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The ability of nutrition scientists to measure the status, bioavailability, and bioefficacy of micronutrients is affected by lack of access to the parts of the body through which a nutrient may travel before appearing in accessible body compartments (typically blood or urine). Stable isotope-labeled tracers function as safe, nonradioactive tools to follow micronutrients in a quantitative manner because the absorption, distribution, metabolism, and excretion of the tracer are assumed to be similar to the unlabeled vitamin or mineral. The International Atomic Energy Agency (IAEA) supports research on the safe use of stable isotopes in global health and nutrition. This review focuses on IAEA's contributions to vitamin A, iron, and zinc research. These micronutrients are specifically targeted by the WHO because of their importance in health and worldwide prevalence of deficiency. These 3 micronutrients are included in food fortification and biofortification efforts in low- and middle-income regions of the world. Vitamin A isotopic techniques can be used to evaluate the efficacy and effectiveness of interventions. For example, total body retinol stores were estimated by using 13C2-retinol isotope dilution before and after feeding Zambian children maize biofortified with β-carotene to determine if vitamin A reserves were improved by the intervention. Stable isotopes of iron and zinc have been used to determine mineral bioavailability. In Thailand, ferrous sulfate was better absorbed from fish sauce than was ferrous lactate or ferric ammonium citrate, determined with the use of different iron isotopes in each compound. Comparisons of one zinc isotope injected intravenously with another isotope taken orally from a micronutrient powder proved that the powder increased total absorbed zinc from a meal in Pakistani infants. Capacity building by the IAEA with appropriate collaborations in low- and middle-income countries to use stable isotopes has resulted in many advancements in human nutrition.

With a fast-approaching post-Millennium Development Goal era, there is an urgent need to boost global investment in efforts to reduce child malnutrition. Critical to the management of moderate malnutrition, and therefore to the new Sustainable Development Goals, is addressing severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Despite the considerable difference in the approximate number of children affected by MAM (33 million) compared with SAM (19 million), there is currently no standardized approach to the management of MAM. In partnership with Valid International, the World Food Programme, and the Micronutrient Initiative, the International Atomic Energy Agency hosted the International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions in Vienna, Austria, 26–29 May 2014. This symposium focused on the management (prevention and treatment) of MAM in children. The symposium convened over 350 participants from 63 countries, the majority of whom represented governments responding to moderate malnutrition in their populations, nearly 70 national and international organizations from the United Nations and nongovernmental sectors, and universities from around the world, as well as donor governments and private-sector entities. The symposium was structured around nine sessions over a 3-day period, progressing from a global analysis of the scale of the problem to recent research findings relevant to designing effective interventions. This Supplement contains a series of papers that summarize the symposium sessions and other fundamental aspects important to improving the management of moderate malnutrition in children.

Accuracy of the bioelectrical impedance analysis (BIA) depends on population-specific prediction equations. The aim of our study was to develop prediction equations for assessing total body water (TBW) and fat-free mass (FFM) in healthy North-African adults.In all, 250 participants (194 women, 56 men) aged 18-64 years were included in the analysis. BIA variables were measured by a tetra-polar device. TBW and FFM were assessed by the dilution of deuterium (D2O). The participants were sorted by gender and randomly split into development and validation subgroups. The validity of other published equations was also tested using Bland and Altman procedure, proportional bias and pure error.The prediction equations derived were: TBW (l)=5.68+0.267 height(2)/resistance+4.42 sex (male=1, female=0) + 0.225 weight-0.052 age (R(2)=0.92, root mean square error (RMSE)=1.75 l, RMSE%=5.65); and FFM (kg)=7.47 + 0.366 height(2)/resistance+6.04 sex + 0.306 weight-0.063 age (R(2)=0.92, RMSE=2.38 kg, RMSE%=5.61). The new equations provided nonsignificant proportional bias values, and better agreement than other tested equations. Bias and pure error values were 0.36 and 1.88 l for men and 0.00 and 1.82 l for women, for TBW equation. For FFM equation, bias values were 0.43 and -0.04 kg, and pure errors were 2.57 and 2.46 kg for men and women, respectively.The new prediction equations provide reliable estimates of TBW and FFM in North-African adults and are recommended for use in these populations.

