Dietary supplementation with black cricket (Gryllus assimilis) reverses protein-energy malnutrition and modulates renin-angiotensin system expression in adipose tissue.

Edible insects are recognized as promising food sources due to their nutritional composition. Some species, such as Gryllus assimilis, contain proteins, lipids, and carbohydrates of high biological value, which regulate several metabolic functions, including the Renin-Angiotensin System (RAS). In this context, the present study aimed to assess the effects of dietary supplementation with whole Gryllus assimilis powder on the metabolism of malnourished mice. Thirty-two male Swiss mice were used and divided into four treatment groups. The groups were identified as (AIN93-M); AIN93-M + Gryllus assimilis diet (AIN93-M + GA); AIN93-M + Renutrition diet (AIN93-M + REN) and AIN93-M + Renutrition diet + Gryllus assimilis (AIN93-M + REN + GA). The results showed that whole Gryllus assimilis powder inclusion promotes recovery from protein-energy malnutrition, reduces adiposity, and improves glucose tolerance and insulin sensitivity. It also reduces total cholesterol, triglycerides, VLDL, and adipocyte area. We also observed a significant increase in the expression of RAS-related genes, such as ACE2 and MasR, followed by a reduction in Angiotensinogen and ACE. The main findings of the present study suggest the use of black cricket as a viable strategy for the prevention and treatment of protein-energy malnutrition, as well as the reduction of adiposity, and improvement of lipid and glycemic parameters, with antihypertensive potential.

Exercise Programs Combined with Diet Supplementation Improve Body Composition and Physical Function in Older Adults with Sarcopenia: A Systematic Review.

Sarcopenia is a progressive and frequent syndrome among older adults highly related to physical inactivity and malnutrition. Nowadays, it is considered a pathology that triggers multiple health complications associated with the loss of muscle mass, strength, autonomy, and quality of life. The objective of the present systematic review was to evaluate the effect of exercise programs combined with dietary supplementation on body composition as the primary outcome. This systematic review was carried out in accordance with the elements considered for planning a systematic review by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the search was performed in the Scopus, EBSCO, and PubMed databases for the last 10 years. A total of 16 studies met the inclusion criteria and were included in this systematic review. Regular resistance exercise together with daily essential amino acids or whey protein and vitamin D supplementation improve the maintenance or gains in appendiceal/skeletal muscle mass and total lean mass in sarcopenic older adults. The data suggest a synergistic effect not only on the primary outcome, but also on other variables such as strength, speed, stability, and other indicators of quality of life. This systematic review was registered in PROSPERO, ID: CRD42022344284.

Diet diversity and seasonality of robust capuchins (Sapajus sp.) in a tiny urban forest.

Capuchins are omnivorous neotropical primates that can survive in urban forests by supplementing their diet with human foods. However, few studies have analyzed the impact of these resources on their diet diversity and feeding seasonality. We aimed to assess the patterns of foraging, feeding, and diet diversity of urban capuchins (Sapajus sp.) that live in a tiny urban forest in Foz do Iguaçu, Brazil, where humans frequently feed them. We predicted that forest degradation and human foods could decrease diet diversity, though capuchins may, conversely, reduce their selectivity and expand their food repertoire. We followed the animals from dawn to dusk between May 2018 and April 2019 to list and quantify the species and items consumed. We used diversity indexes and cluster analysis to understand similarities and differences in the diet composition over the study period. We recorded 58 plant species (being 14 exotics) consumed by the monkeys, and nonconventional items, with low diet diversity overall. The diet consisted mainly of plants (69.8%), animal matter (20.6%), and processed foods (9.5%). Capuchins consumed more food from the anthropic environment (57.5%) than from the forest (42.4%), while their food from the forest included more invertebrates (47.8%) than fruits (40%). The cluster analysis showed two main groups of feeding months, in accordance with the seasons of high and low food production in local forests. Monkeys did not vary the frequencies of foraging or feeding between seasons, probably due to the omnipresent availability of human foods. Despite the high consumption of human foods, capuchins responded to the seasonality of the forest, expanding their feeding diversity in the drier period. Future studies should analyze the correspondence between food consumption and local phenology, as well as the potential role of capuchins as seed dispersers in this depauperate community.

A Patent Data Analysis in Nanotechnology Applied to Essential Oils.

