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The Latin American and Caribbean Region has different general characteristics as compared to other regions of the world. These peculiarities have determined certain food and nutritional problems which require specific programs and policies. Even though the universal coverage of basic needs is desirable, this is not the situation in the Region, and it is possible to identify integral vulnerable groups in every population. The study of problems related to food and nutrition requires a global and multidisciplinary approach considering ecological, economical, social and cultural factors affecting communities, especially marginal urban and rural populations. Nutritional diseases represent the last stages of the natural development of malnutrition, and although they are used as indicators of the nutritional situation, their magnitude always underestimate their real impact. It is in the large cities of Latin America that we can really understand the concept of malnutrition, which includes diseases related with both deficient and excessive food consumption. In fact, the development of sub-urban poor communities in large cities, short lactation period, low wages, low maternal schooling, soon lead to the development of under-nutrition in young urban populations. On the other hand, the interaction of urbanization, sedentary jobs, deficient food knowledge and excessive consumption of cheap foods, sometimes produces on the "survivors of under-nutrition" over-nutrition diseases, a problem which is acquiring more prevalence, especially in adults (obesity, diabetes and atherosclerosis). The real nutritional diseases in Latin America do not depend on the deficit or excess of a specific nutrient. The true causes are to be properly identified in order to state recommendations which benefit population groups, and not only reach academic purposes.
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PMID:[Nutritional pathology in Latin America and the Caribbean]. 315 25

A sample of 271 boys, aged four, eight and 12 years, belonging to the upper socioeconomic strata of Caracas, was studied in order to test the sensibility and specificity of arm muscle and fat indicators, as evaluators of the muscle and fat tissues development, as well as of the nutritional status. Weight, height, arm circumference and triceps skinfold were measured following standardized techniques; muscle and fat areas were calculated from arm circumference and skinfold measurements. For statistical analysis, results were compared with North American reference standards, and correlation and regression analyses were performed. Nutritional assessment was performed using weight-for-age, height-for-age and weight-for-height, arm circumference and skinfold, plus the two derived areas. Malnourished children were identified using WHO guidelines in height and weight. Prevalences were compared and the sensibility, specificity and predictive values were studied. Malnourished children were analyzed individually. Arm circumference was the best predictor of nutritional status and triceps skinfold the worst predictor; muscle and fat areas were moderate predictors. On the average, four-year olds were smaller, lighter and much leaner than the reference, and eight and 12-year olds were taller, heavier and more muscular than the reference. Low fat was most prevalent in four-year olds, while high muscle increased with age and was highest at age 12, consistent with pubertal development. Obesity was most prevalent in eight-year olds. Twenty-eight per cent of the 50 children identified as malnourished in weight and height according to WHO, were normal in muscle and fat, and 66% of the 100 identified as malnourished in muscle and fat were normal according to WHO guidelines. Furthermore, 24% of children classified as overweight by weight-for-height were not obese but high in muscle. It is concluded that muscle and fat areas reflect muscle and fat components but are poor indicators of malnutrition, expressed in terms of weight and height. On the other hand, weight and height do not measure body composition. Weight-for-height should be used in combination with muscle and fat areas. National reference standards are needed and cut-off points should be revised, in order to maximize the efficiency and predictive values of these indicators.
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PMID:[Muscle and fat indicators in boys of the upper socioeconomic strata of Caracas]. 315 94

Records of 86 patients in Ruhengeri Hospital North of Rwanda (east Africa) during nine months, revealed that diabetes was present in about 4% of all these patients. First of all, malnutrition was noted in about 9% of these diabetics. But, features of the diabetes mellitus were usually as described by Sankale as the "Cosmopolitan Diabetes".--67% of all the patients were male persons from 31 to 49 years old--Typical symptoms as: thirst, polyuria and weight loss were noted in most all patients,--Insulin requirement was noted in 65% of the patients,--Only few patients were diabetic for more than 10 years,--Neuropathy, retinopathy were usually shown,--17.5% of the patients had abnormally high blood pressure (Hypertension). Diabetes mellitus cannot be considered as a preferred share in Africa but malnutrition and obesity, at the opposite side of the nutritional spectrum, are the striking originality of this disease in developing countries.
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PMID:[Clinical study of diabetes mellitus in hospital practice in Northern Rwanda (apropos of 86 case reports)]. 318 67