This study aimed to estimate the prevalence of hypertension among a group of adolescents and to assess the relationship of systolic and diastolic blood pressure (SBP, DBP) with body fat mass (BFM), body mass index (BMI) and waist circumference (WC). A total of 167 subjects aged 11-17 years were recruited, 29.3% and 12.6% were overweight and obese respectively. BMI, WC, SBP and DBP were determined using standardized equipment. BFM was estimated by the deuterium oxide dilution. Hypertension (HT) and prehypertension (pre-HT) were observed in 17.4% and 9.6%, of the study population, respectively. The prevalence of HT and pre-HT was significantly higher in boys and in overweight-obese groups (p = 0.044; p = 0.003 respectively). Both SBP and DBP were significantly higher in overweight-obese compared to healthy-weight groups (p < 0.001; p = 0.002 respectively). SBP was significantly higher in boys than girls (p = 0.013). With some exceptions, SBP and DBP were significantly correlated with BMI, WC and BFM in the study population and different weight-status groups of both genders. The relationship of blood pressure with BMI appeared to be more significant than with WC and BFM. The prevalence of hypertension was higher in boys than girls and in overweight-obese than healthy-weight adolescents. Overall SBP and DBP were associated with BFM, BMI and WC. However, the strong association between these variables was seen in girls, and the greater risk of developing hypertension could be associated with increasing BMI.

Regular physical activity is consistent with better health including body composition status. More commonly, studies of physical activity and health have focused on the adult years when poor health as a consequence of inappropriate lifestyle behaviors, becomes more evident. In recent years, greater attention has been paid to developmental aspects of health and disease. This includes the notion that early life experiences or exposures to nutrition and movement and subsequent physical activity and exercise behaviors are related to phenotypic changes including predisposition to overweight and obesity at younger ages. The current obesogenic environment is characterized by the coexistence of overnutrition and low levels of physical activity, a situation that has been referred to as an evolutionary mismatch. Overweight and obesity are commonplace at all stages of the lifespan, including during the reproductive years with the prevalence of maternal obesity and gestational diabetes mellitus increasing rapidly along with obesity and diabetes in their offspring. There is an urgent need for effective strategies to break this cycle, ideally by optimizing physical activity and healthy eating in adolescents and young mothers to increase the opportunity of healthy growth and development, including healthy body composition, in infants and young children.

The aim of the study is to evaluate the prevalence of iron deficiency anaemia (IDA) after a wheat flour fortification program with electrolytic elemental iron in Morocco. Two surveys were conducted after introduction of fortified wheat flour. The target population was women aged 15–49 years and preschool children aged between 2 and 5 years. A total of 1,258 and 1,237 children aged between 2 and 5 years, and 1,497 and 1,537 women of childbearing age have been involved, respectively, in the first and second investigation using a sentinel system. Ferritin and C-reactive-protein analyses were determined in a sub-sample of 268 and 130 women who were selected in May 2006 and January 2008, respectively and, in a subsample of 146 and 201 preschool children who were recruited in May 2006 and January 2008, respectively. The prevalence of anaemia in women was 31.5 and 33.3 % in May 2006 and January 2008, respectively. The prevalence of IDA was 63.9 and 59.1 % in May 2006 and January 2008, respectively. The prevalence of anaemia among preschool children was 47.8 and 37.5 % in May 2006 and January 2008, respectively. The prevalence of IDA in preschool children was 16.7 and 16 % in May 2006 and January 2008, respectively. The flour fortification programme with electrolytic elemental iron in Morocco had no apparent beneficial effect on the prevalence of IDA among women of childbearing age and preschool children.

Background: Vitamin A (VA) deficiency (VAD) is still a concern in many parts of the world, and multiple intervention strategies are being implemented to reduce the prevalence of VAD and associated morbidity and mortality. Because some individuals within a population may be exposed to multiple VA interventions, concerns have been raised about the possible risk of hypervitaminosis A. Objectives: A consultative meeting was held in Vienna, Austria, in March 2014 to (1) review current knowledge concerning the safety and effectiveness of large-scale programs to control VAD, (2) develop a related research agenda, and (3) review current available methods to assess VA status and risk of hypervitaminosis A. Methods: Multiple countries were represented and shared their experiences using a variety of assessment methods, including retinol isotope dilution (RID) techniques. Discussion included next steps to refine assessment methodology, investigate RID limitations under different conditions, and review programmatic approaches to ensure VA adequacy and avoid excessive intakes. Results: Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon. Dietary patterns in several countries revealed that some people may consume excessive preformed VA from fortified foods. Conclusion: Additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake.

