Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren

Background

Intestinal parasitic infections are a public health problem in developing countries such as Mexico. As a result, two governmental programmes have been implemented: a) "National Deworming Campaign" and b) "Opportunities" aimed at maternal care. However, both programmes are developed separately and their impact is still unknown. We independently investigated whether a variety of socio-economic factors, including maternal education and employment levels, were associated with intestinal parasite infection in rural school children.

Methods

This cross-sectional study was conducted in 12 rural communities in two Mexican states. The study sites and populations were selected on the basis of the following traits: a) presence of activities by the national administration of albendazole, b) high rates of intestinal parasitism, c) little access to medical examination, and d) a population having less than 2,500 inhabitants. A total of 507 schoolchildren (mean age 8.2 years) were recruited and 1,521 stool samples collected (3 per child). Socio-economic information was obtained by an oral questionnaire. Regression modelling was used to determine the association of socio-economic indicators and intestinal parasitism.

Results

More than half of the schoolchildren showed poliparasitism (52%) and protozoan infections (65%). The prevalence of helminth infections was higher in children from Oaxaca (53%) than in those from Sinaloa (33%) (p < 0.0001). Giardia duodenalis and Hymenolepis nana showed a high prevalence in both states. Ascaris lumbricoides, Trichuris trichiura and Entamoeba hystolitica/dispar showed low prevalence. Children from lower-income families and with unemployed and less educated mothers showed higher risk of intestinal parasitism (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.6–22.6; OR 4.5, 95% CI 2.5–8.2; OR 3.3, 95% CI 1.5–7.4 respectively). Defecation in open areas was also a high risk factor for infection (OR 2.4, 95% CI 2.0–3.0).

Conclusion

Intestinal parasitism remains an important public health problem in Sinaloa (north-western Mexico) and Oaxaca (south-eastern Mexico). Lower income, defecation in open areas, employment status and a lower education level of mothers were the significant factors related to these infections. We conclude that mothers should be involved in health initiatives to control intestinal parasitism in Mexico.

[Prevalence of overweight and obesity in northwest Mexico by three references of body mass index: differences in classification]

The objective of this study was to compare the prevalence of overweight and obesity in children from northwest of Mexico based on BMI/age and three criteria of growth reference standards. Six hundred and four children, 6 to 10 years of age, from 17 municipalities of the state of Sonora were measured for weight and height and age established from birth certificate school records. The prevalence of overweight and obesity was determined by the new version of the US Centers for Disease Control and Prevention (CDC/NCHS), the International Obesity Task Force (IOTF) and the values proposed by The World Health Organization (WHO) that was utilized in the National Nutrition Survey of 1999 in Mexico (ENN). Using the WHO reference, prevalence of overweight and obesity was 39%. This was higher than the CDC/NCHS (20%) and IOTF (17%) references, respectively. Prevalence of overweight and obesity by CDC/NCHS and IOTF criteria, showed the best agreement (Kappa >80); this was not the case when prevalence from CDC/NCHS and IOTF were compared to the WHO criteria (Kappa <40). For overweight and obesity frequencies, no sex or urban-rural differences were observed (p>0.05). In conclusion, the use of these 3 reference values systems using BMI/ age did not show the same prevalence estimates of overweight and obesity. The use of the WHO method can overestimate the prevalence of obesity in children, therefore the use of these 3 references should be considered for future comparisons.

Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S

OBJECTIVE

Type 2 diabetes and obesity have genetic and environmental determinants. We studied the effects of different environments on these diseases in Pima Indians in Mexico and the U.S.

RESEARCH DESIGN AND METHODS

Adult Pima-Indian and non-Pima populations in the Sierra Madre mountains of Mexico were examined using oral glucose tolerance tests and assessments for obesity, physical activity, and other risk factors. Results were compared with those from Pima Indians in Arizona. Both Pima populations were typed for DNA polymorphisms to establish their genetic similarity.

RESULTS

The age- and sex-adjusted prevalence of type 2 diabetes in the Mexican Pima Indians (6.9%) was less than one-fifth that in the U.S. Pima Indians (38%) and similar to that of non-Pima Mexicans (2.6%). The prevalence of obesity was similar in the Mexican Pima Indians (7% in men and 20% in women) and non-Pima Mexicans (9% in men and 27% in women) but was much lower than in the U.S. Pima Indians. Levels of physical activity were much higher in both Mexican groups than in the U.S. Pima Indians. The two Pima groups share considerable genetic similarity relative to other Native Americans.

