected by sex; (4) micronutrient deficiencies are affected by sex, but this is often culturally specific; and finally, (5) the social and economic costs of micronutrient deficiencies, with particular reference to women and female adolescents and children, are likely to be considerable but are not well quantified. Given the potential impact on reducing infant and child mortality, reducing maternal mortality, and enhancing neuro-intellectual development and growth, the right of women and children to adequate food and nutrition should more explicitly reflect their special requirements in terms of micronutrients. The positive impact of alleviating micronutrient malnutrition on physical activity, education and productivity, and hence on national economies suggests that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.

The need for animal source foods by Kenyan children.

Food intake and dietary patterns in Kenyan households have been studied since the 1920s. Reports on breastfeeding, nutrient intake, micronutrient deficiencies and the impacts of malaria and intestinal parasites on nutritional status are reviewed. Diets are mainly cereal-based, with tubers and a variety of vegetables and fruits when available. White maize, sorghum and millet are high in phytate and fiber, which inhibit the absorption of micronutrients such as zinc and iron. Communities growing cash crops have little land for food crops. Although households may own cattle, goats and poultry, commonly these are not consumed. Adults in nomadic communities consume more meat than nonpastoralists. Lakeside and oceanside communities do not consume adequate amounts of fish. Poor households have a limited capacity to grow and purchase food, therefore they have more nutrient deficiencies. Early weaning to cereal porridge deprives the infant of protein and other nutrients from human milk. Other milk is consumed only in small amounts in sweetened tea. Older children eat adult diets, which are extremely bulky and hard to digest. Anemia is mainly due to iron deficiency, malaria and intestinal parasites. In general, Kenyan children have inadequate intakes of energy, fat and micronutrients such as calcium, zinc, iron, riboflavin and vitamins A and B-12. The multiple micronutrient deficiencies may contribute to early onset of stunting and poor child development, whereas lack of calcium together with vitamin D deficiency are responsible for the resurgence of rickets. There is an urgent need to increase the intake of animal source foods by Kenyan children.

The distribution and mortality impact of chronic energy deficiency among adult Nigerian men and women.

OBJECTIVE: To determine the prevalence of chronic energy deficiency (CED) and associated mortality risk in a cohort of adult Nigerians followed from 1992 to 1997. RESEARCH METHODS AND PROCEDURES: The data for this investigation were derived from an international collaborative study on chronic diseases in populations of the African diaspora. Body mass index (BMI) was used to define three grades of CED in 4061 men and women aged 25 years and older: Grade I (mild CED) as BMI 17.5-18.4, Grade II (moderate CED) as BMI 16.0-17.4, and Grade III (severe CED) as BMI < 16.0 and BMI > or = 18.5 was considered normal. The odds of mortality associated with differing grades of CED was estimated with logistic regression analysis. RESULTS: The prevalence of CED (BMI < 18.5) increased from 14.3% in 1992 to 19.6% in 1997, both genders combined. The prevalence of CED was similar for both sexes in 1992 (14%) but increased to 22.4% in men and 17.4% in women by 1997. The prevalence of CED was 8.5%, 7.6 and 3.4 for Grades I, II and III, respectively. Two hundred and seven deaths occurred during the follow-up period. The mortality rate for the 5.5 y of follow-up was 5.1% (207/4061). The odds ratios (95% CIs) for all cause mortality were 1.4 (0.5, 3.8), 2.4 (1.2, 4.9) and 2.5 (1.0, 6.2), respectively, for CED grades I, II and III adjusting for age and sex. CONCLUSION: Under nutrition is an increasing problem in Nigerian men and women. The economic reforms (structural adjustment program (SAP)) introduced in 1986 in combination with the continued economic woes brought on by political instability, corruption and nepotism have been advanced by several investigators as the main factors in the growing problem of inadequate calorie intake. Intervention strategies both at the government and private sectors are urgently needed to increase food availability.

Iodine supply in different geographical areas of Switzerland: comparison between rural and urban populations in the Berne and the Ticino regions.