Anaemia is a public health problem in Morocco. To limit this problem, Morocco developed a national programme based on fortification of flour with electrolytic elemental iron. To evaluate the programme's impact on the prevalence of anaemia in children between 2 and 5 years, 4 surveys were conducted, between 2006 and 2008, throughout the country. The results showed a significant improvement in the mean rate of haemoglobin accompanied by a significant decrease in the prevalence of anaemia. This improvement appears to be the result of several mutually reinforcing actions in addition to the fortification of flour with iron, including the promotion of a diversified diet rich in micronutrients and the promotion of public health measures.

Background In the search for cost-effective interventions to reduce morbidity and mortality in HIV disease, the identification of nutritional status and levels of micronutrients is very important. Objective To generate information on the level of energy malnutrition and on vitamin A, zinc, and hemoglobin levels and their relationships with disease status in HIV-infected adults in Addis Ababa, Ethiopia. Methods A cross-sectional study was carried out on 153 HIV-positive adults (19% male, 81% female) living in Addis Ababa. The nutritional status and the levels of zinc, retinol, and hemoglobin were determined by anthropometric and biochemical methods. CD4+ counts and C-reactive protein levels were measured by standard methods. Results Of the patients, 18% were chronically energy deficient, 71% were normal, and 11% were overweight. Serum zinc levels were low (< 10.7 μmol/L) in 53% of subjects, and serum retinol levels were low (< 30 μg/dL) in 47% of subjects. Low hemoglobin levels (< 12 g/dL) were observed in only 4.72% of the study population. CD4+ counts under 200/mm3 and elevated C-reactive protein levels were both found in 21% of the subjects. CD4+ counts were positively and significantly correlated with hemoglobin ( r = 0.271, p < .001), zinc ( r = 0.180, p < .033), and body mass index ( r = 0.194, p < .017). There were significant negative associations between levels of C-reactive protein and levels of zinc ( r = −0.178, p < 0.036 and hemoglobin ( r = −0.253, p < .002). Conclusions Our results provide evidence that compromised nutritional and micronutrient status begins early in the course of HIV-1 infection. Low serum zinc and vitamin A levels were observed in almost half of the subjects. The clinical significance of low serum zinc and vitamin A levels is unclear, and more research is required.

Vitamin A deficiency is a major global public health problem. Among the variety of techniques that are available for assessing human vitamin A status, evaluating the provitamin A nutritional values of foodstuffs and estimating human vitamin A requirements, isotope dilution provides the most accurate estimates. Although the relative expense of isotope dilution restricts its applications, it has an important function as the standard of reference for other techniques. Mathematical modelling plays an indispensable role in the interpretation of isotope dilution data. This review summarises recent applications of stable isotope methodology to determine human vitamin A status, estimate human vitamin A requirements, and calculate the bioconversion and bioefficacy of food carotenoids.

The nutritional health in the world is one of the most pressing issues facing different countries today. International organizations like FAO and WHO suggest that there is an improvement of the nutritional situation in Asia and Latin America, though a deterioration in Sub-Saharan Africa does exist. As regards Europe and USA, we are living in the era of “overnutrition.” Unfortunately, the situations of famine, hunger, and starvation do exist in some developing countries. Some of the noncommunicable pathologies like obesity are not only due to the excess of fatty food, but intake of unbalanced diet also contributes significantly to their pathogenesis. Nutrient requirements vary as a function of lifestyle. Infants and pregnancy require more attention because these situations are more vulnerable and are at greater risk for malnutrition that might contribute to metabolic memory, responsible for the pathologies like macrosomia, obesity, type 2 diabetes, and hypertension. To cover all of these areas, there is a pressing need to develop a platform for the translational medicine from fundamental to clinical research in the field of nutrition.

The main purpose of this study is the interaction between nutrition (micronutrients heavy metals: Fe, Zn, Cu) and toxic heavy metals such as Pb in blood of children living in Gharb region of Morocco. This region receives all pollution carried by the Sebou river coming mainly from industrial activities. A rapid and simple analytical procedure was used for the determination of Fe, Cu and Zn trace amounts in blood by total-reflection X-ray fluorescence technique. This method is an energy dispersive XRF technique in a special geometry of primary beam, sample and detector. The sample is deposited on a plane polished surface of a suitable reflector material. It is presented as a few drops (25 μl) from a solution of blood digested in a mixture of HNO 3 and H 2 O 2 using a microwaves accelerated reaction system. The accuracy of measurements has been investigated by using certified materials. The concentration of Cu was found to be normal in all samples (≅ 1 ppm) which ruled out any interaction between this element and the others. On the other hand, amounts of Fe and Zn are very variables, suggesting an interaction between Fe and Zn. However, amounts of Pb in blood are inferior to 50 ppb, suggesting that no interaction exist with this metal and micronutrients.

