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Biomedical subjects

I Darnton-Hill

Publications and source records attributed to I Darnton-Hill.

At least 19 recordsLinked to original sources
PubMed2004

A life course approach to diet, nutrition and the prevention of chronic diseases.

OBJECTIVE: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease. DESIGN: A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. SETTING: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. CONCLUSIONS: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Aging↗
PubMed2000

The impact of consuming iron from non-food sources on iron status in developing countries.

OBJECTIVE: : To determine the impact of contaminant iron and geophagy on iron intake and status of persons living in developing countries. DESIGN: : Literature for review was identified by searching Medline and Agricola, from appropriate other texts and from three reports from the Opportunities for Micronutrient Interventions (OMNI) Project of USAID. SETTING: : The dietary intake of iron by people living in developing countries is generally high but iron deficiency remains prevalent. This apparent paradox is because the iron being consumed is predominantly in the non-haem form, which is poorly absorbed. Some of this non-haem iron is from contamination of food with iron from soil, dust and water; iron leaching into food during storage and cooking; contamination during food processing such as milling; and the practice of geophagy. RESULTS: : Although the contribution of contaminant iron to overall iron intake is well documented, its absorption and thus its impact on iron status is not. To be available for absorption, contaminant iron must join the common non-haem pool, i.e. be exchangeable. The absorption of exchangeable contaminant iron is subject to the same interactions with other constituents in the diet as the non-haem iron that is intrinsic to food. The limited available evidence suggests wide variation in exchangeability. In situations where a significant fraction of the contaminating iron joins the pool, the impact on iron status could be substantial. Without a simple method for predicting exchangeability, the impact of contaminant iron on iron status in any particular situation is uncertain. CONCLUSIONS: : Interventions known to increase the absorption of iron intrinsic to foods will also increase absorption of any contaminant iron that has joined the common pool. Any positive effect of geophagy resulting from an increased intake of iron is highly unlikely, due to inhibiting constituents contained in soils and clays. The efficacy of approaches designed to increase the intake of contaminant iron remains encouraging but uncertain. An approach using multiple interventions will continue to be essential to reduce iron deficiency anaemia.

Biological Availability↗
PubMed2000

Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren.

BACKGROUND: Wheat flour is a possible food vehicle for vitamin A fortification. OBJECTIVE: This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun (pandesal) on the vitamin A status of school-age children. DESIGN: This was a double-masked clinical trial conducted in 396 and 439 children aged 6-13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A-fortified (experimental) or nonfortified (control) group. A 60-g vitamin A-fortified pandesal (containing approximately 133 microg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children ( approximately 75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up. RESULTS: Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P: = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A- fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P: = 0.05). CONCLUSIONS: Daily consumption of vitamin A-fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations.

Adolescent↗
PubMed1999

The challenge to eliminate micronutrient malnutrition.

OBJECTIVE: This paper takes a public health approach to examine briefly: (i) the global magnitude and consequences of deficiencies of iodine, vitamin A and iron; (ii) the intervention options for addressing the deficiencies and associated critical issues; (iii) roles of the main 'players' involved; (iv) current programs and results. METHOD: Analysis of the literature, especially that coming from the UN agencies; distillation of experience from the recently completed OMNI Project, and involvement in relevant international meetings. RESULTS: More than one in three individuals throughout the world are at risk of the health and development consequences of iron, vitamin A and/or iodine deficiencies. There has been a 40% decline in the prevalence of vitamin A deficiency over the last 10 years. More than 60% of all salt is now fortified with iodine. CONCLUSIONS: Significant progress has been made, particularly with the iodine deficiency disorders and vitamin A deficiency. Little apparent progress has been made with iron deficiency anaemia. IMPLICATIONS: National governments, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations, and increasingly, the private sector need to work together in looking for innovative approaches, especially for iron, increasing awareness of the broader social and public health nutrition context, and supporting increased international funding.

Global Health↗
PubMed1999

Iron and folate fortification in the Americas to prevent and control micronutrient malnutrition: an analysis.

