Depressed antioxidant status in pregnant women on iron supplements: pathologic and clinical correlates.

Iron (Fe) remains a commonly prescribed supplement in pregnancy. Its possible pathologic potential is either uncommonly considered or ignored. We determined the antioxidant status in pregnant women with and without Fe supplements. Fifty-eight apparently healthy pregnant women on Fe supplements were selected for the study from the antenatal clinic of the University College Hospital, Ibadan, Nigeria. Fifty-five aged matched pregnant women who were not on Fe from various parishes of the Christ Apostolic Church, Ibadan (non-drug using Christian sect) were randomly selected as controls. Both groups were classified according to the trimesters of pregnancy. The gestational age in both pregnant women on Fe supplements and non-supplement pregnant women was similar. Fruit and vegetables consumption was higher in the supplement than in the non-supplement group (57.2% vs. 37.3%). Anthropometric indices, weight, height, and BMI, were also similar. But while the weight of the Fe supplement group decreased by nearly 3% in the third trimester, it increased by over 10% (p < 0.00) in the non-supplement group in the same period. Serum Fe level was significantly higher in the supplement than the non-supplement group (p < 0.001). In contrast, the levels of the antioxidants, ascorbic acid, copper (Cu), zinc (Zn), and bilirubin were all significantly decreased (p < 0.05, p < 0.001, p < 0.05, and p < 0.05, respectively). Uric acid level though also lower in the supplement group did not reach statistical significance (p > 0.05), while vitamin E was similar in both groups. There was relative stability of all antioxidants except uric acid, which declined from the first to the last trimester in the non-supplement group. The significantly higher Fe level in the second trimester was sustained in the third trimester though to a lesser degree (p < 0.05) and associated with significant decreases in the following antioxidant levels in the supplement group, ascorbic acid, bilirubin, Cu, and Zn (p < 0.02, p < 0.02, p < 0.02, and p < 0.001, respectively). Uric acid and vitamin E though lower in the supplement group were not significantly different. Remarkably, percentage changes between the first and third trimesters revealed that serum Fe increased by over 116% in the Fe supplement group, while it only increased by over 50% in the non-supplement group. This was associated with 23.50% decrease in ascorbate level (p < 0.003) in the supplement group, while it decreased by only 3.70% in the non-supplement group (p > 0.05). Again vitamin E decreased by 17.22% in the supplement group, while it decreased by only 7.30% in the non-supplement group during the period. Uric acid and bilirubin levels decreased by similar proportions during the period, while Zn decreased by 18.55% in the supplement group and by 14.86% in the non-supplement group. In contrast Cu increased by 7.20% in the supplement group, while it increased by only 2.96 in the non-supplement group. Additionally, all the antioxidants in the supplement group except vitamin E, viz, ascorbic acid, bilirubin, Cu, uric acid, and Zn, were significantly inversely correlated with serum Fe level (r - 0.299, p < 0.05, r - 0.278, p < 0.05, r - 0.383, p < 0.05, and r - 0.0369, p < 0.05). These data imply markedly depressed antioxidant status in the Fe supplement pregnant group with attendant oxidative stress (most probably pro-oxidant Fe-induced). This is associated with molecular and cellular damage as well as a number of pathologic and clinical correlates that underlie the exacerbation of morbidity and mortality in maternal and child populations, particularly in the developing countries. This appears to call for serious caution and prior evaluation of antioxidant and Fe status and during the use of Fe supplements in pregnancy for monitoring and prognostic purposes and to avert or ameliorate oxidative stress-induced pathologies in maternal and fetal systems.

Plasma lipoprotein (a), homocysteine, and other cardiovascular disease (CVD) risk factors in Nigerians with CVD.