ObjectiveThe study aimed to detail the lifestyle (physical activity and dietary habits) of Moroccan adolescents.DesignCross-sectional study undertaken in the framework of the ATLS (Arab Teens Lifestyle Study).SettingPhysical activity and dietary habits were determined using a validated questionnaire in public secondary schools.SubjectsA total of 669 adolescents aged 15·0–19·9 years were randomly recruited from Kenitra, Morocco.ResultsPhysical activity patterns and intensity differed between genders. As anticipated, male adolescents were more active than female adolescents across a typical week and engaged in more vigorous-intensity physical activity than female adolescents, who spent more time than male adolescents in moderate-intensity physical activity. Of particular concern was that one in five of the adolescents surveyed was inactive, with almost 45 % of the sample reporting television viewing for more than 2 h/d and 38 % engaged in computer use for a similar period. From a dietary perspective, most adolescents reported that they do not take breakfast or consume milk and dairy products, fruits and vegetables on a daily basis. In contrast, most reported consumption of doughnuts, cakes, candy and chocolate more than three times per week and approximately 50 % consumed sugary drinks more than three times per week.ConclusionsBased on a continuation of the self-reported lifestyle behaviours, adolescents in the present study are at risk of developing chronic diseases. Education programmes are urgently needed to assist in the promotion of a healthy lifestyle and reduce the likelihood of overweight and obesity and related health risks among young people.

Childhood obesity, a significant global public health problem, affects an increasing number of low- and middle-income countries, including in Asia. The obesity epidemic has been fuelled by the rapid nutrition and physical activity transition with the availability of more energy-dense nutrient-poor foods and lifestyles of many children dominated by physical inactivity. During the growing years the pace and quality of grow this best quantified by a combination of anthropometric and body composition measures. However, where normative data are available, this has typically been collected on Caucasian children. To better define and characterise overweight and obesity in Asian children, and to monitor nutrition and physical activity interventions, there is a need to increase the use of standardized anthropometric and body composition methodologies. The current paper reports on initiatives facilitated by the International Atomic Energy Agency (IAEA) and outlines future research needs for the prevention and management of childhood obesity in Asia.儿童肥胖是一个重要的全球性公共健康问题，影响到包括亚洲在内的越来越多 的中低收入国家。快速的营养和体育活动的过渡，即更多的高能量密度低营养 食物的摄入和许多孩子缺乏体力活动为主的生活方式更加助长了肥胖的流行。 在发育期，体格测量和体成分测量相结合是定量生长发育速度和质量最好的方 法。然而，可用的规范数据通常是在白人儿童中收集的。为了更好地定义和描 述亚洲儿童的超重和肥胖，并监测营养和体育活动的干预措施，有必要增加使 用标准化的体格测量和身体成分测量方法。本文报告了国际原子能总署 （IAEA）的促进措施，并概述了未来亚洲在儿童肥胖的预防和管理方面的研 究需求。

The ability to assess energy expenditure and estimate physical activity in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity) and diabetes. It is also important to appreciate that physical activity and energy expenditure are different constructs with physical activity defined as any bodily movement that results in energy expenditure and accordingly, energy is expended as a result of physical activity. However, total energy expenditure, best assessed using the criterion doubly labelled water technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate physical activity in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of physical activity and their relationship with energy expenditure. The measures discussed include those based on energy expenditure or oxygen uptake including doubly labelled water, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures.

The amount of zinc in breast milk is generally regarded as sufficient to cover the increasing zinc demands of most infants. However, this is not well investigated where stores zinc may be compromised in babies with low birth weight (LBW) who are born with low stores of zinc. In Morocco, this is the first time that the amount of zinc transferred in breast milk has been estimated. This study included 32 mother-baby pairs. In our case study, we aimed to measure The quantity of zinc in mothers’ breast milk with normal birth weight (NBW) and LBW babies who were exclusively or not exclusively breast fed at 1,3 and 6 month after birth. The results showed that the majority of mothers have a BMI 􀀁25 kg/m2 this means that all mothers are overweight during 6 months after birth. Zinc concentration (mg/l) in mothers’ breast milk decreased from first month to six month. p- value showed that for mothers with NBW babies, there is a significant difference between the 1 and 6 month (p=0.0003) and between 3 and 6 month after birth (p=0.0007). For mothers with LBW babies, p-value showed a significant difference between the zinc concentration in breast milk in the 1st and 3rd month (p=0.0007), 1 and 6 month (p< 0.0001) and between 3rd and 6th month after birth (p=0.0056). The rate of NBW babies who were exclusively breastfed was 36.67%, 30.25% and 10% successively in 1st, 3rd and 6th month after birth. For LBW babies, the rate of exclusively breastfed was 15.38%, 7.69% and 2.69% successively in 1st, 3rd and 6th month after birth. Based on the K. Brown study in 2009, we can develop a mathematical equation to our own population using our data: Ln [Zinc] = 0.960 – 0.161*Ln(âge) – 0.187*Ln(âge)2. In conclusion the zinc concentration in milk is within normal range and decreases with the age of the babies. The predicted model of zinc concentration in breast milk was developed and tested.

