Jorge L. Rosado

Separate and Joint Effects of Micronutrient Deficiencies on Linear Growth

Recent studies have investigated the effect of micronutrient deficiencies on growth stunting, with special attention toward the effect of zinc, iron, vitamin A and iodine deficiencies. In Mexico, the prevalence of growth stunting in children <5 y old is approximately 24%; it is higher in rural areas and lower in urban areas. In an initial study, the effect of zinc and/or iron supplementation on linear growth was investigated in a longitudinal, placebo-controlled design. After 12 mo of supplementation, there was no difference between the groups supplemented with zinc, iron or zinc plus iron and the placebo group. At baseline, 82% of the children in this study were deficient in at least two out of the five micronutrients that were determined, and 73% were anemic. In another study, a mixture of those micronutrients that were documented to be lacking in Mexican children was formulated in a supplement and given to Mexican children over a period of 12 mo in a longitudinal, placebo-controlled, supplementation design. Children in the low and medium socioeconomic status grew about 1 cm more than similar children in the placebo group. This difference was not found in children of high socioeconomic status. It is suggested that, in most cases, growth stunting is associated with marginal deficiencies of several micronutrients and that in populations with multiple micronutrient deficiencies, the effect on linear growth of supplementation with single nutrients will not be significant. Supplementation with multiple micronutrients is expected to be more effective, but even in that case the actual increment in height was less than the expected potential increment.

Vitamin A deficiency and anemia among children 12-71 months old in Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognized as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14% of the children were subclinically vitamin A deficient (plasma retinol < 20 micrograms/dL) and 32% were at risk of VAD (plasma retinol 20-30 micrograms/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 months old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared with other children. That same doubled risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50% of those mandated by Honduran law. There appears to be significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33% of samples contained no retinol. Overall, 30% of children were anemic (Hb < 11 g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33% greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51% and 21%, respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it.

Absorption of zinc sulfate, methionine, and polyascorbate in the presence and absence of a plant-based rural mexican diet

Abstract Using the zinc tolerance test, we compared the absorption of zinc from zinc methionine with that from zinc sulfate or zinc polyascorbate. Nine adults received 25 mg of elemental zinc in the three different supplements, either alone in a water solution or added to a standard meal (SM). All subjects were also studied with water alone and the SM alone, as controls. The SM contained plant foods that are habitually consumed in rural Mexico. When the supplements were given with water the area under the curve (AUC) for the 4-h observation was: 262±30 μ/dl for zinc methionine, 225±9 μg/dL for zinc polyascorbate, 210±33 μg/dL for zinc sulfate and 1±6 μg/dL for water. Plasma zinc increased more after methionine than after zinc sulfate (p

Nutrition of Honduran mothers/caretakers

In 1996, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. The 1,126 mothers/caretakers who participated in the survey tended to be short and plump. About 15% of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9% had chronic energy deficiency (CED), but 27% were at least 20% overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at least 20% overweight included being over 30 years old, not breast-feeding, having attended no higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26% of nonpregnant and 32% of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasites, especially hookworm. Only 50% of the mothers/caretakers participating in this study had received iron during their last pregnancy, and just 13% had received postpartum vitamin A. The results highlight the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency.

Lactose digestion and maldigestion : implications for dietary habits in developing countries

Milk is an important source of high quality protein, energy, calcium, potassium, phosphorus and riboflavin. It also has good functional properties and a highly acceptable taste, making milk a good alternative for the nutrition of children and for food programmes in developing countries. However, in some instances it has been advocated that milk or milk based products might not be appropriate for nutritional support, given the high prevalence of lactose intolerance among populations in those countries. After reviewing studies in different regions of the world it is concluded that: 1. Prevalence of lactose maldigestion in children and adults is significantly reduced, to less than half in most studies, when assessed with a dose of milk similar to that normally taken in the diet, as distinct from a large dose of lactose used in the lactose tolerance test. 2. Lactose intolerance as a result of consuming a glass of milk occurs only in a small proportion (about 30% in most studies) of lactose maldigesters. Even this small group can ingest smaller amounts of milk without adverse symptoms and there is good evidence that colonic metabolism in these people adapts to the presence of lactose to reduce or eliminate adverse symptoms. 3. Lactose maldigestion and intolerance in children in developing countries is more likely to exist in association with gastrointestinal damage associated with diarrhoea, malnutrition and/or infection. 4. There is no evidence to support a reduction or elimination of milk intake for people in developing countries because of lactose maldigestion or intolerance.

Consumption of dietary fiber in rural Mexico

The average per capita intake of dietary fibre and the relative contribution of different foods to its intake in the Mexican rural population was studied. Food consumption data were obtained from the National Nutrition Surveys of 1979 (21,248 families in 219 rural Mexican communities), and from a similar survey of the same communities in 1989 (20,759 families). Average per capita intake of total dietary fibre (TDF) ranged from 19.8 to 34.0 g/d (average 27.2 ± 3.3) in 1979 and from 17.5 to 27.1 g/d (average 22.5 ± 2.2) in 1989. About 13% of TDF in both surveys was contributed by soluble dietary fibre. Of the 19 regions of the country, 18 exhibited a significant reduction in TDF intake from 1979 to 1989 (p < 0.001). With the exception of two regions on the northern border, maize was the major single source of TDF (from 31 to 74% of TDF). The implication of these observations on disease patterns needs to be studied.