BACKGROUND: Essential oils (EOs) are natural substances that serve as sources of bioactive compounds with antioxidant and antimicrobial properties. OBJECTIVE: This objective is to understand intellectual property related to patent documents on EOs and nanotechnology. METHODS: The nanotechnology growth curve applied to EOs demonstrated that the period from 2015 to 2017 was the most prominent, with a peak in 2016. China is the dominant country, mainly through research developed in the academic area. RESULTS: The food industry area had the highest number of patents filed, highlighting the preservation line. Ginger essential oil, chitosan and Tween 80 were preferentially used as a core, wall material, and emulsifier, respectively. In the market, the use of EOs is more associated with the pharmaceutical/ cosmetics industry. In addition, the food industry market bets more on products based on hemp oil nanocapsules. CONCLUSION: EO nanotechnology is promising for the development of sustainable food systems. However, this nanotechnology in Brazil has not yet advanced enough in the food industry, although there are government incentives that may change this paradigm in the future. The profile of the patent documents and the products in the market differ between the application and the types of oils. In addition, there is a gap between the volume of patent documents investigated and the transfer of technology to the commercial sector, but this constitution could be better explored, given the properties of EOs.

The impact of L-branched-chain amino acids and L-leucine on malnutrition, sarcopenia, and other outcomes in patients with chronic liver disease.

INTRODUCTION: Metabolic and hormonal disorders resulting from chronic liver diseases culminate in increased proteolysis and decreased protein synthesis, which contributes to the development and progression of malnutrition and, consequently, sarcopenia. Nutritional management of sarcopenia in liver cirrhosis is a continuously evolving field and data on essential amino acid supplementation in chronic liver diseases is scarce. AREAS COVERED: This review encompasses the current literature on oral amino acids supplementation in patients with chronic liver disease or patients with liver cirrhosis to try to elucidate the possible effects of L-branched-chain amino acids and isolated L-leucine as a therapeutic approach to malnutrition and sarcopenia. EXPERT COMMENTARY: To ensure an optimal nutritional status and to reduce sarcopenia, it is necessary to assess nutritional status in all patients with liver cirrhosis and to apply nutritional interventions accordingly. The supply of calories, proteins, and essential amino acids is necessary for the maintenance of muscle mass and function. Although supplementation of L-branched-chain amino acids plays an important role in liver disease, L-leucine has been described as the main amino acid involved in protein turnover, reducing proteolysis, and stimulating protein synthesis.

Lymphocyte proliferative responses in dairy cows supplemented with an immunomodulatory feed additive and administered polyvalent vaccination / [Proliferação de linfócitos em vacas leiteiras suplementadas com um aditivo alimentar imunomodulador e vacinadas com vacina polivalente]

O presente estudo avaliou o efeito da suplementação com OmniGen-AF® na proliferação de linfócitos e títulos de anticorpos após vacinação em bovinos leiteiros. Amostras de sangue periférico foram coletadas de 32 vacas leiteiras para quantificação dos títulos de anticorpos anti-Leptospira, e amostras de sangue periférico de 16 vacas leiteiras foram também coletadas para avaliação da proliferação de linfócitos. Observou-se que a suplementação com OmniGen-AF® aumentou a proliferação basal de linfócitos (sem estímulos) 21 dias após a vacinação (P=0,03), apesar de reduzir a proliferação de linfócitos B quando estimulada com Leptospira borgpetersenii serovar Hardjo inativada pelo calor (P=0,03). Ademais, nenhum efeito da suplementação sobre a proliferação de linfócitos no momento imediatamente anterior à vacinação e nos títulos de anticorpos anti-Leptospira foi encontrado. Além disso, a proliferação de linfócitos estimulada com lipopolissacarídeos foi maior em vacas multíparas que em primíparas 21 dias após a vacinação (P=0,03). Desse modo, o presente estudo demonstra que a suplementação com OmniGen-AF® não afetou de forma robusta a proliferação de linfócitos e os títulos de anticorpos anti-Leptospira após vacinação em vacas leiteiras sadias.(AU)

Experimental food supplementation increases reproductive effort in the Variable Antshrike in subtropical Brazil.

Food limitation may interact with nest predation and influence nesting patterns, such as breeding season length and renesting intervals. If so, reproductive effort should change with food availability. Thus, when food is limited, birds should have fewer attempts and shorter seasons than when food is not limiting. Here we experimentally test that increased food availability results in increased reproductive effort in a fragmented landscape in the Variable Antshrike (Thamnophilus caerulescens) in southern Brazil. We followed nesting pairs in a naturally fragmented habitat and experimentally supplemented food for half of those pairs. Birds were seen, but evidence of nesting was never found in two small fragments, even though these fragments were larger than individual territories. Pairs with supplemented food were more likely to increase clutch size from two to three eggs and tended to renest sooner (20 d on average) than control pairs. Also, fragment size was associated with breeding patterns, although fragment replicates were unavailable. Nest duration, nest success and breeding season length were all greater, while renesting intervals were shorter, in the largest fragments. Simulations showed that only the largest fragments were able to have a net production of young. Food availability clearly influenced reproductive effort and as a consequence, because of the interaction with predation risk, forest fragments of varying sizes will have complex reproductive dynamics.

