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The Burg Wartenstein Symposia have become rightly celebrated for achieving their original purpose: to be of service and interest to the anthropological profes­ sion as a whole and to contribute to related sciences. We are specially grateful to the Board of Directors of the Wenner-Gren Foundation for Anthropological Research for the award of a symposium on Physical Anthropology and Nutritional Status. We had considered that such a subject was timely and that an inter-disciplinary approach would contribute useful knowledge in a most important area--particularly in the field of child health. This pUblication of the proceedings will show the degree of success of these aims. Mrs. Lita Osmundsen, Director of Research at the Wenner-Gren Foundation, not only steered us in the early stages but, during our delightful time at Burg Wartenstein, and subsequently, she has been that most charming of crosses--den mother and first class science administrator. We are deeply grateful to her. And grateful, too, for the organization and friendly warm spoiling by the Wenner-Gren staff in residence at Burg Wartenstein. Our nutritional status was high. Nothing was too much trouble for them and it was a wrench to leave and say goodbye to them. The Foundation has since supported our efforts towards this publication. Here we owe a very special debt of gratitide to the cooperation and friendly exper­ tise of Mr. Seymour Weingarten, Senior Editor of the Plenum Publishing Corporation, aided by Mr. John Matzka, Managing Editor of this Corporation.

The Brazilian Society of Nutrition, through the present public­ ation, brings to the attention of the world scientific community the works presented at the XI INTERNATIONAL CONGRESS OF NUTRITION which, promoted by this Society and under the sponsorship of the Interna­ tional Union of Nutritional Science, was held in the city of Rio de Janeiro from August 27th to September lst, 1978. The publication, edited by Plenum Publishing Corporation, is 11 titled Nutrition and Food Science: Presented Knowledge and Utiliza­ tion•• and appears in three volumes. under the following titles and sub-titles: Vol. I - FOOD AND NUTRITION POLICIES AND PROGRAMS - Planning and Implementation of National Programs - The role of International and Non-governmental Agencies - The role of the Private Sector -Program Evaluation and Nutritional Surveillance - Nutrition Intervention Programs for Rural and UrbanAreas - Mass Feeding Programs - Consumer Protection Programs Vol. I I -NUTRITION EDUCATION AND FOOD SCIENCE AND TECHNOLOGY - Animal and Vegetable Resources for Human Feeding - Food Science and Technology - Research in Food and Nutrition - Nutrition Education Vol. I I I -NUTRITIONAL BIOCHEMISlRY AND PATHOLOGY - Nutritional Biochemistry - Pathological and Chemical Nutrition - Nutrition, Growth and Human Development v vi FOREWORD It is hoped that this publication may prove useful to all those who are tnterested in the different aspects of Nutrition Science. Editorial Committee: Walter J. Santos J. J.

The important role that the nutritional status exerts in determining the course of life from birth to death in the human being and especially its impact in disease states is only par­ tially appreciated at this time. Nutritional deficiencies are usually considered to be major problems only in under-privileged or developing populations, except for those occurring in specific diseases. This attitude is incorrect as indicated by reports of Bestrian et al (1974, 1976) and Merritt and Suskin (1979) and others who found evidence of nutritional depletion in as much as 50% of the patients in varied groups of hospitalized patients in the United States. Other studies, some of which are included in this book, emphasized the existence of deficiencies of certain specific nutrients. Despite evidence of nutritional deficiencies occurring more frequently than previously appreciated, there is no well established protocol of laboratory studies that the clinical chemist or scientist should provide to help the physician detect lack of essential nutrients before extensive and possibly irreparable damage has occurred to the individual patient. Considerable research data are needed to determine the best biologic material (i.e., erythrocytes, leucocytes, plasma, serum, urine, cerebrospinal fluid, lymph) for analysis to determine accurately at an early stage metabolic deficiencies due to a specific nutritional element. Improved techniques for analysis of key metabolites and nutrients are available in the research labora­ tory and many of them can be adapted to the clinical laboratory.

This book is the product of the Conference on Nutrition and Human Reproduction, supported and organized by the National Insti­ tutes of Child Health and Human Development, and held at the National Institutes of Health, Bethesda, Maryland, in February 1977. The genesis of this Conference came from the work of the Subcommittee on Nutrition and Fertility of the Committee on International Nutrition Programs of the National Research Council. The purpose of the Conference was to assemble scientists and program planners from a broad range of fields including nutrition, epidemiology, demography, endocrinology, sociology, economics, anthropology, biostatistics and public health. Each individual brought his or her analytical skills and perspective to the meeting, with the goal of developing a more coherent picture of the many facets of nutrition and reproduction. The approach was to get a more comprehensive view by: 1. Clarifying terminology and definitions. 2. Reviewing recent and current work on the biological basis for nutrition-fertility interactions. 3. Reviewing biomedical and socioeconomic factors related to breast-feeding to assess how this practice relates to maternal and infant nutrition and fertility. 4. Assessing some current analytical models for defining nutrition-fertility interrelationships. 5. Reviewing recent field studies from Africa, Asia and Latin America which are examining the interrelationships of nutrition and reproduction.

As is noted in the opening chapter of this volume, nutrition and public health programs have been important throughout Latin America and the Caribbean for many years. This is due to the spe­ cial concerns of those responsible for setting national policies, the program experience and leadership in public health developed by the national governments, and the stimulus and cooperation of the Pan American Health Organization (PARO), including its twelve associated centers which focus on research, training and program development. The need for a coordinated hemisphere-wide attack on malnu­ trition and other health problems was expressed clearly in the'Ten Year Health Plan for the Americas'(1). This plan established specific targets for reducing the prevalence of the major nutri­ tional diseases and other health problems for the decade 1971-1980. It was noted at that time that very few countries had formulated adequate comprehensive national food and nutrition policies and plans, nor had they developed strategies for combating the nutri­ tional deficiencies known to affect large numbers of people through­ out the Region. Following a review of the available data on a country by country basis in 1975, the PARO Directing Council en­ dorsed recommendations for formulating the necessary national poli­ cies and strategies for the intersectorial execution of food, nutri­ tion and health programs (2). This report also summarized the available national data related to nutritional status, existing programs such as food fortification, and the human resources avail­ able for services as well as for research and education.

As widely spread health problems related to over- and undernutrition have grown nowadays to an epidemic extent and even prevail over infectious diseases, a better knowledge of the metabolic basis of clinical nutrition has become essential. The extremes of the nutritional spectrum, undernutrition and obesity, are no longer considered as isolated opposites with different effects on separate risk groups, but paradoxically prove to be interacting in a setting of rapidly changing lifestyles, as is presently the case worldwide. Recurring issues such as insulin resistance, changes in intermediary metabolism, fluid and electrolyte physiology, genetic and non-genetic inheritance are highlighted, as well as the biological linkage between maternal undernutrition and the development of obesity, diabetes and cardiovascular disease in later life. The problems at stake present a new and enormous challenge for future healthcare policies and, therefore, are better tackled today. This book will be an interesting source of knowledge for internists, family physicians, pediatricians, dieticians, endocrinologists, gastroenterologists, and public health officers.