Milk composition in women from five different regions of China: the great diversity of milk fatty acids

Human milk samples were obtained from 146 lactating women living in five distinct geographic regions of the People's Republic of China. The regions were characterized as follows: pastoral, rural, urban 1, urban 2, and marine. Dietary information obtained on a subsample of women providing milk suggested distinct differences in the food availability in the five regions and the habitual diets of the lactating women studied. The milk concentration of docosahexaenoic acid (DHA) varied greatly (g/100 g total fatty acids): 0.44 +/- 0.29 (pastoral), 0.68 +/- 0.29 (rural), 0.88 +/- 0.34 (urban 1), 0.82 +/- 0.35 (urban 2), and 2.78 +/- 1.20 (marine region). Docosahexaenoic acid is critical for brain and retina development in the infant. Milk arachidonic acid (AA) ranged from 0.80 +/- 0.14 (rural) to 1.17 +/- 0.33 and 1.22 +/- 0.32 g/100 g fatty acids from the marine and pastoral regions. Arachidonic acid is associated with infant growth. The AA to DHA ratio (g/g) was highly variable also: 2.77 (pastoral), 1.18 (rural), 1.01 (urban 1), 1.23 (urban 2), and 0.42 (marine). The DHA concentration found in the milk of women from the marine region was twice as high as any reported previously, but was in a range similar to the amounts found in the milk of women fed fish oil. Seafood consumption by the women residing in the marine region is a likely contributor to the DHA concentration in their milk. These data illustrate the heterogeneity of the fatty acid composition of human milk and suggest a great influence of geography and the maternal diet on concentrations of DHA and AA in human milk.

A case-control investigation on cancer of the ovary in Bangalore, India

Cancer of the ovary is the sixth leading cancer among females in Bangalore, and is a leading site of cancer in other population-based cancer registries in India. A case-control investigation was conducted utilizing the data from the population-based cancer registry in Bangalore. In addition to the core patient information, certain other details pertaining to consumption of tobacco, reproductive and obstetric factors and those related to the practice of family planning, including the method adopted, were available with the registry, for the period 1982-1985. Identical information was also available for patients residing in the registry area who did not have cancer. Ninety-seven cases of ovarian cancer in ever-married women were age-matched with 194 controls from the same area who showed no evidence of cancer. The risk of ovarian cancer was not influenced by tobacco habits, alcohol consumption, diet or the various reproductive factors. However, tubectomy as a method of family planning appeared to reduce the risk of development of ovarian cancer. This reduction in risk was not influenced by parity or age of the woman at the time of birth of the first child.

Iodised salt is safe

Iodine deficiency disorders are prevalent in all the States and Union Territories in India. Under the National Iodine Deficiency Disorders control programme, the Government of India has adopted a strategy to iodisation of all edible salt in the country which is a long term and sustainable preventive solution to eliminate iodine deficiency disorders. The benefits to be derived from universal salt iodisation are more to the population. Iodised salt is safe and does not cause any side effect.

National Iodine Deficiency Disorders Control Programme in India

Iodine Deficiency Disorders are one of the biggest worldwide public health problem of today. Their effect is hidden and profound affecting the quality of human life. An attempt has been made to describe the various aspects of the National Iodine Deficiency Disorders control Programme (NIDDCP) being implemented in the country. The paper also focuses about the problems associated in implementing this national programme.

Schoolchildren have similar predicted prevalences of inadequate intakes as toddlers in village populations in Egypt, Kenya, and Mexico

OBJECTIVES

To examine the probability of inadequacy of schoolchild nutrient intakes; to compare the predicted adequacy of schoolchild diets to previously published data for toddler diets and to examine the relative adequacy of the diets of sibling pairs.

DESIGN

Food consumption data were measured 2 days per month across approximately one year. Mean nutrient intakes were calculated and compared to international standards using a probability approach.

SETTING

Villages in Egypt, Kenya, and Mexico.

SUBJECTS

285 school-age children (7-9 years of age) and 255 toddlers (18-30 months of age) including 94 sibling pairs.

RESULTS

Within a country, there was a striking similarity between the nutrients predicted to be inadequate in schoolchild and toddler diets across all nutrients except vitamin B12, which was more likely to be inadequate among schoolchildren. Nutrients of concern for both ages in one or more countries included iron, zinc, calcium, riboflavin, and vitamins B12, D, E, and A. For 94 toddler-schoolchild pairs, siblings at high risk of nutrient inadequacy could be identified from an indicator child with a sensitivity of 43-100% and a specificity of 59-100%.

CONCLUSIONS

Nutrient adequacy tends to be a household characteristic for these two ages of children. Nutritional interventions that target the household have a high probability of benefitting multiple age groups of children.