A conduta dietoterápica no tratamento da doença do refluxo gastroesofágico: relato de caso / Dietary conduct in the treatment of gastroesophageal reflux disease: case report

A doença do refluxo gastroesofágico é causada pela redução da pressão do esfíncter esofágico inferior e pode ser agravado por fracionamento inadequado da dieta e pela produção de espécies reativas ao oxigênio. Os tratamentos medicamentosos e cirúrgicos se destacam, contudo, existem opções de terapêutica não farmacológica, como as vitaminas e minerais com funções antioxidantes, atuam como adjuvantes neste tipo de tratamento. Portanto, este trabalho teve como objetivo avaliar as funções das vitaminas e minerais suplementados junto à dieta fracionada, prescritas a uma paciente de cirurgia de hérnia de hiato, e a diminuição do quadro de esofagite. A paciente chegou com quadro de esofagite de refluxo, disfagia, dores na região gástrica e distensão abdominal. Como conduta foi adotada a suplementação com piridoxina 30mg, zinco quelato 20 mg e ácido pantotênico 20 mg e vitamina C revestida 200 mg, assim como aumento do fracionamento da dieta, refletindo na redução do volume das refeições para amenizar desconfortos gástricos. O fracionamento adequado da dieta, a redução do volume das refeições e a suplementação atuam de maneira eficaz na melhoria do quadro da DRGE. Cabe destacar que é papel do nutricionista garantir a adesão do paciente ao tratamento para não haver recidivas de sintomas.

The gastroesophageal reflux disease is caused by the reduction of the pressure on the lower esophageal sphincter and could be aggravated by inadequate division of the diet and by the production of species that are reactive to oxygen. Medical and surgical treatments are emphasized, but there are also non-pharmacological therapeutic options, such as vitamins and minerals with antioxidant function, acting as adjuvants in this kind of treatment. Therefore, this paper has the purpose of assessing the functions of supplemented vitamin and minerals with a fractionated diet, prescribed to a surgical patient with hiatal hernia, and the reduction of esophagitis. The patient arrived complaining of esophagitis reflux, dysphagia, pain in the gastric region and abdominal distension. Supplementation with 30mg pyridoxine, 20mg zinc chelate and 20mg pantothenic acid was prescribed as treatment, as well as 200mg coated vitamin C tablet, as well as increasing the diet division to reflect the reduction of meal volumes to sooth gastric discomforts. The appropriate fragmentation of the diet, the reduction of meal volumes and the supplementation were effective to improve the GERD condition. It is important to mention that the role of the nutritionist is to ensure the patient adheres to the treatment in order to prevent symptom relapse.

Avaliação da efetividade de programa governamental de distribuição de leite fortificado no crescimento de crianças de 6 a 24 meses de famílias de baixa renda, residentes no interior do Estado de São Paulo / Evaluation the effectiveness of a state-run food supplementation program for child growth according to childrens nutritional status at enrollment

Introdução: A avaliação dos resultados de políticas públicas de suplementação alimentar em condições reais de sua operacionalização (efetividade) é um instrumento imprescindível para área de saúde pública. Objetivos: Avaliar a efetividade de programa governamental de suplementação alimentar no crescimento de crianças, segundo o estado nutricional ao ingressar. Métodos: Estudo de coorte com dados secundários de 25.433 crianças de baixa renda com idade entre 6 a 24 meses que ingressaram em programa de distribuição de leite fortificado "Projeto Vivaleite" de 2003 a 2008, em 311 municípios do Estado de São Paulo. O crescimento foi medido por meio dos valores de escore z de peso para idade (PI), calculados pelo padrão OMS/2006, obtidos, na rotina do programa, ao ingressar e a cada 4 meses durante a permanência. Os critérios de inclusão foram ter idade ao ingressar entre 6 a 24 meses, ter pelo menos duas pesagens, incluindo a obtida na entrada, e não ter relatos de problemas de saúde. As crianças foram divididas em três grupos de escore z ao entrar: sem comprometimento de peso (z> -1); risco de baixo peso (-2 ≤z< -1) e baixo peso (z<-2). Utilizou-se regressão linear multinível (modelo misto), permitindo a comparação, em cada idade, das médias ajustadas do escore z de ingressantes e participantes há pelo menos quatro meses, ajustadas para correlação entre medidas repetidas. Resultados: Verificou-se efeito positivo do Programa no ganho de peso das crianças, variando em função do estado nutricional ao ingressar; para as que entraram sem comprometimento de peso o ganho médio ajustado foi 0,1827 escore z, entre as que entraram com risco de baixo peso foi 0,5659 e entre as ingressantes com baixo peso foi 1,0049 escore z. Conclusões: O programa é efetivo para o crescimento infantil, medido pelo escore z PI, com efeito mais pronunciado entre as crianças que entram no programa em condições menos favoráveis de peso.

