Vitamin A deficiency in preschool children of Recife, Northeast of Brazil

The purpose of the study was to evaluate the extent of vitamin A deficiency (VAD) among preschool children in the city of Recife, Northeast Brazil. The sample comprised 344 children of both sexes, 24 to 60 months old, in 18 public day care centres in the city of Recife, in 2007. The nutritional status of vitamin A was assessed by biochemical (serum retinol) and dietetic (vitamin A rich-food consumption) indicators and the pondo-stature status through anthropometric indicators weight-for-age, height-for-age and weight-for-height. The prevalence of hyporetinolemia (< 0.70 micromol/L) was 7.7% (IC 95% 4.88 - 11.81), which characterizes the VAD as a light-type public health problem, according to World Health Organization criteria. On the other hand, 29.6% (IC 95% 24.22 - 35.63) of children had acceptable or marginal levels (0.70 to 1.04 micromol/L) of retinol. Regarding the vitamin A rich-food intake, values below the EAR (Estimated Average Requirement) - 210 microg/ day for children of 1 to 3 years old and 275 microg/day for children of 4 to 8 years old - were 8.1% and 21.3% respectively. The prevalence of anthropometrical deficits (< -2 scores -Z) in preschool children were 2.5% for the indicator weight-for-age, 8.6% for height-for-age and 1.5% for weight-for-height. The research findings point out to the importance of institutionalization for the appropriate nutritional status of children and maintenance of adequate reserves of vitamin A. However, more studies are needed focusing on non-institutionalized preschool, or children living outside the privileged environment of public day care centres.     

Nutritional recovery of mild and moderately malnourished children under two different treatment approaches (ambulatory versus day-care)

This retrospective analysis was conducted between May 1997 and May 2000 at the Centro de Atención Nutricional Infantil de Antímano, CANIA, in Caracas, Venezuela to assess the efficacy of two treatments (ambulatory versus day-care) of mild and moderate malnourished children. Inclusion criteria were: children under 10 years old with mild and moderate malnourishment, who attended a minimum of 3 control visits during a period of 12 months. One hundred fourteen malnourished children were included: fifty seven in ambulatory treatment and fifty seven in day-care treatment paired per nutritional diagnosis, gender and age (thirty nine mild and eighteen moderate malnourished children). The nutritional recovery criterion was weight for height above tenth percentile. No relation was found between treatment approaches and nutritional recovery at 3 and 6 months of treatment. In the group of mild malnourished children, the percentage of recovered patients at 3 months of treatment, that kept their recovered condition at 6 months was 83% (15/18) in the ambulatory treatment and 82% (18/22) in the day-care treatment Age of children, associated disease, acute morbidity, dietetic risk and mother's education and age were not associated with nutritional recovery at 6 months of treatment (p > 0.05). The day-care approach resulted as effective as ambulatory in mild malnourished children. In moderate malnourished new studies will need to be conducted with greater number of patients.     

Nutritional status of marginated children of the Madrid's autonomous community, Spain

The nutritional status of 101 institutionalized students aged 6 to 13 was assessed from the dietary and biochemical points of view. The children were pupils of a Youth Care Boarding School. The dietary survey revealed an adequate nutrient intake which met the Recommended Dietary Allowances (RDA) in most cases as well as a high protein intake (250% of RDA). A slight deficiency in energy, zinc, magnesium and vitamins B2 and C was found in some cases in the eldest group. Blood parameters (erythrocyte counts, hematocrit, hemoglobin, mean corpuscular values, serum proteins, albumin, globulins, albumin/globulin ratio, urea and cholesterol) showed slightly lower values, mainly on hemoglobin, than those obtained from other similar groups. Nevertheless, urine parameters (nitrogen, urea, uric acid and creatinine) were higher, may be due to the high protein intake, energy deficiency and non-dietary factors such as lack of affection, socioeconomic problems, etc. All of these factors cause a rise in the students' catabolism. Correlations between dietary and biochemical data seem to corroborate that there is a shortage of energy, zinc, riboflavin, magnesium and vitamin C intakes in some cases, which limits the build up of several blood elements.     

