Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women.

Iron deficiency anemia affects a large number of women in developing countries, especially during child-bearing years. The hemoglobin concentration is useful for identifying iron deficiency anemia. The main objectives of this study were, first, to extend algorithms for calculating bioavailable iron from mixed diets, taking into account the enhancers and inhibitors of iron absorption under alternative assumptions on body iron stores. Second, a comprehensive longitudinal model was developed for the proximate determinants of hemoglobin concentration that included the subjects' dietary intakes, nutritional status, morbidity and socioeconomic factors and the unobserved between-subject differences. The model for hemoglobin concentration was estimated using three repeated observations on 514 free living women in Bangladesh. Socioeconomic factors affecting the iron intake from meat, fish and poultry and from all animal sources were also modeled. The main results were that bioavailable iron, women's height and mid upper arm circumference and intake of iron tablets were significant predictors of hemoglobin concentration. Increases in household incomes were associated with higher intake of iron from meat, fish and poultry and from all animal sources. The algorithms for estimating bioavailable iron showed the importance of assumptions regarding body iron stores and underscored the need to develop suitable algorithms for subjects in developing countries.

Synergism of nutrition, infection, and immunity: an overview.

Infections, no matter how mild, have adverse effects on nutritional status. The significance of these effects depends on the previous nutritional status of the individual, the nature and duration of the infection, and the diet during the recovery period. Conversely, almost any nutrient deficiency, if sufficiently severe, will impair resistance to infection. Iron deficiency and protein-energy malnutrition, both highly prevalent, have the greatest public health importance in this regard. Remarkable advances in immunology of recent decades have increased insights into the mechanisms responsible for the effects of infection. These include impaired antibody formation; loss of delayed cutaneous hypersensitivity; reduced immunoglobulin concentrations; decreased thymic and splenic lymphocytes; reduced complement formation, secretory immunoglobulin A, and interferon; and lower T cells and T cells subsets (helper, suppressor-cytotoxic, and natural killer cells) and interleukin 2 receptors. The effects observed with single or multiple nutrient deficiencies are due to some combination of these responses. In general, cell-mediated and nonspecific immunity are more sensitive than humoral immunity.

INFOODS: the international network of food data systems.

A 1983 conference organized by United Nations University proposed an international network of food data systems (INFOODS) to address the need for and limitations of food-composition databases. Concerns of INFOODS include the acquisition and interchange of quality data on the nutrient composition of foods; the development of standards and guidelines for the collection, compilation, and reporting of food-component information; and support of a worldwide network of regional data centers for the generation, compilation, and dissemination of information on food composition. One goal of these centers is to assist in the development of appropriate national databases, especially in developing countries. Much has been accomplished by INFOODS, despite limited resources. Several important documents on food composition have been published, an international journal of food composition has been established, a directory of existing food-composition databases has been compiled, specific recommendations for the construction and use of food-composition databases have been developed, and a system of food nomenclature and coding has been created. Regional food-composition databases have been established throughout the world, with the goal of creating computerized systems that permit easy availability and interchange of food-composition data between regions and countries. In 1993 the Food and Agriculture Organization renewed its interest in the food-analysis capability of developing countries by becoming involved in INFOODS efforts.

Adaptation of lactose maldigesters to continued milk intakes.

Twenty-five lactose-maldigesting and lactose-intolerant African Americans, ranging in age from 13 to 39 y, were given gradually increasing amounts of lactose in milk over a period of time until the maximum lactose dose tolerated was determined. Seventeen (77%) of the 22 subjects who completed the study tolerated > or = 12 g lactose and 5 (23%) tolerated < 12 g. Breath-hydrogen tests done on each subject with the maximum dose of lactose tolerated showed that only four (18%) had a breath-hydrogen concentration < 5 ppm above fasting concentration. This study suggests that the majority of African-American young adults who claim intolerance to moderate amounts of milk can ultimately adapt and tolerate > or = 12 g lactose in milk (the equivalent of 8 oz of full-lactose milk) with minimal or no discomfort if milk is ingested in gradually increasing amounts. The mechanism of adaptation is assumed to be an increased tolerance to colonic lactose-fermentation products.