OBJECTIVE: To assess the effectiveness of a state-run food supplementation program for child growth according to childrens nutritional status at enrollment. METHODS: Cohort study including secondary data of 25,433 low-income children aged between 6 and 24 months enrolled in a fortified milk program "Projeto Vivaleite" in 311 cities in the State of São Paulo, Brazil, between 2003 and 2008. Children's growth was assessed based on weight-for-age (WA) z-scores, estimated following WHO criteria (2006). Data was routinely collected at the program enrollment and every 4 months. Inclusion criteria were: being 6 to 24 months of age at enrollment; having at least two weight measures including the first measure at enrollment; and not having any ill health conditions. At enrollment, children were categorized into three groups based on their z-scores: no compromised weight gain (z> 1); at risk of low weight (-2 ≤z< -1), and low weight (z< -2). Multilevel linear regression analysis (mixed model) was performed for comparison, considering age, of adjusted average z-scores between new children enrolled and those in the program for at least four months, adjusted for correlation between repeat measures. RESULTS: The program had a positive effect on children's weight gain. Based on their nutritional status at enrollment, adjusted average weight gain z-score was 0,1827 in children with compromised weight gain, 0,5659 in those at risk of low weight, and 1,0049 in those with low weight. CONCLUSIONS: The milk program is effective for child growth, as measured by WA z-scores. The most pronounced effect was seen among children who showed less favorable levels of weight at enrollment.

Efeito da suplementação de ß-caroteno sintético no DNA e no metabolismo de células hepáticas de ratos recebendo etanol / Effect of synthetic ß-carotene supplementattion in the DNA and metabolism of hepatic cells of rats receiving ethanol

A suplementação de ß-caroteno em fumantes e alcoólatras pode promover efeitos indesejáveis, manifestando a característica pró-oxidante deste carotenóide. Sabendo que o fígado é principal órgão de armazenamento de vitamina A e ß-caroteno, e local de oxidação do etanol, o presente estudo buscou investigar no fígado de ratos, a influência da suplementação de ß-caroteno isolado ou associado ao etanol, sobre o metabolismo celular, danos no DNA, proliferação celular e função da proteína p53. Os ratos receberam dietas líquidas contendo ß-caroteno (24mg/L dieta) com (GAB) ou sem (GBC) a adição de etanol (36 porcento da calorias totais da dieta) e dieta líquida normal (isenta de ß-caroteno e etanol) (GDN), durante seis semanas de período experimental...

ß-carotene, when supplemented in smokers and alcohol drinkers may act as prooxidant, resulting in undesirable effects. The liver is the ß-carotene and vitamin A main storage organ and where ethanol oxidation takes place. This study investigated in rats' liver, the influence of ß-carotene supplementation either alone or associated with ethanol in cellular metabolism, DNA damage, cellular proliferation and p53 protein function. Three groups of 12 rats received liquid diets containing ß-carotene (24mg/L diet) with (BAG) or without (CBG) ethanol (36% of total energy intake). Control animals received liquid diet free of ethanol and ß-carotene (NDG). After 6 weeks the animals were sacrificed for hepatic and plasma concentrations of ß-carotene, retinol, palmitate retinyl, steatosis, GSH and TBARS, DNA damage, PCNA and p53 expression were evaluated in the liver. Differences were significant for hepatic (BAG: 2.49 ± 0.25; CBG: 4.22 ± 0.24; NDG: 2.83 ± 0.21 mg/g) and plasmatic (BAG: 1.42 ± 0.12; CBG: 0.69 ± 0.06; NDG: 2,37 ± 0,28mmol/L) retinol and hepatic palmitate retinyl (BAG: 40.87 ± 3.98; CBG: 83.72 ± 6.00; NDG: 46.33 ± 3.60), steatosis (BAG: 2.30 ± 0.21; CBG: 1.00 ± 0.00; NDG: 1.00 ± 0.00), DNA damage (BAG: 285.90 ± 15.20; CBG: 273.83 ± 13.39; NDG: 138.00 ±4.04 DNA damages/100 hepatocytes) and PCNA expression (BAG: 7.12 ± 1.46; CBG: 1.47 ± 0.27; NDG: 2.04 ± 0.31) among the groups (p<0.05). Hepatic and plasmatic concentrations of ßcarotene, TBARS and GSH were not statistically different. p53 staining was not detected in any group. This suggests that ß-carotene alone or with ethanol association does not influence lipid peroxidation and p53 expression. ß-carotene+ethanol caused metabolic alteration, steatosis, DNA damage and cellular proliferation in hepatocytes. Furthermore, supplementation with ß-carotene alone had genotoxic effects in the liver.