Food habits and culture factors in pregnant adolescents

The purpose of this study was to identify the food habits of pregnant adolescents and their perception about which, of her cultural concepts, have higher influence. 54 subjects between 12 and 19 years old from Guadalajara City were included and socioeconomic, dietetic data, as food frequency consumption and cultural concepts about feeding were also explored. Chi square was used for identifying association between variables. The fat intake was lower in late vs. Early and middle stage of adolescence (57 vs. 71 g/d, p = 0.05). The iron, calcium and zinc intake was also deficient in the early/middle stage; meanwhile, the folic acid consumption was very low in the late stage of adolescence. Corn tortillas were the most consumed cereal and food (93-96%); junk food and sodas (62 and 55%) prevailed in the early/middle stage. About local costumes, "tacos", "pozole" and burgers were the most referred (74.1%). They also mentioned that fat (36.7%), junk food (30%), chili (26.7%), sodas (23.3%), processed meals (26.7%) and salt (10%) were harmful. They also believed that vegetables (77%), fruits (60 %), milk (21%), broths (17%), and meat (12.5%) were beneficial; and, 96% considered that chicken and bean broths were nutritious (myth). There were some prohibited foods (taboos) during pregnancy: chili (48%), junk food (20%), and salt (16%). Prejudices were more common among later adolescents (60.9%) (p = 0.03). The erratic food habits and the conceptual confusion of these adolescents cause a low intake of nutrients and place them in a nutritional risk.     

Maternal fruit and vegetable or vitamin C consumption during pregnancy is associated with fetal growth and infant growth up to 6 months: results from the Korean Mothers and Children’s Environmental Health (MOCEH) cohort study

Background

Based on data obtained from pregnant women who participated in the Mothers and Children’s Environmental Health (MOCEH) study in South Korea, we aimed to determine whether maternal intake of fruits and vegetables or vitamin C is associated with fetal and infant growth.

Methods

A total of 1138 Korean pregnant women at 12–28 weeks gestation with their infants were recruited as study participants for the MOCEH. Intake of fruits and vegetables or vitamin C during pregnancy was assessed by a 1-day 24-h recall method. Fetal biometry was determined by ultrasonography at late pregnancy. Infant weight and length were measured at birth and 6 months.

Results

A multiple regression analysis after adjusting for covariates showed that maternal intake of fruits and vegetables was positively associated with the biparietal diameter of the fetus and infant’s weight from birth to 6 months. Also, maternal vitamin C intake was positively associated with the abdominal circumference of the fetus and infant birth length. In addition, there was a significant inverse relationship between consumption of fruits and vegetables (below the median compared to above the median of ≥519 g/d) and the risk of low growth (<25th percentile) of biparietal diameter (odds ratio (OR): 2.220; 95% confidence interval (CI): 1.153–4.274) and birth weight (OR: 1.434; 95% CI: 1.001–2.056). A significant inverse relationship also existed between vitamin C consumption (below vs above the estimated average requirement (EAR) of ≥85 mg/d) and the risk of low growth (<25th percentile) of birth weight (OR: 1.470; 95% CI: 1.011–2.139), weight from birth to 6 months (OR: 1.520; 95% CI: 1.066–2.165), and length at birth (OR: 1.579; 95% CI: 1.104–2.258).

Conclusions

An increased intake of fruits and vegetables or vitamin C at mid-pregnancy is associated with increased fetal growth and infant growth up to 6 months of age.

     

Food consumption patterns of children 4 to 14 years old in Valencia, Venezuela

Results from a nutritional assessment are presented to establish the usual food consumption pattern of 438 children between 4-14 years of age, from a low income urban community in Valencia, Venezuela. Food intake data were collected through multiple 24 hours recalls and converted to individual food item weight in grams. Amounts of energy, macronutrients, iron, calcium, vitamin A, and vitamin C were estimated to compare them to national references. The food pattern was established according to intake frequency per food item and per food groups. Arepa was the most commonly consumed food item, and a main source of kilocalories, protein, carbohydrates, iron, and vitamin A. Unlike coffee, fruits were not among the most commonly consumed foods. Black beans were the main source of protein. Cookies and sodas were among the major sources of energy. Energy and nutrient intake were adequate, except for calcium (67% in preschoolers y 43% in school-aged children). Preschoolers' diet showed a better adequacy for all nutrients (p < 0.005), except for iron which was significantly higher in school-aged children. Since children below 15 years old are still forming food behaviors and habits, they are an ideal group to develop nutritional education strategies to modify harmful patterns such as high intake of sodas, and low intakes of calcium rich foods.     

