Lead Toxicity and Pollution in Poland

BACKGROUND

Human exposure to lead can occur in a variety of ways, all of which involve exposure to potentially toxic elements as environmental pollutants. Lead enters the body via ingestion and inhalation from sources such as soil, food, lead dust and lead in products of everyday use and in the workplace. The aim of this review is to describe the toxic effects of lead on the human body from conception to adulthood, and to review the situation regarding lead toxicity in Poland.

RESULTS

Pb is very dangerous when it is absorbed and accumulates in the main organs of the body, where it can cause a range of symptoms that vary from person to person, the time of exposure and dose. Lead in adults can cause an increase in blood pressure, slow nerve conduction, fatigue, mood swings, drowsiness, impaired concentration, fertility disorders, decreased sex drive, headaches, constipation and, in severe cases, encephalopathy or death.

CONCLUSIONS

Exposure to lead in Poland remains an important public health problem. This review will cover the range of lead exposures, from mild to heavy. Public health interventions and policies also are needed to reduce occupational and environmental exposure to this element.

An Analytical Approach for Exploring the Importance of Dietary Quality versus Quantity in the Growth of Mexican Children

The average annual intake of specific nutrients, foods, food groups, and proxies for nutrient bioavailability of 87 Mexican preschoolers and 110 schoolchildren were compared with their anthropometry. Median intakes of energy, protein, thiamine, and iron were adequate; calcium and zinc were low; and other nutrients were very inadequate. Anaemia and low serum retinol were common. Intake of individual nutrients failed to predict size. Correlation matrices, median traces, and principal-components analysis illustrated a dietary continuum ranging from a high dependence on tortillas to more animal products and fruit. Children consuming a lower proportion of tortillas and legumes and more animal products were taller and heavier. Even though the high-tortilla dietary pattern provided more of most nutrients, these were less available. In conclusion, children's size was predicted by dietary quality - not quantity - measured either as a high intake of animal products or as a lower intake of factors inhibiting nutrient bioavailability.

Low-density lipoprotein particle number predicts coronary artery calcification in asymptomatic adults at intermediate risk of cardiovascular disease

BACKGROUND

Clinicians require more discriminating measures of cardiovascular risk than those currently used in most clinical settings. A promising avenue of research concerns the relationship of low-density lipoprotein (LDL) subfractions to subclinical atherosclerosis.

OBJECTIVE

To assess cross-sectional associations between subfractions of LDL cholesterol and coronary artery calcification (CAC).

METHODS

The study sample comprised 284 asymptomatic clinic patients who were at intermediate risk of cardiovascular disease, aged 40-69 years, who were not taking a statin or niacin. Lipoprotein subclass measures were obtained by the use of proton nuclear magnetic resonance spectroscopy. CAC was assessed with computed tomography angiography (CTA). The analyses modeled the presence or absence of CAC.

RESULTS

Total LDL particle number (LDL-P) had a stronger association with CAC than the traditional lipoprotein measures. Patients in the highest tercile of total LDL-P (1935-3560 nmol/L) were 3.7 times more likely to exhibit coronary artery calcification as those in the lowest tercile (620-1530 nmol/L). The independent effects of small LDL-P remained significant after adjustment for LDL-cholesterol, high-density lipoprotein (HDL), triglycerides, non-HDL, and large LDL-P. HDL and non-HDL were not significant, independent predictors of CAC.

CONCLUSION

Small LDL-P was a strong, independent predictor of the presence of CAC. Large prospective studies are needed to examine the effect of LDL particle number and size on coronary artery calcification.

Quantitative approaches to nutrient density for public health nutrition

Nutrient density, the vitamin or mineral content of a food or diet per unit energy, has long been a useful concept in the nutritional sciences. However, few nutritionists have applied the idea in quantitative, population-based nutrition planning and assessment. This paper discusses the conceptual issues related to the calculation of a nutrient density value that, if consumed, should meet the nutrient needs of most individuals in a population or sub-population, and outlines several methods for estimating this value. The paper also discusses the potential influence on the estimate's validity of factors such as skewed distributions and correlated energy intake and nutrient requirement.

A Randomized Control Trial of Continuous Support in Labor by a Lay Doula

OBJECTIVE

To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group).

DESIGN

Randomized controlled trial.

SETTING

A women's ambulatory care center at a tertiary perinatal care hospital in New Jersey.

PATIENTS/PARTICIPANTS

Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula.

INTERVENTIONS

The doula group was taught traditional doula supportive techniques in two 2-hour sessions.

