Chapter 7. The Contributions of the ESPGHAN Committees on Nutrition to Paediatric Nutrition.

The first Committee on Nutrition (CoN) was founded in 1974. Two years later nutrition (N) was added to the society's name, which then became ESPGAN. The Committee systematised compositional and quality criteria for breast milk substitutes and food for special medical purposes, the first of many examples on how recommendations and comments published by the Committees on Nutrition (CsoN) were adopted by the European Economic Community, later the European Union and also influenced the World Health Organization/Food and Agriculture Organization of the United Nations Codex standards. A second CoN focusing on preterm infants was established in 1979 and its recommendations on nutrition of these infants were widely implemented. The third and standing CoN, established 1986, started to organise high-quality symposia at the annual meetings appreciating the need to enhance the expertise in nutritional research. From 1991 the CoN has organised Summer Schools in paediatric nutrition for young colleagues further emphasising its educational interest and more recently an annual, more specialised Nutrition Masterclass. Successively the interest of the CoN has expanded to other areas, such as highlighting dilemmas and uncertainties in the field of nutrition including the design, choice of outcomes and statistical analysis of trials in infant nutrition. The work of the CsoN have had great impact on paediatric nutrition and the committee will continue its important role by writing commentaries and systematic reviews and revising guidelines when required to inform and stimulate discussion among colleagues as well as stimulate training in paediatric nutrition by organising workshops and scientific meetings, training courses, and other approaches, and by interaction with other expert groups.

Transición nutricional, bienestar y salud: el caso de una ciudad industrial, Alcoy (1852-1928) / No disponible

El término transición nutricional describe el paso de una alimentación vegetariana, monótona, local e insuficiente a una dieta también vegetal basada en el consumo de cereales, legumbres y patatas, pero con mayor presencia de alimentos de origen animal, fruta, azúcar y grasas vegetales. El objetivo del presente trabajo, que se enmarca dentro de la primera etapa de la transición nutricional, es el de analizar la composición de la dieta media de la ciudad de Alcoy, compararla con los requerimientos mínimos necesarios para cubrir las necesidades nutricionales básicas y profundizar en la relación que existe entre la evolución de la dieta y otros indicadores del bienestar como la estatura y la mortalidad durante la Revolución Industrial. Para ello se han reconstruido seis dietas para el periodo 1852-1928. Los resultados indican que el consumo de calorías, proteínas e hidratos de carbono aumentó de forma sostenida en Alcoy durante el periodo comprendido entre 1852 y 1928, iniciándose así la transición nutricional a mitad del siglo XIX. Tras comparar los indicadores sobre nutrición con dos indicadores del bienestar, como son la estatura y la mortalidad, se observa como el aumento del input nutricional bruto no siempre fue acompañado de un mayor aumento de talla y de un descenso en la mortalidad, al no lograrse aumentar el input nutricional neto a causa de las duras condiciones del trabajo infantil y adolescente y al aumento de la morbilidad ligado a la urban penalty causada por el hacinamiento, la falta de alcantarillado y el consumo de agua y alimentos en mal estado. No fue hasta finales del siglo XIX y principios del siglo XX, cuando se produjo el descenso de la mortalidad y el aumento de la estatura. Esto fue debido a una mejora cuantitativa de los salarios, al incremento de la oferta de alimentos y a la transición nutricional que la acompañó, al desarrollo de la ciencia de la nutrición y a la puesta en marcha de la reforma sanitaria, factores que permitieron mejorar los niveles de vida de la población y los indicadores del bienestar (AU)

Osteoarchaeological Studies of Human Systemic Stress of Early Urbanization in Late Shang at Anyang, China.