Australian Aborigines develop a high frequency of type-2 diabetes mellitus when they make the transition from a traditional to an urban life-style. Preliminary studies were conducted at an outstation in northeastern Arnhem Land where the Aborigines have been exposed to Western influence for approximately 20 years only and where they continue to follow a life-style that is largely traditional. At the time of the study 31 persons were resident at the outstation, 20 persons were over 15 years of age (adults) and 11 persons were under 15 years of age (children). Eighteen adults and six children were tested. By standard criteria for body mass index these persons were all underweight (less than 20 kg/m2). In spite of this, they displayed no biochemical evidence of malnutrition. Their plasma fatty-acid profiles were consistent with a low dietary fat intake and a high consumption of lean meat. Levels of linoleic acid were much lower and those of arachidonic acid were much higher than are those in persons who consume a Western diet. Fasting glucose and cholesterol concentrations were low relative to those of urbanized Aborigines and white Australians. However, their fasting insulin and triglyceride levels were inappropriately high for their very low body mass index and fasting glucose levels. The mild elevation of triglyceride and fasting insulin levels is consistent with insulin resistance and suggests that these Aborigines (in common with other Aborigines) may become susceptible to obesity and diabetes if they became urbanized further.
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PMID:An investigation of nutrition-related risk factors in an isolated Aboriginal community in northern Australia: advantages of a traditionally-orientated life-style. 327 18

Nutrition, immunity and infection are intricately linked to one another. Nutritional deficiencies and excesses influence various components of the immune system. Early studies investigating the association between nutrition and immunity focused on generalized protein-energy malnutrition, particularly in children in developing countries. The extent of immunological impairment depends not only on the severity of malnutrition but on the presence of infection and on the age of onset of nutritional deprivation, among other factors. In industrialized nations, immune function has been shown to be comprised in many malnourished hospitalized patients, small-for-gestational-age infants and the elderly. Obesity also may adversely influence immune function. Imbalances of single nutrients are relatively uncommon in humans and investigations of protein and amino acids and specific vitamins, minerals and trace elements generally are carried out in experimental animals. Deficiencies of protein and some amino acids, as well as vitamins A, E, B6 and folate, and trace minerals are associated with reduced immunocompetence. In contrast, excessive intake of fat, in particular polyunsaturated fatty acids, iron and vitamin E are immunosuppressive. Knowledge regarding nutritional regulation of immunity is leading to many practical applications.
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PMID:Nutrition and immunity: I. Basic considerations. II. Practical applications. 329 51

Any obesity operation, whether malabsorptive or based upon the production of early satiety, produces weight loss by causing a net reduction in the delivery of nutrients to the portal circulation. The malabsorption caused by jejunoileal bypass produces numerous severe micronutrient deficiencies along with other potentially damaging conditions. Although there are numerous reports of such deficiencies following gastric restrictive procedures (particularly gastric bypass), the conditions are almost always more easily treated than those after intestinal bypass, and resultant clinical illnesses are rare. Physicians should be aware that any obesity procedure carries a risk of nutritional deficiency.
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PMID:Vitamin and mineral deficiencies following obesity surgery. 331 7

A survey of Hereros, Kavangos and Bushmen living in the rural districts of South West Africa/Namibia was undertaken in order to assess their dietary intakes, nutritional status and disease patterns. The results showed that Hereros were taller and heavier, with the highest incidence of obesity (15-30%) and hypertension. Their diet consisted chiefly of refined maize meal supplemented with sour milk, and their blood lipid levels were generally lower than Western standards. The diet of Kavangos, based on homeground millet supplemented with fish and fresh vegetables, was better balanced. However, malnutrition was more common particularly in hospital patients where 40% had infective disease. Finally, the diet of Bushmen was extremely poor consisting of whatever was available (generally maize meal) and excessive use of home-brewed alcohol. The majority were malnourished and 73% of those hospitalised had tuberculosis. The blood lipid levels of Bushmen and Kavangos were exceptionally 'favourable' by Western standards but associated with chronic malnutrition. The survival of Bushmen in modern society is a matter of grave concern.
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PMID:Nutritional status, dietary intake and disease patterns in rural Hereros, Kavangos and Bushmen in South West Africa/Namibia. 337 28