Hmong cultural practices and beliefs: the postpartum period

The purpose of this study was to explore the cultural practices and beliefs of the Hmong in the postpartum period. Using the qualitative research method of in-depth interviewing, data were collected through semistructured interviews. A convenience sample of 52 childbearing Hmong women was interviewed with the help of Hmong interpreters. The interviews were audiotaped and transcribed for analysis. Data analysis revealed cultural practices and beliefs categories related to diet, rest period, appropriate clothing, breast feeding, and sex practices in the postpartum period. Implications for nursing include both cultural sensitivity and an understanding of such traditional practices, before suggesting or implementing any health-promotion activities.

Daily dietary intake of copper, zinc, and selenium of exclusively breast-fed infants of middle-class women in Burundi, Africa

Copper (Cu), zinc (Zn), and selenium (Se) in human milk of middle-class Burundian women during the first 10 mo of lactation have been determined. Wet acid digestion, using nitric and perchloric acids, and atomic absorption spectrometric analysis have been used. Daily intakes have been calculated and proven to decrease from 0.39 +/- 0.05 (colostrum) to 0.16 +/- 0.02 (mature milk), 2.3 +/- 0.3 (colostrum), to 1.2 +/- 0.2 mg (mature milk) and 10.9 +/- 1.5 (colostrum) to 5.3 +/- 0.8 micrograms (mature milk) for Cu, Zn, and Se, respectively. Since values for this African country are nonexistent, intake levels are compared with literature data and found to be somewhat higher than those observed in other poorly nourished countries. The recommended safe and adequate daily intake for infants of 0-6 mo of age, as proposed by the National Research Council of the USA, is only met for Burundian infants < 1 mo of age. The function of copper (Cu) and zinc (Zn) as essential trace elements has been known for quite a number of years (1). Also, selenium (Se) is a trace element essential for the activity of glutathione peroxidase (2) and type I iodothyronine 5-deiodinase (3). For all three elements, an adequate intake is necessary for satisfactory infant growth and development (4). In view of the almost total lack of relevant data on Burundi (Africa), we have determined Cu, Zn, and Se in human milk of middle-class Burundian women during the first 10 mo of lactation (5). The aim of this study is to assess infants' elemental intake for this country and compare this with literature data on trace elemental intake of exclusively breast-fed infants.

Infant weaning practises of some Idoma women in Makurdi, Nigeria

The weaning practices in infants aged 4-9 months of two hundred Idoma women resident in Makurdi were examined. A pre-tested standard questionnaire was used to collect data from mothers who regularly visited the post-natal health clinics in Makurdi. The results showed that better educated mothers breast fed for a shorter time or planned to cease breast feeding after a shorter period than mothers who had little education or no formal training. Most mothers (97%) fed milk formula which they claimed was used to supplement breast milk and was good for their babies. The most influential factors were the hospital and the husband. The majority of the mothers fed pap; 73% using corn in its preparation, with 91% of them storing such paps in flask. More than half of the mothers used a bottle in feeding the paper or gruel to their infants while a similar proportion (65.5%) fed legumes to their infants in addition to fruits. The implications of these practices in comparison with other ethnic groups is discussed.

Dietary considerations in designing nutrition intervention programmes in rural areas of Kenya

A comparative study was carried out in three localities in Kenya: Kwale, Mbooni and Lwak in an attempt to identify dietary factors important in designing community based nutrition interventions. The data indicate geographical differences in age at weaning, reasons for termination of breastfeeding, the variety in the diets consumed and the nutrient intake adequacy. However, there was no difference in the duration in breastfeeding and, for children above 6 months (a period when weaning is recommended) rarely was there any food termed as "baby food" but children consumed bits and portions of the family food. In all the localities, there was no statistical difference between households with malnourished children and those without in most of the factors. Households with children admitted in the nutritional rehabilitation centres in the localities were, however, different in most of the characteristics examined. It is concluded that dietary interventions should be targeted to households and not children, mothers' care and nutrition are of paramount importance if the nutrition condition of their children is to be improved and, planning of nutritional interventions should be specific to the districts.

An operational evaluation of the Community Oral Rehydration Units in Peru

Since 1984, in Latin America donor agencies and national governments have extensively supported the implementation of the Community Oral Rehydration Units (CORUs) in an attempt to increase the access to oral rehydration therapy and improve the case management of diarrhoea at the community level. This study surveyed 40 CORUs in two regions of Peru to assess their operation, the number of patients with diarrhoea attended, and the knowledge of volunteers in charge. The results show that CORUs were mainly implemented close to existing health centres; the median of case load was 2.0 patients in the preceding month; and the volunteers' knowledge of case management was principally deficient in the diagnosis of hydration status, dietary management and in preventive measures. This lack of knowledge was replicated by professionals at the supervising health centres. Despite the fact that CORUs have been functioning for around four years, they exhibit numerous deficiencies which prevent them from fulfilling their objectives. A global review of the whole CORU strategy is called for.