CONCLUSIONS

The much lower prevalence of type 2 diabetes and obesity in the Pima Indians in Mexico than in the U.S. indicates that even in populations genetically prone to these conditions, their development is determined mostly by environmental circumstances, thereby suggesting that type 2 diabetes is largely preventable. This study provides compelling evidence that changes in lifestyle associated with Westernization play a major role in the global epidemic of type 2 diabetes.

[The menarche age in teenagers of the Northwest of Mexico]

The beginning of sexual maturity in individuals is a measure commonly used as an indicator of a population's quality of life. Among women, one of the most frequently used indicators is the age of menarche. The objectives of this research were to obtain the age of menarche in school age girls from the Northwest of Mexico, and to establish the relationship between the latter with their socioeconomic level, body weight, and height. The sample was taken from 857 girls between 7 and 17 years old from different socioeconomic level sectors. The age of menarche of these girls was determined by the statu quo method. The value found for menarche was 12.06 +/- 0.44 years old. We also found an association of menarche to height (p < 0.01) and to socioeconomic level (p < 0.01). The value for age of menarche in this study was similar to the one reported for other Latin-American populations. Taking into consideration that approximately 70% of the Mexican population has been considered of low income level and that the environmental conditions are not entirely favorable, it is possible that this could be the result of genetic and environmental interactions.

Total energy expenditure, resting metabolic rate and physical activity level in free-living rural elderly men and women from Cuba, Chile and México

OBJECTIVE

The objective of this study was to assess total energy expenditure (TEE), resting metabolic rate (RMR) and physical activity level (PAL), and to estimate energy requirements (ERs) in free-living elderly subjects from Cuba, Chile and Mexico.

DESIGN

Cross-sectional study designed to estimate ERs.

SETTING

Rural regions of Cuba, Chile and Mexico.

SUBJECTS

Forty subjects >60 years old were selected to participate in this study.

INTERVENTIONS

A dose of doubly labeled water (DLW) was administered and urine samples were collected in the following 12-14 days. From the isotopic analysis, TEE was derived. RMR was measured by indirect calorimetry.

RESULTS

TEE in Chilean (8.8+/-1.6 MJ/day) and Cuban (8.3+/-1.3 MJ/day) elderly was not different, and was higher for the Mexican group (9.5+/-1.5 MJ/day) (P < 0.0001). RMR was not different between countries. PAL and activity energy expenditure (AEE) were only different between Chile and Mexico (P < 0.002). For the three regions, overall PALs were 1.70+/-0.16 for male and 1.62+/-0.13 for female subjects (P < 0.02), and AEE was 3.05+/-0.66 and 2.27+/-0.66 MJ/day for male and female subjects, respectively (P < 0.001). Predictive equations (MJ/day) were RMR = 1.6447 + 0.05714 x weight (kg) + 0.449 sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.479) and TEE = 3.414 + 0.0795 x weight (kg) + 1.227 x sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.668).

CONCLUSIONS

There were differences in TEE and PAL owing to sex and region. The average PAL in men was higher than the PAL reported either with factorial approach or with the DLW method in elderly. Predictive ER equations based on RMR and TEE gave very similar results to calculations from the 2004 FAO/WHO/UNU report.

Impact of lifestyle on prevalence of kidney disease in Pima Indians in Mexico and the United States

Pima Indians in the United States and Mexico share a common genetic background but have very different lifestyles. Comparisons were made of the frequency of obesity, diabetes, hypertension, and kidney disease in these geographically separated but susceptible populations. Mexican Pimas had higher levels of physical activity, less obesity, and a lower prevalence of diabetes than their US Pima counterparts. Mean blood pressure rose with worsening glucose tolerance, and the prevalence of elevated urinary albumin excretion was higher in patients with diabetes than in those without, regardless of whether they lived in the United States or Mexico. These findings illustrate the importance of lifestyle in the development of diabetes and in the subsequent occurrence of diabetic kidney disease.

