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Presents a study on combatting malnutrition in developing countries. Objectives of this study; Discussion on the role of plants in the combat of malnutrition; Examines the issue of processing carotene-rich foods in relation to this topic; Results from this study.

Plasma samples were obtained before, and 8 and 24 h after the ingestion of an ad libitum amount of cooked carrots by 23 school children from a peri-urban community in Guatemala City. The single-meal consumption of cooked carrots ranged from a low 122 g to a high of 961 g (mean: 370.5 +/- 237.2 g; median: 268.4 g). The measured beta-carotene content of the carrots was 10.1 mg per 100 g of edible portion; therefore, the range of intake of beta-carotene was 12.4 to 97.0 mg (mean: 37.4 +/- 24 mg; median: 27.1 mg). Changes in plasma beta-carotene levels at 8 h ranged from a decrement of -0.32 mumol/l (-16.98 micrograms/dl) to an increment of 0.79 mumol/l (42.44 micrograms/dl), with a mean of 0.11 +/- 0.24 mumol/l (5.97 +/- 12.82 micrograms/dl). Changes at 24 h were less dramatic than those at 8 h. A regression of the 8-h changes in plasma beta-carotene on the amount of carrot carotene consumed (corrected by body weight) had an r-value of 0.12. Baseline levels of plasma retinol were poor predictors of the plasma beta-carotene response with this sample size (r = 0.10). The magnitude of the plasma response to beta-carotene from carrots appears to be lower than that observed with pure, powdered, crystalline carotenes; moreover, the variability of the post-carrot response seems to be greater--and its association to dosage appears to be weaker--than with the pharmacological beta-carotene. [ABSTRACT FROM AUTHOR]

The use of discretionary salt, which is salt added during cooking and at the table, as a suitable vehicle for iodine intake was assessed by measuring salt consumption using the lithium-marker technique in rural areas of Guatemala and Benin. In both countries, we studied boys aged 6-12 y and their mothers. Subjects used lithium-labeled salt after all unlabeled salt was removed from their households. In Guatemala, 24-h urine samples for 9 mother-son pairs were collected at baseline and on days 7, 8, and 9 during the use of lithium-labeled salt. Total maternal salt intake averaged 5.2 +/- 1.7 g/d (mean +/- SD), of which 77 +/- 24% came from discretionary sources, whereas Guatemalan boys consumed 1.8 +/- 0.6 g salt/d, of which 72 +/- 12% came from discretionary sources. In Benin, urine collection from 13 mother-son pairs took place at baseline and on days 5 and 7. Beninese mothers had a total salt intake of 9.0 +/- 2.9 g/d and their sons had an intake of 5.7 +/- 2.8 g/d; discretionary salt contributed 52 +/- 14% and 50 +/- 13%, respectively, of total salt consumed. Therefore, fortification of household salt appears to be an appropriate method of controlling iodine deficiency in both countries, although fortification of other salt sources could be considered in Benin. Copyright (c) 1998 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Coffee is widely consumed by children in Guatemala. To evaluate whether coffee has an adverse effect on growth or morbidity, 160 children 12-24 mo of age who had received coffee for > or = 2 mo and had at least one indicator of iron deficiency were stratified by initial hemoglobin (Hb) (A = anemic vs. NA = "nonanemic", i.e., Hb > or = 105 g/L) and randomly assigned to a control (C = continuation of coffee) or intervention group (S = provided with a substitute consisting of sugar and coloring) for 5 mo. Anemic children were provided iron supplements for 2-3 mo. Hematological and anthropometric measurements were made before and after the intervention, and dietary and morbidity data were collected every 2 wk. A total of 139 children completed the intervention: 45 C-NA, 56 S-NA, 19 C-A and 19 S-A. Compliance with the intervention was good: median coffee intake was 127 mL/d in group C vs. 3 mL/d in group S (P = 0.0001). There were no significant differences between C vs. S groups in food intake before or after the intervention. In the total sample, there was no effect of the intervention on weight or length gain. However, in children initially consuming more than 100 mL/d of coffee (n = 96), length gain was 22% greater in the S vs. the C group (P = 0.07), and weight gain was 46% greater in the S-A vs. the C-A group (P < 0.05; NS in the NA groups). Total illness prevalence (particularly respiratory illness) was significantly lower in the S-NA vs. the C-NA group (P < 0.05), but somewhat higher in the S-A vs. the C-A group (P = 0.09). Morbidity differences did not explain the effect of the intervention on growth. These results indicate a modest increase in growth associated with discontinuation of coffee consumption by toddlers with initial intakes >100 mL/d. [ABSTRACT FROM AUTHOR]

