Agarwal Kn

Nutritional anemia and its control

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1–6 years of age, 88% adolescent girls (3.3% had hemoglobin < 7.0 g/dl; severe anemia) and 85% pregnant women (9.9% having severe anemia) were anemic. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia. National programmes to control and prevent anemia have not been successful. Experiences from other countries in controlling moderately-severe anemia guide to adopt long-term measures i.e. fortification of food items like milk, cereal, sugar, salt with iron. Use of iron utensils in boiling milk, cooking vegetables etc may contribute significant amount of dietary iron. Nutrition education to improve dietary intakes in family for receiving needed macro/micro nutrients as protein, iron and vitamins like folic acid, B12, A and C etc. for hemoglobin synthesis is important. As an immediate measure medicinal iron is necessary to control anemia. Addition of folate with iron controls anemia and is neuroprotective. Evidence in early childhood suggests vitamin B12 deficiency anemia; thus it may also be given alongwith iron and folate.

CORD BLOOD HAEMOGLOBIN, IRON AND FERRITIN STATUS IN MATERNAL ANAEMIA

ABSTRACT. Maternal and cord blood haemoglobin, serum iron, transferrin saturation and ferritin were studied in sets of 30 anaemic (haemoglobin <110 g/l) and 21 nonanaemic (haemoglobin ≧110 g/l) mothers. The cord serum iron, transferrin saturation and ferritin concentrations had significant correlation with maternal haemoglobin. The significant low levels of these parameters suggested that maternal anaemia adversely affected the iron status including iron stores of the newborns. The cord serum iron of 15.2±4.35 μmol/l and ferritin of 29.7±10.93 ng/ml seem to be effective to maintain cord haemoglobin levels. Thus, anaemic mothers with reasonably maintained ferritin and trasferrin saturation levels provide sufficient iron for maintenance of cord haemoglobin, although foetal iron stores are likely to be depleted.

Effect of latent iron deficiency on metal levels of rat brain regions

Seven different metals (iron, copper, zinc, calcium, managanese, lead, and cadmium) were studied in eight different brain regions (cerebral cortex, cerebellum, corpus striatum, hypothalamus, hippocampus, midbrain, medulla oblongata, and pons) of weaned rats (21-d-old) maintained on an iron-deficient (18–20 mg iron/kg) diet for 8 wk. Iron was found to decrease in all the brain regions, except medulla oblongata and pons, in comparison to their respective levels in control rats, receiving an iron-sufficient (390 mg iron/kg) diet. Brain regions showed different susceptibility toward iron deficiency-induced alterations in the levels of various metals, such as zinc, was found to increase in hippocampus (19%,p<0.05) and midbrain (16%,p<0.05), copper in cerebral cortex (18%,p<0.05) and corpus striatum (16%, p<0.05), calcium in corpus striatum (22%,p<0.01) and hypothalamus (17%,p<0.02), and manganese in hypothalamus (18%,p<0.05) only. Toxic metals lead and cadmium also increased in cerebellum (19%,p<0.05) and hippocampus (17%,p<0.05) regions, respectively.Apart from these changes, liver (64%,p<0.001) and brain (19%,p<0.01) nonheme iron contents were found to decrease significantly, but body, liver, and brain weights, packed cell volume, and hemoglobin content remained unaltered in these experimental rats. Rehabilitation of iron-deficient rats with an iron-sufficient diet for 2 wk recovered the values of zinc in both the hippocampus and midbrain regions and calcium in the hypothalamus region only. Liver nonheme iron improved significantly; however, no remarkable effect was noticed in brain nonheme iron following rehabilitation. It may be concluded that latent iron deficiency produced alterations in various metal levels in different brain regions, and corpus striatum was found to be the most vulnerable region for such changes. It is also evident that brain regions were resistant for any recovery in their altered metallic levels in response to rehabilitation for 2 wk.

Effect of latent iron deficiency on the levels of iron, calcium, zinc, copper, manganese, cadmium and lead in liver, kidney and spleen of growing rats

Feeding a marginally low iron content diet (18–20 mg iron/kg diet) to weaned (21-day-old) rats for 8 weeks produced a significant decrease in liver non-heme iron (66%, p<0.001) but no change in blood hemoglobin. Total iron contents of liver (56%, p<0.01), spleen (20%, p<0.05), and kidney (19%, p<0.05) were also found to decrease along with increased zinc, copper, calcium, manganese lead and cadmium in various organs. The magnitude of alteration of a metal was different in different organs. However, liver was found to be the most affected organ. Two weeks of rehabilitation with iron-sufficient diet (390 mg iron/kg diet) normalized these altered levels.

Impact of chronic undernutrition on higher mental functions in Indian boys aged 10-12 years.