MAIN OUTCOME MEASURES

Length of labor, type of delivery, type and timing of analgesia/anesthesia, and Apgar scores.

RESULTS

Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group.

CONCLUSION

Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.

Pulque intake during pregnancy and lactation in rural Mexico: alcohol and child growth from 1 to 57 months

OBJECTIVE

To examine maternal intake of a mildly alcoholic beverage (pulque) during pregnancy and lactation, and its potential effect on postpartum child growth and attained size.

DESIGN

A prospective cohort study that followed mothers (during pregnancy and lactation) and their offspring (from birth to approximately 57 months of age).

SETTING

Six villages in rural, central Mexico.

SUBJECTS

Subjects are 58 mother-child pairs. Pulque intake was measured as part of a dietary assessment that was conducted for 2days/month during pregnancy and early lactation.

RESULTS

Most mothers consumed pulque during pregnancy (69.0%) and lactation (72.4%). Among pulque drinkers, the average ethanol intake was 125.1 g/week during pregnancy and 113.8 g/week during lactation. Greater pulque intake during lactation, independent of intake during pregnancy, was associated with slower weight and linear growth from 1 to 57 months, and smaller attained size at 57 months. Low-to-moderate pulque intake during pregnancy, in comparison to either nonconsumption or heavy intake, was also associated with greater stature at 57 months.

CONCLUSIONS

Pulque intake during lactation may have adversely influenced postnatal growth in this population. Public health interventions are urgently needed in Mexico to reduce heavy intake of pulque by pregnant and lactating women, and to replace intake with foods that provide the vitamins and minerals present in the traditional alcoholic beverage.

Interrelationships between power-related and belief-related factors determine nutrition in populations

The vast majority of social research in nutrition has focused either on economic, material and political factors ("power-related" variables) or on psychological, cultural and attitudinal factors ("belief-related" variables). Even when data on both classes of factors are collected, the orientation in analysis is to treat one of the two classes as "confounding" or "control" variables. Although single-focus studies have yielded essential knowledge about the role of specific factors, they fail to reveal the mechanisms through which belief-related and power-related variables interact to produce nutritional outcomes. Data from the Nutrition CRSP project in Mexico are used to illustrate the interactions between household economic conditions and maternal education on household diet. As has been seen in other developing country contexts, women in more favorable economic circumstances, and who have more education, tend to feed their children a higher quality diet. However, even in better-off households dietary quality is not uniformly high, a finding that reflects the operation of other values and cultural factors that direct resource allocation to other sectors of family activity.

Diet and iron status of nonpregnant women in rural Central Mexico

BACKGROUND

Few studies have examined the relation of iron status to diet in populations from developing countries with high levels of iron deficiency and diets of poor quality.

OBJECTIVE

The objective was to identify nutrients, dietary constituents, and foods that are associated with better iron status in a rural Mexican population.

DESIGN

A prospective cohort study was conducted in rural central Mexico. The subjects were 125 nonpregnant women aged 16-44 y. During the 12 mo before blood collection, food intakes were assessed repeatedly by a combination of dietary recalls, food weighing, and food diaries [mean (+/-SD) days of food intake data: 18.8 +/- 5.9 d]. Hemoglobin, hematocrit, and plasma ferritin were measured at the end of the study.

RESULTS

Higher plasma ferritin concentrations were associated with greater intakes of nonheme iron and ascorbic acid after control for age, BMI, breast-feeding, season, and the time since the birth of the last child. Higher ascorbic acid intakes, but not higher intakes of heme and nonheme iron, predicted a lower risk of low hemoglobin and hematocrit values after control for the background variables. Consumption of the alcoholic beverage pulque predicted a lower risk of low ferritin and low hemoglobin values. Seasonal variation in ferritin, hemoglobin, and hematocrit values was observed.

CONCLUSION

Better iron status was associated with greater intakes of foods containing nonheme iron and ascorbic acid. PULQUE:a beverage containing iron, ascorbic acid, and alcohol-may influence the iron status of women in rural central Mexico.

The history and future of food fortification in the United States: a public health perspective

For more than 50 years, the United States federal government has regulated food fortification. During this time, the nutritional situation in the United States has improved greatly, whereas scientific information about the role of vitamins and minerals in human growth and development has increased exponentially. Concurrently, government authority to regulate food fortification has declined. This paper provides a brief history of U.S. food fortification policy and describes the contribution of food fortification to U.S. nutrient intakes. The paper highlights future directions of food fortification in the United States in light of these important developments, and addresses the issue of risk and the need to balance deficiency and toxicity in a generally well nourished population.