Background: Spot ferritin assay on dried serum spot (DSS) samples provides reliable and accurate assessment. Standard DSS preparations, however, involve precise serum aliquots and require some skill and training of field personnel., Objective: We evaluated the validity of the spot ferritin assay on DSS samples prepared by simplified approaches and standard technique in Guatemala City., Design: Venous blood (5 mL) was obtained from 104 subjects aged 24 +/- 15 y (x +/- SD) and transferred into nonheparin-containing (2 plain and 2 self-sealing) capillary blood collection tubes. Three DSS samples were prepared: A (standard, 20 microL serum), B (blot, approximately 30-35 mm serum column), and C (dispenser, 20 microL serum pushed directly from self-sealing capillary tubes with a dispenser). Spots were air-dried and placed in hermetic plastic bags with a desiccant. Two weeks later, entire spots for DSS A and C samples and a circle in the center for DSS B samples were analyzed., Results: DSS ferritin A, B, and C correlated strongly with traditional ferritin (r = 0.71-0.88, P < 0.001). The geometric mean (-1 SD and +1 SD) values for the DSS A, B, and C and traditional ferritin methods were 27.5 (12.6, 60.2), 32.4 (13.5, 77.6), 27.5 (11.7, 64.6), and 30.2 (13.8, 66.1) microg/L, respectively, and did not differ significantly. The difference in ferritin values by various DSS approaches compared with the traditional approach was small (<4 microg/L; P > 0.05)., Conclusions: Simplified and standard DSS methods provide accurate iron-status assessment in population studies. The simplified DSS approaches for serum ferritin measurement need to be evaluated further in populations in whom iron deficiency is prevalent.

Objective: To assess the within-subject and between-subject coefficients of variation (CV) of iron, zinc and copper concentrations in the milk of Guatemalan mothers., Methods: We performed a cross-sectional study in lactating women who had delivered a healthy infant 1 to 6 months previously in two low-income peri-urban areas (San Bartolome Milpas Altas and Ciudad Peronia) and a low-income rural area (San Juan Chamelco) in Guatemala. Women infested with Ascaris lumbricoides or Trichuris trichiura received a single dose of albendazole (400 mg) or placebo. Two weeks after treatment, milk samples were collected on 3 or 4 consecutive days. Trace element concentrations in milk were measured by inductively coupled plasma/atomic emission spectrometry., Results: The instrumental error of the inductively coupled plasma/atomic emission spectrometry method, expressed as SD, was 0.04, 0.27 and 0.02 mg/L for iron, zinc and copper, respectively. Concentrations in milk samples collected from 47 mothers on 3 or 4 consecutive days, expressed as mean +/- SD, were 0.28 +/- 0.13, 2.03 +/- 0.37 and 0.29 +/- 0.07 mg/L for iron, zinc and copper, respectively. The within-subject CV was 46.1%, 18.2%, and 22.8% and the between-subject CV was 61.2%, 48.3% and 31.7% for iron, zinc and copper, respectively. Stage of lactation, infestation with intestinal parasites and residential area had a significant influence on milk zinc, copper and iron concentrations., Conclusions: One sample of milk is sufficient to give a reliable estimate of the zinc concentration in milk. Two samples taken on consecutive days are required for a reliable estimate of iron and copper concentrations.

Background: Nicaragua initiated a national program of vitamin A fortification of its domestic sugar supply starting with the 1999-2000 sugarcane harvest., Objective: This study was conducted to document any change in the vitamin A status of a cohort of children during the first year of the program., Design: The vitamin A status of 21 Nicaraguan schoolchildren (mean age: 6.7 y; range: 5.3-9.3 y) was assessed in March 2000 and in March 2001. Total-body vitamin A stores and liver vitamin A concentrations were estimated with the deuterated-retinol-dilution (DRD) technique at a dose of 5 mg [(2)H(4)]retinyl acetate at baseline and 5 mg [(2)H(8)]retinyl acetate during the repeat test 1 y later. Plasma retinol and carotenoids were measured by HPLC., Results: Median total-body vitamin A stores increased from 0.33 to 0.72 mmol (P = 0.0001), liver vitamin A concentrations from 0.52 to 0.78 mumol/g (P = 0.0003), and plasma retinol concentrations increased from 0.97 to 1.17 mumol/L (P = 0.01)., Conclusion: The vitamin A status of Nicaraguan schoolchildren improved during the year after the initial distribution of vitamin A-fortified sugar in Nicaragua.