Elevated plasma lipoprotein (a) (Lp(a)) and total homocysteine (tHcy) concentrations, as well as fat distributions, are associated with cardiovascular disease (CVD) risk. The purpose of this study was to evaluate plasma Lp(a), tHcy, percentage body fat, anthropometric indices, and blood pressure (BP) and their relationships with each other in well-defined, hospital-based, CVD patients in a Nigerian African community. One hundred seventy patients suffering from hypertensive heart disease, hypertension, ischaemic heart disease, and myocardial infraction with the mean age of 45.3 +/- 1.3 years and 58 apparently healthy volunteers with the mean age of 44.8 +/-1.2 years were selected. Anthropometric indices and BP were measured. Percentage body fat, body mass index, and waist-to-hip ratio (WHR) were calculated. Plasma Lp(a) and tHcy concentrations were determined. The results showed significant increases in BP, skinfold thickness (SFT) variables, and WHR in all of the CVD patients. Plasma Lp(a) was also significantly increased (p < 0.001), whereas the slight increase in the mean tHcy was not statistically significant. Positive significant correlations were found between systolic BP, triceps, SFT, and percentage body fat (p < 0.01), whereas significant correlations were found between some body composition variables, tHcy, and systolic BP (p < 0.05). Our findings provide supportive evidence for altered plasma Lp(a) concentration in addition to some other traditional CVD risk factors in Nigerians. The role of homocysteine is not well defined.

Pattern of skin surface lipids in some south-western Nigerians with acne vulgaris.

UNLABELLED: Unanswered questions still exist regarding pathophysiology of acne vulgaris generally and particularly in this environment. METHODS: Skin surface lipid (SSL) samples were collected by the heptane sponge technique from faces of 20 Nigerians with facial acne vulgaris and 25 controls. The subjects were classified into mild and moderately severe acne groups. Total cholesterol and triglycerides were determined and expressed in percentage (%) while Undetermined Skin Surface Lipids (USSL) (free fatty acids + squalene + wax ester + diglycerides) were computed. RESULTS: Triglycerides and total cholesterol levels were significantly higher in subjects with acne vulgaris compared with controls (p < 0.001 and p < 0.029 respectively). There was a progressively significant increase in triglycerides from control, though mild to moderately severe acne vulgaris subjects (P < 0.01) in all cases. In contrast there was a significant progressive decrease in USSL among the three groups (P < 0.001) in all cases. No significant difference was evident for all the values on comparison of female subjects with male subjects. There were however, significant increases in triglycerides and significant decreases in USSL levels for both male and female subjects with acne vulgaris compared with their respective controls (P < 0.02, P < 0.01, P < 0.03 and P < 0.014). CONCLUSION: Alterations in composition of SSL may in part be the pathophysiological basis of inflammatory acne vulgaris. Severity of the disorder appears to parallel triglyceride level but there was no association with sex. Triglycerides and total cholesterol levels are lower in SSL in this environment compared with hotter climates.

Relationship between area deprivation and the anticaries benefit of an oral health programme providing free fluoride toothpaste to young children.