The Kingdom of Morocco launched the flour and oil fortification stage of its National Micronutrient Program in December 2000. The vitamin A (oil) and iron (flour) fortification components of the program are based on the 1994 and 1996 national and regional surveys, which showed that 38% and 40.6% of children under five years of age, respectively, were iron and vitamin A deficient. Morocco is following the example of many countries that fortify their salt with iodine and flour with iron, folate, and/or B vitamins. In addition, it is innovative in including vitamin A–fortified oil in its pioneering fortification program, the first in North Africa. This paper concerns the advocacy and consensus-building components in support of iron, vitamin B, and folatefortified flour and for vitamin A–fortified oil (iodized salt began in 1996). As part of its efforts to implement a sustainable food-fortification strategy, the Ministry of Health has already launched a series of activities. The selection of flour and oil to fortify is based on food-consumption patterns. Hydrogenated cooking oil was identified as a good vehicle for fortification because it is centrally processed and over 90% of households use it daily for a variety of cooking purposes. Oil is an excellent fortification vehicle for vitamin A because it is a fat-soluble vitamin. Flour was identified as a good vehicle for iron fortification because 95% of households use it as the main ingredient in bread. The entire population consumes centrally processed flour, even households that also use homemade flour. This is because about one million metric tons of centrally processed flour are subsidized by the Government, at a savings of at least 50% compared with nonsubsidized flour. One innovation of the program is to launch fortification for the general public at the beginning of Ramadan, a month-long religious period, when oil and flour consumption increase significantly.

Background: The prevalence of obesity and related diseases such as metabolic syndrome (MetS) are increasing in young populations over the world, especially in developing countries. This study aimed to estimate the prevalence of MetS and its individual components, and to assess their association with both overweight/obesity and excess body fat. Methods: This study included 192 adolescents (77 boys and 115 girls) aged 11 to 17 years. Blood pressure and anthropometric measurements were done using standardized techniques. Fasting blood samples were taken for determination of glucose and lipids levels. Percent body fat was estimated using deuterium oxide. The international diabetes federation criteria were applied for the diagnosis of MetS. Results: The prevalence of MetS among overweight/obese adolescents was 18.6% while it was not observed in their normal weight counterparts. The most common abnormality found in the study population was reduced HDLcholesterol (26.6%) followed by elevated fasting blood glucose (22.4%) and high waist circumference (19.3%). Among overweight/obese groups, the rates of individuals with raised TG and reduced HDL-cholesterol were significantly higher in boys than girls (35.0% vs. 15.2%, p=0.044; and 32.5% vs. 13.0%, p=0.038, respectively). Compared to normal-weight adolescents, overweight/obese subjects had higher odds of having at least two MetS components (OR=5.37, 95%CI: 2.72-10.59), or at least three MetS components (OR=11.80, 95%CI: 3.40-41.03). Excess body fat showed similar degrees of association with clustering MetS components. Conclusions: The prevalence of MetS and its individual components was quite high among the study population, particularly among overweight/obese adolescents. MetS components were strongly associated with both overweight/ obesity and excess body fat. MetS and its components might be best predicted by obesity indexes, determined according to age and body mass index in adolescents, than accurate percent body fat.

