Iron fortification of domestic drinking water to prevent anemia among low socioeconomic families in Brazil.

Iron deficiency anaemia is a most common micronutrient deficiency affecting mostly the low socioeconomic populations of the developing world. The objective of this study was to evaluate the feasibility of iron fortification of household drinking water to prevent iron deficiency anaemia among members of the low socioeconomic families of Southern Brazil. A total of 21 low socioeconomic families representing 88 subjects including 1-6 years old children whose haemoglobin level was between 10 and 12 g/dl were selected to participate in this study. Nine families in the control group were supplied with placebo solution and 12 families in the experimental group were supplied iron solution with ascorbic acid to be added to their domestic drinking water over a period of 4 months. The feasibility and acceptability of iron fortified drinking water was assessed through home visits and questionnaires. Blood samples were collected at the beginning and after 4 months of the study for the determination of haemoglobin and serum ferritin levels. The results of this study indicated that iron fortified drinking water was well received by the low socioeconomic families and that it was effective in improving the haemoglobin and serum ferritin levels. It can be concluded from this study that iron fortification of household drinking water is a simple and effective alternative for developing countries along with other technological approaches to iron fortification of foods.

Feeding premature infants banked human milk homogenized by ultrasonic treatment.

Premature neonates fed ultrasonically homogenized human milk had better weight gain and triceps skin-fold thickness than did a control group given untreated human milk (p < 0.01) and also had lower fat loss during tube feeding (p < 0.01). Ultrasonic homogenization of human milk appears to minimize loss of fat and thus allows better growth of premature infants.

[The use of drinking water as a vehicle of nutrients: experimental studies with iron]. / Utilização da água potável como veiculo de nutrientes: estudos experimentais com ferro.

This investigation is part of a large project, the objective of which is to study the possibility of utilizing drinking water as a carrier of nutrients, such as iron. Various iron salts and in different concentrations, were added to water and tested for their effect on color and turbidity. The bioavailability of various forms of iron salts added to drinking water was tested using the rat bioassay technique. The results of this study indicated that ferric ammonium citrate changed very little the color and turbidity of the water solutions. It was considered the best suitable form of iron to be added to drinking chloride water. Ferric ammonium citrate, ferrous sulfate and ferrous gluconate were all found effective in preventing rat anemia when added to their drinking water.

Progress in the diagnosis of hypovitaminosis A: clinical and biochemical correlations.

Hypovitaminosis A is a widespread problem, especially among preschool children in many parts of the world. According to the World Health Organization (WHO) estimates, about 100,000 children become blind every year, and many are dying due to vitamin A deficiency while millions of others are suffering from other consequences of vitamin A deficiency such as growth retardation and increased susceptibility to infection. It is, therefore, very important that not only the severe cases of hypovitaminosis A be diagnosed for immediate treatment, but also the marginal cases of vitamin A deficiency in vulnerable populations be diagnosed as early as possible so that appropriate preventive measures be implemented. Available methods for the diagnosis of vitamin A deficiency can be classified into four categories: clinical, biochemical, functional, and dietary. Clinical diagnosis is based on examining ocular and extraocular signs of hypovitaminosis A, and is only useful for the detection of severe cases. Biochemical methods are based on the plasma concentrations of retinol and retinol-binding protein (RBP), and liver reserve of vitamin A whenever possible. Two other commonly used diagnostic tests are: functional testing for nightblindness using dark adaptation time, and pathological testing for ocular signs of conjunctival xerosis, with or without the use of Rose Bengal or lissamine green dye. Dietary method for the diagnosis of vitamin A deficiency is based on the estimation of dietary intake of vitamin A and carotenoids. In addition, there are newer methods such as isotope dilution and relative dose response (RDR) techniques which have been recently proposed for the diagnosis of vitamin A deficiency. RDR appears to be a reliable and sensitive indicator of marginal vitamin A. However, the most desirable approach to diagnosis may be one based on multiple indicators for the accurate assessment of vitamin A status in the community. The purpose of this paper is to draw attention to the problems of diagnosis, to recent advances and to our Brazilian experience in this important area of vitamin A research with significant global implications.