Correlation of lactose maldigestion, lactose intolerance, and milk intolerance.

Lactose digestion and tolerance were evaluated in 164 African Americans ranging in age from 12 to 40 y who claimed intolerance to one cup (240 mL) or less of milk. With use of a breath-hydrogen test with 25 g lactose as test dose and the presence or absence of symptoms, 50% of the subjects were classified as lactose maldigesters and intolerant, 8% were maldigesters but tolerant, 15% were digesters but intolerant, and 27% were digesters and tolerant. Forty-five subjects from the lactose maldigesting and intolerant group were further tested for milk intolerance in a double-blind study. Sixty-seven percent of the subjects reacted appropriately to the presence or absence of lactose in ingested milk whereas 33% reported symptoms to both low-lactose milk and milk containing lactose. The results suggest that the cause of milk intolerance in as many as one-third of African Americans claiming symptoms after ingestion of a moderate amount of milk cannot be its lactose content.

Effect of infection on nutritional status.

All infections no matter how mild decrease nutrient intakes and increase nutrient losses even when subclinical. The losses include decreased intestinal absorption, direct loss of nutrients in the gut, internal diversion for metabolic responses to infection and increased BMR when fever is present. Infection influences in this way not only protein and energy status but also that of most other nutrients. The clinical importance of these consequences of infection depends on the prior state of the individual, the nature and duration of the infection and the diet of the individual during the infection, particularly dietary intake during the convalescent period and whether full recovery takes place before another infection occurs. In industrialized countries particular attention must be paid to the nutrition of hospitalized patients since they are frequently debilitated by their primary disease, morbidity, and their nutritional status. Morbidity and mortality are increased by nosocomial infections to which the poorly nourished individual is more susceptible.

Rhoades Lecture. Effect of infection on nutrient requirements.

All infections, no matter how mild, decrease nutrient intakes and increase nutrient losses even when subclinical. The losses include decreased intestinal absorption, direct loss of nutrients in the gut, internal diversion for metabolic responses to infection and increased basal metabolic rate when fever is present. In this way, infection influences not only protein and energy status but also that of most other nutrients. The clinical importance of these consequences of infection depends on the prior state of the individual, the nature and duration of the infection, and the diet of the individual during the infection, particularly dietary intake during the convalescent period and whether full recovery takes place before another infection occurs. In industrialized countries particular attention must be paid to the nutrition of hospitalized patients inasmuch as they are frequently debilitated by their primary disease, morbidity, and nutritional status. Morbidity and mortality are increased by nosocomial infections to which the poorly nourished individual is more susceptible.

Iron deficiency.

PIP: The world's leading nutritional problem is iron deficiency. 66% of children and women aged 15-44 years in developing countries have it. Further, 10-20% of women of childbearing age in developed countries are anemic. Iron deficiency is identified with often irreversible impairment of a child's learning ability. It is also associated with low capacity for adults to work which reduces productivity. In addition, it impairs the immune system which reduces the body's ability to fight infection. Iron deficiency also lowers the metabolic rate and the body temperature when exposed to cold. Hemoglobin contains nearly 73% of the body's iron. This iron is always being recycled as more red blood cells are made. The rest of the needed iron does important tasks for the body, such as binds to molecules that are reservoirs of oxygen for muscle cells. This iron comes from our diet, especially meat. Even though some plants, such as spinach, are high in iron, the body can only absorb 1.4-7% of the iron in plants whereas it can absorb 20% of the iron in red meat. In many developing countries, the common vegetarian diets contribute to high rates of iron deficiency. Parasitic diseases and abnormal uterine bleeding also promote iron deficiency. Iron therapy in anemic children can often, but not always, improve behavior and cognitive performance. Iron deficiency during pregnancy often contributes to maternal and perinatal mortality. Yet treatment, if given to a child in time, can lead to normal growth and hinder infections. However, excess iron can be damaging. Too much supplemental iron in a malnourished child promotes fatal infections since the excess iron is available for the pathogens use. Many countries do not have an effective system for diagnosing, treating, and preventing iron deficiency. Therefore a concerted international effort is needed to eliminate iron deficiency in the world.^ieng