[Effect of a School Breakfast Program on the prevalence of obesity and cardiovascular risk factors in children]

OBJECTIVE

To determine the effect of a School Breakfast Program on obesity and some cardiovascular risk factors in 6 to 10 year old schoolchildren.

MATERIAL AND METHODS

A quasi-experimental prospective study was conducted in 2002-2003, in 17 municipalities of Sonora State, Mexico. The intervention group consisted of 254 children participating in a School Breakfast Program (SBP group). The control group (NSBP group, n=106) included children who did not participate in the program. In both groups the body mass index for age (BMI/age) and body composition by electrical resistance using bioelectrical bioimpedance analysis (BIA) were estimated at the beginning and at the end of a 9-month period. In a subgroup of 264 school-children (SBP and NSBP children), serum cholesterol, triglycerides and fasting glucose were measured at the start and at the end of the program.

RESULTS

The body mass index in the SBP and NSBP groups was not different at the start or at the end of the school period (p>0.05). The proportion of overweight and obese children and the percentage fat remained similar in both groups. However, the lean mass increased (p>0.05) at the end of the school period in both groups, and hence, cannot be attributed to the program. The biochemical parameters showed no change (p>0.05) in blood glucose, total serum cholesterol, and triglycerides in either group at the end of the school period.

CONCLUSIONS

Study results showed no evidence of a negative effect of SBP in terms of risk factors for obesity and cardiovascular disease.

Prevalence and intensity of intestinal parasitic infections in relation to nutritional status in Mexican schoolchildren

Undernutrition and intestinal parasitic infections affect childhood development and morbidity in many developing countries. Undernutrition may increase susceptibility to parasitic infections which in turn impair the nutritional status of the host. The relationship between intestinal parasitic infections and nutritional status in 400 Mexican schoolchildren was investigated. More than half of the children in the study showed intestinal parasites and polyparasitism. The prevalence of helminth infections was significantly higher in Oaxaca than in Sinaloa (P < 0.05). Z scores for weight-for-age (WA) and height-for-age (HA) were much lower in children of Oaxaca than in Sinaloa (P < 0.001). A significantly higher Z score for weight-for-height (WH), WA, and HA were found in non-infected versus infected children (P < 0.05). Higher prevalences of intestinal infections were found in children with lower HA and WA than in normally nourished children (P < 0.05). Higher intensities of Ascaris lumbricoides and Trichuris trichiura were found in the schoolchildren of Sinaloa than in Oaxaca (P < 0.01). Negative and significant associations were found between Hymenolepis nana and T. trichiura infection (eggs per gram) and nutritional status. Intestinal parasitic infections may be regarded as main risk factors associated with poor nutritional status in Mexican schoolchildren.

The usefulness of stable isotopes in nutrition and human health: the application of mass spectrometry and 13C-breath tests to detect helicobacter pylori infection

The interest in Helicobacter pylori has escalated in recent years. H. pylori may produce a chronic gastric infection which is usually life-long and many epidemiological studies have shown that this is the most common bacterial infection throughout the world involving 50% of the world population. Thus, it is clear that the diagnosis of H. pylori infection represents at least a key step in the management of many of the patients referred to the gastroenterologist. Additionally, due to the wide range and relevance of pathologies possibly related to this infection, from micronutrient malnutrition and co-infections to malignancies, there is the potential for H. pylori to be a major health problem. Improved methods for the diagnosis and follow up treatment of the infection have been developed. Use of stable isotopes as non-invasive and safe diagnostic methods, namely (13C) breath tests, has been the key to a new era of research in H. pylori epidemiology and diagnosis as well as the establishment of eradication therapies. This non-invasive nuclear technique, that is considered the gold standard for the diagnosis of this bacterial infection, has successfully been standardized and implemented along Latin America. Taking into account the high prevalence of this bacterial infection, the impact of this technique in the whole region is very high. In this article we discuss several aspects of this methodology in order to harmonize the application of this method in developing regions.

Body Composition by Three-Compartment Model and Relative Validity of Some Methods to Assess Percentage Body Fat in Mexican Healthy Elderly Subjects

BACKGROUND

In Mexico, there is scarce information about the body composition in the elderly. Some researchers have measured body fat by anthropometry and bioelectrical impedance. These techniques are practical and can be used in the field; however, proper validation is required. This implies the use of accurate and precise methods. In the elderly, Siri's three-compartment (3C) model has been proposed as feasible alternative to the gold standard four-compartment model.