OBJECTIVE: To determine the effectiveness of providing free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-old children living in areas with different levels of material deprivation. DESIGN: Five-year, examiner-blind, randomized, controlled, parallel-group, clinical trial. Children were randomly assigned to three groups. SETTING: Health Districts in the north-west of England with high levels of dental caries. Clinical examinations were performed in schools during the period October 1999 to April 2000 when the children were 5-6 years old. PARTICIPANTS: Children from 3-month birth cohorts resident in nine, nonfluoridated health districts. INTERVENTIONS: Toothpaste containing either 440 or 1450 ppm F and dental health literature posted at 3-month intervals and toothbrush provided annually from the age of 1-5 years. Comparison group received no intervention. MAIN OUTCOME MEASURES: Mean dmft and proportion of participants with dmft > 0, dmft > or = 4, upper primary incisor caries and extraction of one or more primary teeth. Outcomes tabulated for quartiles of participants based on the distribution of the Townsend index of material deprivation. RESULTS: A total of 3467 children were included in the final data analysis. The Townsend index was found to be useful in identifying groups of children with increased caries risk. Overall, participants in the programme using the high-fluoride toothpaste had significantly (P < 0.002) less caries than the comparison group with similar absolute reductions in mean dmft for the most- and least-deprived groups. Relative to the comparison group the association between deprivation and dental caries was changed so that in the most-deprived quartile those using the low-fluoride toothpaste tended to have less dental caries than the comparison group whereas in the least deprived they tended to have more. This difference in the association (slope) was statistically significant (P < 0.05). Provision of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions for participants in the most-deprived quartile (P < 0.05). CONCLUSION: The relative benefits of the programmes supplying the two toothpastes considered in this study are different depending on the deprivation status of the participants. For the most-deprived groups postal provision of either a low- or high-fluoride toothpaste provides similar levels of benefit. In the less deprived groups only provision of the high-fluoride toothpaste provided a benefit. The absolute caries reduction seen for provision of the high-fluoride toothpaste was not related to the deprivation status and hence the programme did not reduce deprivation-related health inequalities. Targeting the programme using the methods employed in this study is unlikely to improve the effectiveness of the programme.

An assessment of the cost effectiveness of a postal toothpaste programme to prevent caries among five-year-old children in the North West of England.

OBJECTIVE: To assess the cost effectiveness of a postal toothpaste programme to prevent caries in 5-year-old children in the north west of England. PARTICIPANTS: Birth cohorts of children aged 12 months were recruited from high caries risk populations in nine health districts. DESIGN: The results of a randomised controlled trial to measure the effects of a postal toothpaste programme are used and related to the costs of running a similar programme. Children in the trial received free toothpaste on four occasions a year and a toothbrush once a year for four years from age 12 months to 5 years. When aged 5-6 years children were examined by trained, calibrated examiners using BASCD standards. Those who received toothpaste containing 1450 ppm F were found to have a significantly lower mean dmft than those who had not. The costs that would be incurred by a public dental service running such a postal toothpaste programme are identified, measured and related to the likely health improvement that could be achieved. MAIN OUTCOME MEASURES: The cost per tooth saved and the cost per child saved from caries experience and extraction experience. RESULTS: The estimated cost per tooth saved from carious attack was pounds sterling 80.83 and the cost per child of preventing caries experience was pounds sterling 424.38 and avoiding any extractions was pounds sterling 679.01. Analysis resulted in an overestimation of costs and underestimation of benefits. CONCLUSION: The programme achieved a significant caries reduction in children who received the 1450 ppm F toothpaste and the costs are now available to those considering provision of treatment services in areas where children are at high caries risk.

Selective cholesterol deposition in the kidney tissue of rats fed palm kernel oil diet.

Plasma and tissue lipids were determined in twenty-four rats fed on locally prepared 'Ogi' diet containing palm kernel oil (PKO), red palm oil (RPO) and mixture of both oils. Fasting blood sample was obtained from each animal by cardiac puncture under light ether anesthesia after feeding on different diets for twelve weeks. There were significant variations in the mean liver, kidney, spleen (p < 0.001, p < 0.03, p < 0.002) tissue weights in the different dietary groups compared with the corresponding control values. The plasma total cholesterol, triglyceride and lipoprotein cholesterol concentrations in the dietary group showed no significant changes when compared with the corresponding control values. The liver, spleen and heart total cholesterol concentrations were not significantly different from the corresponding values in the control group, but within group analysis showed significantly elevated total cholesterol in the kidney tissue of rats consuming PKO diet (p < 0.001). The total cholesterol level in rats consuming PKO diet was significantly higher than the corresponding concentration in those consuming the diet containing a mixture of PKO + RPO [p < 0.02] and control (p < 0.02) diets. There was also a significant increased in the kidney tissue cholesterol of rats fed RPO diet when compared with the corresponding control value (p < 0.05). The histological findings revealed no abnormality except in rats fed on PKO and RPO diets where nephrocalcinosis was found.