Diet and serum iron status in pregnant and lactating Hausa women in Kano State, Nigeria

Serum iron concentrations were studied in two groups of Hausa women, one of pregnant subjects attending the antenatal clinics at a health centre and one of lactating subjects attending the centre's postnatal clinics. It was thought possible that the normal diet of the pregnant women had sufficient iron content to meet the women's increased demands for this metal. Of the pregnant women, 17% had serum iron concentrations of < or = 490 micrograms/litre [14% with microcytic hypochromia and a mean cell haemoglobin concentration (239 +/- 2 g/litre) indicative of iron deficiency, plus 3% with normocytic-microcytic hypochromia] and 7% had normocytic-microcytic cells and 525 +/- 25 micrograms iron/litre of serum. The low serum iron in 17% of the pregnant women may be the result of repeated pregnancies without proper child spacing, leading to maternal iron deficiency syndrome, or of infestation by the parasites that are prevalent in rural areas, or to both. None of the lactating mothers was found to be iron deficient and there were apparently no cases of haemosiderosis. Mean (+/- S.D.) blood haemoglobin concentrations (87.5 +/- 1.3 g/litre), packed cell volumes (32 +/- 3.2%), mean cell haemoglobin concentrations (274 +/- 37 g/litre) and serum iron concentrations (735 +/- 261 micrograms/litre) were all significantly lower in the pregnant women (P < 0.001) than in the lactating women (105.7 +/- 12.9 g/litre, 36.8 +/- 3.4%, 288 +/- 32 g/litre and 1154 +/- 277 micrograms/litre, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of cervical cancer mortality with reproductive and dietary factors, and serum markers in China

BACKGROUND

Cervical cancer is the second leading cause of cancer death among Chinese women. Within China, a considerable geographical variation in mortality rates has been observed, but the reasons are not well understood.

METHODS

Cervical cancer rates were examined in relation to indices of reproductive factors, dietary habits, and selected serum biomedical markers in 65 rural Chinese counties.

RESULTS

Cervical cancer mortality rates correlated positively and significantly with antibodies to herpes simplex virus type 2 (HSV-2) (r = 0.40, P < 0.01), serum levels of ferritin (r = 0.33, P < 0.01), body mass index (BMI) (r = 0.42, P < 0.01) and cigarette smoking (r = 0.51, P < 0.05) and negatively and significantly with age at first birth (r = -0.51, P < 0.01), consumption of green vegetables (r = -0.40, P < 0.01) and animal foods (r = -0.40, P < 0.01), and serum levels of selenium (r = -0.26, P < 0.05). When these variables were considered in the multiple regression analysis, early age at first birth and higher BMI were positively associated with cervical cancer mortality, while consumption of green vegetables and animal foods were negatively correlated. In the serum model, infection with HSV-2 and low levels of sex hormone binding globulin (SHBG) were positively related to cervical cancer mortality. No relation was found for consumption of fruits.

CONCLUSIONS

Although limitations of these ecologic data preclude causal inferences, findings in this study, including associations with HSV-2 infection, early age at first birth, consumption of green vegetables and animal foods, may provide clues to cervical cancer aetiology.

Nutritional status of 3-6 year-old African children in the Cape Peninsula

A survey was conducted in the Cape Town metropolitan area in 1990 to determine the dietary intake and anthropometric status of 3-6 year-old African children (N = 163). Dietary data obtained from 24-hour recalls revealed that mean energy intake (5200 kJ) was low and that mean intakes of most nutrients fell considerably below the recommended dietary allowances (RDAs). The average diet included an adequate number of portions from the meat and cereal groups, but was inadequate with respect to the milk and fruit/vegetable groups when compared with the recommendations of the Department of Health Services and Welfare. The macronutrient energy distribution was within prudent dietary guidelines, with 28.1% of energy (E) being obtained from total fat, 63.7% from carbohydrate and 13.2% from protein. Anthropometric profiles expressed in terms of the National Centre for Health Statistics' (NCHS) standards, revealed evidence of growth retardation and wasting in this population, coexisting with emergent obesity. The development of a nutrition and health policy to address the problems of both deficit and excess represents a pressing challenge.

The 24-hour recall for Senegalese weanlings: a validation exercise

OBJECTIVE

In Africa, where growth retardation is highly prevalent, the use of expensive and time-consuming diet assessment techniques is a major obstacle to the collection of dietary data on large samples of children. The 24-h recall could be a valuable alternative. Its validity and reproducibility were assessed by comparison with the precise weighing technique.

DESIGN & SUBJECTS

Intakes of complementary foods of 45 Senegalese weanlings, aged 11-18 months, were estimated with both techniques on the same days.