OBJECTIVE

To evaluate the body composition by the 3C model and the relative validity of densitometry and hydrometry methods to assess the percentage body fat (%BF) in 37 healthy Mexican elderly subjects.

METHODS

The body density was measured by air displacement plethysmography, total body water was evaluated by means of an isotopic dilution technique, and two different hydration factors were used to determine the fat-free mass. These measurements were used to calculate %BF by the 3C model. Accuracy and precision of the methods were tested by a two-way analysis of variance and regression procedures and bias by Bland and Altman analysis.

RESULTS

In men and women as a whole group, the %BF by the 3C model was 34.4 +/- 8.01. Women had higher values of %BF as compared with men (41.7 +/- 3.7 vs. 29.4 +/- 6.4; p < 0.0001). The regression procedures showed that air displacement plethysmography was accurate and precise only in women and in the whole group. Regression analyses of %BF by total body water (using both hydration factors) and 3C model showed that the intercepts were not different from zero and that the slopes were not different from 1.0 in men and women separately and as group.

CONCLUSION

In this study, the total-body water method revealed a good relative validity (accuracy, precision, and freedom from bias) as compared with the 3C model in men and women both separately and as a group and may be acceptable for the estimation of %BF in individuals or groups of healthy elderly subjects.

Determination of body composition using air displacement plethysmography, anthropometry and bio-electrical impedance in rural elderly Mexican men and women

BACKGROUND AND AIMS

Air displacement plethysmography with the BOD-POD is a new densitometry technique, and has been found to be an accurate method to measure body composition. The aim of this study was to assess body composition in a group of free living healthy subjects 60 years of age or older from a rural area of Northwest Mexico, and to evaluate body composition by anthropometry and bioelectrical impedance (BIA) using equations reported for other elderly populations.

METHODS

Body composition was evaluated in 21 women and 26 men with the BOD-POD, by anthropometry, and BIA and compared to different equations using the Bland- Altman procedure.

RESULTS

Body fat in elderly women and men was 42.7 and 30.2 % respectively. In women, Segal's equation using BIA 1, based on standing height, showed no significant differences with the BOD-POD. There was satisfactory agreement between Segal's equation and BOD-POD. In men similar results was found with Deurenberg's equation using B1A 2 based on recumbent length.

CONCLUSIONS

Segal's and Deurenberg's equations were accurate and precise for the estimation of body fat in the elderly of this study. The use of these equations could improve the estimation of body composition for similar elderly subjects. Further studies are recommended with a larger size samples to include elderly subjects from other Latin American countries.

Estimation of body fatness from body mass index and bioelectrical impedance: comparison of New Zealand European, Maori and Pacific Island children

OBJECTIVE

To compare percentage body fat (%BF) for a given body mass index (BMI) among New Zealand European, Maori and Pacific Island children. To develop prediction equations based on bioimpedance measurements for the estimation of fat-free mass (FFM) appropriate to children in these three ethnic groups.

DESIGN

Cross-sectional study. Purposive sampling of schoolchildren aimed at recruiting three children of each sex and ethnicity for each year of age. Double cross-validation of FFM prediction equations developed by multiple regression.

SETTING

Local schools in Auckland.

SUBJECTS

Healthy European, Maori and Pacific Island children (n=172, 83 M, 89 F, mean age 9.4+/-2.8(s.d.), range 5-14 y).

MEASUREMENTS

Height, weight, age, sex and ethnicity were recorded. FFM was derived from measurements of total body water by deuterium dilution and resistance and reactance were measured by bioimpedance analysis.

RESULTS

For fixed BMI, the Maori and Pacific Island girls averaged 3.7% lower %BF than European girls. For boys a similar relation was not found since BMI did not significantly influence %BF of European boys (P=0.18). Based on bioimpedance measurements a single prediction equation was developed for all children: FFM (kg)=0.622 height (cm)(2)/resistance+0.234 weight (kg)+1.166, R(2)=0.96, s.e.e.=2.44 kg. Ethnicity, age and sex were not significant predictors.