Anorexia nervosa (AN) is a state of self-induced malnutrition characterized by a marked pursuit of thinness and the fear of obesity. Although low fasting blood glucose and insulin have been demonstrated, there is contradictory data on insulin sensitivity and a lack of information about insulin metabolism and its metabolic effects in AN. Insulin sensitivity, kinetics, and metabolic effects were measured using the euglycemic clamp in nine females with AN (age 25.2 +/- 1.9 years and 70.6 +/- 2.2% ideal body weight), and the results compared with seven female normal controls (NC) (age 23.6 +/- 1.0 years and 92.7 +/- 2.5% ideal body weight). Fasting plasma glucose (FPG), immunoreactive insulin (IRI), and C-peptide were significantly lower in AN as compared to NC (84.3 +/- 1.5 v 91.5 +/- 1.7 mg dL-1, 9.3 +/- 1.0 v 13.5 +/- 1.4 microU mL-1, and 0.26 +/- 0.03 v 0.41 +/- 0.02 pmol mL-1) (P less than 0.05). During the glucose clamp, the glucose metabolized (M), the metabolic clearance rate of glucose (MCRg), and the glucose metabolized per unit of insulin (M/I ratio) were all higher in AN as compared to NC (M, 8.7 +/- 1.2 v 6.9 +/- 0.6 mg min-1 kg-1; MCRg, 9.9 +/- 1.5 v 7.4 +/- 0.6 mL min-1 kg-1; M/I ratio, 8.6 +/- 1.6 v 5.0 +/- 0.3 mg min-1 kg-1/microU mL-1 X 100), but only the M/I ratio attained statistical significance (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changes in insulin sensitivity and clearance in anorexia nervosa. 353 30

Malnutrition is the most common cause of acquired immune dysfunction worldwide. Nutritional deficiencies, excesses, and imbalances influence specific components of the immune system. The severity of immunological impairment depends upon the extent and nature of undernutrition, the presence of infection, and the age of onset of nutritional deprivation. Profound immunological changes occur in children with marasmus and kwashiorkor as well as in deficiencies of vitamins A, E, B6, folate, zinc, iron, copper, and selenium. On the other hand, obesity and excessive intake of several vitamins, minerals, cholesterol, and polyunsaturated fatty acids also impair immunocompetence. These epidemiological observations and immunological phenomena are of practical significance in clinical practice.
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PMID:Golan memorial lecture. Nutritional regulation of immunity and infection: from epidemiology to phenomenology to clinical practice. 354 Feb 55

Diet-induced thermogenesis (DIT) is defined as a regulatory, facultative component of energy expenditure, stimulated by overeating, which helps maintain energy balance. DIT may play a central role in the regulation of energy expenditure and in the etiology of certain types of obesity. Most experiments testing the existence or the mechanisms of DIT have used the cafeteria diet for the purposes of stimulating hyperphagia, a requisite for studies of DIT. Yet such a diet is inappropriate for studies of thermogenesis because its use prevents researchers from obtaining an experimental outcome that can be clearly interpreted. The primary limitation of the cafeteria diet is that its nutritional composition is uncontrolled. The diet is self-selected from a variety of supermarket foods that tend to be high in fat and/or carbohydrate and low in protein, vitamins and minerals. Hence, the diets consumed by the animals are likely to be deficient in protein, vitamins or minerals. There is evidence that dietary deficiency of protein, vitamins and minerals can increase thermogenesis and in protein-adequate diets, the balance of fat and carbohydrate in the diet can also influence thermogenesis with high carbohydrate diets increasing thermogenesis more than isoenergetic high fat diets. Hence, an observed increase in thermogenesis in cafeteria fed animals might be interpreted incorrectly to be the result of increased energy consumption when it is attributable to dietary imbalance or deficiency. Because the diet is self-selected, it is possible for each animal to choose a diet that varies in nutritional composition from that selected by every other animal, so control of dietary intake is compromised.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The cafeteria diet--an inappropriate tool for studies of thermogenesis. 355 6


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