A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children.

OBJECTIVE: To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries. DESIGN: Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old. SETTING: A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools. PARTICIPANTS: 7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups. INTERVENTIONS: Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years. MAIN OUTCOME MEASURES: The dmft index, missing teeth and the prevalence of caries experience. RESULTS: An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship. CONCLUSION: This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.

Biochemical indicators of metabolic poisoning associated with lead based occupations in nutritionally disadvantaged communities.

The biochemical alterations that occur in chronic lead exposure were studied in 86 males who were occupationally exposed to the metal. The biochemical indices investigated were blood lead, total and ionized calcium, inorganic phosphate, total protein and albumin, uric acid and 1,25 dihydroxycholecalciferol [1,25] (OH2 D3]. Serum total and ionized calcium levels and 1,25 [OH2] D3 were significantly lower in lead workers than in the control population (P < 0.01 and P < 0.001, respectively). Multiple regression analysis showed an important relationship between blood lead and serum calcium. Uric acid which was positively correlated with blood lead levels was significantly higher in lead workers than in controls P < 0.001. There were no changes in the other biochemical indices studied. The biochemical abnormalities that were established in this report which actually reflect metabolic poisoning may be helpful in the early detection of plumbism before the onset of clinical lead poisoning, particularly in nutritionally disadvantaged communities.

Increased high density lipoprotein cholesterol in adult nephrotic syndrome in Nigeria.

Forty-eight adult subjects consisting of 28 patients with nephrotic syndrome and 20 control subjects were studied. The plasma levels of high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and very low density lipoprotein (VLDL) cholesterol were all significantly elevated in the patients with nephrotic syndrome. The elevations in plasma total cholesterol and triglyceride concentrations and the ratio of LDL cholesterol/HDL cholesterol were also significant. On the other hand, there was a significant reduction in the ratio of HDL cholesterol to total cholesterol in the nephrotics. Our results suggest altered lipid and lipoprotein metabolism in adult nephrotic syndrome. The significant increase in low density lipoprotein cholesterol and the reduction in the ratio of HDL cholesterol to total cholesterol, despite the high HDL cholesterol, probably suggests an increased risk for developing coronary heart disease in Nigerian adults suffering from nephrotic syndrome. It is therefore suggested that patient-management strategies for nephrotic syndrome should include lowering of cholesterol by dietary and/or pharmacological therapies.

Influence of baseline values. I: Effects on plasma total cholesterol and triglyceride levels during doxazosin treatment for hypertension.

Forty-six African patients with essential hypertension aged 40 to 65 years had plasma total cholesterol and triglyceride levels determined at four different periods during a 12-month treatment with doxazosin. The patients were classified according to their pretreatment (baseline) values into 'low', 'medium' and 'high' baseline value groups. The mean total cholesterol levels significantly decreased in the three baseline groups while mean triglyceride levels reduced only in the patients that belonged to the medium and high baseline value groups. The baseline values of total cholesterol did not influence the beneficial cholesterol changes in all the patients, while the lack of significant favorable triglyceride changes was influenced by the low baseline values of triglyceride of the patients during doxazosin treatment. A similar study involving lipoprotein fractions and sub-fractions is also in progress.

Influence of baseline values. II: Variations in plasma lipoprotein fractions during doxazosin treatment for hypertension.