RESULTS

There was neither a level-dependent nor a systematic bias with the 24-h recall for energy and macronutrient intakes. Mean differences between techniques were < 11% of mean intakes. Rank order correlations (r) ranged from 0.60 to 0.81 for energy and macronutrients. However, the analysis by food group showed that the 24-h recall was less precise than the reference, especially for foods from the household common pot (r ranged from 0.31 to 0.61 for rice, oil and fish). In particular, measuring rice intake as a number of 'handfuls' was not satisfactory. The technique needs further improvement for these foods.

CONCLUSION

Since it provides unbiased estimates of weanlings' intakes, the 24-h recall can be used for diet surveys of groups of children. Its lack of precision, which could cause attenuation in epidemiological studies, can be compensated by increasing the number of days of survey. This study suggests that a precision equivalent to that of a 1-day weighed survey could be obtained with two 24-h recalls, at a considerably lower cost.

Dietary variation in arctic foxes (Alopex lagopus)-an analysis of stable carbon isotopes

We used stable carbon isotopes to analyse individual variation in arctic fox diet. We extracted collagen from bones (the lower jaw), and measured stable carbon isotopes. The foxes came from three different localities: Iceland, where both microtines and reindeer are rare; west Greenland, where microtines are absent; and Sweden, where scat analyses showed the primary food to be microtine rodents and reindeer. The Icelandic samples included foxes from both coastal and inland habitats, the Swedish sample came from an inland area, and the Greenland sample from coastal sites. The spatial variation in the isotopic pattern followed a basic division between marine and terrestrial sources of protein. Arctic foxes from inland sites had δ¹³C values of -21.4 (Iceland) and -20.4‰ (Sweden), showing typical terrestrial values. Coastal foxes from Greenland had typical marine values of -14.9‰, whereas coastal foxes from Iceland had intermediate values of -17.7‰. However, there was individual variation within each sample, probably caused by habitat heterogeneity and territoriality among foxes. The variation on a larger scale was related to the availability of different food items. These results were in accordance with other dietary analyses based on scat analyses. This is the first time that stable isotopes have been used to reveal individual dietary patterns. Our study also indicated that isotopic values can be used on a global scale.

Dietary management of acute diarrheal disease: contemporary scientific issues

Contemporary issues in the dietary management of children with acute diarrhea include the optimal timing of introduction of foods during illness, the appropriate use of milk-containing treatment regimens and mixed diets containing common staple foods, and the proper use of specific micronutrient supplements. Results of recent clinical trials indicate that children should be fed continuously during illness with their usual diets. Most young children fed exclusively with non-human milks can continue to consume these products. However, the subgroup of patients with more severe diarrhea and dehydration may have a slightly increased rate of complications and would, therefore, benefit from close supervision or a modification of their diet. Breastfed infants should continue to nurse at the breast during diarrhea. Treatment of anorexia consists of correction of the underlying metabolic derangements and antimicrobial therapy when indicated. Despite the previous focus of dietary management during diarrhea, attention to convalescent feeding is also necessary to assure complete nutritional recovery following illness.

Within- and between-individual variation in energy intakes by low-income Peruvian infants

OBJECTIVES

(i) To examine the components of variation in infant energy intake. (ii) To calculate the precision of estimates of energy intake from different sources. (iii) To estimate the number of dietary studies required to estimate true energy intake with varying degrees of precision.

DESIGN

Energy intakes were determined from monthly 12-h observations with test-weighing of breastmilk and all foods consumed. Variance components were evaluated by pooling results of studies performed when infants were 1-4, 5-8 and 9-12 months old.

SETTING

Pueblo Joven Huáscar, a low-income, peri-urban community in Lima, Peru.

SUBJECTS

124 infants who were enrolled at birth and followed monthly.

RESULTS

Within-to-between infant variance ratios were > 1.0 for total energy and energy from solid foods, and < 1.0 for energy from breast- and non-human milks during the 4-month periods examined. Total energy and energy from breastmilk were estimated to within 13-24% of infants' true intake. Non-breastmilk energy was estimated to within 19-143% of true intake. Four dietary studies per age period are required to estimate total energy and breastmilk energy consumption with 20-30% precision. At least 16 studies are required to estimate infants' average energy intake from solid foods from 5-8 months with 30% precision.

CONCLUSIONS

The degree of precision achieved during assessment of infants' usual energy intake changes with age and composition of the diet. Thus, the number of dietary studies required to obtain a fixed level of precision differs according to these characteristics.

