Alimentación y desarrollo infantil I; El estado nutritivo de los niños en edad escolar de un suburbio madrileño (Rev Clin Esp 1944; XII: 87-94) / Nutrition and child development I; nutritional status of school children in a peripheral district of madrid (Rev Clin Esp 1944; XII: 87-94)

El estudio clínico del estado nutritivo de un grupo de niños en edad escolar, habitantes de un suburbio madrileño revela la existencia, relativamente rara, de signos carenciales específicos, que contrasta vivamente con el considerable retraso que se observa en su desarrollo somático. Los hechos parecen demostrar que el problema nutritivo de estos niños es sobre todo un problema cuantitativo. El retraso de la evolución está en relación con la insuficiencia global de la dieta y con el déficit de calcio que es probablemente el elemento individual con mayor grado de carencia en las dietas. La anemia que presenta el 98% de los niños no parece deberse únicamente a una deficiencia de hierro porque la dieta parece tener una cantidad adecuada; probablemente esté más en relación con el exiguo contenido de proteínas animales de la ración (AU)

A clinical study on the nutritional status of a group of school-aged children from a poor Madrilenian neighbourhood reveals the -relatively infrequent- existence of specific signs of deficiencies. There is a surprising contrast between this status and the considerable delay observed in the somatic development. Evidences seem to show that these children’s nutritional problem is mainly a quantitative one. Their development delay is associated with an overall diet deficiency and more specifically with calcium deficiency, which is probably the most deficient item in these children diets. Anemia, present in 98% of the children, is not probably only due to a deficiency in iron, as the diet seems to bring a sufficient amount. It is more likely to be related to the poor content of animal protein in their daily intake (AU)

Health and disease in a Roman walled city: an example of Colonia Iulia Iader.

The paper presents the results of the bioarchaeological study of a Roman period (3rd-5th century) skeletal sample from Zadar, Croatia with the focus on subadult stress indicators (cribra orbitalia and dental enamel hypoplasia) and indicators of non-specific infectious diseases (periostitis). The total frequency of cribra orbitalia, an indicator of iron deficiency anaemia, in Zadar is 20.1%. Half of the subadult skeletons from Zadar exhibit signs of cribra orbitalia, of which two are in active form. Adults not affected by cribra orbitalia lived on average 4.5 years longer than individuals affected by this pathological change. Total frequency of dental enamel hypoplasia in adults is 61.1% with somewhat higher frequency in females. The frequency of periostitis in subadults (66.7%) is significantly higher than in adults (30.4%). A positive correlation was established between cribra orbitalia and periostitis in males. The presented data suggest relatively low quality of life in Roman Zadar, most probably due to the overcrowding inside the walled city which led to deterioration of sanitary conditions and the occurrence of infectious diseases.

Lasthénie de Ferjol syndrome: a rare disease with fascinating history.

In our paper, we present the fascinating story of Lasthénie de Ferjol syndrome. A rare self-induced iron deficiency anaemia caused by surreptitious blood-letting. The French haematologist Jean Bernard first described the syndrome and named it after the heroine of Barbey d' Aurevilly's novel The Story without a Name. This factitious anaemia presents a great challenge for physicians even today, both in diagnosis and in therapy.

INCAP studies of hematologic and gastrointestinal function in healthy individuals and those with protein-energy malnutrition and infection.