Although there has been a remarkable decline in the proportion of malnourished children in Latin America, micronutrient deficiencies, especially iron deficiency anemia, remain significant public health problems. A substantial reduction in the prevalence of iron deficiency anemia is an important goal for the end of the decade. Interest in fortifying wheat flour and dry-milled maize flour is thus growing, and significant experience in the fortification of flours with iron and the B vitamins, including folate, is emerging. It is necessary to ensure that fortification levels and standards, legislation, and quality assurance and control measures are in place nationally and harmonized regionally.

Anemia, Iron-Deficiency↗
PubMed1998

Feast and famine: socioeconomic disparities in global nutrition and health.

OBJECTIVE: To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health. DESIGN: Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions. SETTING: The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries. RESULTS: Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty percent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable diseases (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries, cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata. CONCLUSIONS: The apparent contradictions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

Adolescent↗
PubMed1997

Developing industrial-governmental-academic partnerships to address micronutrient malnutrition.

Micronutrient malnutrition affects approximately 2 billion people and has a significant impact on mortality, morbidity, reproductive health, individual growth and development, and economic productivity. The World Bank has suggested that micronutrient interventions are among the most cost-effective of all health interventions. Therefore, greatly increased collaborative efforts are needed to bring about further reductions in micronutrient malnutrition. At the FAO/WHO International Conference on Nutrition, the importance of various partners in improving nutrition was recognized in the World Declaration on Nutrition and adopted unanimously by 159 governments: "Governments, academic institutions and industry should support the development of fundamental and applied research directed towards improving the scientific and technological knowledge base" for addressing malnutrition, including micronutrient malnutrition. Food-based strategies, including fortification, provide a good example.

Government↗
PubMed1996

Nutritional aspects of changes in disease patterns in the Western Pacific region.

One impact of socioeconomic progress on populations has been to reduce the number of cases due to diseases of undernutrition and microbial contamination of food, which affected mostly infants and young children, and to increase those due to diseases of excessive food consumption, which are affecting adults and a growing number of children. This article reviews the main dietary factors which have an influence on cardiovascular disease and cancer, and discusses the link between economic development and increased rates of chronic diseases. There is evidence that the noncommunicable diseases and their risk factors have risen rapidly in countries of the WHO Western Pacific Region. Data from 29 countries and areas in the region indicate that 70% of them show lifestyle diseases in three or more of the top five causes of death. While public health measures have been implemented by some countries to prevent and control nutrition-related chronic diseases, further action is needed.

Adult↗
PubMed1995

Healthy aging and the quality of life.

The size of the elderly population, both in numbers and as a proportion of the whole, is increasing rapidly in most parts of the world. This trend, together with other deep changes in society, has made traditional ways of understanding and accommodating the aging process inadequate. Surveys suggest that economic security, psychosocial well-being, and a sense of being in reasonably good health are the most important values to aim for.

Aged↗
PubMed1993

Vitamin supplementation and nutritional status in homeless men.

Homeless men and women are both physically and socially disadvantaged. Their nutritional status is also often compromised. In this sample of 107 homeless men in Sydney, about half reported taking vitamin supplements (with varying duration and regularity), usually a regimen consisting of thiamin, vitamin C, folic acid and a multivitamin-B-complex capsule. In this cross-sectional study, little effect could be seen on clinical health between those reporting taking vitamin supplementation and those not doing so. However, biochemical measurements showed significant differences. The numbers of men classified as deficient were higher by about 20 per cent for those reporting not taking vitamins. The mean biochemical levels were significantly better for the supplemented group for thiamin, as assessed by TPP per cent effect (P = 0.04), vitamin B6, as assessed by P5'P per cent effect (P = 0.002), vitamin C (P < 0.001) and blood folate (P < 0.02). Consequently, on the basis of mean biochemical levels of vitamin status, the supplemented group were better off and it is reasonable to presume that in the long term this would be reflected in improved clinical status.

Adult↗
PubMed1990

Thiamin status of a sample of homeless clinic attenders in Sydney.