CONCLUSIONS

A robust equation for estimation of FFM in New Zealand European, Maori and Pacific Island children in the 5-14 y age range that is more suitable than BMI for the determination of body fatness in field studies has been developed.

Body composition by hydrometry (deuterium oxide dilution) and bioelectrical impedance in subjects aged >60 y from rural regions of Cuba, Chile and Mexico

BACKGROUND

In Latin American and Caribbean countries such as Chile, Mexico and Cuba, the population over 60 y has increased steadily. In this age group, there is scarce information about body composition, particularly for those living in rural areas.

OBJECTIVE

The purpose of this study was to determine body composition in free-living and healthy elderly subjects >60 y from rural areas of Chile, Cuba and Mexico using deuterium oxide dilution and bioelectrical impedance (BIA) and to develop and cross-validate a predictive equation for this group of subjects by BIA for future use as a field technique.

SUBJECTS

The study included 133 healthy subjects (73 males and 60 females) >60 y from rural regions of Cuba, Chile and Mexico.

MEASUREMENTS

Total body water, body weight, height and other anthropometric and BIA variables (resistance and reactance) were measured.

METHODS

Total body water was determined by deuterium oxide dilution, and fat-free mass (FFM)/fat mass were derived from this measurement. The total sample was used in a split-sample internal cross-validation. BIA and other anthropometric variables were integrated to multiple regression model to design the best predictive equation, which was validated in the other sample. ANOVA, multiple regression and Bland and Altman's procedure were used to analyze the data.

RESULTS

Body weight, percentage of fat and fat-free mass were lower in the Cuban men and women compared with Chilean and Mexican men and women. The best predictive equation of the FFM was: FFM kg=(-7.71+(H(2)/R x 0.49)+(country or ethnicity x 1.12)+(body weight x 0.27)+(sex x 3.49)+(Xc x 0.13)), where H(2) is height(2) (cm); R is resistance (Omega); country: Chile=1, Mexico=2 and Cuba=3; sex: women=0 and men=1; body weight (kg) and Xc is reactance (Omega). R(2) was 0.944 and the root mean square error (RMSE) was 2.08 kg. The mean+/-s.d. of FFM prediction was 44.2+/-9.2 vs 44.6+/-10.1. The results of cross-validation showed no significant difference with the line of identity, showing that the predicted equation was accurate. The intercept (=-0.32) was not significantly different from zero (P=0.89) and the slope (=1.02) not significantly different from 1.0 (P>0.9). The R(2) was 0.86, RMSE=3.86 kg of FFM and the pure error was 3.83.

CONCLUSION

The new BIA equation is accurate, precise and showed good agreement. The use of this equation could improve the estimates of body composition for the elderly population for these regions, as well as enhancing the opportunity to conduct studies in the elderly population from Latin America.

Nuclear techniques in nutrition and health: importance and applications in developing regions

Nuclear and isotope methods in one form or another are regarded as essential tools for carrying out nutrition research besides enhancing sensitivity of nutrition monitoring techniques. They have been used extensively in industrialized countries to analyse human energy requirements, body composition including bone mineral density, and the metabolism of important nutrients such as protein, fat, vitamins and minerals. The information acquired has led to many improvements in nutrition and health. Currently, several strategic applications of isotopic techniques are being introduced in developing countries where they can benefit millions through monitoring improvement in nutritional status, and serve as specific indicators of broader social and economic advances.

Measuring the intakes of foods and nutrients of marginal populations in north-west Mexico

OBJECTIVE

To describe methodological issues regarding the measurement of food intake of marginal populations in the north-west of Mexico.

METHODS

Dietary data from three sources were analysed. The Sonora State Food Basket Study (505 individuals from all ages, both sexes, high, medium and low income, and from urban and rural settings), 144 individuals from rural Indian communities, and 152 low-income urban women. Methods of dietary data collection were single 24-hour recalls for the first two studies, and four non-consecutive 24-hour recalls as well as a food-frequency questionnaire (FFQ) for low-income urban women.