Influence of prenatal iron and zinc supplements on supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant Peruvian women.

BACKGROUND: It is estimated that 60% of pregnant women worldwide are anemic. OBJECTIVE: We aimed to examine the influence of iron status on iron absorption during pregnancy by measuring supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant women. DESIGN: Subjects were 45 pregnant Peruvian women (33+/-1 wk gestation), of whom 28 received daily prenatal supplements containing 60 mg Fe and 250 microg folate without (Fe group, n = 14) or with (Fe+Zn group, n = 14) 15 mg Zn, which were were consumed from week 10 to 24 of gestation until delivery. The remaining 17 women (control) received no prenatal supplementation. Iron status indicators and isotopes were measured in maternal blood collected 2 wk postdosing with oral (57Fe) and intravenous (58Fe) stable iron isotopes. RESULTS: Maternal serum ferritin and folate concentrations were significantly influenced by supplementation (P < 0.05). Serum iron was also significantly higher in the Fe than in the Fe+Zn (P < 0.03) or control (P < 0.001) groups. However, the supplemented groups had significantly lower serum zinc concentrations than the control group (8.4+/-2.3 and 10.9+/-1.8 micromol/L, respectively, P < 0.01). Although percentage iron absorption was inversely related to maternal serum ferritin concentrations (P = 0.036), this effect was limited and percentage iron absorption did not differ significantly between groups. CONCLUSIONS: Because absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, prenatal iron supplementation is important for meeting iron requirements during pregnancy.

PIP: The influence of iron status on iron absorption during pregnancy was examined among pregnant Peruvian women. This was done by measuring supplemental iron absorption, red blood cell iron incorporation and iron status. The subjects were 45 pregnant Peruvian women (33 +or- 1 week gestation) who were divided into 2 groups. The first group of 28 pregnant women received daily prenatal supplements containing 60 mg of iron and 250 mcg of folate with or without 15 mg of zinc, from week 10 to 24 of gestation until delivery. The second group of 17 women served as the control group. The control group was not given prenatal supplementation. The iron status indicators and isotopes were measured in maternal blood collected 2 weeks postdosing with oral iron-57 and intravenous iron-58 stable isotopes. The results showed that supplementation significantly influenced the maternal serum ferritin and folate concentrations (P 0.05). The serum iron of the iron group was significantly higher than that of the iron + zinc group (P 0.03) or control group (P 0.001). However, the serum zinc concentrations were lower in the supplemented group than in the control group. Even though the percentage of iron absorption was inversely related to maternal serum ferritin concentration, the effect was limited and the percentage of iron absorption did not differ significantly between the two groups. Considering that the absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, it was concluded that prenatal iron supplementation is essential for meeting iron requirements, especially during pregnancy.

Ecuador holds National Immunization Day.

PIP: Ecuador conducted its National Immunization Day on August 2-13, 1999, against 10 vaccine-preventable diseases, and distributed vitamin A supplementation to children between the ages of 6 to 36 months. The goals of the campaign were: 1) indiscriminate vaccination with oral polio vaccine of all children under 5 years old; 2) nationwide introduction of measles, mumps, and rubella vaccines to all children aged 12-23 months; 3) hepatitis B vaccine introduction to all children below 1 year in the eastern part of the country, vaccination with dT of 60% of all women of childbearing age in 71 areas identified at risk for neonatal tetanus, and nationwide vaccination with dT of all pregnant women; and 4) yellow fever immunization of all children aged 1-14 years in the eastern provinces located in the Amazon Basin and of all adults aged 15-49 years in the provinces of Sucumbios, Napo, Orellana, and the area of Mumullacta in Pastanza.^ieng

Infant feeding practices and child health in Bolivia.

The effects of breast-feeding and supplementation practices on recent diarrhoea occurrence and stunted growth are modelled using logistic regression techniques. Data from the Demographic and Health Survey of Bolivia, 1989, show that, among children aged 3-36 months at the date of interview, the benefits of breast-feeding to child health were most pronounced among children living in rural poverty. Reduced breast-feeding among these children increased the likelihood of diarrhoea and stunted growth. In addition, the introduction of solid foods to currently lactating infants negatively influenced child health.