Through the analysis of human skeletal remains and mortuary practice in Yinxu, this study investigates the impact of early urbanization on the commoners during the Late Shang dynasty (ca. 1250-1046 B.C.). A total of 347 individuals examined in this study represent non-elites who were recovered from two different burial contexts (formally buried in lineage cemeteries and randomly scattered in refuse pits). Frequencies of enamel hypoplasia (childhood stress), cribra orbitalia (childhood stress and frailty) and osteoperiostitis (adult stress) were examined to assess systemic stress exposure. Our results reveal that there was no significant difference in the frequency of enamel hypoplasia between two burial groups and between sexes, suggesting these urban commoners experienced similar stresses during childhood, but significantly elevated levels of cribra orbitalia and osteoperiostitis were observed in the refuse pit female cohort. Theoretically, urbanization would have resulted in increased population density in the urban centre, declining sanitary conditions, and increased risk of resource shortage. Biologically, children would be more vulnerable to such physiological disturbance; as a result, high percentages of enamel hypoplasia (80.9% overall) and cribra orbitalia (30.3% overall) are observed in Yin commoners. Adults continued to suffer from stress, resulting in high frequencies of osteoperiostitis (40.0% total adults); in particular, in the refuse pit females who may also reflect a compound impact of gender inequality. Our data show that the non-elite urban population in the capital city of Late Shang Dynasty had experienced extensive stress exposure due to early urbanization with further social stratification only worsening the situation, and eventually contributing to collapse of the Shang Dynasty.

Trastornos neurológicos relacionados con la malnutrición en la Guerra Civil Española (1936-1939) / Neurological changes related to malnutrition during the Spanish civil war (1936-1939)

En esta conferencia, dictada en el marco de las Jornadas Internacionales de Neurociencias, Quito, Mayo 31 a Junio 1, 2013, se hizo una exposición de lo que fueron las situaciones de hambruna acaecidas en España durante la Guerra Civil de 1936-39. Su capital, Madrid sufrió durante todo ese periodo racionamientos de alimentos, agua y leche. Esta situación dio lugar a unas condiciones que pusieron de manifiesto las relaciones entre sistema nervioso y alimentación. La población madrileña estuvo sometida a un verdadero experimento de hipo alimentación, análogo al que se puede realizar en el laboratorio. Al concluir la guerra, la Dirección General de Sanidad y el Instituto de Investigaciones Médicas, con la colaboración de la Fundación Rockefeller, realizaron una serie de encuestas clínicas y de consumo alimentario entre la población de Madrid. Hubo tres situaciones médicas que tuvieron especial relevancia durante la Guerra Civil y durante la posguerra: La epidemia de pelagra, la aparición de latirismo y el denominado síndrome de Vallecas. La aparición de casos de pelagra fue trascendental porque permitió, a partir de una avitaminosis conocida, replantearse toda la sintomatología inespecífica que se había estado observando. La pelagra pasó a ser la enfermedad carencial más prevalente, y la más claramente vinculada a la alimentación. El latirismo es una intoxicación crónica producida por la acumulación de neurotoxinas. Se debe al consumo frecuente de almortas (Lathyrus sativus). La almorta es toxica solo cuando constituye más del 30% de las calorías diarias consumidas durante un período continuado de dos a tres meses. El Latirismo volvería a afectar a los españoles durante los años 1941 y 1942, en los llamados "años del hambre" de la posguerra, cuando, debido a la escasez de alimentos, fue consumida gran cantidad de harina de almortas. Las neuropatías carenciales observadas en Madrid durante la Guerra Civil dieron lugar a descripciones clínicas novedosas y originales. En niños de colegios del barrio de Vallecas se describió un síndrome carencial, probable mente de vitaminas del complejo B, que originaba calambres musculares y debilidad muscular, que se dio en llamar síndrome de Vallecas. Se destacó la pobreza en grasas de la dieta y una ligera disminución de la cifra de calcio, ya muy pobre, en el grupo con calambres. Tanto con la administración de tabletas conteniendo una proporción adecuada de calcio y fósforo como con la ingestión diaria de 4 a 6 miligramos de tiamina, consiguieron hacer desaparecer los calambres musculares o aminorar considerablemente su frecuencia e intensidad (AU)