RESULTS

The food patterns in the three studies showed similar core foods; however, food diversity resulted in 19, 13 and 57 different foods reported by 90% of the population in the state, Indian communities and urban women, respectively. Mean intakes of selected food components in the sample of urban women vs. a representative sample of the population of the state were similar, although smaller variation in consumption was observed in urban women with repeated 24-hour recalls. Inter-individual variation in intake of food components was similar in the state and urban women samples, but the Indian communities showed lower coefficients of variation (CVs). Use of four 24-hour recalls decreased the inter-individual variation in food component intakes of low-income urban women, especially for vitamin intakes. The FFQ did not show an additional decrease in inter-individual variation for macronutrients, but reduced even more the CVs for vitamins. Intra-individual variation was higher than inter-individual variation for urban women's intakes when estimated by repeated 24-hour recalls. This effect was reversed when estimated by duplicate food frequencies. Ratios of intra-individual to inter-individual variation in food intake were lower for Mexican when compared with US women. These results should be considered, especially for association analysis of low-income women's diets and health outcomes.

Body composition in Mexican adults by air displacement plethysmography (ADP) with the BOD-POD and deuterium oxide dilution using infrared spectroscopy (IRS-DOD)

Thirty four subjects (13 men and 21 women), 24 to 70 years old from northern Mexico, were measured for body density by air displacement plethysmography (ADP) with the BOD-POD, and for total body water by deuterium oxide dilution and infrared spectroscopy (IRS-DOD). Subjects were given a 30 g dose of deuterium oxide. Saliva samples were filtered, sublimated, and deuterium was measured using a Miran 1 FF, IRS. Linear regression of the fat mass (FM) derived from both methods showed that the intercept (0.071) was not different from zero (p = .96) and the slope was 0.96 (p < .0001) demonstrating the techniques to be equivalent. Further, mean FM was 26.7 +/- 12.4 and 25.6 +/- 12.4 kg, for IRS-DOD and ADP techniques, respectively (p = .08). Precision analysis by the model R2 showed that 92.3% of the variability was explained (SEM = 3.4 kg). Bland-Altman analysis showed no significant bias (r = 0.017; p = .93). Mean difference between methods was -1.08 (CI: -2.3 to + 0.13) kg FM.

Isotopic tools for strengthening health and nutritional monitoring and their current applications in developing regions of the world

Nuclear and isotope methods in one form or another are regarded as essential tools for carrying out nutrition research besides enhancing sensitivity of nutrition monitoring techniques. They have been used extensively in industrialized countries to analyze human energy requirements, body composition including bone mineral density, to determine food composition, and to study metabolism of important nutrients such as protein, fat, vitamins, and minerals. The information acquired has led to many improvements in nutrition and health. Importantly, the developmental needs of countries in economic transition are being increasingly identified and resolved through field applications of isotopic tools, thus strengthening health and nutrition monitoring. Currently, several strategic applications of isotopic techniques are being introduced in developing countries where they can benefit millions through monitoring improvement in nutritional status, and serve as specific indicators of broader social and economic advances. These examples are highlighted in this report.

Measurement of deuterium oxide by infrared spectroscopy and isotope ratio mass spectrometry for quantifying daily milk intake in breastfed infants and maternal body fat

Measurements of deuterium oxide concentrations (DOC) in saliva by infrared spectroscopy (IRS) and isotope ratio mass spectrometry (IRMS) were compared for the calculation of infants' milk intake and maternal body fat. Deuterium oxide (30 g) was given to the mother. DOC by IRS and IRMS were 340 +/- 209 and 345 +/- 202 ppm. The mean difference between both methods (4.62 +/- 76.3) was not different from zero (p = .57). Bland and Altman analysis showed no significant overall bias (r = 0.10; p = .33), but dispersion within the limits of agreement. The mean milk intake in the infants' by IRS and IRMS were 624 +/- 296 g/day and 634 +/- 327 g/day (p = .642) and the mothers' mean body fat were 31.3 +/- 12% and 31.5 +/- 13% (p = .755). The results appear to be the same for milk intake and body fat by the two methods and no evidence of bias was found.