Background: Vitamin A deficiency (VAD) is a major public health problem in the developing world, leading to >3 million eye-related problems in preschool children. Nearly 250 million children have subclinical VAD, resulting in a 23% increase in childhood mortality. Difficulties in obtaining samples to assess VAD have hampered the detection, intervention, and surveillance of VAD. The use of dried blood spots (DBS) could ameliorate many problems of vitamin A assessment., Objective: The objective of this study was to validate the use of retinol in DBS for vitamin A assessment by comparing it with venous and capillary serum retinol., Design: Venous and capillary blood specimens were obtained simultaneously from 20 healthy adult volunteers. From each blood specimen, both DBS and liquid serum were prepared (a total of 80 samples). All specimens were maintained at -70 degrees C until HPLC analysis., Results: The mean retinol concentrations in the 4 sample types were as follows: venous serum (2.02 +/- 0.42 micromol/L, or 58 +/- 12 microg/dL), capillary serum (2.06 +/- 0.42 micromol/L, or 59 +/- 12 microg/dL), venous DBS (2.06 +/- 0.49 micromol/L, or 59 +/- 14 microg/dL), and capillary DBS (2.09 +/- 0.45 micromol/L, or 60 +/- 13 microg/dL). Of the 6 possible 2-way combinations, the R(2) values ranged from 0.77 for capillary DBS versus venous DBS to 0.95 for venous serum versus capillary serum., Conclusions: DBS retinol measured by HPLC is comparable with serum retinol. Thus, it is possible to compare and combine blood retinol concentration data obtained from DBS with current and historic measurements in serum.

The intestinal helminthiasis and hematological status was assessed in 100 elderly residents of two low-land communities, one at sea-level and the other at 61; m, equally representative of men and women. These are beth low-income communities. The population showed a 48% helminth infection rate which consisted of hookworm, Trichuris, and Ascaris infection. The prevalence of each of the individual parasites was considered light to moderate and the intensity of infection was generally low in this population. A strong inverse association between intensity of hookworm infection and hemoglobin levels was observed but only at intensities greater than 2,000 eggs/gram feces. Lower intensities of infection had no apparent influence on hematological status. The evaluation of hematological status using hematocrit and hemoglobin showed different prevalences of risk of anemia of 14.1% and 43.8%, respectively. These differences may reflect the chosen cut-off values. Iron deficiency does not appear to be a major problem in this population with only 5% or 11% having absent stores using the low and high cut-off values of circulating serum ferritin, respectively.

We present here the results of a nutritional survey to show the pattern of food consumption, as well as nutrient intake, of 303 pre-school children (six to 71 months old) from three rural hamlets of the South-East region of Guatemala. This survey was performed prior to the establishment of a nutritional intervention in the same geographical area. Information was gathered from June through August 1991, by personnel from the Center for Studies of Sensory Impairment, Aging, and Metabolism (CeSSIAM) using two data collection instruments during home visits. Informats were mothers or other caretakers in charge of the children feeding. Data collected were initially converted to individual food item weight, and then, to micronutrients values. These values were used to establish their adequacy to standard requirements for children of these ages. Results showed a pattern in which corn tortilla, and beans were the most commonly consumed food items. Those items were also the relatively most important sources of calories, protein, and iron. Vitamin A intake was low, and it came mainly from plant sources. Nutrients intake was below the recommended dietary allowances, except for protein and iron.

Plasma retinol and beta-carotene levels were measured in 502 preschool Guatemalan children from five rural hamlets. Their ages ranged from 6 to 78 months (mean: 42.9 +/- 19.2 months); 45% males and 55% females. The mean retinol value in the whole group was 0.9 +/- 0.4 mumol/l (range: 0.1 to 8.4 mumol/l). There was no significant difference between sexes in retinol mean values nor in the incidence of retinol values less than 0.7 mumol/l (22% in males, 18% in females). When grouped by age and community, significant low retinol mean values were found in two hamlets in the youngest age group (12 to 23 months) as compared to the other age-groups (p < 0.05). In the other two hamlets, there were no significant differences among retinol means by age-group. The highest prevalence of deficient retinol values by age-group was in the 12 to 23 months group (40%), and decreased as age increased. The mean value for beta-carotene in the whole group was 0.13 +/- 0.18 mumol/l (range: 0.01 to 2.23 mumol/l). There were no significant differences in beta-carotene means between sexes in the whole group. Stratifying the beta-carotene data by age-groups and community, values were significantly higher in the 48-59 months and 72-83 months groups, as compared with the other age groups in two of the communities (p < 0.05). Significant differences across communities for beta-carotene were found only in the 12 to 23 months group.