In this lecture, given at the International Conferences on Neuroscience, in Quito, May 31st-June 1st of 2013, the topic of famine situations during the Spanish Civil War, 1936-1939, was approached. Madrid, the capital of Spain, was under food, water and milk rationing during that period. This situation led to conditions that showed the relationships between the nervous system and nutrition. The Madrilenian population was submitted to a real experiment of hyponutrition, similar to the one that may be reproduced at the laboratory. At the end of the war, the National Direction on Health and the Institute of Medical Investigations, with the collaboration of the Rockefeller Foundation, carried out a series of clinical and food consumption surveys among the Madrilenian population. There were three medical situations that were of particular relevance during the Civil War and after it: the pellagra epidemics, the onset of lathyrism, and the socalled Vallecas syndrome. The occurrence of pellagra cases was paramount because it allowed reconsidering all the unspecific symptoms observed from an already known vitamin deficiency. Pellagra became the most prevalent deficitrelated disease, and most clearly related to nutrition. Lathyrism is a chronic intoxication produced by the accumulation of neurotoxins. It is due to common intake of chickling peas (Lathyrus sativus). Chickling peas are toxic only if they represent more than 30% of the daily calories consumed for a prolonged period greater than two to three months. Lathyrism would reoccur in the Spanish population after the war, in 1941 and 1942, the so called "famine years", when due to the scarcity of foods chickling pea flour was again consumed in high amounts. Deficiency-related neuropathies observed in Madrid during the Civil War led to new and original clinical descriptions. In children from schools of the Vallecas neighborhood, a deficiency syndrome, likely related to vitamin B complex deficiency, was described, which manifested by muscle cramps and weakness, and was termed the Vallecas syndrome. Poor fat content in the diet and a light decrease in calcium levels, which were already very low, were observed in the group with cramps. Both the administration of tablets containing an adequate amount of calcium and phosphorus and the daily intake of 4-6 milligrams of thiamine, achieved a considerable reduction in the frequency and severity of the cramps, or their complete resolution (AU)

Evolución de la mortalidad por diabetes en España (1900-1974): consecuencias de la malnutrición por exceso / Trends of diabetes mortality in Spain (1900-1974): excess malnutrition consequences

Introducción: La transición epidemiológica y nutricional que vivió la población española a lo largo del siglo XX se caracterizó por el aumento progresivo que mostró la mortalidad por causas de malnutrición por exceso en contraposición con la disminución progresiva de la mortalidad por desnutrición y peligro alimentario. Objetivo: El trabajo analiza la evolución de la mortalidad por diabetes durante el siglo XX en España y su distribución espacial por comunidades autónomas. Métodos: Se han analizado los datos de mortalidad por diabetes del Movimiento Natural de la Población publicados por el Instituto Nacional de Estadística desde 1900 hasta 1974. Se calcularon las tasas brutas de mortalidad por diabetes para el conjunto de las provincias españolas y el Índice 100 de cada comunidad autónoma. Resultados, discusión y conclusiones: La mortalidad por diabetes mostró un incremento progresivo durante las tres primeras décadas del siglo XX. Durante el periodo de la posguerra se produjo un importante descenso. Superando aquel paréntesis la mortalidad por diabetes volvió a aumentar como reflejo de la transición nutricional que estaba viviendo la población española. Las comunidades autónomas más afectadas por la epidemia de diabetes fueron aquellas que, como en el caso de las del arco mediterráneo, vivieron con mayor precocidad dicha transición (AU)

Introduction: The epidemiologic and nutritional transition lived by the spanish population throughout the XX century showed a progressive increase of causes of excess malnutrition mortality in contrast to the continuous decrease of undernutrition and food hazards. Objective: The study analizes the evolution of diabetes mortality during the XX century in Spain and its map distribution by regions. Methods: Diabetes mortality data from the Natural Movement of Population published by the National Institute of Statistics was analyzed from 1900 to 1974. The diabetes mortality crude rates and the Index 100 for each region were calculated. Results, discussion y conclusions: Diabetes mortality showed a progresive increase during the first three decades of the XX century. During the postwar period an important decrease took place. After this moment, diabetes mortality increased again as a consequence of the nutrition transition that the spanish population was experiencing. The most affected by the diabetic epidemy regions where those of the mediterranean which lived this transition in advance (AU)