Chemical and sensory characterization of cakes enriched with dietary fiber and micronutrient for the elderly

This study presents the development of individual cakes enriched with dietary fiber (lupin and oat fiber), vitamins and minerals; as recent research has shown that the average daily dietary fibre intake of the elderly population in Chile is only 12 g. Each cake contains 4.8 g of dietary fibre and a 30% of the RDA of vitamins A, B1, B2, B6, B12, E, nicotinamide and folic acid, 40% of the RDA of vitamin D3, 15% of the RDA of calcium, 12% of the RDA of magnesium and 3% the RDA of zinc. Polydextrose and sorbitol were added to improve flavor and texture. Response Surface Methodology (RSM) was used for optimization, based on a two-variable composite design. Thirteen experimental runs were carried out, with polydextrose (1 to 40% based on flour content) and sorbitol (1 to 30% based on flour content) as independent variables. The response variable was sensory quality obtained by the Karlsruhe test. Sensory attributes of texture and overall quality showed a good fitting with high determination coefficients and were used for optimization. The optimized cake contained 11.5% polydextrose and 4.4% sorbitol (both based on flour content). Quality of the optimized product was controlled by means of physical, chemical, microbiological and sensory analyses. Overall sensory quality was 8.18 ("very good") and good quality and nutritive value were achieved. In an acceptance test carried out with 150 adults, 100% acceptability was obtained in the hedonic scale categories "like it" and "like it very much". A shelf life study performed with cakes packaged in polypropylene bags of 30 microns thickness indicated a shelf life of 13 days stored at room conditions (25 degrees C and 55-60% R.H.).     

Diet,Plasma, Erythrocytes,and Spermatozoa Fatty Acid Composition Changes in Young Vegan Men

There has been increasing interest in vegan diets, but how this dietary pattern regulates tissue fatty acids (FA), especially in men, is unclear. Our aim was to evaluate the effect of a vegan diet on plasma, erythrocyte, and spermatozoa FA composition in young men. Two groups consisting of 67 young (18–25 years old) men were studied. One group following an omnivore diet but did not consume fish, shellfish or other marine foods (control, n = 33), and another group following a vegan diet (vegan, n = 34) for at least 12 months were compared. Dietary intake was assessed via a food frequency questionnaire and a 24-h recall. FA composition was measured in plasma, erythrocyte phospholipids, and spermatozoa by gas–liquid chromatography. Compared to controls, the vegan group had higher reported intakes of carbohydrate, dietary fiber, vitamins (C, E, K, and folate), and minerals (copper, potassium) but lower intakes of cholesterol, trans FA, vitamins B₆, D, and B₁₂, and minerals (calcium, iron, and zinc). Vegan's reported a lower saturated FA and not arachidonic acid intake, both groups did not intake eicosapentaenoic acid and docosahexaenoic acid (DHA), but vegan's showed a higher alpha linolenic acid ALA intake. Vegans had higher plasma, erythrocyte phospholipid, and spermatozoa ALA, but lower levels of other n-3 polyunsaturated fatty acid (PUFA), especially DHA. Vegans were characterized by higher ALA, but lower levels of other n-3 PUFA, especially DHA in plasma, erythrocytes, and spermatozoids. The biological significance of these findings requires further study.     

Reproducibility and validity of the food frequency questionnaire for estimating habitual dietary intake in children and adolescents

Background  

A previous study reported the development a 75-item food frequency questionnaire for Japanese children (CFFQ). The first aim was to examine the reproducibility and validity of the CFFQ in order to assess dietary intake among two groups; 3-11 year old children (YC group) and 12-16 year old children (AD group). The second aim was to use the CFFQ and the FFQ for adults (AFFQ), and to determine which was better suited for assessing the intake of children in each group.     

