Low serum cholesterol levels and subclinical malabsorption

Hematocrit and risk of coronary heart disease: the Puerto Rico Health Program

Hematocrit was determined in 2555 rural and 6151 urban men age 45 to 64 years participating in the Puerto Rico Health Program, a prospective epidemiologic study of coronary artery disease (CAD). These participants were reexamined three additional times and mortality by cause and coronary heart disease (CHD) morbidity were carefully documented for 8 years of follow-up. Since hematocrit (Hct) is an indirect measure of blood viscosity, its value an an independent risk factor of CHD was evaluated. Within the Puerto Rican cohort, Hct is slightly lower in older age groups, and appears slightly lower in the rural than in the urban area. In the rural area 4.6% had Hct values below 40%; in the urban area 3.0% were below 40%. A higher Hct level was associated with cigarette smoking, higher relative weight, higher blood pressure, and higher serum cholesterol. An elevated Hct level was also associated with an increased risk of myocardial infarction (MI), coronary insufficiency or CHD death in the urban area. Incidence of MI, coronary insufficiency, or CHD death was more than double in the high hematocrit group (Hct greater than 49%) compared to the low group (Hct less than 42%). Using a multivariate logistic function, the relationship remained statistically significant after adjustment for the above mentioned risk factors. These results provide further insight concerning the issue of the potential impact of elevated Hct as an independent risk factor contributing to the incidence of CHD mortality and morbidity.

Tropical enteropathy in Rhodesia

Tropical enteropathy, which may be related to tropical sprue, has been described in many developing countries including parts of Africa. The jejunal changes of enteropathy are seen in Rhodesians of all social and racial categories. Xylose excretion, however, is related to socioeconomic status, but not race. Upper socioeconomic Africans and Europeans excrete significantly more xylose than lower socioeconomic Africans. Vitamin B12 and fat absorption are normal, suggesting predominant involvement of the proximal small intestine. Tropical enteropathy in Rhodesia is similar to that seen in Nigeria but is associated with less malabsorption than is found in the Caribbean, the Indian subcontinent, and South East Asia. The possible aetiological factors are discussed. It is postulated that the lighter exposure of upper class Africans and Europeans to repeated gastrointestinal infections may accound for their superior xylose absorption compared with Africans of low socioeconomic circumstances. It is further suggested that the milder enteropathy seen in Africa may be explained by a lower prevalence of acute gastroenteritis than in experienced elsewhere in the tropics.

Chronic pancreatitis in African diabetics

Steatorrhea due to chronic pancreatitis was found in 23 percent of a consecutive series of 107 new african diabetics; 3 had pancreatic calcification. Of 16, 14 had definitely abnormal exocirne secretion function testing using secreation pancreozymin stimultion. Themorphology and function of the small intestine were normal by local standards. When compared with diabetics without steatorrhea they weighed less, their fasting blood sugars were lower, and their insulin requirements were greater. High alcoholic intake might be significant cause, but the incidence was similar in the diabetics without steatorrhea. No evidence of childhood or adult malnutrition was established. The etiology of this high incidence of chronic pancreatitis among african diabetics remains unexplained.

Risk factors and prevalence of coronary heart disease in Puerta Rico

In spite of an apparently increasing mortality rate from coronary heart disease in Puerto Rico, the age-specific mortality rate from this illness is considerably lower in the island than in the U. S. mainland. Examination of 9,814 Puerto Rican urban and rural men in the 45 to 64-year age group revealed sizable and statistically significant differences in monthly income, cigarette smoking, ingestion of fats, blood pressure, heart rate, relative weight, serum cholesterol, serum glycerides, prevalence of diabetes, and prevalence of hypertension (lower in rural dwellers), and also in vital capacity, consumption of calories per unit body weight, and physical activity (higher in rural area). No urban-rural difference in coronary heart disease prevalence was found, but the prevalence of definite myocardial infarction, established on basis of electrocardiographic criteria alone, was significantly higher in the 45 to 54-year urban group. Follow-up of this population to study incidence of disease and the influence of the various factors upon the development of disease is being conducted.

Normal absorption in Thai subjects with non-specific jejunal abnormalities

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