Notas para una historia de la desnutrición en la Iberoamérica del siglo XX / Notes for a history of the malnutrition in the Latin America of the 20th century

El trabajo analiza los principales determinantes y las características de la desnutrición en América Latina durante la segunda mitad del siglo XX. En primer lugar, se explican las bases del problema moderno del hambre y la desnutrición, tanto en su dimensión fisiológica como social, al destacarse su condición de calamidad social y de expresión biológica del subdesarrollo y de las desigualdades sociales. En segundo lugar, a partir de testimonios contemporáneos, se exponen las principales características de la desnutrición que ha afectado a la población iberoamericana, y las causas que la explican. Por último, a modo de conclusión, se subrayan las consecuencias negativas de no haber aprovechado la oportunidad que conllevaba el reto de superar los factores condicionantes de la malnutrición por defecto, y haber finalizado el siglo XX con un panorama epidemiológico nutricional donde los problemas del hambre y la desnutrición conviven con fenómenos como los de la obesidad de la pobreza (AU)

The work analyzes the principal determinants and the characteristics of the malnutrition in Latin America during the second half of the 20th century. First, are explained the bases of the modern problem of the hunger and the malnutrition (undernourishment), so much in his physiological as social dimension, on having been outlined his condition of social calamity and of biological expression of the underdevelopment and of the social inequalities. Secondly, from contemporary testimonies, there are exposed the principal characteristics of the malnutrition that has affected the Latin-American population, and the causes that explain it. Finally, like conclusion, are underlined the negative consequences of not having taken advantage of the opportunity that was carrying the challenge of overcoming the determining factors of the malnutrition (undernourishment), and to have finished the 20th century with an epidemiological nutritional panorama where the problems of the hunger and the malnutrition coexist with phenomena as those of the obesity of the poverty (AU)

Early INCAP longitudinal nutrition studies at the community level.

This paper reviews the findings of early field studies of INCAP comparing the effects of vitamin B12 and animal and vegetable protein on the growth of poorly nourished schoolchildren. It also describes a 5-year community-based intervention study showing that a protein-rich supplement given to preschool children improves growth and cognition and decreases morbidity and mortality. Medical care in one village had no detectable benefits. A classical seven-year community-based detailed observational study of the infection status and growth in children from birth is also summarized.

Animal experimentation--a personal view.

Disagreement about the use of animals in biomedical research has resulted in absurd positions by both sides. Increasingly, some zealots against animal experimentation have resorted to violence or other illegal acts to support their points of view. The value of animal research in providing better health for man and animals is incontrovertible. This is illustrated by references to animal research in the field of nutrition.

Diseases and medical disabilities of enslaved Barbadians from the seventeenth century to around 1838: part I / Enfermedades y discapacidades médicas de los barbadenses esclavizados, desde el siglo diecisiete hasta alrededor de 1838: (parte I)

The disease environment, health problems and causes of mortality of enslaved Barbadians are described. Data are derived mainly from documentary sources; also included are bio-archaeological data from analyses of skeletons recovered from Newton Plantation cemetery. Major topics include infectious diseases transmitted from person to person, as well as those contracted through water, soil, and other environmental contaminations, and diseases transmitted by insects, parasites, and other animals; nutritional diseases, including protein energy malnutrition, vitamin deficiencies, anaemia, and geophagy or "dirt eating"; dental pathologies; and lead poisoning, alcoholism, traumas, and other disorders, including psychogenic death or illness caused by beliefs in witchcraft or sorcery.

Se describe el ambiente de enfermedades, problemas de salud y causas de mortalidad de los barbadenses esclavizados. Los datos proceden de fuentes documentales, e incluyen también datos bio-arqueológicos a partir del análisis de esqueletos recuperados del cementerio de la Plantación Newton. Los asuntos principales incluyen las enfermedades infecciosas transmitidas de persona a persona, así como aquellas contraídas por el agua, el suelo, y otros medios de contaminación ambiental. Asimismo se incluyen enfermedades transmitidas por insectos, parásitos, y animales; enfermedades nutricionales, incluida la malnutrición energético-proteica, las deficiencias de vitaminas, la anemia y la geofagia o el "comer tierra", las patologías dentales, el envenenamiento por plomo, el alcoholismo, los traumas, y otros trastornos, incluyendo la muerte psicogénica o las enfermedades causadas por creencias en la brujería y la hechicería.

