Ann F. Walker

Risk Factors for Early Childhood Malnutrition in Uganda

Objective. To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <30 months of age in a central Ugandan community, whose main dietary staples are banana (matoki) and maize. Methods. The study was a cross-sectional survey using stratified multistage random sampling to select households with a child <30 months of age in rural and semi-urban environments. A questionnaire was administered to mothers of 261 infants and toddlers in their home setting. Their health status was assessed by clinical examination and anthropometric measurements (mid-upper arm circumference [MUAC], weight, and supine length). Results. A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23.8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lack of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cows milk consumption, low intake of energy from fat, and less well educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had been immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, there was a high prevalence of infection in the week preceding the survey interview, including diarrhea (23.0%), malaria (32.3%), or cough/influenza (72.8%). Conclusions. This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.

Acute effects on mood and cognitive performance of breakfasts differing in fat and carbohydrate content

Sixteen subjects consumed low-fat/high-carbohydrate (LFHC), medium-fat/ medium-carbohydrate (MFMC), high-fat/low-carbohydrate (HFLC) iso-energetic breakfasts and no breakfast in a counterbalanced order on four separate days. The LFHC breakfast was similar in macronutrient composition, though not in meal size (more kcal) and types of foods offered, to the habitual breakfast of the subjects. A battery of cognitive performance tasks together with mood and appetite ratings were completed before and during the 3 h following breakfast. Results showed no clear differences in performance between the four dietary conditions, but significant effects on mood were observed. Mood improved (a decline in fatigue/dysphoria) following the LFHC breakfast compared to the other meals. The findings show that the macronutrient content of breakfast, independent of energy value and oro-sensory qualities, can exert small but reliable effects on subsequent mood, and suggest that deviation from habitual meal composition can produce a relative decline in mood state. These conclusions are supported by results from a previous study of the effects of lunch which found very similar relationships between meal composition, habitual choices and postprandial mood changes.

Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: A randomized, double blind placebo controlled trial

Cardiovascular diseases are the chief causes of death in the UK, and are associated with high circulating levels of total cholesterol in the plasma. Artichoke leaf extracts (ALEs) have been reported to reduce plasma lipids levels, including total cholesterol, although high quality data is lacking. The objective of this trial was to assess the effect of ALE on plasma lipid levels and general well-being in otherwise healthy adults with mild to moderate hypercholesterolemia. 131 adults were screened for total plasma cholesterol in the range 6.0-8.0 mmol/l, with 75 suitable volunteers randomised onto the trial. Volunteers consumed 1280 mg of a standardised ALE, or matched placebo, daily for 12 weeks. Plasma total cholesterol decreased in the treatment group by an average of 4.2% (from 7.16 (SD 0.62) mmol/l to 6.86 (SD 0.68) mmol/l) and increased in the control group by an average of 1.9% (6.90 (SD 0.49) mmol/l to 7.03 (0.61) mmol/l), the difference between groups being statistically significant (p=0.025). No significant differences between groups were observed for LDL cholesterol, HDL cholesterol or triglyceride levels. General well-being improved significantly in both the treatment (11%) and control groups (9%) with no significant differences between groups. In conclusion, ALE consumption resulted in a modest but favourable statistically significant difference in total cholesterol after 12 weeks. In comparison with a previous trial, it is suggested that the apparent positive health status of the study population may have contributed to the modesty of the observed response.

A Synergistic Effect of a Daily Supplement for 1 Month of 200 mg Magnesium plus 50 mg Vitamin B6 for the Relief of Anxiety-Related Premenstrual Symptoms: A Randomized, Double-Blind, Crossover Study

To investigate single and combined effects of daily dietary supplementation with 50 mg of vitamin B6 and 200 mg magnesium (as MgO) for one cycle for the relief of mild premenstrual symptoms, a randomized, double-blind, placebo-controlled, crossover design was used. Forty-four women with an average age of 32 years took part in the study. Each woman was randomly assigned, according to a Latin square design, to take consecutively all four of the following treatments daily for one menstrual cycle: (1) 200 mg Mg, (2) 50 mg vitamin B6, (3) 200 mg Mg + 50 mg vitamin B6 and (4) placebo. Throughout the study, each volunteer kept a daily record of symptoms using a 5-point ordinal scale in a menstrual diary of 30 symptoms. Symptoms were grouped into six categories: anxiety, craving, depression, hydration, other, and total. Urinary magnesium output for 24 hours was estimated using the Mg/creatinine concentration ratio. ANOVA showed no overall difference between individual treatments, but predefined treatment comparisons using factorial contrasts in ANOVA showed a significant effect of 200 mg/day Mg + 50 mg/day vitamin B6 on reducing anxiety-related premenstrual symptoms (nervous tension, mood swings, irritability, or anxiety) (p = 0.040). Urinary Mg output was not affected by treatment. A small synergistic effect of a daily dietary supplementation with a combination of Mg + vitamin B6 in the reduction of mild premenstrual anxiety-related symptoms was demonstrated during treatment of 44 women for one menstrual cycle. In view of the modest effect found, further studies are needed before making general recommendations for the treatment of premenstrual symptoms. The study indicated that absorption from MgO was poor and daily supplementation for longer than 1 month is necessary for tissue repletion.