PIP: This study assesses, in two models, the effects of infant feeding practices on stunted growth and diarrhea incidence among breast fed children aged 3-36 months in Bolivia. Data were obtained from the 1989 Demographic and Health Survey, which included 1143 breast-fed children. About 38% of the children were stunted. Stunting increased with age and parity. In the bivariate analysis, breast feeding increased stunting, and maternal characteristics were related. Stunting increased with maternal age and indigenous ethnicity. Stunting was associated with blue collar and agricultural households and households in the rural Altiplano and Valles regions. About 33% of the children had experienced an episode of diarrhea. Bivariate analysis revealed that only maternal education and having waste removal were related to the occurrence of diarrhea. Logistic models show that the positive effects of breast feeding were more prominent in impoverished environments. Cessation of breast feeding among infants 6 months or less and living in households with extreme rural poverty increased the risk of stunting fourfold. Children with birth intervals of 2-3 years were at 1.5 times lower risk. Children in rural areas were less likely to be stunted than children in urban areas, when socioeconomic status was controlled. Children who had diarrhea were 40% more likely to be stunted. Diarrhea decreased with maternal education. Diarrhea increased with the number of household members. Food supplementation introduced at about 6-9 months, when most infants are fed solids, increased the risk of stunting by about 75%. Introduction earlier or later had no significant impact on child growth. Only 30% of infants received solids before the age of 4 months. Personal living conditions or socioeconomic status were key explanatory factors in stunting and diarrhea.

Fortified foods contribute one half of recommended vitamin A intake in poor urban Guatemalan toddlers.

Vitamin A intake from food sources, not including breast milk, was determined from seven consecutive 24-h recalls for 55 children (mean age 20.8 mo, SD 8.9) from two poor communities of Guatemala City. Not including vitamin A derived from fortified sugar or breast milk, the median daily vitamin A intake was 194 retinol equivalents (RE). Including vitamin A derived from fortified sugar but not including that derived from breast milk, the median total vitamin A intake (25th and 75th percentiles) was 338 RE (146 and 617 RE) of which 78% was preformed retinol and 22% provitamin A. More than 90% of total vitamin A intake from non-breast milk food sources was derived from only 10 items; over half came from three fortified foods: fortified sugar, Incaparina and margarine. Sugar samples from 91 households in 1991 had a median of 3.3 RE/g (range, 0.0-29.9 RE/g), <25% of the target level (13-17 RE/g); nevertheless, fortified sugar provided 25% of these children's total vitamin A intake (81 RE/d) from non-breast milk food sources and their intake approached the level recommended by the FAO/WHO (400 RE/d). These results show that fortified foods make an important contribution towards vitamin A intake in this sample of poor urban Guatemalan toddlers.

PIP: Vitamin A intake from food sources was measured in 55 randomly selected toddlers 6-36 months of age (mean age, 20.8 months) from two poor communities in Guatemala City, Guatemala, in 1990. Seven consecutive 24-hour dietary recalls were obtained from mothers. Sugar, coffee, and tortilla accounted for one-third of the 7114 food items reported. Excluding vitamin A derived from breast milk or fortified sugar, the median daily vitamin A intake was 194 retinol equivalents (RE). Including vitamin A derived from fortified sugar but not from breast milk, median total vitamin A intake was 338 RE, of which 78% was preformed retinol and 22% was provitamin A. This figure was 162 RE in breast-fed children and 597 RE in weaned children. Only 10 food items contributed 91% of total vitamin A intake and 55% came from three fortified foods: fortified sugar, Incaparina, and margarine, contributing medians of 81, 94, and 61 RE/g, respectively). The mean retinyl palmitate concentration in sugar samples collected from 91 households in the study communities in 1991 was 3.3 RE/g (less than 25% the stipulated amount) and 24 of these samples did not have detectable vitamin A. Since collection of these sugar samples, the association of sugar manufacturers in Guatemala has strengthened quality control measures. Political will is required, however, to enhance and enforce sugar fortification efforts and protect this vital source of vitamin A.

Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil.