Thiamin is one of the marginally adequate nutrients in the Australian diet. The incidence and prevalence of Wernicke-Korsakoff syndrome in this country may be the highest in the world. Homeless men could be at risk for low intakes of thiamin in association with irregular high alcohol intakes. A sample of 107 homeless men from two hostels and one clinic for homeless persons in inner Sydney was investigated for nutritional status; their thiamin status is reported here. By means of 24-hour recall methods, their mean dietary thiamin intake--0.76 mg per day--was less than the National Health and Medical Research Council's recommended dietary intake of 1.1 mg per day; at 0.076 mg/MJ it was even less than the minimal requirement of 0.08 mg/MJ. It was much lower than the mean intake of 1.38 mg per day that was found in the 1983 National Dietary Survey of adults and the distribution of thiamin intakes in this study was skewed positively, with the largest intake being in the range of 0-0.1 mg per day. On clinical examination we found a high prevalence of signs that were consistent with thiamin deficiency. Twenty-four per cent of the subjects showed three-or-more of the signs of the Wernicke-Korsakoff syndrome (ophthalmoplegia, nystagmus, ataxia, peripheral neuropathy and global confusion). In assaying for red-cell transketolase levels, this subgroup showed higher thiamin pyrophosphate effects than did the whole sample. Thirty-six per cent of the whole sample showed subnormal thiamin status by the thiamin pyrophosphate effect. Thus, in this sample, homeless men showed a high prevalence of dietary, biochemical and clinical features to indicate subclinical or early clinical thiamin deficiency.

Adult↗
PubMed1990

Sociodemographic and health factors in the well-being of homeless men in Sydney, Australia.

Throughout the world, homelessness is generally increasing. This paper examines some of the historical precedents and, in an Australian sample, some of the factors leading to ill-health in this group. All studies have shown the ill-effects on health of being homeless and in this group drinking alcohol and length of time on skidrow appear to be the major factors. It is also suggested that the homeless are generally from comparatively disadvantaged backgrounds before becoming homeless, and more likely to be migrants. They were also less likely to have ever married and more likely to have been in jail or psychiatric institutions.

Alcoholism↗
PubMed1987

Vitamin and iron status in new vegetarians.

This study assessed the biochemical status of a number of vitamins and iron in a group of new vegetarians. Values were compared with a group of omnivores of similar age. Satisfactory to high levels of serum folate, vitamin E, and riboflavin were found, and all were significantly higher in vegetarians than omnivores. Thiamin status was satisfactory in both groups although a small but statistically significant difference in favor of the omnivores was found. Serum vitamin B-12 was significantly lower in vegetarians, and iron status as measured by serum ferritin was very significantly lower in vegetarians. Pyridoxine status was similar in both groups. A number of sex differences were found in the vegetarian sample. New vegetarian women appear to be at particular risk of developing low iron stores.

Adult↗
PubMed1986

Lactase deficiency in Australian school children.

The prevalence of lactase deficiency is high in Mediterranean, Middle Eastern and Asian countries, which suggests that many immigrants and immigrant children from these regions may be unable to produce lactase. Therefore, the aim of this study was to determine the prevalence of lactose malabsorption in primary school-aged children, in two communities with a high proportion of immigrants in metropolitan Sydney. A total of 109 children, aged five to 12 years, were studied by means of the breath hydrogen method. Forty per cent (44/109) showed lactose malabsorption, as defined by a rise in end-expiratory hydrogen levels of 20 ppm or more, two hours after loading with lactose. The prevalence was highest in the subjects of Asian origin (93%; 14/15), followed by Greek subjects (56%; 14/25) and subjects from other Mediterranean and Middle Eastern countries (41%; 15/37). Of the 77 children who were available for follow-up, 57% (44) reported symptoms of lactose intolerance, of whom nearly two-thirds were children who showed lactose malabsorption. The high prevalence of lactase deficiency in children at both schools underlines the need to consider the multiracial identity of Australians in planning educational programmes about nutrition.

Animals↗
PubMed1986

Urine mutagenicity as an indicator of exposure to dietary mutagens formed during cooking of foods.

Studies were undertaken with individuals fed fried bacon meals to determine whether fruit or vegetables, ingested along with bacon, modified uptake and subsequent excretion of bacon mutagen(s). Urinary mutagenic activity was significant in those who had consumed bacon or mixed bacon/vegetable or bacon/fruit meals within the previous 2 to 3 hr period. Although urine activity varied by a factor of 4 among 15 subjects who consumed different meals, there was no evidence from this investigation that fruit or vegetables contributed to the inherent variability in total urinary mutagenic activity. However, some differences in excretion kinetics may be attributable to vegetable or fruit supplements in mixed meals.

Animals↗