Interactions between birth cohort and urbanization on gastric cancer mortality in Taiwan

Birth-cohort analysis is of particular importance for gastric cancer since migrant studies have indicated that early life experiences play a dominant role in the occurrence of the disease. However, none of the birth-cohort analyses conducted in various countries have provided information on variation in the birth-cohort phenomenon. To examine the interaction of birth cohort and urbanization, mortality data for gastric cancer between 1971 and 1990 in differentially urbanized areas in Taiwan were analysed. Traditional birth-cohort analysis and age-period-cohort (APC) analysis were employed in the study. The identification problem inherent in the APC analysis was circumvented by the 'individual record' method. Grading of the degree of urbanization of each township and district in Taiwan was based on an urbanization index derived from several demographic and socioeconomic variables. The birth-cohort effects diffused from urban to rural areas after fitting the APC model. In the older generations, born before 1910, the relative risks of gastric cancer were higher in urban areas than in rural ones, but in recent generations, i.e. those born after 1916-1922, the reverse was true. The age curves of gastric cancer mortality emerged as almost straight lines when plotted on a double logarithmic scale. Sex ratios increased with age up to age 60 and then remained constant. The spread of the birth-cohort effects suggested that dietary factors, e.g. dietary habits and food processing practices, in the early life of the population play an important role in the occurrence of gastric cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional status of primary school children with endemic goitre in Caprivi, Namibia

The nutritional status of primary school children living in an endemic goitre area in eastern Caprivi, Namibia, was assessed by means of clinical, biochemical, anthropometrical and dietetic observations. An approximately 20 pc sample, consisting of 380 primary school children, aged six to 18 years and representing eight schools in the Cuando River area of eastern Caprivi, was included in the study. Their goitre prevalence of 34.5 pc has been reported earlier. A significantly lower mean thyroxine level in goitrous compared to non-goitrous children indicated that dietary iodine deficiency was the primary cause of the endemic goitre. The present paper focuses on the nutritional status of these primary school children. Anthropometrically, these children were severely undernourished, as indicated by a high prevalence of low (below the third NCHS percentile) weight and height for age values, ranging from 38.0 pc to 55.9 pc. Dietary analysis revealed a low energy intake as well as dietary deficiencies in folic acid (only girls), ascorbic acid, vitamin A, nicotinic acid, iron, riboflavin and calcium. A high percentage (43.9 pc of boys and 33.7 pc of girls) of the children were biochemically anaemic whilst less than one pc of the children showed clinical signs of anaemia. Nutritional intervention programmes in this area should not only treat and prevent the endemic goitre but also attend to the energy and micro-nutrient deficiencies in these children.

Performance of children on weaning foods in Jos, Nigeria

A Nutritional survey on weaning foods used in Jos, Nigeria, was conducted on representative samples of 572 mothers of children between the ages of one and 18 months. The nutritional status of the children was determined by using weight for age. Four weaning foods were assessed, namely, commercial weaning food (CWF), family menu, Ogi (a sour maize beverage), ogi plus legumes and/or animal products. Only 147 (25.7%) of the mothers still depended on CWF with the rest,209 (36.5%) using fortified ogi; ogi alone by 112 (19.6%) and family menu by 104 (18.2%). No differences in weight were noticed in children, aged 6 months or under. Thereafter, the children on ogi or ogi based diet had significantly lower mean weights (p < 0.01) when compared with those on CWF. This could be attributed to lack of sufficient knowledge and exposure in preparing well balanced diet from locally available food stuff by mothers. While discouraging the use of CWF because of cost, efforts should be made to educate the mothers on how to prepare traditional multimix of good nutriture. Emphasis should be placed on how to increase the energy density by adding edible oil or using sprout grains.

Nutrition and the variation in level and age patterns of mortality

We examine the associations between nutrition and mortality at the national level. Altogether four aspects of this association are explored: (1) total calories with expectation of life, (2) dietary composition with expectation of life, (3) total calories with the age patterns of mortality, and (4) dietary composition with the age patterns of mortality. The data consist of life tables and national food balance sheets for 341 populations from 96 countries. A preliminary principal components analysis conducted on the dietary composition data yields three dietary components: (1) the overall quality and quantity of the diet, (2) the relative contribution of carbohydrates versus fats, and (3) the relative contribution of fats versus proteins. The results indicate that expectation of life at birth increases with total calories, with overall quality and quantity of the diet, and with the ratio of fats to proteins. The ratio of carbohydrates to fats is negatively associated with level of mortality. However, evidence indicates that the main effect of the ratio of fats to proteins is reversed when diets are high in quality and that all the effects tend to saturate at high nutrient availability. Variation in nutrition is also strongly associated with the international variation in age patterns of mortality. For example, when expectation of life is held constant, populations with higher quality diets tend to have lower childhood mortality and higher adult mortality. The results indicate that nutritional patterns are highly correlated with much of the worldwide variation in mortality and may be a useful criterion for selecting or predicting the best suited model life table for use on a particular population.

