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A 32-mo-long, double-blind field study involving one highland control community receiving only vitamin A-fortified sugar and three vitamin A- and FeNaEDTA-sugar-fortified communities, two in the lowlands and one in the highlands of Guatemala, was undertaken to test the effectiveness of this approach in controlling iron deficiency. The communities' population ranged between 1200 and 17000. Sugar fortified with 1 g FeNaEDTA and 15 mg retinol as retinyl palmitate/kg was stable, did not segregate, and was well accepted by the communities. The impact of fortification on iron nutrition was estimated at 8, 20, and 32 mo of intervention. All pregnant women and subjects with severe anemia received supplements or treatment and were excluded from the analysis. Iron stores in the fortified communities increased significantly except for women 18-48 y of age in one lowland community and > 49 y in the highland community. Iron stores in the control community remained unchanged except for a rise among adult males.

An energy supplementation program provided free of charge a low energy (15 kcal) and a high energy (350 kcal) soft drink to two group of sugarcane workers in Guatemala. The high energy supplement supplied 550 kcal/day on a weekly basis. The workers tended to be moderately energy deficient before supplementation. Significant increases in total daily energy intake were obtained with the high energy supplement, but by less than the energy content of the supplement. Workers maintained energy balance with supplementation. The degree of substitution with energy supplementation was not related to the energy intake status of the workers' households. These households did generally not improve their energy intake status with worker supplementation.

A long-term energy supplementation program was carried out to determine its effect on the productivity of agricultural workers in Guatemala. The program provided, free of charge, a low-energy (24 Kcal) and a high-energy (350 Kcal) bottled, orange-flavored soft drink to two groups of long-term resident sugar-cane cutters who worked on the same plantation, located in the Pacific Coast. Previous to, and periodically thereafter during implementation of the program, data relative to energy intake and anthropometry were collected. Through data obtained from payroll lists, a longitudinal series of average productivity (tons of sugar cane cut and loaded per day) covering 48 weeks of pre-supplementation, 90 weeks of supplementation and 21 weeks post-supplementation, was constructed. Control of the supplement consumption was daily observed. Random assignment of workers to the high-energy supplement (HES) and the low-energy (LES) groups, was not possible. Prior to supplementation both groups presented the same characteristics in terms of age, energy intake level, weight, height, tricipital adiposity and daily productivity. Little variation was found throughout the time the supplement was consumed by the HES Group. Energy intake of workers increased significantly in absolute terms in relation to the LES Group, except towards the end of the 28 months' supplementation period. Energy balance was maintained by workers throughout the study period. A time series of the difference in mean productivity of the two supplement groups (Yt) was modeled using the ARIMA techniques. No auto-regressive term was present in the Yt series. The ARIMA (0,0,1) model was fitted and expanded with different intervention components. None of the estimated parameters of the intervention components were statistically significant. It was therefore concluded that no abrupt, or gradual and sustained energy supplementation effect on productivity was present.

Body iron reserves (using serum ferritin as an index), hematological status, and other indicators of iron nutrition were evaluated in three groups of non-pregnant nulliparous women with ages comprised between 14 and 29 years (mean = 19 years). The first group (n = 33) included residents of the rural coastal area (less than 750 m above sea level) (group RCG); the second (n = 32) from the rural highlands (751-1,500 m) (group RHG); and the third group (n = 104) from urban Guatemala City (1,500 m) (group UG). The women in the UG group belonged to the middle or high socioeconomic stratum. Median values in serum ferritin levels (ng/ml) for each group were: RCG = 11.5 (undetectable 50.6); RHG = 17.2 (1.9-83.1) and UG = 20.2 (3.9-56.7). The difference between RCG and UG was statistically significant (P less than 0.05). The percentage of women with serum ferritin levels less than or equal to 9 ng/ml (iron deficiency) was 45 in the RCG, 25 in the RHG and 12 in the UG group. In addition, the prevalence of subnormal hemoglobin levels (below mean - 1 SD) was 46% in the RCG, 12% in the RHG and 8% in the UG. There were no cases of subnormal blood folate levels. As results indicate, the women studied had low iron reserves, the rural coastal group being the most affected. They also evidenced the high prevalence of iron deficiency in the region and the need for public health actions to overcome this nutrition problem.

This paper selectively reviews the main findings of studies on the possible effects of iron deficiency on cognitive function among infants and preschool children published after 1976, and presents data from a study recently conducted in rural Guatemala. In comparison to infants without signs of sideropenia, infants with iron deficiency with and without anemia tend to score lower in the Bayley Scale of Mental Development; conversely, there is no evidence for an association between iron deficiency and delayed motor development. Iron repletion therapy implemented over a period of 7 to 10 days is likely to result in an improvement in mental development scale scores among infants with iron deficiency with or without anemia. In comparison with preschool children without sideropenia, preschool children with iron deficiency with or without anemia are less likely to pay attention to relevant cues in problem solving situations.