Forty-two Nigerian hypertensive men and women aged 40 to 60 years treated with doxazosin for 12 consecutive months were studied. Before the doxazosin therapy, all the patients had their baseline lipoprotein fractions determined and that was used to classify the patients into 'low', 'medium' and 'high' baseline values. The assays were repeated 4 times at every 3 months during the 12-month treatment with doxazosin. The mean high density lipoprotein-cholesterol (HDLC) levels were significantly reduced in the patients with high baseline values, and remained unchanged for the patients with low and medium baseline values during doxazosin therapy. Low density lipoprotein-cholesterol (LDLC) levels were apparently reduced in all the groups and this was significant for the patients with high baseline values. The mean levels of very low density lipoprotein-cholesterol (VLDLC) increased in the patients with low baseline values, and decreased in the patients with medium and high baseline values during the 12 months of doxazosin therapy. We therefore conclude that although the overall risk of developing coronary heart disease as measured by the risk predictor index LDLC/HDLC ratio was not affected by the baseline values of the patients, it is, however, important to note that adverse lipoprotein changes such as raised VLDLC and reduced HDLC may be seen in patients with low and high baseline values, respectively, during doxazosin treatment for hypertension. These observations will call for more serious monitoring of these lipoprotein fractions in patients with variable baseline values, by physicians and all health workers concerned during doxazosin treatment for hypertension.

Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys.

OBJECTIVE: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for. DESIGN: Ecological study based on results from the NHS dental surveys in 5 year olds in 1991-2 and 1993-4 and Jarman underprivileged area scores from the 1991 census. SETTING: Electoral wards in three areas: Hartlepool (naturally fluoridated), Newcastle and North Tyneside (fluoridated), and Salford and Trafford (non-fluoridated). SUBJECTS: 5 year old children (n = 10,004). INTERVENTION: Water fluoridation (artificial and occurring naturally). MAIN OUTCOME MEASURE: Ward tooth decay score (score on the "decayed, missing, and filled tooth index" for each electoral ward). RESULTS: Multiple linear regression showed a significant interaction between Jarman score for ward, mean number of teeth affected by decay, and both types of water fluoridation. This confirms that the more deprived an area, the greater benefit derived from fluoridation, whether natural or artificial (R2 = 0.84, P < 0.001). At a Jarman score of zero (national mean score) there was a predicted 44% reduction in decay in fluoridated areas, increasing to a 54% reduction in wards with a Jarman score of 40 (very deprived). The area with natural fluoridation (at a level of 1.2 parts per million-higher than levels in artificially fluoridated areas) had a 66% reduction in decay, with a 74% reduction in wards with a Jarman score of 40. CONCLUSION: Tooth decay is confirmed as a disease associated with social deprivation, and the more socially deprived areas benefit more from fluoridation. Widespread water fluoridation is urgently needed to reduce the "dental health divide" by improving the dental health of the poorer people in Britain.

Social deprivation and tooth decay in Scottish schoolchildren.

OBJECTIVES: To quantify the association between dental decay in Scottish Schoolchildren & social deprivation as measured by the Carstairs Index from the 1991 census. DESIGN: An ecological study using data from the Scottish Health Boards Dental Epidemiology Programme and The Public Health Common Data set. SETTING: Scottish Health Boards from 1992-3 to 1994-5. SUBJECTS: Random samples of 5,920 five-year-olds, 5,344 12-year-olds and 6,007 14-year-olds across the 15 Health Boards in Scotland. RESULTS: Positive correlations were demonstrated in all age groups; 12-year-olds (r = 0.72) in 1992-3, 5-year-olds (r = 0.8) in 1993-4 and 14-year-olds (r = 0.55) in 1994-5. Dental decay in all age groups was positively and significantly associated with deprivation as measured by the Carstairs index. CONCLUSION: Tooth decay was confirmed as a disease associated with social deprivation in Scotland. The increasing polarisation of decay to socio-economically deprived groups of the population, suggests a 'whole population' approach such as water fluoridation would prevent tooth decay in these deprived groups most effectively. Nevertheless all evidence-based interventions should be used to try to narrow the "Dental Health Divide' by improving the dental health of deprived individuals.

Index of Orthodontic Treatment Need, its use in a dental epidemiology survey calibration exercise.