Progress in the diagnosis of hypovitaminosis A: clinical and biochemical correlations

La hipovitaminosis A es un problema que se presenta en gran escala en el mundo entero, especialmente entre los niños de edad preescolar. De acuerdo a predicciones de la Organización Mundial de la Salud (OMS), alrededor de 100,000 niños pierden la vista anualmente mientras que un número considerable muere debido a deficiencia de vitamina A, y millones sufren serias consecuencias relacionadas con la deficiencia de vitamina A, tales como retardo en crecimiento y cresciente susceptibilidad a las infecciones. Consecuentemente, no sólo es importante que los casos de deficiencia severa de vitamina A sean diagnosticados, sino también los casos marginales. Sobre todo, es crítico que la población susceptible sea diagnosticada lo antes posible, a fin de aplicar las medidas de prevención del caso. Los métodos dispnibles para diagnosticar la deficiencia de vitamina A pueden ser clasificados en cuatro categorias: clínico, bioquímico, funcional y dietético. El diagnóstico clínico se basa en el examen ocular y extraocular para determinar los síntomas de hipovitaminosis A, pero sólo se utiliza para detectar los casos severos. Otras dos pruebas de diagnóstico usadas comúmente son: el test funcional de ceguera nocturna, y las pruebas patológicas, utilizando no "Rosa de Bengala" o "dissaminegreen dye". Los métodos dietéticos para diagnosticar la deficiencia de vitamina A están fundados en la estimación de absorbancia de vitamina A y carotenoides. Además, existen otros métodos tales como dilución isotópica y reacción a dosis relativa (RDR), técnicas éstas que han sido recientemente propuestas para diagnosticar la deficiencia de dicha vitamina. La RDR parece ser de un indicador sensitivo de vitamina A entre grupos sin signos clínicos de hipovitaminosis A. No obstante, el mejor enfoque puede ser el basado en indicadores múltiples para el asesoramiento acertado de la función de vitamina A en la comunidad. El objetivo del trabajo que nos ocupa es llamar la atención a los problemas de diagnóstico, a los recientes adelantos, y a nuestra experiencia en Brasil en este importante campo de investigación de la vitamina A, investigación de implicaciones globales significativas

Nutritional needs assessment of rural agricultural migrants of southern Brazil: designing, implementing and evaluating a nutrition education program.

A nutritional needs assessment was conducted among rural agricultural migrant women (target group) and children (less than 5 years). The study was conducted in Vila Diogo, a slum located on the periphery of Nuporanga, a village in Sao Paulo state, Brazil. A nutrition education program was designed on the basis of evidence obtained from demographic/socioeconomic information of the study population and a nutritional needs assessment of women (target group) and children less than 5 years of age. The nutritional needs assessment consisted of anthropometry, dietary assessment, and nutrition knowledge, attitudes, and beliefs questionnaires. Formative and summative evaluation of the nutrition education program, using appropriately selected criteria and comparisons of nutrition knowledge scores before and after the program, were used to determine program effectiveness. Major findings of the study were: Diets of Vila Diogo residents were generally simplistic, consisting primarily of rice, beans, and coffee with sugar. Vila Diogo women appeared to be at a relatively high risk for vitamin A, iron, calcium, ascorbic, and riboflavin deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. Children (2-5 years) appeared at high risk for vitamin A, iron, and ascorbic acid deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. All children less than 5 years of age had been breast-fed at birth, but more than one half of children had been weaned by the third month. Infant feeding practices during fever and diarrhea were nutritionally detrimental. Women generally recognized a relationship between dietary intake during pregnancy and fetal nourishment. Using weight-for-height index, a significant number of women were probably undernourished; a small percentage of women, however, were overweight or obese. Although children less than 5 years of age did not generally appear malnourished, a relatively large number were stunted in growth. Although Vila Diogo women reported many food taboos during various physiological states (menstruation, pregnancy, immediately post partum, lactation), relatively few food taboos had potentially negative nutritional consequences. For women who participated in the nutrition education program, nutrition knowledge scores after the program showed improvement which was statistically significant at alpha = 0.05, using Wilcoxon signed rank test.

Ultrasonic homogenization of expressed human milk to prevent fat loss during tube feeding.

Effective use of expressed human milk in infant feeding requires proper handling, processing, storage, and administration in order to maintain its unique nutritional properties. One of the problems with expressed human milk is the separation of fat during processing, storage, and administration to the infant. Administration by continuous nasogastric infusion, either by intermittent gravity flow or by continuous mechanical pump, resulted in significant loss of fat and variation in the constitution of the milk delivered. Homogenization by ultrasonic treatment prevented changes in fat concentration during infusion and essentially eliminated loss of this nutrient during administration. The conditions necessary to achieve fat dispersion and stabilization of fat particles in human milk by ultrasonic treatment are described.

Evaluation of rose bengal staining test and rapid dark-adaptation test for the field assessment of vitamin A status of preschool children in Southern Brazil.

The objective of this study was to evaluate two of several methods presently available for assessing vitamin A status of marginally malnourished preschool children of socioeconomically deprived families in Southern Brazil. The rose bengal staining test and rapid dark-adaptation test were evaluated by comparing their results with conventional methods that require estimation of dietary intake of vitamin A equivalents and determination of plasma levels of retinol before and after an oral supplementation of 200 000 IU vitamin A. Results indicate that neither test evaluated is useful by itself. There was no significant correlation between the results of the rose bengal staining test and the plasma levels of retinol. Also, no significant correlation was observed between the rapid dark-adaptation time and the vitamin A status of the preschool children as determined by plasma-retinol levels before and after vitamin A supplementation.