Objectives. The study aimed to assess the relationship between body fat and each of body mass index (BMI) and waist circumference (WC), and to test the effectiveness of fat mass (FM), percent of body fat (PBF), BMI, and WC in predicting high levels of fasting blood glucose (FBG).Methods. A total of 167 adolescents aged 11–17 years were recruited from Rabat region. BMI and WC were determined using standard equipments. FM and PBF were derived from isotope dilution technique. FBG was determined by the hexokinase method.Results. Regardless of the weight status, BMI showed a strong positive correlation with FM and PBF in both genders. WC was significantly correlated with FM in boys and girls, and with PBF in different groups of girls and boys of the study sample. However, there was no significant relationship between WC and PBF in normal weight and overweight-obese groups of boys. FBG was highly correlated with FM and PBF in girls of the study sample and in overweight-obese girls. Similar significant relationship between FBG and both BMI and WC was observed in overweight-obese girls, while there was no significant association between FBG and other variables in boys and normal-weight girls.Conclusion. BMI and WC were closely associated with FM and PBF, respectively. However, the degree of these associations depends on gender and weight status. BMI may provide a better proxy estimate of overall adiposity than WC; nevertheless, both of them would appear to be a reasonable surrogate for FM and PBF as screening tools to identify adolescents at risk of developing excess body fat and high level of FBG.

Abdulrahman O Musaiger1, Hazzaa M Al Hazzaa2, Aayed Al-Qahtani3, Jalila Elati4, Jasem Ramadan5, Nebal A AboulElla6, Najat Mokhtar7, Hashem A Kilani81Arab Center for Nutrition, Bahrain; 2,3King Saud University, Saudi Arabia, 4National Institute of Nutrition, Tunisia; 5University of Kuwait, Kuwait; 6National Nutrition Institute, Egypt; 7Ibn Tofail University, Morocco; 8Sultan Qaboos University, OmanAbstract: Obesity has become a major public health problem in the Arab countries, creating a health and economic burden on these countries’ government services. There is an urgent need to develop a strategy for prevention and control of obesity. The third Arab Conference on Obesity and Physical Activity was held in Bahrain in January 2010, and proposed the Strategy to Combat Obesity and Promote Physical Activity in Arab Countries. This strategy provides useful guidelines for each Arab country to prepare its own strategy or plan of action to prevent and control obesity. The strategy focused on expected outcomes, objectives, indicators to measure the objectives, and action needs for 9 target areas: child-care centers for preschool children, schools, primary health care, secondary care, food companies, food preparation institutes, media, public benefit organizations, and the workplace. Follow-up and future developments of this strategy were also included.Keywords: obesity, physical activity, strategy, Arab countries

This study examined the impact of physical training on cardiac mitochondrial respiration of rats with chronic diabetes mellitus. Diabetes was induced by an intravenous injection of STZ (50 mg/kg) and only rats with a blood glucose level between 14 and 22 mM 1 wk later were kept in the protocol. Exercise training was conducted on a treadmill with a progressive 10-wk program. Animals were killed at the end of the training program, and mitochondria were isolated from ventricular tissue by differential centrifugation. Both state 3 respiration and oxidative phosphorylation rates were depressed significantly in the mitochondria of diabetic rats. These alterations were reversed completely to normal by physical training, without any significant changes in plasma glucose or insulin levels. The activity of ANT was not affected by diabetes or training. These results indicate that the depressed OPR present in isolated heart mitochondria from chronically diabetic rats is reversed to normal by physical training, apparently by mechanisms independent of blood glucose control. This correction in mitochondrial energy production may explain the improvement in cardiac function previously reported in trained diabetic rats.

The world's scientific community has recognized that isotopic techniques play a vital role in monitoring the effectiveness of nutrition intervention by providing precise data on absorption, bioavailablity and interaction of various micronutrients in a cost effective manner. The International Atomic Energy Agency (IAEA) has been supporting many such health related studies in Member States from developing countries using nuclear and isotopic methods for over 20 years. This report documents the Agency's support for a variety of projects in East Asia and Pacific countries to assess body composition, total energy expenditure, nutrient intake, osteoporosis, infection, vitamin and mineral bioavailability as well as food composition. The IAEA spent a total of 10,302,356 US dollars through Coordinated Research Projects (CRP) and Technical Cooperation Projects (TCP) over the past 20 years. Out of this only 2,732,802, US dollars or 26.5% was used by the East Asia and Pacific countries. While the participation of East Asia and Pacific countries was strong in CRPs and moderate in regional TCPs, they did not participate in national TCPs at all. The non-participation under national TCPs is a serious deficiency when compared with Latin American and African regions and therefore, more participation from the East Asia and Pacific countries in national TCPs is strongly encouraged in the future.