Serum homocysteine, folate and vitamin B12 in venezuelan elderly

The anatomical and physiological changes of aging make elderly people a vulnerable group to malnutrition and specific deficiencies of nutrients such as vitamin B12 and folate. This study was aimed to establish relationships among serum vitamin B12, folate, homocysteine concentrations and dietary intake and adequacy. Fifty five male and female elderly (60 and more years), free-living, were assessed. Measurements were: serum vitamin B12 and folate by radioimmunoanalysis (RIA), homocysteine by polarized fluorescence immunoassay, nutrient intake by three 24 hours recalls and food frequency questionnaire. Nutritional status was determined by Body Mass Index (BMI). Serum vitamin B12 and folate were at normal range (423,3+/-227,6 pmol/l and 6,4 +/- 4,5 mg/ml), but 17,5% of elderly had B12 deficiency and 12% had folate deficiency. Serum homocysteine was higher than reference values (15,8+/-4,4 mmol/l), but 47,5% showed concentrations above 15 mmol/L, male population showed higher mean value (p: 0,01). Nutrient intake was inadequate by deficiency. BMI indicated 11,8% of undernutrition, 29,4% of overweight and 20,6% of obesity A negative and inverse correlation between homocysteine and serum folate was found. Results suggest a biochemical deficiency of B12 and folate that is expressed as elevated homocysteine levels. These finding represent a high cardiovascular risk factor for this elderly group.     

Efficacy of a national program to promote breast feeding: Chile 1993-2002

Promotion of breast feeding is a priority in Chilean health's policies. The aim of the study was to evaluate the tendency of breastfeeding (exclusive, continued, partial), in children less than 18 months old, controlled in the Chilean public health system, based in four national surveys. Through a 24 h food intake recall (breastfeeding, water, juice, infant formula, solids) food patterns were explored every 3 years, as well as maternal participation in jobs located away from home. the sample consisted of approximately 10 thousand children, less than 18 months old of the 28 health services throughout the country. The prevalence of children with exclusive breastfeeding, predominant (breastfeeding, water or juice), complemented (breastfeeding plus solids) or any other way of feeding for each month of age in each survey, and changes in period studied, was determined. Between 1993 and 2002, exclusive breastfeeding for 6 months increased from 16 to 43.1% (p<0.001) and predominant breastfeeding from 25.4 to 57.4%. at the same time, complemented breastfeeding at 12 months increased from 10.7 to 21.3%, and partial or complemented breastfeeding in 12 to 18 month old children went from 24.1 to 46.7%. Maternal work located away from home was inversely associated with the prevalence of exclusive and complemented breastfeeding during the first year (p<0.001). There has been a significant increase of maternal breastfeeding in the period analyzed. The negative effects of maternal labor on breastfeeding suggests to explore more effective forms of social support to the working mother.     

Dietary evaluation of pregnant adolescents during first, second and third trimester

In order to identify risk of inadequate intake of calories and nutrients during pregnancy, 75 pregnant adolescents (14 to 18 years old) apparently healthy, from low socioeconomic level, in their first prenatal control (12 weeks) were studied by two 24 hour recalls and a food frequency questionnaire at each trimester. Nutritional status was assessed by body mass index (pregestation weight/height) and classified according to American Medicine Institute reference. Paired t-test, frequency distribution and ANOVA were used for statistical analysis. Low weight was found in 34.6% of adolescent at the first visit and 5.3% were overweight. Even though, caloric intake was below recommendation, significant increases were observed between first and second trimester for energy, carbohydrates, niacin and zinc (p < 0.001) and for fat, proteins, riboflavin, thiamin, vitamin C, calcium and iron (p < 0.05). From second to third trimester, differences (p < 0.05) were significant only for vitamin A. Between first and third trimester, differences were significant (p < 0.05) for energy, proteins, carbohydrates, niacin, riboflavin, zinc and for thiamin, vitamin A and calcium (p < 0.05). A high proportion of pregnant adolescent did not reach recommendations for energy, folate, calcium and zinc. Food intake pattern did not change significantly among trimesters. Mean total weight gain was 9.2 kg and 0.412 +/- 0.4 g/week. Newborn's mean weight was 3.221 +/- 418 grams. It is concluded that adolescents are at high nutritional risk and deficiency of dietary intake should be followed. Attention should be addressed from the preconceptional period to postpartum in order to improve maternal and fetal conditions.     

