Biomedical subjects

W H Lamb

Publications and source records attributed to W H Lamb.

29 records · Page 2Linked to original sources

PubMed1984

Maintenance energy cost of pregnancy in rural Gambian women and influence of dietary status.

A major assumption in current dietary advice for pregnancy is that the amount of energy expended on tissue maintenance increases by 36 000 kcal over the whole gestation period. In a group of rural Gambian women engaged in subsistence farming, the increase was much smaller and depended on maternal dietary status. In women having the customarily low food intake the net extra cost of tissue maintenance was just 1000 kcal; even in those given a dietary supplement in amounts previously shown to increase birthweight it was only 13 000 kcal. This finding partly explains why mothers, particularly those in the Third World, can apparently accomodate pregnancy without substantially increasing their dietary energy intake. The findings are of importance in the formulation of realistic dietary health strategies for such communities.

Adult↗

PubMed1984

The effect of water abstention on milk synthesis in lactating women.

The effects of dehydration on mechanisms of water balance and milk synthesis were investigated in ten lactating Gambian women who were fasting during Ramadan. Ten non-pregnant, non-lactating women acted as controls. Fasting consisted of total water abstention from 05.00 hours to 19.30 hours and was accompanied by high insensible water losses. Lactating women lost 7.6% of their total body water between 07.00 hours and 19.00 hours. Control subjects lost significantly less. Plasma indices of dehydration (osmolality, sodium, uric acid) showed a greater rise in the lactating women than in the control subjects over the period of fasting. However, the 19.00 hours values remained in the normal range obtained on non-Ramadan days. During Ramadan the lactating women restricted their urinary output to a lesser degree than the controls, and for much of the day their urine was also less concentrated. The lactating women appeared to have adapted by superhydrating themselves overnight. This resulted in very low urine concentrations (osmolality, sodium, urea, creatinine) in morning samples. Urine concentrations approached, but did not exceed, non-Ramadan levels by late afternoon. The daily water turnover of 6.4 litres in the lactating women was 2 litres greater than in the controls. This difference was much greater than that required for milk synthesis (500 ml) and may represent a further protective mechanism. Fasting caused changes in milk osmolality, lactose, sodium and potassium concentrations indicative of a marked disturbance of milk synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

Prenatal dietary supplementation of African women and birth-weight.

Gambian women, who show marked seasonal fluctuations in energy balance, were offered a dietary supplement during pregnancy. This resulted in a net energy increment of 431 kcal/day. In the wet season, when the women were normally in marked negative energy balance due to food shortages and a high agricultural work load, the supplementation improved birth-weight by a mean of 224 g and reduced the incidence of low-birth-weight babies (less than 2.5 kg) from 28.2% to 4.7%. In the dry season, when the women were previously in positive energy balance despite an energy intake of only 60% of the recommended dietary allowance, the supplement had no beneficial effect on birth outcome. This threshold effect indicates the need to identify truly at-risk groups for prenatal supplementation programmes in developing countries.

Birth Weight↗

PubMed1983

A trial of ascorbic acid and of multivitamin supplementation on the oral health of West African children.

204 children between the ages of 1.5 and 6.5 years living in a West African village where the incidence of gingivitis and bleeding gums is about 40% of the population at the end of the rainy season, were given vitamin C or a placebo for 69 days, followed by a multivitamin supplement or placebo for 47 days. The condition of their gums was continuously monitored by trained field workers and by a paediatrician during the supplementation period, and was also assessed in greater detail by the paediatrician at the beginning and end of each treatment period. No benefit of either type of supplement could be detected, either on incidence of bleeding, or on over-all severity of gingivitis, although there was a clear-cut seasonal trend towards lower incidence of bleeding in both groups as the study progressed.

Ascorbic Acid↗

PubMed1983

A prospective survey of gingivitis in Keneba, a rural West African community.

The prevalence and severity of gingivitis was studied in 204 children living in a rural West African community. Seasonal prevalence varied from 38.6% to 9.5%. The lowest prevalence coincided with the seasonal consumption of citrus fruits and mangoes. Prevalence increased with age. Of the children, 13.7% required treatment with a standard antibiotic regime for severe gingivitis. Severe gingivitis occurred frequently in children under three years of age and in females. There was no clear relationship between the prevalence of gingivitis and malnutrition as assessed by anthropometric indices obtained from the children. Findings in this study suggest that measures to improve oral hygiene is the intervention most likely to reduce the prevalence of gingivitis.

Age Factors↗

PubMed1983

Efficacy of a riboflavin supplement given at fortnightly intervals to pregnant and lactating women in rural Gambia.