The etiology of obesity in North Africa is not well understood and few studies shed any light on its development among women. This study compiles what is known about the prevalence of obesity and its determinants in Morocco and Tunisia. Results from the authors' two surveys on nutrition-related disease among reproductive-age women (sample size: 2800) and their children (1200 children under 5 y and 500 adolescents) were combined with data from four national income and expenditure surveys (dating from 1980) to assess obesity trends and development in Morocco and Tunisia. Overall levels of obesity, identified by body mass index (BMI) > or = 30 kg/m(2), were 12.2% in Morocco and 14.4% in Tunisia. Obesity is significantly higher among women than among men in both countries (22.7% vs. 6.7% in Tunisia and 18% vs. 5.7% in Morocco) and prevalence among women has tripled over the past 20 y. Half of all women are overweight or obese (BMI > 25) with 50.9% in Tunisia and 51.3% in Morocco. Overweight increases with age and seems to take hold in adolescence, particularly among girls. In Tunisia, 9.1% of adolescent girls are at risk for being overweight (BMI/age > or = 85th percentile). Prevalence of overweight and obesity are greater for women in urban areas and with lower education levels. Obese women in both countries take in significantly more calories and macronutrients than normal-weight women. The percentage contribution to calories from fat, protein and carbohydrates seems to be within normal limits, whereas fat intake is high (31%) in Tunisia and carbohydrate intake (65-67%) is high in Morocco. These are alarming trends for public health professionals and policy makers in countries still grappling with the public health effects of malnutrition and micronutrient deficiencies. Health institutions in these countries have an enormous challenge to change cultural norms that do not recognize obesity, to prevent significant damage to the public's health from obesity.

Introduction et but de l’etude Une revolution demographique est en cours dans le monde. Aujourd’hui le nombre de personnes âgees (PA) de 60 ans et plus est de quelque 600 millions ; ce chiffre doublera vers 2025 et atteindra deux milliards vers 2050, dont la majorite dans les pays en developpement. Il est donc indispensable d’inscrire le vieillissement au centre des grands problemes de developpement ou la nutrition constitue la pierre angulaire aussi bien pour la sante que pour le bien-etre des PA. Sachant que l’etat nutritionnel d’une personne est reflete par l’etat de ses compartiments corporels, notre objectif ici est de mesurer la composition corporelle (CC) chez les PA marocaines par la methode des isotopes stables en utilisant l’eau marquee au deuterium (D2O) et valider des methodes conventionnelles a savoir l’impedancemetrie multifrequence (BIA). Materiel et methodes L’etude a porte sur un echantillon de 79 PA de 60 ans et plus, des 2 sexes et des 2 milieux de residence (41 urbains et 38 ruraux). La CC a ete mesuree par BIA (n=79) et par dilution isotopique du D2O (n=40; 20 au rural et 20 en urbain) ; le sex-ratio est equilibre. Les sujets ont recu une dose orale de 15 g de D2O. Des echantillons de salive ont ete preleves juste avant, puis a 3 h, a 4 h et a 5 h apres administration de la dose. Le D2O dans les echantillons de salive a ete mesure par le FTIR. Resultats L’âge moyen de la population etudiee est de 69,8 ans. Le poids moyen est de 65,6 Kg. La taille moyenne est de 161,6 cm. L’analyse de la CC par dilution isotopique a montre que chez les femmes 72,2 % ont pourcentage de masse grasse (MG) superieur a la normale, 72,2 % ont un pourcentage de masse maigre (MM) inferieur a la normale et 72,2 % ont un deficit en eau corporelle totale (ECT). Ce pourcentage est de 80 % chez les hommes pour ces 3 compartiments. La CC mesuree par BIA presente une forte correlation avec les resultats obtenus par dilution du D2O pour les differents compartiments (MG, MM et ECT). Conclusions La CC chez les PA semble desequilibree, avec un exces de graisse et un deficit hydrique. La determination d’une equation predictive de la BIA en reference a la dilution isotopique permettra une evaluation a large echelle de l’etat nutritionnel de la population des PA marocaines.

