Jesus Bulux

Haematological response to haem iron or ferrous sulphate mixed with refried black beans in moderately anaemic Guatemalan pre-school children

OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets. For this purpose, a new haem iron preparation was developed. The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate (FeSO4). DESIGN In a masked, stratified-randomised intervention trial, children received five 156-g cans of refried black beans per week for 10 consecutive weeks. The beans-only (control), FeSO4 and haem iron groups were offered a cumulative dose of 155 mg, 1625 mg and 1700 mg of iron from the bean intervention, respectively. Haemoglobin (Hb) and ferritin concentrations were determined at baseline and after 5 and 10 weeks. Compliance was examined weekly. SETTING A low-income community in Guatemala City. SUBJECTS One hundred and ten children aged 12-36 months with initial Hb values between 100 and 115 g l(-1). RESULTS The cumulative intake of beans was approximately 80% of that offered, signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks. Hb concentrations increased by the order of 7.3-11.4 g l(-1) during the intervention, but without significant differences across treatments. Average ferritin concentrations were unaffected by treatment assignment. However, post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group (13.1+/-7.7 g l(-1)) to be significantly greater than the respective increases (6.8+/-11.2 and 6.4+/-8.5 g l(-1)) in the inorganic iron and beans-only groups. CONCLUSIONS Canned refried beans are a candidate vehicle for fortificant iron. Given the improved colour and organoleptic properties imparted by haem iron added to refried beans, its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4.

Comparison of three methods for estimating daily individual discretionary salt intake: 24 hour recall, duplicate-portion method, and urinary lithium-labelled household salt excretion

Objective: To compare methods for estimating discretionary salt intake, that is, salt added during food preparation and consumption in the home.Setting: The study was carried out in a rural Guatemalan village.Subjects: Subjects were selected non-randomly, based on their willingness to cooperate. Nine mother-son dyads participated; the sons were aged 6–9 y.Interventions: Three approaches for estimating the discretionary salt consumption were used: 24 h recall; collection of duplicate portions of salt; and urinary excretion of lithium during consumption of lithium-labelled household salt. Total salt intake was assessed from the excretion of chloride over 24 h.Results: The mean discretionary salt consumption based on lithium excretion for mothers was 3.9±2.0 g/d (mean±s.d.) and for children 1.3±0.6 g/d. Estimates from the 24 h recalls and from the duplicate portion method were approximately twice and three times those measured with the lithium-marker technique respectively. The salt intake estimated from the recall method was associated with the lithium-marker technique for both mothers and children (Spearman correlation coefficient, 0.76 and 0.70 respectively). The mean daily coefficient of variation in consumption of discretionary salt measured by the three methods, for mothers and boys respectively, were: lithium marker, 51.7 and 43.7%; 24 h recall, 65.8 and 50.7%; and duplicate portion, 51.0 and 62.6%.Conclusions: We conclude that an interview method for estimating discretionary salt intake may be a reasonable approach for determining the relative rank-order in a population, especially among female food preparers themselves, but may grossly overestimate the actual intake of salt added during food preparation and consumption.

Test-Retest Reproducibility of the Relative Dose Response for Vitamin A Status in Guatemalan Adults: Issues of Diagnostic Sensitivity

The relative dose response (RDR) test has been used as a functional measure of whole-body stores of vitamin A in humans. We have examined the reproducibility of the RDR procedure in a population of Guatemalan adult subjects who would be expected to show a moderate prevalence of hypovitaminosis A. Fifty-one subjects were administered a standard RDR test, and the plasma samples were analyzed for retinol, tocopherol, retinol binding protein (RBP) and prealbumin (PAL). Thirty-four of the subjects underwent repeat RDR tests 7 d later. Plasma levels in fasted subjects were as follows: retinol, 1.35 +/- 0.30 mumol/L; RBP, 37.8 +/- 7.7 mg/L; PAL, 187.0 +/- 39.0 mg/L; and tocopherol, 16.6 +/- 6.2 mumol/L. RDRs ranged from -35.2% to +63.1%, with a mean of 2.6 +/- 10.4%. Overall, we observed poor within-subject reproducibility of the RDR procedure whether expressed numerically or by diagnostic classification. Moreover, in contrast to previous studies in children, we observed fewer positive RDR tests than would be expected for the population studied. Nevertheless, the mean RDR was inversely proportional to fasting retinol levels, thus confirming the validity of the biological basis of the RDR procedure in humans. Because of high intra-individual variability with this test, investigators should be cautious when using the RDR procedure in serial studies to monitor the efficacy of therapeutic interventions or subject compliance to dietary regimens.

Day-to-Day Variations in Iron, Zinc and Copper in Breast Milk of Guatemalan Mothers

Objective: To assess the within-subject and between-subject coefficients of variation (CV) of iron, zinc and copper concentrations in the milk of Guatemalan mothers. Methods: We performed a cross-sectional study in lactating women who had delivered a healthy infant 1 to 6 months previously in two low-income peri-urban areas (San Bartolomé Milpas Altas and Ciudad Peronia) and a low-income rural area (San Juan Chamelco) in Guatemala. Women infested with Ascaris lumbricoides or Trichuris trichiura received a single dose of albendazole (400 mg) or placebo. Two weeks after treatment, milk samples were collected on 3 or 4 consecutive days. Trace element concentrations in milk were measured by inductively coupled plasma/atomic emission spectrometry. Results: The instrumental error of the inductively coupled plasma/atomic emission spectrometry method, expressed as SD, was 0.04, 0.27 and 0.02 mg/L for iron, zinc and copper, respectively. Concentrations in milk samples collected from 47 mothers on 3 or 4 consecutive days, expressed as mean ± SD, were 0.28 ± 0.13, 2.03 ± 0.37 and 0.29 ± 0.07 mg/L for iron, zinc and copper, respectively. The within-subject CV was 46.1%, 18.2%, and 22.8% and the between-subject CV was 61.2%, 48.3% and 31.7% for iron, zinc and copper, respectively. Stage of lactation, infestation with intestinal parasites and residential area had a significant influence on milk zinc, copper and iron concentrations. Conclusions: One sample of milk is sufficient to give a reliable estimate of the zinc concentration in milk. Two samples taken on consecutive days are required for a reliable estimate of iron and copper concentrations.