Diseases and medical disabilities of enslaved Barbadians from the seventeenth century to around 1838. Part I.

The disease environment, health problems and causes of mortality of enslaved Barbadians are described. Data are derived mainly from documentary sources; also included are bio-archaeological data from analyses of skeletons recovered from Newton Plantation cemetery. Major topics include infectious diseases transmitted from person to person, as well as those contracted through water soil, and other environmental contaminations, and diseases transmitted by insects, parasites, and other animals; nutritional diseases, including protein energy malnutrition, vitamin deficiencies, anaemia, and geophagy or "dirt eating"; dental pathologies; and lead poisoning, alcoholism, traumas, and other disorders, including psychogenic death or illness caused by beliefs in witchcraft or sorcery.

Head shape and size of adult males as possible indicators of childhood stress in northern Jordan (1900-1978): a study in human biology and political economy.

Stature, sitting height, stature by weight, and head circumference change with varying economic conditions during early childhood. Our hypothesis is that adult head shape, as well as head size, is influenced by changes in childhood nutrition. When economic conditions are bad, nutrition and health suffer, and the result is dolichocephaly. To test this hypothesis, we measured the head length, width, and circumference of 398 adult males in Jordan. Fifty-six percent are ethnic Jordanians, and 44% are ethnic Palestinians. We divided the modern history of Jordan and the West Bank into four periods developed from historical economic data. The results of the study show that the cephalic index (CI) among Jordanians increased significantly with economic improvement but decreased slightly during the best economic period, whereas CI remained stable across all periods among Palestinians. The pattern among Jordanians can be explained in terms of maternal environment and early childhood nutrition. The lack of pattern in Palestinians may be due to changing nursing practices, bottle feeding, or sleeping position. When economic conditions were bad, Jordanian mothers and infants suffered from malnutrition and deficits in health care services during pre- and postnatal periods. Infants were born with very low birth weight and longer heads. However, the highest mean value of head size, circumference, among Jordanians and Palestinians is obtained from individuals who were children during the bad economic period, an unexpected result. No significant linear or quadratic trend was found for either Palestinians' or Jordanians' head circumference over time.

Continuity or discontinuity of the life-style in central Italy during the Roman Imperial Age-Early Middle Ages transition: diet, health, and behavior.

Dento-alveolar pathologies and alterations (dental wear, caries, abscesses, ante mortem tooth loss (AMTL), calculus, hypoplastic defects, and chipping) and skeletal markers of health (cribra orbitalia and periostitis) were analyzed in two skeletal samples from the necropolises of Quadrella (I-IV c. AD) and Vicenne-Campochiaro (VII c. AD) in the Molise region of central Italy. The aim was to determine if the Roman Imperial Age-Early Middle Ages transition characterized by political, socioeconomic, and cultural transformations affected the biology of these populations, particularly their alimentation and health status. The frequencies of caries and AMTL, similar in the two samples, suggest a high consumption of carbohydrates. The higher levels of heavy wear, calculus, and interproximal chipping in the Vicenne population indicate a greater use of fibrous foods (both meat and others), in line with the dietary model of Germanic peoples. Health conditions do not appear to have been good in either period, as shown by the high frequencies of linear hypoplasia and the presence of cribra orbitalia and periostitis. The diet of the individuals buried with horses of the Vicenne population did not differ from that of the rest of the population, whereas there were evident differences in the use of the teeth for nonmasticatory activities among these individuals. Therefore, from the point of view of alimentation and health status, the profound socioeconomic and cultural transformations during the Late Antiquity-Early Middle Ages transition do not seem to have been translated into a true discontinuity of the two Molisan populations.