Effects of asymptomatic Giardia intestinalis infection on carbohydrate absorption in well-nourished Mexican children

The aim of this study was to evaluate carbohydrate absorption in well-nourished children with asymptomatic giardiasis. Two groups were selected based on results of stool examination of 211 children attending pre-school centers in Hermosillo, Sonora, Mexico: a control group of six non-infected children, and an infected group of seven children harboring Giardia intestinalis, without gastrointestinal symptoms of disease. Carbohydrate absorption was determined in the control group, before and after drug therapy in the infected group by the hydrogen breath test. Hydrogen production after lactose ingestion was higher in children with giardiasis compared with control group and after anti-parasite treatment; however, hydrogen production was not high enough to classify children as lactose malabsorbers by the cut-off criteria. Similar results were obtained for xylose absorption. None of the children had hydrogen increments high enough to be considered xylose malabsorbers. In conclusion, children asymptomatically infected with G. intestinalis showed significantly higher hydrogen production. However, the biological relevance is questionable since they did not exceed cut-off criteria to classify them as carbohydrate malabsorbers.

Dietary fiber and lifestyle influence serum lipids in free living adult men

OBJECTIVE

The aim of this study was to determine the effect of dietary fiber consumption and lifestyle on serum lipids in adult men with non-restricted diet and physical activity.

METHODS

Two groups of 19 men were classified as high (48 g/day) and low fiber groups (27 g/day). Anthropometry, food frequency, daily weighed intakes and physical activity were done for a seven-day period. Fasting blood was collected and serum was analyzed for triglycerides, total cholesterol and lipoprotein cholesterol fractions.

RESULTS

Crude correlation coefficients showed that total cholesterol was negatively associated with physical activity, total dietary fiber and P/S ratio (r = 0.52; p < 0.001. r = -0.44; p < 0.01, r = 0.51, p < 0.001). LDL-C was also correlated negatively with total dietary fiber and P/S ratio (r = -0.34, p < 0.03; r = -0.53, p < 0.01). It was also positively associated with dietary cholesterol and body weight (r = 0.34, p < 0.03; r = 0.31, p < 0.05). Serum triglycerides had an inverse association with total dietary fiber and physical activity (r = -0.30: p < 0.05; r = -0.45, p < 0.004). After controlling for energy intake, total fat, saturated fat, dietary cholesterol, physical activity and body mass index, LDL-C/HDL-C, and TC/HDL-C, remained significantly associated with dietary fiber (r = 0.34; p < 0.05 and r = -0.38; p < 0.02, respectively).

CONCLUSIONS

This study provides evidence in free living men that there is an association between dietary fiber intake and favorable lipid status and that lifestyle defined by socioeconomic status, physical activity and the quality of the dietary fat intake can play an important role. Public health nutrition advice and policy should continue to emphasize the importance of these factors.

Response to liposomal doxorubicin and clinical outcome of HIV-1-infected patients with Kaposi's sarcoma receiving highly active antiretroviral therapy

PURPOSE

HIV-associated Kaposi's sarcoma (KS) may not resolve despite highly active antiretroviral therapy (HAART). Moreover, the therapeutic goal has shifted from palliative care to long-term durable complete remission. The objective of the study was to assess the impact of liposomal doxorubicin in the treatment of HIV-associated KS in the HAART era.

METHOD

In this prospective, noncomparative, multicenter study, patients with more than 10 cutaneous lesions or visceral disease were treated with 20 mg/m(2) of liposomal doxorubicin (Caelyx) every 3 weeks in addition to their antiretroviral therapy. In addition to tumor measurements and laboratory tests, human herpes virus 8 (HHV-8) polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC) was performed.

RESULTS

Out of 79 participants enrolled in the study, 47 (59%) had stage T(1), 41 (52%) I(1), and 32 (40%) S(1). Nine individuals were not evaluable for response, 32 (40%) had complete response, 30 (38%) partial response, 5 (6%) stable disease, and 3 (4%) progression. Regression analysis did not find any statistically significant factor predicting response. HHV-8 PCR was positive in 37/53 (70%) patients with available PBMC samples, and HHV-8 viremia cleared in 14/27 (52%) without correlation with clinical response. Eleven (14%) participants experienced a relapse of KS, while at the last update of data, 49 (62%) remained stable. The only risk factor for recurrence identified was the follow-up time (odds ratio [OR] 1.21, 95% CI 1.07-1.36; p =.002).

CONCLUSION

The response rate of AIDS-associated KS to liposomal doxorubicin administered with HAART was high, and most often the response was durable. HHV-8 viremia did not correlate well with clinical outcome.