Maternal consumption of pulque, a traditional central Mexican alcoholic beverage: relationships to infant growth and development

OBJECTIVES

To document the consumption during pregnancy of pulque, a traditional central Mexican alcoholic beverage, and its relationship to subsequent infant size, physical growth and performance on the Bayley Scales of Infant Development.

DESIGN

Prospective cohort study.

SETTING

Six villages in rural, central Mexico in 1984-1985.

SUBJECTS

Seventy mother-infant pairs.

RESULTS

Most women (72.9%) consumed pulque during pregnancy, and 28.6% consumed more than 150 g ethanol week(-1) from the beverage. Individuals who consumed pulque showed no compensating decrease in energy obtained from other foods. Pulque consumption possessed curvilinear relationships with both infant length (at 1 and 6 months) and Bayley mental performance (at 6 months). Heavy pulque intakes were associated with smaller infant size and poorer mental performance. In modest quantities, pulque consumption may have been beneficial due to its micronutrient content.

CONCLUSIONS

Intakes of alcohol from pulque were common among pregnant women in these rural, central Mexican villages. Given current scientific knowledge of the adverse effects of ethanol on foetal development, public health interventions are needed to reduce heavy pulque consumption during pregnancy in some areas of rural Mexico.

Obesity among offspring of women with type 1 diabetes

OBJECTIVE

To determine subsequent growth and body composition of children born to women with type 1 diabetes compared with controls.

DESIGN

Prospective cohort study.

SETTING

Follow-up of offspring born to women with type 1 diabetes and controls from an earlier study of diabetes and lactation.

SUBJECTS

Seventeen nondiabetic offspring of women with type 1 diabetes and 18 offspring of control women (age range 5.9 to 9.0 years).

OUTCOME MEASURES

Anthropometric measures at follow-up included height, weight, triceps and subscapular skinfold thickness. Information on usual nutrient intakes and physical activity patterns was elicited through questionnaires. Body composition was determined from skinfold thickness measures and bioelectrical impedance analysis. A child was identified as obese if he or she met at least 2 of the following 4 criteria for obesity: (1) weight-for-height equal to or greater than 120% of the National Center for Health Statistics (NCHS) reference median plus triceps skinfold greater than the 85th percentile; (2) body mass index (BMI) greater than the 95th percentile for age and sex; (3) percent body fat (from impedance measures) equal to or greater than 25 for boys and 30 for girls; or (4) percent body fat (from sum of skinfold measures) equal to or greater than 25 for boys and 30 for girls.

RESULTS

There were 7 obese children in the type 1 diabetes group and none in the control group (p = 0.007). Obese children did not differ from nonobese children in birth weight, body fat patterning, nutrient intake, physical activity patterns, maternal pregravid weight or blood glucose control during the last trimester of pregnancy. Mothers of obese children, however, had fewer years of education and gained more weight during pregnancy compared with mothers of nonobese children in the type 1 diabetes group (p < 0.05).

CONCLUSION

Obesity during childhood is a significant problem among nondiabetic children of women with type 1 diabetes. The association of childhood obesity with lower maternal education and excessive pregnancy weight gain warrants further investigation.

Women with insulin-dependent diabetes mellitus (IDDM) complicated by eating disorders are at risk for exacerbated alterations in lipid metabolism

OBJECTIVE

To examine lipid parameters that are affected in women with insulin-dependent diabetes mellitus (IDDM) who engaged in disordered eating behaviours.

DESIGN

Randomized, unmatched.

SETTING

Tertiary care.

SUBJECTS

Ninety women (18-46 y) with IDDM.

INTERVENTIONS

Classification of subjects based on severity of eating disorder: clinical (n = 14), subclinical (n = 13) and control (n = 63). Blood was analysed for glycosylated haemoglobin (HbA1c) and serum for triglycerides and cholesterol. Carotenoid and tocopherol concentrations were analysed by high performance liquid chromatography (HPLC). Dietary intake was assessed by the National Cancer Institute food frequency questionnaire.

RESULTS

HbA1c was significantly increased im women demonstrating clinical and subclinical symptoms compared to control (10.4 +/- 2.6, 10.0 +/- 1.5 and 8.3 +/- 1.6%, respectively, P < 0.05). Triglycerides concentrations were significantly increased in women with subclinical eating disorders compared to controls. In women who intentionally omitted or reduced insulin, triglyceride cholesterol and HbA1c were significantly increased compared to controls. Women with IDDM and eating disorders who exhibited bulimic behaviours consumed significantly more energy, total fat and cholesterol compared to controls and women with eating disorders who were restrained eaters.