Anemia is highly prevalent, especially in poorly nourished populations living in unsanitary conditions. Studies of the Central American population showed that iron was the predominant deficient hematopoietic micronutrient and that correction of nutrient deficiencies led to hematological normality as defined by WHO. The bioavailability of diverse iron compounds added to the mostly vegetable diets of such populations showed the superior absorption of chelated iron (NaFeEDTA) and its strong effectiveness in correcting iron deficiency when added to sugar. The consequences on development and mental behavioral functions as well as on work capacity of iron deficiency and anemia in infants, children and adults, and the positive effects of their correction was demonstrated. In protein-energy malnourished (PEM) children, the deficit in active tissue mass (basal oxygen consumption) and in total hemoglobin content were closely related. This relationship persisted as the rates of active tissue mass repletion was modified by levels of protein intake. This demonstrated the strong adaptive nature of hemoglobin content in response to oxygen needs in PEM and during recovery. Gastrointestinal functions in PEM and in populations demonstrated the bacterial invasion of the upper GI tract and how this resulted in secondary bile acids that are toxic to the intestinal mucosal cells impairing their absorptive functions. Environmental hygiene in populations reversed gut bacterial migration and improved GI function.

Evolution of iv iron compounds over the last century.

Administration of intravenous (IV) iron has become pivotal in the management of anaemia in patients with chronic kidney disease (CKD). Since parenteral iron was first introduced for human use in the 1930s, things have come a long way. Seventy years ago, iron was toxic, administered as an iron oxyhydroxide complex. This problem was circumvented with the introduction of compounds containing iron in a core surrounded by a carbohydrate shell. The carbohydrate shell consists of molecules such as dextran, sucrose, dextrin or gluconate. The first dextran-containing IV iron preparations carried a small risk of anaphylaxis, but the more recently introduced low molecular weight iron dextran preparation has significantly less risk of this. Iron reactions occur with all IV iron preparations, but are generally not thought to be immune based. Recently, newer IV iron preparations have appeared in the market, including Ferumoxytol (Feraheme) and ferric carboxymaltose (Ferinject). These latest IV iron preparations do not contain a requirement for a test dose, and a much higher dose of iron can be delivered as a single administration. Thus, giving supplemental iron to man has come a long way since 1930s; we are now in an era when we are able to administer higher doses of iron with acceptable safety and without significant adverse effects. However, the long-term safety of the newer IV iron preparations is not yet established.

A brief history in nephrology pharmacotherapy.

Advances in drug therapy for patients with kidney disease have contributed to increased exercise capacity, reduced cardiovascular disease, decreased renal bone disease, improved quality of life, and most importantly, reduced morbidity and mortality. New insights into the pathophysiology of chronic kidney disease (CKD) have helped lead to the development of many novel drugs and treatments. The purpose of this article is to highlight some of the developments in nephrology pharmacotherapy that occurred during the first 40 years of the American Nephrology Nurses' Association.

[A new approach to the identification and the interpretation of the various forms of cribra orbitalia]. / Pour une nouvelle approche de l'identification et de i'interprétation des diverses formes de cribra orbitalia.

The so-called cribra orbitalia lesion was described for the first time in 1885 by H. Welcker. Since then the cribriform tectum of the orbit has provoked the most varied pathogenic interpretations. However for 40 years the whole paleopathologist community agreed to recognize that anaemia and generally deficiency in iron, food or infections were the causes of medullary hyperplasia which would be the alone responsible for the damage. Through new macroscopic explorations and new understanding of the genesis of the lesion, the author does not admit the principle of an universal hyperplasia but he suggests to distinguish three causes ofcribra orbitalia: the anatomic variations, the osteoperiostitis, the cortical erosion.

[Pica, a strange symptom unveiled even in "Don Quixote"]. / Pica en "Don Quijote".

Pica, the compulsive eating of non edible substances, is known by the medical profession for centuries. In the novel by Miguel de Cervantes "Adventures of the famous knight Don Quixote de la Mancha'', there is a history in which "women that by caprice eat soil, plaster coal and other disgusting substances'' are mentioned. This description configures the clinical diagnosis of pica. This fact has not attracted the attention of the critics of Cervantes' novel, up to now. This unequivocal reference of pica suggests that iron deficiency anemia, caused by chronic hemorrhages in adults, was frequent in 1605, when the book was first published.

Prevalence and etiology of acquired anemia in Medieval York, England.