OBJECTIVE: To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population. DESIGN: A prospective double-blind, part-randomised efficacy trial. SETTING: A low-income population in Pernambuco, northeast Brazil, where the economy is largely dependent on sugar-cane production, and where over 90% of deliveries occur in health facilities. SUBJECTS: During a 20-month period, all singleton, term infants weighing 1500-2499 g born to families of low income ( < US $280/month) were enrolled at birth (n = 205). At 6 and 12-months, the numbers tested were 163 and 138 respectively. INTERVENTION: Infants born from January 1993-January 1994 were randomly assigned to receive daily, except Sundays, a placebo (n = 66) or 1 mg zinc (n = 68). Those born February-August 1994 were given 5 mg zinc (n = 71). Supplementation was for eight weeks, starting at birth. Field workers visited each infant at home to administer the supplement. RESULTS: At 6 and 12-months, mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found. At 12-months, behaviour was also assessed on 5 ratings. Ratings were highest in infants given 5 mg zinc (P = 0.042). CONCLUSIONS: Zinc supplementation (5 mg/d) for eight weeks may reverse some of the poor behaviours, particularly responsiveness, exhibited by low birth weight infants. No amelioration of their mental and psychomotor deficits was found.

PIP: Severe zinc deficiency, widespread in developing countries, has been associated with cognitive and psychomotor impairment in animal studies. The capability of zinc supplementation, to reduce the deficits in mental development and behavior found in low-birth-weight term infants, was assessed in a prospective study conducted in a low-income community in Pernambuco, Brazil. All 205 singleton, term infants, delivered at the local hospital in a 20-month period and weighing 1500-2499 g at birth, were enrolled. Infants born from January 1993 to January 1994, were randomly assigned to receive either a placebo (n = 66) or 1 mg of zinc (n = 68) 6 days a week. The 71 low-birth-weight infants delivered from February to August 1994, were given 5 mg of zinc 6 days a week. Supplementation administered by local health workers was initiated at birth and lasted for 8 weeks. Mental and psychomotor development was measured at 6 and 12 months of age by the Bayley Scales of Infant Development. There were no significant differences between infants in the 3 study groups on this test. Also at 12 months, infant behavior was assessed on 5 scales. Ratings for one of these scales (responsiveness to tester) were significantly higher in infants who received 5 mg of zinc than in the 2 other groups, and the 5 mg zinc group also had the highest scores on the 4 other scales. Further studies are urged to investigate the effect of zinc provided later in life, and for longer periods of time, on the development of low-birth-weight infants.

A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children.

Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

[Ocular manifestations of vitamin A deficiency and their prevention]. / Les manifestations oculaires de la carence en Vitamine A et leur prévention.

PIP: Vitamin A deficiency and xerophthalmia are among the most widespread human nutritional problems worldwide. High levels of vitamin A deficiency are seen especially among disenfranchised populations where young children are the most severely affected, leading to blindness and early mortality. Not seen in the industrialized countries since the 1950s, vitamin A deficiency still exists in Africa, Asia, and South America. There are approximately 10 million new cases of xerophthalmia per year, of which 280,000-500,000 are blinded. For 20 years, international organizations, governments, and private concerns have found such deficiency with some, but not complete, success. The authors describe the metabolism of vitamin A, analyze its ocular manifestations, and consider the epidemiology of vitamin A deficiency, its association with excess infant mortality, and the course of disease leading to blindness. The global distribution of vitamin A deficiency and xerophthalmia are described. All factors related to vitamin A level in the human body can be changed for the better. Food supplementation with vitamin A and the occasional administration of vitamin A are discussed as possible options to pursue.^ieng

Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial.

The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.

PIP: Findings from this study of the link between nutritional supplementation during breast feeding and infant growth disagree with earlier studies. The effect of nutritional supplementation on growth in length was only modest, but significant only in Senegal and not significant in the Congo, Bolivia, and New Caledonia. It is hypothesized that food supplementation during the 4-7 month period would have a positive effect on linear growth. This study included four controlled randomized trials among 120 infants in the Congo, 110 infants in Senegal, 127 infants in Bolivia, and 90 infants in New Caledonia. The infants were 4 months old when placed in the supplement or control groups. Supplementation included the addition of a cereal-based precooked porridge twice daily for 3 months. Both groups continued to eat local foods. Breast feeding patterns were different in New Caledonia, where only 47% of infants were still breast fed at 7 months of age. Mean daily supplementation varied among countries, from 558 to 790 kJ/day. Mean length was lowest in Bolivia, higher in Senegal and the Congo, and close to the US National Center for Health Statistics reference measures in New Caledonia. The study was conducted in rural parts of Senegal and New Caledonia and periurban parts of Bolivia and the Congo. Supplementation was supervised by field workers. The samples included infants with a length-for-age score of -2.5 or higher and a weight-for-length Z score of -2 or higher at 4 months. Anthropometric measurements were taken at 4 months and 4, 8, and 13 weeks later (at 4.9, 5.8, and 7.0 months of age). 24-hour food recalls were collected monthly for consumption of breast milk, special local infant food, commercial "western" baby food, milk substitutes, family food, water, and other than milk liquids.

