Adding alpha-amylase to weaning food to increase dietary intake in children. A randomized controlled trial.

The addition of alpha-amylase to a food supplement for weaning-age children was proposed as an alternative to traditionally prepared Amylase-Rich Foods (ARF) for reducing the dietary bulk of weaning diets. In a self-controlled clinical trial including 30 healthy children, aged 10-24 months, the effect of the addition of alpha-amylase and extra cereal to a diet including three meals, was determined in terms of dietary intake. A mean increased intake of 23.8 per cent in energy and 10.4 per cent in protein was found. The addition of commercial alpha-amylase to maize-based weaning foods is a useful method of increasing the nutritional value of weaning diets.

Changes in the anthropometric status of rural African under-fives during a decade of primary health care.

Protein energy malnutrition (PEM) is a major cause of hospital admissions and death in most impoverished Third World countries. In the Gelukspan Health Ward, in rural Western Transvaal, a primary health care (PHC) programme, based on the GOBI-FFF strategy, commenced in 1980. Community health surveys on African under-five children were regularly undertaken. In 1990, to assess improvements achieved, anthropometric and other data were obtained on a representative series of 926 children. Harvard standards were used prior to 1984, and American NCHS reference standards thereafter. Low weight-for-age fell from 28 to 19%, low height for age from 33 to 17%, and low weight-for-height from 5 to 1%. The percentage with low arm circumference was unaffected, 3 and 4%, respectively. The improvements described are believed to be due in part to the PHC programme. Greater definition of the causes and extent of improvements are needed to optimize the State's present desire to intensify PHC, especially in rural areas.

Is the lesser growth of African schoolchildren essentially prejudicial to their present and future health?

In African and other Third World countries, 20-50% of schoolchildren lie under the 5th centile of US National Center for Health Statistics (NCHS) growth reference standards for weight- and height-for-age. Such lesser growth, orthodoxly, categorizes those affected as malnourished, at greater risk of disease, of lesser intelligence, and in need of nutritional supplementation. Questions arising include: 'Are there limitations to the application of NCHS reference standards?' In African schoolchildren, is lesser growth attributable largely, or marginally, to insufficient food intake? How powerful are the non-dietary influencing factors? What are the associated disadvantages to health? Conversely, could lesser growth around puberty even be beneficial respecting possible lessening of subsequent risk of degenerative diseases? Discussion indicates that there are numerous complexities in the whole subject of anthropometry, malnutrition and its stigmata, and interventions, dietary and non-dietary, in the youth of poor populations. In view of the invariably low health funds available in Third World countries, only intervention measures of proven significance to pupils' health warrant implementation.

Maximal genetic potential for adult stature: is this aim desirable?

Current nutrition theory holds that maximization of human growth and stature is a desired anthropometric outcome. However, some evidence demonstrates that lower energy intakes may actually confer a degree of future protection against degenerative processes, particularly atherosclerosis and cancer.

The cumulative dose response effect of eicosapentaenoic and docosahexaenoic acid on blood pressure, plasma lipid profile and diet pattern in mild to moderate essential hypertensive black patients.

In this study eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were given in a cumulative manner, every 6 weeks, starting with 10 mg, then 100 mg, 1000 mg and 10,000 mg EPA daily to mild to moderate essential hypertensive black patients. The corresponding DHA doses were 3, 33, 333 and 3333 mg. A control group was given olive oil as placebo for the entire 24 weeks. The placebo group had lower diastolic and systolic blood pressures after 24 weeks than the EPA and DHA group. No effect was seen on plasma triglycerides, cholesterol, HDL-cholesterol and gamma-glutamyltranspeptidase at any stage of the trial. In the EPA group plasma free-EPA increased significantly from 1000 mg onwards and plasma free-arachidonic acid (AA) decreased after 1000 mg EPA. No other plasma free essential fatty acid changed during the trial, although the HDL:cholesterol increased slightly but non-significantly with an increase in EPA and DHA. No significant changes in diet pattern or body mass was observed. It is therefore concluded that EPA and DHA supplementation had no beneficial effects in mild to moderate essential hypertensive black patients except for a lowering of plasma AA.

Perplexing features in the occurrence of dental caries and its relationship to sugar intake.

Epidemiologically, there are numerous perplexing features, insufficiently appreciated, in the occurrences of degenerative diseases, and in the roles of their risk factors. This applies particularly to dental caries, the commonest of all diseases, and the risk factor, sugar intake. In some contexts, caries scores are much lower, or are much higher, than expected. Moreover, even in contexts where outwardly the same risk factors are widespread, ranges of scores are much wider than would be expected. In all contexts, among groups and more especially among individuals, the association of caries experience and dietary intakes, particularly that of sugar intake, is limited. Accordingly, caution must be exercised in the over-blaming of sugar and in the overclaiming of benefits to be derived from reducing intake.

Combating protein-energy-malnutrition in a rural/peri-urban southern African black population.

PROTEIN-ENERGY-malnutrition (PEM) is a major cause of morbidity and mortality in young children in Africa. In South Africa, in 1987, to help combating and preventing PEM in the rural black population, the Gold Fields Nutrition Unit was inaugurated at the Medical University of Southern Africa. In 1987-9, 442 patients (rural/peri-urban) plus their mothers or child carers were admitted, and 406 attended as outpatients. Average age was 15.4 +/- 7.6 months, weight 7.0 +/- 1.6kg, stay in hospital, 12 +/- 10.8 days, and daily weight gain during treatment was 31 +/- 48g. Mothers mainly were young and unmarried. Primary causative factors were infections, ignorance, and insufficiency of food. Since results from rehabilitation are usually poor, mothers and carers were taught how best to prepare meals using local foodstuffs. The interventions included teaching and demonstrations of how to grow vegetables, maintain an orchard, a fowl-run, and improve kitchen and laundry facilities. In 1990, in a follow-up of 73 patients, no deaths had occurred within a 12 month period. This far better than usual outcome is being furthered by setting up satellite nutrition clinics.