Vitamin A status of young children in Southern Brazil.

A comprehensive survey was carried out to assess the vitamin A status of preschool children of poor migrant families in the periurban population of Ribeirao Preto, a typical agricultural town in the sugarcane and coffee region of the State of Sao Paulo in Southern Brazil. The intake of vitamin A and carotenoids from the rice and bean based diet of these children is considered low and appears to influence blood concentrations and liver reserves of this vitamin. With respect to plasma vitamin A, 1.8% of the children had a deficient level (less than 10 micrograms%), whereas 48.8% of the children had a low level (less than 20 micrograms%). Most children with inadequate plasma vitamin A (less than 20 micrograms%) responded positively to a massive dose of 200,000 IU vitamin A, suggesting that these children may be at risk of having low liver stores of vitamin A. Rose Bengal staining test and rapid dark adaptation time did not indicate definite signs of conjunctival xerosis and night blindness among these children. No ocular evidence of hypovitaminosis A was found in the children studied, but marginal or inadequate vitamin A status appears to be a common public health problem among young children in this region of Brazil.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil.

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.

Evaluation of plasma tocopherols in relation to hematological indices of Brazilian infants on human milk and cows' milk regime from birth to 1 year of age.

A study was carried out to evaluate the effects of a human milk and cows' milk regime on plasma tocopherols and hematological status of 176 Brazilian infants from birth to 12 months of age. Plasma total tocopherols and the ratio of tocopherols/total lipids were significantly higher (p less than 0.01) for breast-fed infants than for cows' milk-fed infants at all ages. Hydrogen peroxide-stimulated erythrocyte hemolysis was greater for cows' milk-fed infants than breast-fed infants; the difference was statistically significant (p less than 0.01) at 3, 6, and 9 months of age. Among the hematological indices examined, Hb levels were significantly higher (p less than 0.01) for the breast-fed infants at 3 and 12 months, while the reticulocyte counts were significantly higher for the cows' milk-fed infants at all ages; hematocrit values more or less remained similar for both groups. It is concluded from these results that although a human milk regime is ideal as compared to a cow's milk regime for maintaining adequate vitamin E status during the 1st year of early life, there may be other influencing factors besides vitamin E to explain such differences in the hematological indices of the breast-fed and cows' milk fed-Brazilian infants.

Transient lipoprotein deficiency at birth: a cause of low levels of vitamin E in the newborn.

In newborns, the level of vitamin E in blood is very low as compared to that of placental intervillous blood and maternal blood. In our attempt to investigate the role of placenta in the transfer of vitamin E from the maternal to the newborn circulation, we have discovered that vitamin E is able to enter placental blood but is not being efficiently transferred from the placental to the newborn circulation. It appears from our preliminary study that the most limiting factor in the transfer of vitamin E from the placental to the newborn circulation is the transient deficiency of prebeta lipoprotein in the newborn blood at birth. A transient lipoprotein deficiency is implicated as a cause of low levels of vitamin E in the newborn.

Dietary supplementation and improvement in physical work performance of agricultural migrant workers of southern Brazil.

A three-month trial was carried out on 14 agricultural migrant workers (Bóias-Frias) residing on the periphery of Ribeirão Preto, an agricultural and industrial town in the interior of the State of São Paulo in southern Brazil. This group can be considered as marginally malnourished. Their nutritional status and physical work performance was measured before and after receiving a supplemented lunch over a three-month period. The main change in their nutritional status during this period was an increase in body weight. Their physical work performance, as measured by a bicycle ergometer test, improved significantly after the supplementation of their traditional diet.

Dietary supplementation and improvement in physical work performance of agricultural migrant workers of Southern Brazil.

Se llevo a cabo un ensayo de tres meses de duracion en l4 peones agricolas migrantes (Boias-Frias) residentes en la periferia de Ribeirao Preto, ciudad agricola e industrial situada en el interior del Estado de Sao Paulo en el sur del Brasil. Este grupo se puede considerar como marginalmente malnutrido. Su estado nutricional y rendimiento en el trabajo fisico se midio antes y despues de recibir un almuerzo suplementado durante el periodo mencionado.En ese lapso, el principal cambio observado en su estado nutricional fue un incremento del peso corporal. Segun mediciones practicadas utilizando la prueba de bicicleta con ergometro, su rendimiento en el trabajo fisico mejoro en forma significativa despues de la suplementacion de su dieta tradicional