Prospective evaluation of insulin resistance and lipid metabolism in women receiving oral contraceptives

OBJECTIVES

It has been suggested that normal women receiving oral contraceptives (OC) may develop a series of metabolic side-effects which relate to the risk of cardiovascular disease. These metabolic disturbances include changes in glucose and insulin metabolism, raised serum lipid and lipoprotein concentrations and elevated blood pressure. All these changes indicate that OC might cause insulin resistance. We have prospectively examined the effect of OC on insulin resistance and lipid metabolism including Lp(a) values.

PATIENTS

The study group comprised 13 normally menstruating Chinese women.

DESIGN

The study subjects were given a combined triphasic oral contraceptive which was administered on a 21-day on, 7-day off medication cyclic regimen, the first pill being administered on day 5 from the beginning of menses. The metabolic investigations were carried out during luteal phase before OC and again the third week of the third month of OC administration.

MEASUREMENTS

Metabolic evaluation including insulin secretion and insulin-mediated glucose uptake were evaluated by oral glucose tolerance test and the modification of insulin suppression test. Fasting triglyceride, cholesterol, HDL-cholesterol and Lp(a) concentrations were also measured.

RESULTS

The plasma glucose and insulin responses during a 75-g oral glucose challenge increased significantly (P < 0.05 and P < 0.03, respectively). The steady-state plasma glucose (SSPG) concentrations achieved during constant infusion of glucose, insulin and somatostatin increased significantly after 3 cycles of OC administration (glucose 7.5 +/- 0.8 vs 12.4 +/- 0.7 mmol/l, P < 0.001) while the steady-state plasma insulin (SSPI) concentrations were relatively similar (410 +/- 14 vs 391 +/- 7 pmol/l, NS). Plasma triglyceride levels increased significantly (0.81 +/- 0.12 vs 1.09 +/- 0.19 mmol/l, P < 0.03) following OC administration. Fasting plasma cholesterol, HDL cholesterol and calculated LDL cholesterol concentrations did not change as compared with baseline values, nor did the ratio of total cholesterol to HDL cholesterol. The Lp(a) concentrations did not change during the administration of OC (81 +/- 25 vs 71 +/- 21 mg/l, NS).

CONCLUSIONS

These data indicated that intake of OC for 3 cycles induced glucose intolerance, hyperinsulinaemia and insulin resistance in normal menstruating Chinese women. These changes occurred in association with elevated plasma triglyceride concentrations and no alteration in Lp(a) or other lipid values.

Calcium intakes and bone densities of lactating women and breast-fed infants in The Gambia

The calcium required for breast-milk production and infant growth can be a substantial proportion of dietary intakes especially in regions of the world were calcium consumption is low. Insufficient calcium supply might lead to maternal bone loss, reduced breast-milk calcium secretion and impaired infant bone growth. However, changes in calcium absorption and excretion may be sufficient to allow these requirements to be met without affecting maternal or infant health. A limited number of studies have investigated changes in maternal bone mineral, absorption, excretion and metabolism during lactation but few have addressed whether any changes are influenced by calcium intakes. Ongoing detailed research by the MRC Dunn Nutrition Unit in a rural area of The Gambia amongst mothers and infants with habitually low calcium intakes will provide valuable information about calcium needs during lactation and growth.

Vitamin B12 metabolism and status during pregnancy, lactation and infancy

This overview of vitamin B12 metabolism and requirements during the continuum of pregnancy and lactation has identified several gaps in our knowledge. More information is needed concerning the roles of the different transcobalamins during pregnancy and lactation, including their impact on placental and mammary transfer of cobalamin and their effect on intestinal absorption in the infant. Knowledge is needed about the relative importance of maternal stores and current dietary intake on fetal storage of the vitamin, and on its concentration in breast milk. Because there is some evidence that infant's urinary methylmalonic acid excretion is reduced by intakes slightly higher than the current RDA, the adequacy of the current RDA for vitamin B12 during infancy should be verified. Finally, it is possible that vitamin B12 deficiency is more common in pregnant and lactating women and their young children in developing countries than has been recognized previously, due primarily to malabsorption. It is important to confirm whether or not this is the case, in view of its potential impact on infant neurobehavioral development and the relative ease with which supplements of the vitamin could be provided.

Nutritional status of preschool children in poor rural areas of China

Described are the main findings of the first large-scale nutrition monitoring project carried out over a 4-year period in China. The nutritional status of nearly 10,000 preschool children in 18 comparatively poor rural areas in seven provinces was followed each year over the period 1986-89 in order to identify their major nutritional problems and improve their growth and development. Physical measurements were made and dietary surveys and biochemical tests were performed on a subsample of the children. The proportion of stunted and underweight children was far higher than the national average. Based on the possibilities offered by local circumstances, the prevalences of stunting and underweight were lowered and anaemia was greatly reduced. Along with the progress in nutrition monitoring, major efforts were made to train health workers, as well as to encourage increased production of green vegetables, poultry, and small livestock. The wealth of information collected and the experience gained may serve as a baseline record, the project currently being expanded to cover 100 counties throughout China.

