To evaluate the iodine status of Dutch adults we used three different iodine status indicators, namely urinary 24-hour iodide excretion (I/24 h), iodide/creatinine ratio in 24-hour urine samples (I/Cr) and 24-hour iodide excretion per kilogram body weight (I/kg). Additionally, the habitual daily iodine intake was calculated. Men had higher mean I/24 h and mean iodine intake than women. No differences between men and women were found for mean I/Cr and mean I/kg. Relatively high (greater than or equal to 18%) prevalences of low values for the different iodine status indicators were found, especially for I/24 h. The intraindividual variance for all three indicators was high. Risk assessment regarding iodine supply, based on urinary iodide excretion, depends on the indicator used, and therefore caution is called for when drawing conclusions. Our results do not argue against the usage of I/24 h as iodine status indicator. More research is needed to solve the question whether iodine requirement depends on such factors as body size, body composition and physical activity.

To assess the food intake and to evaluate the relationship between socioeconomic status (SES) and food consumption of northeastern Thai children a dietary survey was carried out among 108 urban and rural 3-8-year-olds in Sakon Nakhon province. Energy and nutrient intakes were assessed by the 24 hour recall method and calculated with local food consumption tables. Urban children consumed significantly more eggs and products containing animal proteins than rural children. In urban areas the percentage of users of meat, eggs, and fruit was significantly higher than in rural areas; fish was consumed more frequently in rural areas. As compared with the FAO/WHO RDA (Recommended Daily Allowances) all children showed a very inadequate supply of energy, calcium, iron (except urban children), vitamin A, thiamin, riboflavin, and niacin. The mean daily protein intake was almost equal to or higher than the calculated requirements. Children of lower socioeconomic background showed a lower fat intake, a lower contribution of fat to the energy intake, and a higher contribution of carbohydrates to the energy intake than children from families with a higher SES. This study shows that nutrient intakes far below recommended intakes are common among the examined northeastern Thai children and of a serious nature, and that much more emphasis needs to be given to increase the energy or food intake rather than the protein content of their grossly inadequate diets.

To assess the prevalence and species of intestinal parasitoses and to evaluate the effects of parasitic infections on the nutritional health of northeastern Thai children a survey was carried out among 343 urban and rural 3-8-year-olds in Sakon Nakhon province. Approximately 57% suffered from single or multiple helminthiasis (ancylostomiasis (AD), ascariasis (AL), opisthorchiasis (OV) and/or strongyloidiasis (SS)) and/or giardiasis (GL). In rural areas the prevalence of AD and SS was higher than in urban areas (p less than 0.01 and p less than 0.05 respectively). OV was found more frequently among 6-8-year olds (18%) than among 3-5-year olds (5%); among 3-5-year olds the prevalence of GL was higher than among 6-8-year olds (17 vs 8%). Multiple infections were observed in 13% of the children. Infected children showed lower daily intakes of protein, iron and riboflavin as well as lower menas for haemoglobin, haematocrit, serum ferritin, and Z-score height for age than non-infected children. The prevalence of stunted children was lower among non-infected children (32%) than among infected children (53%), and children with AL (49%), SS (55%), and GL (45%). Anaemia was found more frequently among the infected children (59%) and GL-children (61%) than among non-infected children (42%). Inadequate daily intake of energy and nutrients of most of the children, in combination with parasitic infections, still common in rural northeast Thailand, was shown to result in a serious public health problem.

A cross-sectional study, a follow-up study, and an intervention trial were carried out to investigate the association between mild vitamin A deficiency and the occurrence of diarrhea and respiratory diseases. Cross-sectional analysis was performed among 1,772 children, aged 1-8 years, in the Sakon Nakhon province of northeastern Thailand. Children with a history of diarrhea or respiratory disease had lower levels of serum retinol and retinol-binding protein. Adjusted for age, sex, nutritional status, and level of urbanization, logistic regression using data for 877 children showed a negative association between serum retinol and both diarrhea and respiratory diseases. A follow-up three months later (n = 146 children) showed that children with deficient serum retinol (less than 0.35 mumol/liter) had a fourfold greater risk of respiratory disease (p less than 0.01). No relation was found for diarrhea. An intervention trial (n = 166 children aged 1-5 years) showed that, during 2 months of follow-up after administration of oral vitamin A (200,000 IU), the control group (aged 3-5 years) had a higher incidence of respiratory disease (2.9 times) as well as diarrhea (3.1 times). Between 2 and 4 months, a significantly (p less than 0.025) higher incidence of respiratory diseases (2.5 times) could be observed in children aged 1-2 years. This study supports earlier reports on a greater risk of respiratory diseases and of diarrhea in mild vitamin A deficiency. Supplementation reduced the incidence of both diarrhea and respiratory disease for a period of at least 2 months.