Studies on the bioconversion of β-carotene to active vitamin A in underprivileged Guatemalan children

Abstract The mechanism by which the rate of β-carotene conversion to active vitamin A in the enterocyte is poorly understood. It is postulated that body vitamin A status plays a very important role. Unitl recently, it has not been possible to detect and quantify the product of β-carotene bioconversion, i.e., retinal, in the gut, and retinyl ester, in the circulation. This study aimed at confirming that a rise in plasma retinyl palmitate concentration would occur after administration of β-carotene to underprivileged Guatemalan schoolchildren. Twenty rural children, aged 7 to 11 years, received 30 mg of pure, crystalline β-carotene in oral capsules in the fasting state. Thirteen peri-urban poor children participated as controls; each received capsules of cellulose. Standard meals with low vitamin A levels were served during the observation period. Plasma levels of β-carotene, retinol, and retinyl palmitate were determined by HPLC at baseline, 2 hr, and 24 hr after ingestion of capsules. Anthropometric and biochemical characteristics were similar in both groups at baseline. An average increase of 0.15 ± 0.05 μmol/L in retinyl esters was observed in the supplemented group at 2 hr, with a return to baseline levels at 24 hr; whereas in the control group no retinyl esters were detected at all at any time. A tendency of a greater retinyl ester response with a lower baseline circulating retinol level was observed. This is the first instance in which β-carotene bioconversion to retinyl palmitate has been quantified in children. We propose that the rise in retinyl esters after oral administration of β-carotene could be used to examine the factors that influence the rate of bioconversion of β-carotene to active vitamin A.

Sweet potato buds: the origins of a "designer" food to combat hypovitaminosis A in Guatemala. Processing, vitamin A content and preservation characteristics

Abstract A Guatemalan version of sweet potato flakes, called “sweet potato buds” (SPB), was created from Ipomoea batata by the drum-drying technique used to create instant mash potatoes. The yield on the first production run was 11% and that on the second production run was 13%. The amount of β-carotene per weight was concentrated from 16.5 to 42.2 μg/g from the whole sweet potato to the dried flakes. On one occasion, the β-carotene concentrations in the common variety of Guatemalan yellow-pulp sweet potato was 42.2 μg/g or 7.0 retinol equivalents (RE)/g in the SPB and on another 57.5 μg/g or 9.6 RE. Thus, a usual serving of one ounce (28 g) of SPB provides from 196 to 269 RE or 49 to 67% of the daily recommended amount. With storage in plastic or foil packaging, the β-carotene levels fell steeply, to the point of extinction within 4 months, independent of the type of barrier or the addition of food-grade antioxidants.

Blood retinol and β-carotene levels in rural Guatemalan preschool children

Plasma retinol and β-carotene levels were measured in 502 preschool Guatemalan children from five rural hamlets. Their ages ranged from 6 to 78 months (mean: 42.9±19.2 months); 45% males and 55% females. The mean retinol value in the whole group was 0.9±0.4 µmol/1 (range: 0.1 to 8.4 µmol/1). There was no significant difference between sexes in retinol mean values nor in the incidence of retinol values less than 0.7 µmol/1 (22% in males, 18% in females). When grouped by age and community, significant low retinol mean values were found in two hamlets in the youngest age group (12 to 23 months) as compared to the other age-groups (p<0.05). In the other two hamlets, there were no significant differences among retinol means by age-group. The highest prevalence of deficient retinol values by age-group was in the 12 to 23 months group (40%), and decreased as age increased. The mean value for β-carotene in the whole group was 0.13±0.18 µmol/1 (range: 0.01 to 2.23 µmol/1). There were no significant differences in β-carotene means between sexes in the whole group. Stratifying the β-carotene data by age-groups and community, values were significantly higher in the 48–59 months and 72–83 months groups, as compared with the other age groups in two of the communities (p<0.05). Significant differences across communities for β-carotene were found only in the 12 to 23 months group.

Haematological status of school children in two regions of Guatemala : relevance of normality standards

Haematocrit values of 1484 Guatemalan children aged 5 to 18 years (mean: 10 years), 897 males and 587 females, were determined in a haematological survey. Five hundred and eight were sampled in the highland province of Alta Verapaz (AV) and 976 in the coastal province of Retalhuleu (Reu). Packed cell volumes were classified as ‘normal’ or ‘subnormal’ using two published standards, both adjusted by age, gender, and altitude of origin (Interdepartmental Committee for Nutrition in National Development, 1969; Viteri et al, 1972). The former gave a global prevalence of haematological subnormality of 7.7%: 10.6% in AV and 6.3% in Reu; the latter gave a global prevalence of 8.0%: 16.1% in AV and 6.3% in Reu. The lowland population, paradoxically, had the lower rate of low haematocrits. Males had more subnormal haematocrits than females. Only 37 of 196 children (19%) were identified as having a haematological deficit by both systems simultaneously. For assessment of the haematological status of the Guatemalan pop...