CONCLUSION

While IDDM is known to perturb lipid metabolism, these data demonstrate that eating disorders, in combination with IDDM, results in additional alterations in lipid metabolism.

Examining the gender gap in nutrition: an example from rural Mexico

Gender differences in nutrient and food intake were examined in Mexican Nutrition CRSP (Collaborative Research Support Program) infants (N = 75), preschoolers (N = 80), and school children (N = 91). No significant gender differences in dietary quality or quantity were seen for infants and preschoolers. For school children, the contribution of various foods to total energy intake (dietary quality) was also quite similar for girls and boys. Equity in dietary quality remained even under conditions of economic and demographic stress. Nevertheless, school girls consumed significantly less energy per day than boys (-300 kcal/d or 1.3 mJ/d), and less of all micronutrients examined. Gender differences in estimated basal metabolic rates of school children were slight (-20 kcal/d), and body composition and size were similar. When energy intakes were expressed as a percent of estimated requirement (calculated from age, sex and weight using WHO/FAO/UNU equations), intakes were adequate and not significantly different between girls (mean = 111%) and boys (mean = 113%). Playground observations showed girls to be less active than boys, which may reflect both cultural and biological influences. Apparently due to this lower activity, school girls consumed less energy, and may have been at much higher risk than boys of micronutrient deficiency. The lower food intakes of girls did not appear to be due to purposeful dietary discrimination, but rather to culturally patterned sex roles involving lower activity.

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control

OBJECTIVE

To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM.

RESEARCH DESIGN AND METHODS

Ninety women with IDDM (18-46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R).

RESULTS

Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c.

CONCLUSIONS

HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.

Olfactory dysfunction and related nutritional risk in free-living, elderly women

OBJECTIVE/DESIGN

To determine the nutritional risk associated with measured olfactory dysfunction in free-living, elderly women through analytic observational methods. Olfactory perception was measured orthonasally (odor: butanol threshold and odor identification) and retronasally (flavor: orange flavor threshold in sweetened gelatin).

SETTING/SUBJECTS

Elderly women were recruited from New Haven, Conn, through posters and direct contact. Screening of 120 elderly women identified 80 with high personal functioning to participate (mean age = 76 +/- 6 years, range = 65 to 93 years). All data were collected in subjects' homes.

MAIN OUTCOME MEASURES

Nutritional risk was assessed in several ways: food behavior questionnaire; food preference questionnaire; interviews based on the National Cancer Institute food frequency questionnaire; five nonconsecutive, 24-hour food records; and weight, height, waist, and hip measurements.

STATISTICAL ANALYSES

Correlation and regression analyses determined the separate association between olfactory perception and nutrition variables.

RESULTS

Nearly half of the women (37 of 80) had olfactory dysfunction. The following nutritional risk pattern was associated with lower olfactory perception: lower interest in food-related activities (eg, enjoying cooking, eating a wide variety of foods); lower preference for foods with predominant sour/bitter taste (eg, citrus fruits) or pungency (eg, horseradish); higher intake of sweets; less intake of low-fat milk products; and nutrient intake profile indicative of higher risk for cardiac disease.

APPLICATIONS

Olfactory dysfunction may make it more difficult for elderly women to maintain a diet to control risk for chronic disease. Practitioners should target nutrition intervention to elderly women with measured or self rated difficulty in preventing odors or olfactory flavor. Capitalizing on primary-taste quality and texture may help to compensate for the loss of olfactory flavor perception.

The interactive effects of dietary quality on the growth and attained size of young Mexican children

Predictors of attained size at 30 mo and growth rate between 18 and 30 mo (eg, diet, maternal size, morbidity, age at weaning, and selected environmental factors) were investigated by using longitudinal data from 67 Mexican children aged 18-30 mo. These children were small because of growth stunting in early infancy. Between 18 and 30 mo they grew on average at the 50th percentile of National Center for Health Statistics references values for weight, and the 25th for length. Size at 30 mo and growth rates were unrelated to energy or protein intakes during the previous year, but positively related to consumption of animal-origin foods. Maternal weight predicted size and growth only for children with larger intakes of animal products. Individual rates of weight and length growth were uncorrelated on average, correlated negatively when animal-product intake was low, and positively only when more animal products were consumed. Integrated weight and length growth, and the influence of maternal size on growth, may be disrupted by poor dietary quality. Different children would be identified as malnourished depending on whether weight or length growth was measured.