Comparison of effects of breast-feeding practices on birth-spacing in three societies: nomadic Turkana, Gainj, and Quechua

Variation in the duration and pattern of breast-feeding contributes significantly to inter-population differences in fertility. In this paper, measures of suckling frequency and intensity are used to compare the effects of breast-feeding practices on the duration of lactational amenorrhoea, and on the length of the birth interval in three prospective studies undertaken during the 1980s, among Quechua Indians of Peru, Turkana nomads of Kenya, and Gainj of Papua New Guinea. In all three societies, lactation is prolonged well into the second year postpartum, and frequent, on-demand breast-feeding is the norm. However, the duration of lactational amenorrhoea and the length of birth intervals vary considerably. Breast-feeding patterns among Gainj and Turkana are similar, but Turkana women resume menses some 3 months earlier than do the Gainj. The average birth interval among the Gainj exceeds that of nomadic Turkana by over 15 months. Suckling activity decreases significantly with increasing age of nurslings among both Gainj and Quechua, but not among Turkana. Earlier resumption of menses among Turkana women may be linked to the unpredictable demands of the pastoral system, which increase day-to-day variation in the number of periods of on-demand breast-feeding, although not in suckling patterns. This effect is independent of the age of infants. The short birth intervals of Turkana women, relative to those of the Gainj, may be related to early supplementation of Turkana nurslings with butterfat and animals' milk, which reduces energetic demands on lactating women at risk of negative energy balance.

EFFECT OF THE MENSTRUAL CYCLE PHASE AND DIET ON BLOOD LACTATE RESPONSES TO EXERCISE

Previous research has shown women on normal mixed diets have varied blood lactate (LA) responses to exercise across their menstrual cycle (MC) phases. This study examined the effect of diet on this finding. Eurmenonrheic women (n=10) completed a discontinuous exercise protocol consisting of 4 intervals of 6 min exercise, separated by 6 min rest, at 30, 50, 70 and 90% V̇O₂max. The exercise was performed after a 3 day pen od under each of the following conditions: 1 - low carbohydrate (35% of total caloric intake) - mid-follicular phase (LCHO-FP), 2 - low carbohydrate - mid-luteal phase (LCHO-LP), 3 - high carbohydrate (75%) - mid-follicular phase (HCHO-FP), 4 - high carbohydrate - mid-luteal phase (HCHO-LP). Eucaloric status was maintained during the study. The MC phase was confirmed by blood hormonal levels. Significant (P<0.05) MC phase - diet interaction effects were found. LA was lower at 70% V̇O₂max in the LCHO-LP (3.7±0.2 mmol·l^-1) than at the other conditions (5.0±0.7 to 6.0±0.7 mmol·l^-1; mean ±SEM). Also, LA during LCHO-LP at rest and all other exercise intensities tended to be lower than all other MC phase/diet conditions (P<0.06). LA responses at rest and during exercise in the HCHO-LP, HCHO-FP, and LCHO-FP conditions did not differ significantly. The present findings demonstrate that an "athletic type diet", high in carbohydrates, negates the menstrual cycle phase difference in lactate responses to exercise previously reported in the literature; however, the menstrual phase differences do exist when a diet low in carbohydrates is consumed.

Changes in body composition of malnourished children after dietary supplementation as measured by bioelectrical impedance

Body composition was measured with bioelectrical impedance in 35 malnourished children aged 24-59 mo to investigate the effect of a 3-wk feeding supplementation. Twenty children received a high-protein diet with 15% of total energy as protein, whereas 15 children received an isoenergetic standard-protein diet with 7.5% of energy as protein. Bioelectrical impedance analysis and anthropometry were done before and after 21 d of dietary supplementation. The children fed the high-protein diet gained significantly more body weight than those receiving the standard-protein diet (1.33 +/- 0.54 vs 0.88 +/- 0.47 kg, P < 0.02). The total body water and fat-free mass determined by bioelectrical impedance analysis showed that the group fed the high-protein diet increased significantly more (0.92 vs 0.58 kg) than those on the standard-protein diet (P < 0.02). Results of this study suggest that feeding a high-protein diet accelerates catch-up growth and restores the reference body composition in children recovering from malnutrition.