Effect of processing including domestic cooking on nutritional quality of legumes

Food legumes are divided broadly into two types, those in which energy is stored as lipid material-the leguminous oilseeds such as soya bean and groundnut and those in which energy is stored as starch-the pulses such as peas, beans and lentils. The cluster bean (Cyamopsis tetragonoloba (L.) ‘raub.) is used for the extraction of guar gum and is unusual among the food legumes in that most of the energy is stored as a galactomannan. However, the mature seeds are not normally eaten as food by humans. Most studies of the effects of processing on grain legumes have been carried out with soya beans; however, in this discussion consideration is primarily given to pulses. Table I shows names of commonly-eaten pulses with the region in which they are eaten. Confusion has arisen in the past over the nomenclature of pulses for several reasons. First, many species previously classified as Phaseolus have now been reclassified as belonging to the genus Vicia. Secondly, common names for two species may be the same, such as the use of the term field bean for varieties of both P. vulgaris and V. faba (see Table I). Finally, a single species may contain within it many morphological types and therefore it is difficult to distinguish the species from the seeds alone. This is particularly true now that unfamiliar varieties are being released from breeding stations. Thus, for example, coloured varieties of cowpea may be identical to seeds of P. vulgaris. Legumes contain a wide range of toxic components (Aykroyd el af. 1981). (The term toxic being defined in the liberal sense according to Liener (1980) as ‘an adverse physiological response produced in man or animals by a particular food or substance derived therefrom’). The effects of most of these components are small or negligible in a mixed diet especially when legumes are properly cooked. However, a few (shown in Table 2) deserve mention as their presence in foods does have some public health significance. During the processing of legumes it is important that toxic components be reduced to levels that pose no threat to health. However, improvements in breeding legumes may result in higher levels of toxins, requiring more severe processing conditions for detoxification. Until recently only those legumes of primary importance in the industrialized countries, such as beans (P . vulgaris), peas, groundnuts and soya beans had received much attention from plant breeders. In the early 1970s a number of international agricultural research centres were established for the breeding of tropical and subtropical legumes. At these centres most of the breeding effort is aimed at higher, more stable yield. One aspect which contributes to low yield is the particular susceptibility of legume plants to insect attack in the field. Therefore,

Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies

Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. All previous trials, which have been uncontrolled or comparative studies, indicate its potential use for the treatment of osteoarthritis. This paper reviews the mechanism of its putative therapeutic actions, those clinical trials that have assessed its use in osteoarthritis to date, as well as considering the safety implications of this supplement for osteoarthritis and reviewing the evidence to date regarding the dosage for treating this condition. The data available at present indicate the need for trials to establish the efficacy and optimum dosage for bromelain and the need for adequate prospective adverse event monitoring in such chronic conditions as osteoarthritis.

The effect of daily baked bean (Phaseolus vulgaris) consumption on the plasma lipid levels of young, normo-cholesterolaemic men.

1. Thirteen normo-cholesterolaemic male students consumed one 450 g can of baked beans (Phaseolus vulgaris) in tomato sauce, daily, for 14 d as part of their normal diet. After a 14 d washout period, eleven of the students went on to consume one 440 g can of spaghetti in tomato sauce, daily, for 14 d. 2. Fasting blood samples were taken frequently for measurement of plasma cholesterol, high-density lipoprotein (HDL)-cholesterol, triacylglycerols, glucose, insulin and C-peptide. Diet diaries (3 d) were completed by the subjects during each period. 3. Consumption of beans and spaghetti led to a significant reduction in the amount of fat eaten daily (P less than 0.05). Bean consumption also resulted in significant increases in protein, fibre and sugar intakes (P less than 0.02, P less than 0.001 and P less than 0.05 respectively). 4. During the bean-eating period the mean total plasma cholesterol level of the students fell significantly from 5.1 to 4.5 mmol/l (P less than 0.02). No reduction in plasma cholesterol occurred during the spaghetti-eating period. 5. HDL-cholesterol levels fell significantly during both periods (P less than 0.001), but HDL:total cholesterol ratio was significantly reduced only during the spaghetti-eating period (P less than 0.001). Neither beans nor spaghetti affected triacylglycerol, insulin or C-peptide levels. 6. The benefits of a legume-rich diet are discussed.