Plasma concentrations of beta-carotene and retinol after supplementation of children with beta-carotene in supplements and in foods were compared in Guatemalan children. The children received 6 mg/d beta-carotene [1000 retinol equivalents (RE)] as purified supplements or as carrots for 20 d and the effects on plasma beta-carotene and retinol concentrations were assessed. Plasma concentrations of beta-carotene were increased by 0.59 +/- 0.65 and 0.60 +/- 0.67 mumol/L after supplementation with beta-carotene capsules for 10 and 20 d, respectively. Addition of cooked carrots to the diet resulted in no significant change in plasma beta-carotene. Fasting plasma retinol concentrations were 1.23 +/- 0.35 mumol/L and were not significantly changed in response to supplementation with either of the carotene treatments with retinyl palmitate (1000 RE/d) for 20 d. Possible explanations for the differences in effects of plasma concentrations between the two methods of supplementation are discussed.

Although certain green edible plants and fruits are natural sources of beta-carotene, their inclusion in the diets of children in third world countries as a practical source of vitamin A may be unrealistic due to cultural bias. Further examination of cultural perceptions and beliefs should be undertaken before proposing or endorsing dietary recommendations.

Hypovitaminosis A is a problem in many parts of the developing world. Beyond the stop-gap measures of capsule distribution and food fortification, increased consumption of accessible sources of vitamin A, specifically of the carotenoid provitamin A in yellow, orange, and green plants, has been promoted as the sustainable, long-term solution. However, a search of the available literature reveals few examples of human studies to support the effectiveness of this solution. Evidence from feeding studies shows an almost universally poorer uptake of intact carotenoids from plant sources as opposed to pure, chemical sources. With notable exceptions, the bioconversion of plant carotenoids to preformed vitamin A also seems to be inefficient. Epidemiologic observations in poor Third World populations and in vegetarians in an industrialized nation indicate a relatively greater potency for animal sources of vitamin A. In developing countries, low fat intakes, intestinal roundworms, recurrent diarrhea, and tropical enteropathy all may contribute to reduced utilization of plant provitamin A. The accepted 6:1 equivalency of beta-carotene to preformed vitamin A must be challenged and reexamined in the context of dietary plants. The consequences of operating on a miscalculation could be serious indeed for public health programs designed to alleviate and eradicate hypovitaminosis A.

The relative dose response (RDR) test has been used as a functional measure of whole-body stores of vitamin A in humans. We have examined the reproducibility of the RDR procedure in a population of Guatemalan adult subjects who would be expected to show a moderate prevalence of hypovitaminosis A. Fifty-one subjects were administered a standard RDR test, and the plasma samples were analyzed for retinol, tocopherol, retinol binding protein (RBP) and prealbumin (PAL). Thirty-four of the subjects underwent repeat RDR tests 7 d later. Plasma levels in fasted subjects were as follows: retinol, 1.35 +/- 0.30 mumol/L; RBP, 37.8 +/- 7.7 mg/L; PAL, 187.0 +/- 39.0 mg/L; and tocopherol, 16.6 +/- 6.2 mumol/L. RDRs ranged from -35.2% to +63.1%, with a mean of 2.6 +/- 10.4%. Overall, we observed poor within-subject reproducibility of the RDR procedure whether expressed numerically or by diagnostic classification. Moreover, in contrast to previous studies in children, we observed fewer positive RDR tests than would be expected for the population studied. Nevertheless, the mean RDR was inversely proportional to fasting retinol levels, thus confirming the validity of the biological basis of the RDR procedure in humans. Because of high intra-individual variability with this test, investigators should be cautious when using the RDR procedure in serial studies to monitor the efficacy of therapeutic interventions or subject compliance to dietary regimens.

This case report describes a 14-month-old Guatemalan boy suffering from diarrhea and malnutrition. He had been healthy and experienced normal growth until weaning, which began at six months of age. Introduction of semisolid foods at this time was accompanied by bouts of diarrhea and a reduced growth rate. After admission to hospital at 14 months of age, he was found to have protein-energy malnutrition of the edematous type (kwashiorkor) and to be infected with Giardia lamblia. Therapy with metronidazole and a high-protein diet resulted in satisfactory weight gain and cessation of the diarrhea.