The evaluation of breast milk intake is of particular importance for setting future breast-feeding recommendations and to investigate success strategies for breastfeeding promotion. Exclusive breastfeeding during the first 6 months of an infant's life is an important factor for optimal growth and health of the child. Moreover, the assessment of postpartum changes in ma- ternal body composition provides important information. In Morocco, this is the first time that breastfeeding practices and human milk intake have been quantified, and that changes in maternal body composition postpartum have been assessed. This study included 32 mother-baby pairs. The exclusive breastfeeding rate, intake of human milk and water from other sources, and the body composition of the mothers were measured at 1 st , 3 rd and 6 th month postpartum by using the deuterium oxide dose-to-mother technique. Results showed that the exclusive breastfeeding rate was 33.3% at the first month, 26.7% at the third and 12.5% at the sixth. Mean intake of breast milk was 615.6 g/d, 741.9 g/d and 843.6 g/d at 1, 3 and 6 months respectively. As expected, there was a significant change in the mothers' body composition between the first and sixth months. As a proportion of body weight, fat free mass increased by 13.4% and fat mass decreased by 33.4%. In conclusion, the rate of exclusive breast- feeding in Morocco remains low, despite advice on the benefits of breastfeeding, clearly showing a resistance to change the behavior of these mothers.

This study was designed to assess the effect of physical training on high-energy phosphate levels in the heart of diabetic rats. Diabetes was induced with streptozocin (50 mg/kg), and exercise training was carried out on a treadmill with a progressive 10-wk program. Plasma glucose levels at the end of the training program showed only a small improvement of the diabetic state in trained animals (21.7 +/- 1.3 vs. 24.4 +/- 0.8 mmol/l; P < 0.05). The lower heart rate observed in sedentary diabetic rats (279 +/- 6 vs. 356 +/- 5 beats/min; P < 0.001) was improved by physical training (301 +/- 8 beats/min; P < 0.05 vs. sedentary diabetics). Significantly lower phosphocreatine levels were found in sedentary diabetic rats (12.0 +/- 0.7 mumol/g dry wt) than in sedentary control rats (15.0 +/- 0.9 mumol/g dry wt; P < 0.05) but not in trained diabetic rats (13.7 +/- 0.7 mumol/g dry wt). ATP levels were not affected by diabetes but were increased by training. The increased long-chain acyl-CoA levels in sedentary diabetic rats (146 +/- 7 vs. 119 +/- 8 mumol/g dry wt in sedentary control rats; P < 0.05) were improved by training (138 +/- 6 mumol/g dry wt; P > 0.05 vs. sedentary control rats). These data indicate that the diminution in phosphocreatine levels observed in the heart tissue of chronically diabetic rats can be attenuated by an exercise training program.

The effect of physical training on total creatine kinase (CK), CK-MM, and CK-MB isoenzyme activity was studied in hearts of diabetic and control rats. Diabetes was induced with streptozotocin (50 mg/kg), and only rats with blood glucose levels between 14 and 22 mmol/L 1 week later were kept in the protocol. Exercise training was performed on a treadmill in a progressive 10-week program. Physical training did not induce any significant changes in plasma glucose or insulin levels in diabetic rats. Total CK, CK-MM, and CK-MB activity was decreased in diabetic rat heart by 27%, 22%, and 56%, respectively. Physical training did not induce any important changes in CK activity in heart of nondiabetic rats. However, in diabetic rat heart, training increased total CK activity by 13%, CK-MM activity by 12%, and CK-MB activity by 31%. We conclude that the decrease in cardiac CK activity observed in chronic experimental diabetes mellitus can be partly alleviated by a program of physical training. This may be one of the mechanisms whereby physical conditioning improves cardiac function in experimental diabetes.

Background Vitamin A and zinc are crucial for normal immune function, and may play a synergistic role for reducing the risk of infection including malaria caused by Plasmodium falciparum. Methods A randomized, double-blind, placebo-controlled trial of a single dose of 200 000 IU of vitamin A with daily zinc supplementation was done in children of Sourkoudougou village, Burkina Faso. Children aged from 6 to 72 months were randomized to receive a single dose of 200 000 IU of vitamin A plus 10 mg elemental zinc, six days a week (n = 74) or placebo (n = 74) for a period of six months. Cross-sectional surveys were conducted at the beginning and the end of the study, and children were evaluated daily for fever. Microscopic examination of blood smear was done in the case of fever (temperature ≥37.5°C) for malaria parasite detection. Results At the end of the study we observed a significant decrease in the prevalence malaria in the supplemented group (34%) compared to the placebo group (3.5%) (p < 0.001). Malaria episodes were lower in the supplemented group (p = 0.029), with a 30.2% reduction of malaria cases (p = 0.025). Time to first malaria episode was longer in the supplemented group (p = 0.015). The supplemented group also had 22% fewer fever episodes than the placebo group (p = 0.030). Conclusion These results suggest that combined vitamin A plus zinc supplementation reduces the risk of fever and clinical malaria episodes among children, and thus may play a key role in malaria control strategies for children in Africa.