Boletin de la Oficina Sanitaria Panamericana. Pan American Sanitary Bureau最新文献

Fortifying sugar with vitamin A was adopted by various Central American countries as their main strategy for reducing vitamin A deficiency in the seventies, but after being in effect a few years, such fortification became lax. Nationwide studies from the late eighties and early nineties showed that vitamin A deficiency was still a widely prevalent public health problem in Guatemala, El Salvador, Honduras, and Nicaragua. The situation led to the reappearance and strengthening of national programs for the fortification of sugar. Experience gathered over the past three years confirms the fact that such fortification is technically feasible and that it is safer, more effective, and more practical than other types of interventions. Essential to the success of this program is the establishment of a reliable and permanent quality control system for guaranteeing that, through sugar, households receive vitamin A in sufficient amounts to complete an adequate dietary supply. At present a quality control system is being implemented at three levels: production, government supervision, and community monitoring. INCAP has developed analytical methodologies that are fit to support control measures in each of these three levels. It is surmised that a program aimed at fortifying sugar with vitamin A, if optimally executed, would render a preventive supplementation program unnecessary. However, constant monitoring and supplementation of natural sources of vitamin A are always recommended in children under 3 and lactating mothers.

The epidemic of neuropathy that arose in Cuba in late 1991 has clinical manifestations similar to those of other neuropathies that are nutritional in origin. In an effort to identify its possible association with the diet, a case-control study was conducted at the beginning of the epidemic in Isla de la Juventud. Dietary intake was assessed through a semi-quantitative survey of consumption frequency obtained by direct personal interviews, and measurements were taken of the weight, height and skin fold thickness of 34 cases and 65 controls. As compared to controls, cases showed more pronounced weight loss prior to becoming ill, a lower body mass index (BMI), a lower percentage of body fat, and a poorer diet. According to odds ratios (OR) resulting from the separate analysis of each variable, factors associated with illness were weight loss, low BMI, low weight for height, a lower consumption of bread and rice, a less balanced diet, lack of milk intake, an intake of sugar greater than 15% of total energy consumed, consumption of alcohol, and smoking. The association was protective in the case of beans, tubercles, starchy roots, oil, and meat substitutes made from soy. Multifactorial analysis revealed higher OR values, adjusted for smoking and alcohol consumption, for intakes of less than 50% of the recommended daily allowance of protein, pyridoxine, thiamine, energy, vitamin E, niacin, folic acid, fat, riboflavin, and vitamin A. The results of this analysis show that tobacco and alcohol promote the effects of a deficient diet, but do not in and of themselves explain the association. A global analysis of these results leads to the conclusion that a diet poor in energy, calories, fats, and those micronutrients that have come under study, and that is unbalanced because of a relative excess of sugars, with its resulting effect on body weight, is strongly associated with and causally related to epidemic neuropathy.

The purpose of this monograph is to describe the sociodemographic and health characteristics of individuals who identified themselves as diabetics (through self-notification) in a national health survey that was conducted in Mexico in 1988 and in which information about more than 200,000 persons was collected by interviewing an adult member of each household. Of the population surveyed, 1.2% stated being diabetic, and it was noted that the frequency of the disease increased with age and socioeconomic status and that it was 30% higher in women than in men. Diabetics had higher notification rates for hypertension, heart disease, and blindness than the rest of the population. Twenty percent of diabetic patients and 12% of nondiabetic individuals smoked. People with diabetes consulted physicians twice as often as nondiabetics and their chances of being hospitalized were four times higher. At the end we discuss the limitations and possible biases of self-notification as a method for detecting diabetics. Finally we conclude that diabetes is an important health problem in Mexico and that it warrants more attention from epidemiologists and other public health specialists.