Thirty-seven women living in two rural Gambian villages, who were either pregnant or lactating at the outset of the study, received a tablet containing 15 mg riboflavin, or a placebo, at fortnightly intervals for 10 weeks at a time of year when riboflavin status was deteriorating. Clinical assessments were carried out once a week, with particular attention to signs and symptoms of riboflavin deficiency, and blood samples were taken at the beginning of the study and after 4 and 10 weeks supplementation for the assessment of riboflavin status by the activation coefficient of erythrocyte glutathione reductase. The overall incidence of lingual papillary atrophy increased significantly during the course of the study, but the increase was significantly smaller in the supplemented than in the placebo group. More complaints of sore mouths were encountered in the placebo group. Biochemical evidence of deficiency was very marked at the outset, and showed some improvement after supplementation, but values within the normal range were not achieved. It is concluded that a riboflavin supplement given at spaced intervals can be clinically beneficial, despite failure to achieve normal biochemical indices. This may have practical implications for intervention programmes.

Atrophy↗

PubMed1983

Metabolic consequences of fasting during Ramadan in pregnant and lactating women.

In studies in a rural West African village it was observed that all lactating women and 90 per cent of pregnant women fasted throughout the period of Ramadan. The metabolic consequences of this fasting were studied by measuring serum glucose, free fatty acid, triglyceride, beta-hydroxybutyrate, alanine, insulin, glucagon and T3 levels at 0700 h and 1900 h in 22 pregnant, 10 lactating and 10 non-pregnant, non-lactating women. Results were also compared with overnight-fasted values obtained outside Ramadan. Values for the lactating women were not significantly different from the non-pregnant, non-lactating controls despite the additional metabolic stress of lactation. Ramadan-fasted (1900 h) glucose values from women in late pregnancy (3.01 +/- 0.11 mmol/l) were significantly lower than all other groups (P less than 0.01) and were 15 per cent (P less than 0.01) lower than overnight-fasted values from similar subjects. Ramadan-fasted free fatty acid and beta-hydroxybutyrate levels were significantly higher (P less than 0.05) and alanine values were significantly lower (P less than 0.05) in late than in early pregnancy. It is concluded that the phenomenon of 'accelerated starvation' occurs when women in late pregnancy fast during Ramadan. The possible consequences of this failure to maintain glucose homoeostasis are discussed with reference to the poor outcome of the actual pregnancies studied.

3-Hydroxybutyric Acid↗

PubMed1983

The relative effectiveness of iron and iron with riboflavin in correcting a microcytic anaemia in men and children in rural Gambia.

Adult males and children between 4 and 12 years in a subsistence farming community in The Gambia were screened for haematological status. 80 men and 80 children with initially poor status were identified and allocated to three treatment groups comprising: a placebo, ferrous sulphate, and ferrous sulphate with riboflavin. Over a period of 6 weeks of supplementation there was a general improvement in haematological status in the two supplemented groups. The inclusion of riboflavin in the supplement enhanced recovery, particularly in those individuals with strikingly low levels of haemoglobin at the outset.

Adolescent↗

PubMed1983

The effect of vitamin C supplementation on lactating women in Keneba, a West African rural community.

A study of vitamin C requirements was undertaken in the village of Keneba, The Gambia, during the rainy season, when the intake of vitamin C-rich foods is very low. The effect of four supplementary levels of vitamin C (0, 24, 47 and 60 mg/day), together with a milk and biscuit food supplement which provided 34 mg vitamin C/day, was studied for a five-week period. Plasma ascorbate increased from 0.25 to 0.72 mg/dl; buffy coat ascorbate increased from 14.7 to 24.3 micrograms/10(8) cells and breast milk ascorbate increased from 3.4 to 5.5 mg/dl as intake increased from 34 to 103 mg/dl. Breast milk ascorbate approached a plateau at the high intakes. A fasting plasma ascorbate of at least 0.3 mg/dl in 97.5% of the population of lactating women in Keneba would require a daily vitamin C intake of about 117 mg. No differences between vitamin C supplementation levels were observed with respect to changes in plasma iron, total iron-binding capacity or its percentage saturation. Whole blood histamine levels showed a slight downward trend as the vitamin C intake increased.

Adult↗

PubMedDate not supplied

Epidemic measles in a highly immunized rural West African (Gambian) village.

A measles epidemic occurred in a rural West African village, despite documented immunization in 90% of the less than 10-year age group. In contrast to previous epidemics, this outbreak caused no associated deaths among the 54 cases diagnosed. Immunization protected against infection--only 3.6% of immunized children developed measles, whereas 30.1% of those not immunized became ill (P less than .001). Thus, the vaccine efficacy rate was 90.1%. The average age at presentation was 72 months, and older patients were more likely to have severe disease. Nutritional status had no effect on susceptibility to measles infection or on outcome; weight loss (350 +/- 170 g) was most marked during the prodromal phase in young children. Infection was more severe when more than one case was diagnosed in a household (P less than .05) and in conditions of overcrowding, which were also associated with higher infection rates (P less than .02). Although immunization did not stop the spread of the epidemic within the village, a strict quarantine in the medical clinic probably prevented spread to other villages.

Age Factors↗

PubMedDate not supplied

Childhood diabetes.

There has been a quiet revolution in the care of children with diabetes over the last decade. The establishment of child-centred teams together with advances in management help the child achieve a normal lifestyle while avoiding both the long- and short-term complications of diabetes.

Blood Glucose Self-Monitoring↗