The Contribution of Weaning Foods to Protein–Energy Malnutrition

I N T R O D U C T I O N . . 25 P R O T E I N E N E R G Y M A L N U T R I T I O N A N D D I E T A R Y S U R V E Y D A T A . 26 IS T H E R E A BEST A G E F O R W E A N I N G ? . . . 29 P R O T E I N R E Q U I R E M E N T S D U R I N G W E A N I N G . . 30 I N F E C T I O N A N D T H E WEANLING’S D I L E M M A . . 31 I N F A N T F E E D I N G P R A C T I C E S I N T H E T H I R D W O R L D . . . 32 AGE OF W E A N I N G . . 33 FREQUENCY OF FEEDING . . 33 INFLUENCE OF MOTHER’S BELIEFS O N FEEDING PRACTICE . . 34 AMOUNTS OF BREAST MILK . . . 34 P R E P A R A T I O N OF T R A D I T I O N A L W E A N I N G F O O D S . . 35 N U T R I T I V E V A L U E O F T H I R D W O R L D W E A N I N G F O O D S . . 35 PROTEIN C O N T E N T . . . 36 ENERGY C O N T E N T . . . 38

Effects of enhanced consumption of fruit and vegetables on plasma antioxidant status and oxidative resistance of LDL in smokers supplemented with fish oil

Objective: To determine whether consumption of five portions of fruit and vegetables per day reduces the enhancement of oxidative stress induced by consumption of fish oil.Subjects: A total of 18 free-living healthy smoking volunteers, aged 18–63 y, were recruited by posters and e-mail in The University of Reading, and by leaflets in local shops.Design: A prospective study.Setting: Hugh Sinclair Unit of Human Nutrition, School of Food Biosciences, The University of Reading, Whiteknights PO Box 226, Reading RG6 6AP, UK.Interventions: All subjects consumed a daily supplement of 4 × 1 g fish oil capsules for 9 weeks. After 3 weeks, they consumed an additional five portions of fruits and vegetables per day, and then they returned to their normal diet for the last 3 weeks of the study. Fasting blood samples were taken at the ends of weeks 0, 3, 6 and 9.Results: The plasma concentrations of ascorbic acid, lutein, β-cryptoxanthin, α-carotene and β-carotene all significantly increased when fruit and vegetable intake was enhanced (P<0.05). Plasma concentrations of α-tocopherol, retinol and uric acid did not change significantly during the period of increased fruit and vegetable consumption. Plasma oxidative stability, assessed by the oxygen radical absorbance capacity (ORAC) assay, also increased from weeks 3–6 (P<0.001) but not in association with increases in measured antioxidants. Lag phase before oxidation of low-density lipoprotein (LDL) significantly decreased in the first 3 weeks of the study, reflecting the incorporation of EPA and DHA into LDL (P<0.0001). Subsequent enhanced fruit and vegetable consumption significantly reduced the susceptibility of LDL to oxidation (P<0.005).Conclusion: Fish oil reduced the oxidative stability of plasma and LDL, but the effects were partially offset by the increased consumption of fruit and vegetables.Sponsorship: This study was supported by funding from the Ministry of Agriculture, Fisheries and Food, and from Boots plc.

Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults

There is preliminary clinical evidence to support the contention that the anti-inflammatory and analgesic properties of bromelain help to reduce symptoms of osteo- and rheumatoid arthritis. However, there have been no controlled studies of its effects on joint health in healthy subjects who lack such diagnosis. The current study investigated the effects of bromelain on mild acute knee pain of less than 3 months duration in otherwise healthy adults. The study was an open, dose-ranging postal study in volunteers who had been recruited through newspaper and magazine articles. Two validated questionnaires (WOMAC knee health Index and the Psychological Well-Being Index) were completed at baseline and after one months intervention with bromelain, randomly allocated to volunteers as either 200 mg or 400 mg per day. Seventy seven subjects completed the study. In both treatment groups, all WOMAC symptom dimension scores were significantly reduced compared with baseline, with reductions in the final battery (total symptom score) of 41 and 59% (P = 0.0001 and <0.0001) in the low and high dose groups respectively. In addition, improvements in total symptom score (P = 0.036) and the stiffness (P = 0.026) and physical function (P = 0.021) dimensions were significantly greater in the high-dose (400 mg per day) compared with the low-dose group. Compared to baseline, overall psychological well-being was significantly improved in both groups after treatment (P = 0.015 and P = 0.0003 in the low and high dose groups respectively), and again, a significant dose-response relationship was observed. We conclude that bromelain may be effective in ameliorating physical symptoms and improving general well-being in otherwise healthy adults suffering from mild knee pain in a dose-dependant manner. Double blind, placebo-controlled studies are now warranted to confirm these results.