This paper presents three distinct models for the development of acquired anemia: iron-deficiency anemia produced by the inadequate intake and/or absorption of iron, the anemia of chronic disease (ACD) caused by the body's natural iron-withholding defense against microbial invaders, and megaloblastic anemia caused by insufficient intake and/or absorption of vitamin B(12) or folic acid. These etiological models are used to interpret the distribution and etiology of anemia among adult individuals interred at the Medieval Gilbertine Priory of St. Andrew, Fishergate, York (n = 147). This bioarchaeological analysis uncovered not only a strong relationship between decreasing status and increasing prevalence of anemia for both men and women, but also identified clear sex-based differences at this site. Within the high-status group, blood and iron loss as a result of rampant parasitism likely produced an environment ripe for the development of iron-deficiency anemia, while the parasitic consumption of vitamin B(12) may have caused occasional cases of megaloblastic anemia. As status decreases, the interpretation of anemia becomes more complex, with megaloblastic anemia and ACD emerging as viable, potentially heavy contributors to the anemia experiences of low-status people at St. Andrew's. Apart from status effects, women (especially young women) are disproportionately affected by anemia when compared to men within their own status group and, on average, are also more likely to have experienced anemia than their male peers from other status groups. This suggests that high iron-demand reproductive functions helped to make iron-deficiency anemia a chronic condition in many women's lives irrespective of their status affiliation.

[Cribra orbitalia, dentin hypoplasia and life expectancy of 20-year-old persons as social and sex specific stress indicators in correlation with the health status of an early medieval population]. / Cribra orbitalia, Schmelzhypoplasie und Lebenserwartung der 20 jährigen als sozial- und geschlechtsspezifische Stressindikatoren bezüglich der Gesundheitssituation einer frühmittelalterlichen Bevölkerung.

The aim of this study is based on the analysis of diachronically social and sexual specific considerations on the life situation of the early medieval population of Schleitheim, Kanton Schaffhausen, Switzerland. Cribra orbitalia and the linear enamel hypoplasia of the teeth are considered as stressors. This study is based on the life expectancy of the 20 years old, as the life expectancy gives information on the health condition of a social group or an entire population. The considered indicators show the same tendencies in three of the four social groups (women social group A and group B/C, men of the social group A). The female and male population of the social group A show a steady decrease in the indicator from the 5th century to come to its lowest level in the 7th century. The same parameters indicate a continuous increase in stress for the female population of the group B/C. Only one of the three indicators, the Cribra orbitalia, shows a positive tendency in the male population of the social group B/C from the 6th century to the following period, while hypoplasia and the life expectancy on the other hand indicate a negative tendency. The results show equal tendencies in the three independent indicators concerning three of the four social groups. This proves the high reliability of the indicators. These results are astonishing in two ways. First of all, the tendencies show that the originally better life situation of women of the higher ranking social group decreases in the following periods, whereas the women of the lower social group show an inverse development. This female population of low life situation in the 5th century shows an increase in life qualities in the following periods. Remarkable, too, is the fact, that the female population of both social groups shows a lower level of stress than the corresponding male population. This fact is astonishing, as we would expect inverse results in a patriarchal society. This may point to a well known fact: Women show a higher vitality than the male population.

Defining iron-deficiency anemia in public health terms: a time for reflection.

This paper provides a historical context for this meeting, which aimed to examine critically the way we have defined iron-deficiency anemia as a public health problem. The terms and concepts used to define the problem are reviewed first, followed by estimates of the global prevalence of the problem from 1985 to 2000. It is argued that recent estimates are not credible and that we must redefine the problem in terms that are important, measurable and addressable. This meeting was designed to take first steps toward that goal, namely, to identify the causal factors (e.g., iron deficiency vs. iron-deficiency anemia vs. severe anemia from any cause) that link iron-deficiency anemia to important health outcomes and to estimate the magnitude of their effects in public health terms.

Subadult health and disease in prehistoric Tonga, Polynesia.