To investigate the association between vitamin A and iron metabolism, two studies were carried out: a cross-sectional study and an intervention trial. The cross-sectional analysis was carried out in 1060 children aged 1–8 y. Multiple-regression analysis was used to adjust for effects of age, gender, indices of the protein nutritional status, and infections. Retinol was significantly associated with hematocrit, serum Fe, transferrin, ferritin, and saturation of transferrin (%ST). To obtain further evidence as to whether this observed association is a causal one, an intervention trial was carried out. After collection of the baseline data of 300 children, 166 children with a hemoglobin concentration less than 7.5 mmol/L were selected. A random sub-sample of 78 children received vitamin A capsules; the other children served as control subjects. Two months after supplementation significant differences, adjusted for age, were found for retinol, retinol-binding protein, serum Fe, and %ST between the supplemented and the control group. After 4 mo none of the indices were found to be significantly different between the supplemented and the control group. Periodic massive doses of vitamin A may play a role in improving the Fe status as well.

An epidemiologic survey of the prevalence of xerophthalmia and vitamin A deficiency was conducted in May and June 1985 in a multistage random sample of 1,772 children 1-8 years of age from 16 rural villages and the capital city of the Sakon Nakhon province in northeastern Thailand. Data of clinical eye examinations were available for 92% (n = 903) of the eligible children aged 1-5 years (n = 982); history of night blindness was obtained from a reliable source from 93% (n = 1,644) of the whole sample; and biochemical data were available for 60% (1,060) of the children examined. The distribution of clinical signs of xerophthalmia and serum retinol levels differed between the rural and urban areas. In the urban area, no signs of xerophthalmia or deficient serum retinol levels were found in the preschool children examined. The prevalence of night blindness in the rural area was 1.3% in children aged 1-5 years (95% confidence interval (Cl) 0.7-1.9); Bitot's spots were seen in 0.4% (95% Cl 0.1-1.0); 12.7% (95% Cl 9.9-15.5) showed deficient serum retinol levels (less than 0.35 mumol/liter). Of the children aged 1-8 years, 9.6% (95% Cl 7.8-11.4) showed deficient serum retinol levels. In the rural area, the prevalence of night blindness, Bitot's spots, and deficient serum retinol levels indicates a problem of public health importance according to World Health Organization criteria.

The influence of external abdominal irradiation and cytostatic therapy on the vitamin status was studied in patients with cancer of the uterus, bladder or prostate and in patients with malignant lymphoma. It was found that the vitamin status of these patients at the beginning of therapy in general was adequate, though vitamin A and vitamin D levels were reduced. During radiotherapy decreases of vitamin E, vitamin C, vitamin B12 and folic acid levels were observed. Chemotherapy caused a decrease of the folic acid levels after a few months. No clinical symptoms of vitamin deficiency were observed.

Changes in dietary intake, nutritional status, body composition and well-being were studied in 108 cancer patients over a period of 20 weeks. The patients, constituting a group of elderly women with uterine cancer, a group of elderly men with urological cancer and a group of male and female patients of various ages with malignant lymphoma, were prospectively followed during and after aggressive treatment given with curative intent. Detailed information on the dietary intake was measured by a dietary history and cross-check method covering the 2 months prior to the onset of therapy and a 48-hr dietary record which was applied seven times during the observation period. The nutritional status was monitored by anthropometric measurements and laboratory assays in blood and urine. The patient's well-being was assessed by the use of standard performance scales by the observers and the application of patient's questionnaires concerning complaints, ability to self-care, mobility and daily activities. The main results are described here, indicating that: (1) most patients studied had a more than adequate diet during the 2 months preceding cancer therapy when compared to the Dutch Recommended Dietary Allowances; (2) the impact on dietary intake and nutritional status was relatively minor and generally transient; and (3) the treatment course was accompanied by distinct changes of well-being associated with, but not necessarily resulting from or leading to, changes of dietary intake.