Undernourished rural children 10–12 years of age demonstrated the following, when compared to normal nourished children: (i) a relative deficit of memory quotients assessed by the Wechsler memory scale; (ii) lower scores for abilities related to personal and current information, orientation, mental control, logical memory, digit span, visual reproduction and associative learning; (iii) impaired set formation and flexibility in attention as assessed by the card sorting test; and (iv) impairment in conditional learning on maze and conditional associative learning tests. The performance on the finger dexterity test for fine motor coordination was not affected in undernourished children.

Influence of Malnutrition on Cognitive Development Assessed by Piagetian Tasks

ABSTRACT. Cognitive development of 1336 children (6–8 yr) was studied in relation to their nutritional status. Seven Piagetian tasks covering the mental process of a concrete operational period were given to each child to assess the cognitive development. Weschler intelligence scale for Indian Children was used to assess the IQ of each child. The percentage of malnourished children in stage I of development (preoperational) was significantly higher as that of wellnourished children. A higher percentage of children in the latter group was in stage III of development (concrete operation). In boys performance on all the tasks was influenced by undernutrition except for class inclusion. In girls this was true only for conservation of liquid, substance and ordinal relation. “he results of the regression analysis showed that nutrition was the only thctor weakly assdated with the poor performance of the children En various tasks. Further, the effect of nutrition was more pronounced in conservation tasks indicating poor verbal reasoning aud comprehension in malnourished children. Information was also collected regarding the parental education and occupation, socio‐economic status, caste, economic sufficiency, psychosocial stimulation and home environment. However, these environmental factors did not inflnence the development of rnl children. This might be due to the fact that the population in the present study did not vary much with regard to these variables.

Muscular sufficiency, serum protein, enzymes and bioenergetic studies (31-phosphorus magnetic resonance spectroscopy) in chronic malnutrition

Muscle sufficiency was significantly lower in 1336 children with chronic malnutrition of moderate to severe degree. Eighteen children with a chronic moderate degree of malnutrition and 8 well‐nourished, age‐matched controls were selected for biochemical and 31‐phosphorus magnetic resonance spectroscopy (31 ‐P MRS) studies. The results showed that: (a) serum total protein, albumin, iron, calcium and inorganic phosphate were similar in both groups; (b) serum enzyme levels were significantly increased in the malnourished group; (c) 31‐P MRS showed significantly higher means for total ATP, β‐ATP, a‐ATP and inorganic phosphate for the malnourished compared to the control group. In chronic malnutrition, proteins are maintained by degradation in muscle resulting in release of amino acids and enzymes. 31‐P MRS studies showing increases in total ATP, β‐ATP and inorganic phosphate and a decrease in phosphocreatine suggest that ATP is maintained at the cost of phosphocreatine.

Vitamin A administration and preschool child mortality.

Abstract A double blind study conducted during January 90–March 91 in a rural part of Varanasi district in Uttar Pradesh state of India on 9987 and 5260 children under six years of age demonstrated that administration of vitamin A reduced overall mortality by 14.0%. The additional data collected from January 1991 to February 92 under similar settings on 1314 and 1200 children of same age in the experimental and control groups respectively and from all children suffering from xerophthalmia who received mega dose of vitamin A (200,000 I.U.), taken together, show that vitamin A supplementation results in 16.9% reduction in mortality. Mortality was reduced in unimmunized children by 22.0%, diarrhea by 18.8% and measles by 9.0%. However, significant reduction in mortality in vitamin A supplemented group was observed only for deaths due to severe malnutrition. No death was recorded in xerophthalmia children who received mega dose of vitamin A (200,000 I.U.). The child survival pattern remained unaltered and mortality pattern remained unchanged significantly even after one year of withdrawal, thus denying the possibility of any substantial change in the study area for births and deaths. Thus the finding that vitamin A supplementation protects against overall mortality and in particular deaths due to gastroenterits, severe malnutrition and in unimmunized children is of significance.

Latent iron deficiency alters gamma-aminobutyric acid and glutamate metabolism in rat brain.

A diet containing 18–20 mg iron/kg to young weaned rats for 8 weeks altered the metabolism of gamma-aminobutyric acid and glutamate in the central nervous system without affecting blood hemoglobin. Subsequent rehabilitation with 390 mg iron/kg diet for 2 weeks normalized these changes.

Soft Neurological Signs and EEG Pattern in Rural Malnourished Children

ABSTRACT. The present study was carried out in 208, 8–10 yr old male, rural, primary school children of Kashi Vidyapith Block, Varanasi. These children were examined for anthropometry, soft neurological signs and electroencephalographic pattern. It was found that the presence of soft neurological signs was related to the severity of malnutrition. The relationship between nutritional status and motor tasks showed that the performance in successive finger tapping, toe tapping, heel toe tapping, hand patting and alternating hand pronation supination in both hands while finger tapping with the right, was significantly affected. The EEG pattern in 16 children with soft neurological signs showed abnormalities in the form of slow and sharp waves, particularly in the frontal lobe, but also in the parietal and temporal lobes. The motor deficits were more marked on the contralateral side of the EEG abnormality.