Some Environmental Aspects of Ischaemic Heart Disease

IHD from copper deficiency: a unified theory

The theory, in brief outline here, implicating deficiency of Cu in the aetiology and pathophysiology of IHD explains more attributes of the disease than any other theory. This theory satisfies several of Hill's criteria of a half-century ago for deducing association between an environmental feature and presence of an illness. Most important is the temporal association between the rise of IHD and the decrease in dietary Cu since the 1930s along with a parallel increase in the supplementation of pregnant women with Fe, a Cu antagonist. There are more than eighty anatomical, chemical and physiological similarities between animals deficient in Cu and individuals with IHD. Few of these similarities have been produced by other dietary manipulations because feeding cholesterol induces Cu deficiency in animals. The most recent of these to be identified is decreased serum dehydroepiandrosterone. Some concomitant aspects of Cu metabolism and utilisation have been identified in other theories about heart disease: fetal programming, homocysteine, and Fe overload.

Medical Examination in Nutrition Surveys

Pellagra was the most important deficiency disease used as a model for nutrition surveys, because its diagnosis depended on physical signs. By the mid twentieth century, laboratory tests improved the specificity of physical signs in diagnosis of deficiency disease. The author uses his experience in Panama to illustrate how attention to the details of a medical examination can improve accuracy and sensitivity of a nutrition survey.