The Index of Orthodontic Treatment Need (IOTN) was included in a pre-survey calibration exercise of 18 dental epidemiologists. Nine months later 16 of the epidemiologists were re-calibrated in the IOTN. The Index was readily accepted by the experienced dental epidemiological examiners and each examination was estimated to be extended by, on average, less than two minutes. The inter-examiner agreement of the dental health component using the weighted kappa statistic improved from a mean of 0.53 (moderate agreement) for the first calibration to 0.66 (good agreement) at the second calibration. The mean inter-examiner agreement on the aesthetic component using the weighted kappa statistic reduced from 0.52 for the first calibration to 0.49 at the second. Using sensitivity and specificity to measure agreement on the dichotomous decision of those defined as having a definite treatment need, mean sensitivity rose from 0.72 to 0.79 and specificity from 0.90 to 0.97. It is concluded that dental examiners for epidemiological surveys can be trained to use the IOTN by using a pre-calibration exercise and that agreement on the dental health component improves after the index has been used for some months.

Biochemical changes during a cross-over treatment of doxazosin, moduretic and amlodipine in hypertensive patients.

A cross-over study was done to compare the effects of doxazosin, moduretic and amlodipine on biochemical values in 9 hypertensive Nigerians aged 35 to 65 years. Doxazosin therapy was characterized by significant increase in the levels of mean plasma total protein and albumin, while moduretic therapy showed significant reduction in the mean values of plasma creatinine and calcium. All other parameters did not show any significant variation during doxazosin and moduretic treatment phases; and amlodipine therapy did not have any effect on the biochemical values of the hypertensive patients.

A novel school dental screening programme.

The study validated a novel school dental screening test based on the professional and public belief that regular, or asymptomatic dental attendance is beneficial to oral health. A randomly selected group of 175, 14-15-year-old boys and girls were questioned about their dental attendance which was verified either by the dentists whom they claimed to visit or by further questioning those whose behaviour was not clear. This method of separating symptomatic from asymptomatic attenders had a sensitivity of 1.00 and a specificity of 0.72. The method was inexpensive and acceptable to both the school staff and the pupils. The preventive dental knowledge of both groups was high. Although the dental attitudes of the asymptomatic attenders were significantly better than those who attended symptomatically it was not possible to demonstrate with confidence that they had better dental health.

North West Water and water fluoridation.

Campaigners for fluoridation in the north-west eagerly awaited publication of the Oral Health Strategy for England in the hope that it would include the Government's plan of action to ensure the implementation of fluoridation where most needed and most cost effective. The Government's strategy was 'in areas which do not presently enjoy fluoridated supplies, health authorities and water suppliers should now re-examine how this public health need can best be met.' This account of how health authorities in the north-west have been examining for 25 years just how this public health need can best be met, and the surprising way in which they have been treated by their water supplier over the last 7 years, calls the effectiveness of such a strategy into question.

The effects of doxazosin on plasma lipid and lipoprotein levels in hypertensive patients.

Plasma lipid and lipoprotein levels were evaluated in 27 adults with essential hypertension at four different periods during a 12-month treatment with doxazosin. Mean plasma total cholesterol (TC), low-density lipoprotein-cholesterol (LDLC), triglyceride (TG), very low density lipoprotein-cholesterol (VLDLC) and the LDLC/HDLC ratio were significantly reduced following doxazosin therapy. The HDLC/C ratio was found to be increased, while mean high density lipoprotein cholesterol (HDLC) level remained unchanged at 3, 6, 9 and 12 months of measurement after doxazosin treatment. Our data showed that the duration of doxazosin treatment did not influence the observed favourable lipid changes; but TC and LDLC appear to be the lipid fractions most affected by doxazosin in all the patients. In order to determine the possible factors responsible for the lipid-altering actions of doxazosin treatment, we observed beneficial lipid and lipoprotein changes in both the male and female subpopulations of patients with a slightly higher magnitude in the females. The dosage of doxazosin was, however, found to have no influence on the lipid-altering actions; a further study was therefore recommended.