School breakfast and cognition among nutritionally at-risk children in the Peruvian Andes.

PIP: In 1993, in Peru, the Institute of Nutritional Research conducted two studies in Huaraz in the Andean region to evaluate the educational and nutritional impact of the government's School Breakfast Program. The school breakfast included a small cake and a glass of Amilac (similar in taste and color to milk), which provided 30% of each child's energy requirements, 60% of recommended dietary allowances for minerals and vitamins, and 100% of dietary iron needs. A case control study examined the effects of breakfast on cognition among 54 elementary schoolchildren 9-11 years old. It found that the school breakfast did not have a significant effect on the children's performance in the Number Discrimination, Peabody Picture Vocabulary Test, Raven Progressive Matrices, or Reaction Time tests. Children nutritionally at risk who received the placebo had significantly slower short-term memory scanning than their counterparts who received the breakfast. The no-risk placebo group exhibited more rapid discrimination between visual stimuli than the no-risk breakfast group. A field evaluation of the program in 10 rural schools, which were randomly assigned to a treatment or control condition, was conducted. In terms of energy, protein, and iron intake, the children in the case and control conditions were not significantly different. The children tended to be either very stunted or overweight. School attendance increased 0.58 points in the experimental group, while it decreased by 2.92 points in the control group (p 0.05). When both groups received the breakfast, attendance rates increased significantly in both groups (p 0.05). Vocabulary was sensitive to the effects of the breakfast. Specifically, the greater the child's weight, the higher his/her vocabulary test scores (p 0.05). These findings suggest that the brain is sensitive to decreases in the short-term availability of nutrients, and that an overnight and morning fast produces a physiological state accompanied by changes in brain function, especially working memory, particularly among nutritionally at-risk children.^ieng

Differential response to early nutrition supplementation: long-term effects on height at adolescence.

BACKGROUND: The classical risk approach to predicting who benefits from an intervention is unsound because it relies on the theoretical assumption that those at risk will necessarily benefit. A better approach to systematically test who benefits from nutrition supplementation is proposed using interactive models. METHODS: Differential effects of nutrition supplementation during early childhood on stature at adolescence were studied in 245 males and 215 females to identify determinants of long-term benefit from food supplementation. Factors studied included family socioeconomic status (SES) and children's home diet and diarrhoea during the first 3 years of life. To determine whether a factor conferred benefit, the statistical significance of the interaction between this factor and the intervention was tested. Data from the INCAP supplementation trial in Guatemala and from the follow-up of the same subjects at adolescence were used. RESULTS: Ordinary least squares (OLS) showed that high rates of diarrhoea in males and poor SES in females were significant determinants of benefit from supplementation at adolescence, and that the effects were mediated by length at 3 years old. Results of two-stage least squares (2SLS) analysis showed that length at 36 months, maturation and maternal height were significant determinants of height at adolescence but SES was not. CONCLUSIONS: Nutrition supplementation in early childhood has long-lasting effects on body size and the larger benefits acquired by some groups of children remain throughout early adulthood. The relevance of these findings for screening and targeting of nutritional interventions is discussed.

PIP: Differential effects of nutrition supplementation during early childhood on stature at adolescence were studied in 245 males and 215 females, 14-20 years old, who had been exposed to either a high-calorie, high-protein drink (Atole) in 2 villages or a low-calorie, non-protein drink (Fresco) in 2 other villages from birth to 3 years of age in order to identify determinants of long-term benefit from food supplementation. Factors studied included family socioeconomic status (SES), children's home diet, and diarrhea during the first 3 years of life. To determine whether a factor conferred benefit, the statistical significance of the interaction between this factor and the intervention was tested. Data from the Institute of Nutrition of Central America and Panama (INCAP) supplementation trial in Guatemala and from the follow-up of the same subjects at adolescence were used. In women differences between the groups were significant only for length at 36 months and height at adolescence. In males length at 36 months was statistically greater among the Atole group, but height in adolescence was not. Ordinary least squares (OLS) showed that high rates of diarrhea in males and poor SES in females were significant determinants of benefit from supplementation at adolescence, and that the effects were mediated by length at 3 years old. Male children who benefited from the supplementation were those with more diarrhea in early infancy. The difference in length at 36 months was 3.03 cm in favor of the Atole group compared to 0.98 cm for the groups with less diarrhea. 2-stage least squares analysis showed that length at 36 months, maturation, and maternal height were significant determinants of height at adolescence but SES was not. Nutrition supplementation in early childhood has long-lasting effects on body size, and the larger benefits acquired by some groups of children remain throughout early adulthood.