OBJECTIVE: We studied the question of possible regional differences of iodine intake in the population of rural and urban areas north and south of the Alps. DESIGN: Transversal study. SETTING: Six different regions from northern (Canton Berne) and southern Switzerland (Canton Ticino). SUBJECTS: For each region 30 individuals were studied. RESULTS: While significant differences of urinary iodine between some regions were found (range from 79 microg iodine/g creatinine in Chiasso to 130 microg iodine/g creatinine in the Maggia Valley), no significant differences between rural and urban populations of north and south of Switzerland were observed. Mild iodine deficiency affected 35%, moderate iodine deficiency 12% and severe iodine deficiency 0.6% of the total population investigated. CONCLUSIONS: 49% of this population showed at least mild or moderate iodine deficiency. The mean urinary iodine was just at the lower recommended limits. Significant differences were found between individual regions (such as Chiasso and the Valley of Maggia), but not generally between rural and urban areas in the north and south of the Alps.

The nutritional status of older Rwandan refugees.

OBJECTIVE: To assess the nutritional status of older people in an unstable situation. DESIGN: Anthropometric and socioeconomic data were collected cross-sectionally. Body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were calculated to evaluate nutritional status. For 41 subjects with kyphosis, height was estimated from arm span using sex-specific regression equations from the non-kyphotic group. SETTING: The study was carried out in the post-emergency phase in a Rwandan refugee camp in Karagwe district, north-west Tanzania. SUBJECTS: Measurements were obtained from 413 men and 415 women aged 50-92 years. RESULTS: The prevalence of undernutrition (BMI < 18. 5) was 19.5% in men and 13.1% in women and was higher above age 60 years in both sexes: in men the prevalences were 23.2% and 15.0% (P < 0.05) and in women 15.1% and 10.9% for the older and younger age groups respectively. AMA, which is important in relation to the ability to remain active and independent, was also significantly lower in older age groups. No difference was found in AFA. The proportion with low BMI was much higher in the group with kyphosis. CONCLUSIONS: Even in this population of older Rwandans who managed to reach the camp and survive in exile for more than a year, undernutrition does occur and is more prevalent at an advanced age. The higher prevalence of undernutrition in kyphotic people illustrates the importance of including this group in nutritional status assessments.

Iodine deficiency disorders in Kapenguria: a urinary iodine estimation.

Iodine deficiency disorders (IDD) are known to be a potential problem for billions of people living in the highland areas of Africa and Asia. One method of determining the severity of IDD in a region is to determine the iodine content of the urine of school aged children. The iodine status in four primary schools in the Kapenguria Division of West Pokot district was assessed by determining the urinary iodine concentration in 102 children from the four schools. The median urine iodine concentrations were obtained as Kammorou (n = 24): 2.0-2.5 micrograms/dL (p < 0.01), Nasokol (n = 28): 2.5-3.0 micrograms/dL, Nangrotum (n = 27): 2.5-3.0 micrograms/dL and Makutano (n = 23): 5.5-6.0 micrograms/dL. For a goitre free area, the urinary iodine concentration should be above 5.0 micrograms/dL.

Four ways of becoming ill.

Illnesses are classified by whether or not etiologies are comprehensible or incomprehensible. The comprehensible diseases are divided into those due to four classes of etiologic agents: toxicity, heredity, infection and deficiency. Cooperations between two members of these classes are described to illustrate the concepts of hereditary intoxication, infectious intoxication, toxic deficiency, hereditary infection, hereditary deficiency and infectious deficiency. Examples in which cooperations among members of three or four classes of etiologic agents are required to produce illness also are provided. It is concluded that there are only four known ways of becoming ill and that cooperations can explain much variability of human disease.

[Hypolipidemias]. / Hypolipidämien

Hypolipidemias can be divided in primary, familial and hereditary forms and symptomatic forms which may accompany other diseases. The primary hypolipidemias (abetalipoproteinemia, hypobetalipoproteinemia and analphalipoproteinemia) are very rare. Severe hypolipidemia can be found in some peoples (e.g. the Masai). This article is chiefly devoted to secondary hypolipidemias such as those associated with malabsorption, malnutrition and maldigestion including protein-losing gastroenteropathy, with liver diseases, endocrine diseases (hyperthyroidism, hirsutism) and anemia. Finally, the hypolipidemias secondary to the formation of autoantibodies against HDL and LDL in M-gradient, carcinoma and rheumatoid arthritis are briefly reviewed.