A case control study of nutritional factors and cervical dysplasia

The association of nutritional factors with cervical dysplasia was examined through a case-control study. Analysis was conducted in 257 cases and 133 controls confirmed both by cytological examination and colposcopic findings. A 24-h dietary recall questionnaire was used to assess nutritional intake. Various risk factors (including age at first intercourse, number of sexual partners, parity, cigarette smoking, oral contraceptive use, human papillomavirus type 16 infection, and age and race) were adjusted for their potential confounding effects. While analyses were also performed to adjust for total calories, results were not changed significantly. Among the nutrients examined, vitamin A intake showed a significantly increased risk at the lowest quartile compared to the highest quartile, with an odds ratio of 2.2 (95% confidence interval, 1.2-4.2). A significant trend of increasing risk was also observed with lower intake of vitamin A (P = 0.05). Riboflavin showed increased risk at the two lower quartiles of intake with a trend test P value of 0.04. Increased risk was also found for lower intakes of vitamin C compared to the highest intake level. For folate, increased risk was found in the second highest quartile compared with the highest quartile with an odds ratio of 2.0 (95% confidence interval, 1.0-3.8). The calcium:phosphorus ratio showed an increased risk at the lowest level (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). Insufficient intake of vitamin A, riboflavin, ascorbate, and folate is associated with an increased risk of cervical dysplasia.

The effects of the acute administration of RU 486 on dietary fat preference in fasted lean and obese men

The effects of RU 486, a potent glucocorticoid antagonist, on dietary fat preference were explored in obese men and lean controls in a double-blind crossover study. An oral 10 mg/kg dose of RU 486 or placebo was administered at midnight the second night of a 48-h hospital stay. Macronutrient and caloric intakes were calculated each day and a taste test of six commercial dairy products (fat content by weight < 0.5%, 2.0%, 3.3%, 10.5%, 18%, and 36%) was performed. Dairy products were judged for pleasantness, creaminess, and overall preference. Subjects were then asked to consume their favorite dairy product until sated. Urinary free cortisol (UFC) and plasma adrenocorticotropic hormone (ACTH), cortisol, insulin, and glucose were determined. Intake of a self-selected diet was recorded. As expected, in response to RU 486, UFC increased from 120 +/- 25 micrograms/24 h to 297 +/- 73 micrograms/24 h (p < 0.05) in obese men and from 81 +/- 10 micrograms/24 h to 357 +/- 109 micrograms/24 h (p < 0.05) in lean men. Plasma cortisol increased from 26.1 +/- 1.1 microgram/dl to 31.8 +/- 1.0 microgram/dl (p < 0.05) in obese men and from 26.1 +/- 1.7 micrograms/dl to 32.2 +/- 1.7 micrograms/dl (p < 0.05) in lean men. Plasma insulin was significantly higher in obese 24.6 +/- 3.2 microIU/ml than in lean men 12.8 +/- 1.1 microIU/ml (p = 0.0001) but was unaffected by RU 486. RU 486 did not decrease fat intake in either obese or lean men.(ABSTRACT TRUNCATED AT 250 WORDS)

The zinc nutriture of preschool children living in two African countries

The zinc nutrition of rural Malawian children (24 females, 33 males; age 62 +/- 10 mo) consuming cereal-based diets was compared with that of rural Ghanaian children (43 females, 33 males; age 59 +/- 10 mo) consuming cereals or starchy staples, using hair zinc concentrations, growth and body composition indices, and dietary intakes. Intakes of energy, protein, Ca, Zn, dietary fiber and phytate at two seasons of the year were estimated from 3-d weighed food records, using analyzed and literature food composition values. The mean annual intakes of energy (5419 +/- 1081 vs. 4698 +/- 885 kJ), protein (31.8 +/- 7.0 vs. 24.1 +/- 6.8 g), Zn (7.4 +/- 1.9 vs. 5.1 +/- 1.1 mg) and phytate (1899 +/- 590 vs. 604 +/- 151 mg), and the mean molar ratios of [phytate]/[Zn] and [Ca] x [phytate]/[Zn] mmol per MJ (25 +/- 4 vs. 12 +/- 2 and 44 +/- 13 vs 20 +/- 8 mmol/MJ), were higher for Malawian than for Ghanaian children. More Malawian than Ghanaian children had [phytate]/[Zn] > or = 15 (72% vs. 0%) and were severely stunted (57 vs. 28%). Ninety-four percent of children in Malawi and 83% in the Ghanaian village of Slepor had low hair Zn concentrations (< 1.68 mumol/g) compared with 39% in Gidantuba, Ghana. In Gidantuba, children with low hair Zn concentrations had low upper-arm-muscle-area-for-age and upper-arm-muscle-area-for-height Z-scores. The high intakes of phytic acid relative to zinc in Malawi suggest that these children were at greater risk for inadequate zinc nutriture than their Ghanaian counterparts.

Preconception care. An opportunity to maximize health in pregnancy

In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: "Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling." Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi

Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.