This article focuses on the differential diagnosis of pathologic lesions recorded on the limbs and crania of 17 subadults from two pre-European burial mounds in Tonga, western Polynesia. All affected subadults were between the ages of 6 months and 3 years at death. The lesions described consist primarily of subperiosteal new bone deposition on the limbs and endocranial surface. However, the presence of cribra orbitalia in a number of individuals indicates concurrent iron-deficiency anaemia. A differential diagnosis of haematogenous osteomyelitis, congenital syphilis, yaws, scurvy, hypervitaminosis A, trauma, Caffey's disease, and iron-deficiency anaemia is discussed. It was concluded that the most likely cause for the lesions observed is a synergistic relation between infection (weanling diarrhoea, yaws) and metabolic disease (scurvy and possibly hypervitaminosis A). Trauma is not ruled out as contributing to the development of some pathologic lesions. It is concluded that, in the Pacific Islands at least, multiple causes for skeletal pathology in subadults should be considered rather than a single aetiology.

Nutritional research in World War 2: the Oxford Nutrition Survey and its research potential 50 years later.

To investigate the nutritional status of the population of the UK during the Second World War, nutritional surveys were commissioned in 1941. These included surveys of two groups of pregnant women: the first comprised 120 working-class women who were studied in the spring of 1942, and a second group of 253 women in 1944. Both groups were followed up until after delivery. Detailed biochemical assessments were performed on each subject. Our statistical analysis of the haematological data showed that nearly 25% of women from the 1942 group were deficient in protein, over 60% were deficient in Fe and vitamin A, and over 70% had severe vitamin C deficiency. The findings were reported to the Ministries of Health and Food who instigated a food supplementation policy at the end of 1942 that entitled pregnant women in the UK to extra rations of fruit, dairy produce and to a supply of cod-liver-oil tablets. A second group of 253 pregnant women were studied 15 months later which enabled the effects of this programme to be investigated. Supplementation reduced the proportion of women with vitamin A concentrations below the normal range from 63% to 38%, and vitamin C from 78% to 20%, but protein and Fe concentrations were not increased but actually declined. These findings continued to exert an influence over government food policy for pregnant women until the abolition of rationing in 1954.

Nutritional anemias.

Folate, vitamin B12, and iron are the subjects of active biochemical and molecular research so that further understanding of their metabolism in health and in a wide variety of Inherited and acquired diseases can be achieved. The roles of folate and vitamin B12 in cardiovascular and neurologic diseases and in neural tube defects (NTDs) will be further explored in the next decade. The effects of prophylactic therapy and of food fortification with the vitamins on these diseases remain to be established. Iron deficiency is a public health problem in all countries and prevention or treatment, particularly in children in developing countries, are major goals. The increased recent understanding of iron metabolism and absorption may clarify the etiology of diseases of iron metabolism and of dietary iron overload. Improved iron chelation therapy for transfusion-dependent patients with refractory anemias will continue to be actively researched over the next decades.

[Iron deficiency towards the year 2000]. / Deficiencia de hierro hacia el año 2000.

This is a non-comprehensive overview of the latest 50 years about the evolution of iron metabolism and the methodology we currently have for the diagnosis of iron deficiency and its effects on human health. In the 40's iron absorption was determined by chemistry. The amount of iron absorbed was calculated as the difference between dietary iron and excreted iron. The other methods used to measure dietary iron was hemoglobin repletion. In the 70's the measurement of plasmatic ferritin was an important contribution to iron metabolism to assess iron deficiency and iron overload. In the same decade the extrinsic and intrinsic labelled methodology was an important advancement. The 70's and 80's were years where scientists aimed at finding iron absorption inhibitors, namely coffee, calcium, tea, zinc and fiber. The 80's and 90's were characterized for the emerging knowledge an iron absorption from a food, a meal and a complete diet and for the favorable effect of food iron fortification in developing countries. Also for the effect of iron excess in overall health and myocardial infarction in developed countries were studied.