Alimentary, nutritional and health aspects of elderly women in attendance at the Núcleo de Atenção ao Idoso, Recife/2005

Aging has become a worldwide problem. In order to identify food, nutritional and health aspects of elderly women, a across-sectional study was carried out in 2005 with 106 women over 60 years of age cared for at Núcleo de Aten??o ao idoso-NAI at Federal University of Pernambuco. Clinical and social-demographic variables, along with the nutritional status by BMI (OMS and Lipschtz) were assessed, and the frequency of food intake according to food groups. The results disclosed that 38% of the elderly were pre-obese (WHO) and 47.2% were overweight (Lipschitz). As for blood pressure (BP) 69% was found to be hypertensive and 31% normotensive. The BMI mean of hypertensive and normal elderly women was statistically significant (p=0.027). Cereal and bread groups were reported to have been the highest consumption on a daily basis by the elderly women, 89% and 82% respectively. Legumes were present in 53% of the women's meals followed by vegetables with 61% and fruits with 66%. Concerning water intake, 51.9% stated to have ingested one to four glasses of water daily. There was a positive correlation between BMI and systolic (SP) and diastolic pressure (DP) (p<0.001). SP and DP levels showed no correlation with the food intake studied. The results are indicative of an overweight and not conscientious population as regards adequate food intake and point to the necessity of more effective actions in control and/or prevention, particularly for those still young.     

Pre-cooked corn flour intake and its contribution of iron and vitamin A in low income preschoolers

The objective of this study was to determine whether the addition of iron and vitamin A (VA) to corn flour, supplied through a national enrichment program since 1993, allows preschoolers to achieve an adequate intake of these nutrients. Data from the assessment of 196 children (4-6 year old) from Valencia, Venezuela is presented, including socio-demographic, anthropometric, anemia, VA deficiency (by conjunctival impression cytology (CIC) and serum retinol), and food intake. 92% of the children lived in poverty. 12% were below the norm for weight-for-height. 13% had anemia, 9% had VA deficiency according to CIC, and 0.5% according to serum retinol (< 0.70 mumol/L), 30% were at risk of VA deficiency (0.70-1.05 mmol/L). 17%, 37%, and 5% of the sample had an insufficient intake (< 80% of RDA) of energy, iron, and VA, respectively. When excluding from the analysis the amount of iron and VA from corn flour enrichment, an additional 38% and 10% of the sample showed deficient intakes of each nutrient, respectively. According to the weight-for-height indicator, iron intake was significantly lower in undernourished children (p < 0.05) than in those normal or above the norm; this was not so for VA. It is concluded that iron enrichment contributes to the improvement of the intake of this nutrient but is not enough to provide an adequate amount of it; and that the addition of VA does not seem to have an important effect on the diet of this age group.     

乙型肝炎基因工程疫苗的反应及效果观察

应用重组痘苗病毒表达的乙肝基因疫苗接种了100名7～9岁儿童。采用0、1、2月免疫程序,3个不同剂量组(20,10及5μg)均产生较高的抗体阳转率:3个月时大于96％、9个月时均达100％,免后2年仍在85％以上。9月时抗体水平达高峰,其抗体GMT分别为540.4(20μg),556.8 (10μg)及392.3m(?)u/ml(5μg)。没有观察到严重的副反应。与酵母重组疫苗(Merck产品)和血源疫苗的免疫效果比较无明显区别。表明重组痘苗病毒表达的乙肝疫苗是安全、有效的。     

Total and Plant Protein Consumption: The Role of Inflammation and Risk of Non-Communicable Disease

Background: Inflammatory cytokine levels are associated with Non-Communicable Diseases (NCDs) and can be influenced by a person’s macronutrient profile. This work aims to evaluate the relationship between the compliance with the age-specific recommended protein intake and the levels of inflammatory markers related to the risk of NCDs. Methods: The study participants included 347 participants (119 men and 228 women), ages 18 to 86 years. Cardio-metabolic risk evaluations, including an assessment of the prevalence of Metabolic Syndrome, were performed. Leptin, IL-15, IL-6, and TNF-α levels were measured. Results: The adequacy of the total protein (TP) intake was lower in old people compared to individuals aged <60 years, and only few volunteers consumed the suggested 50% plant protein (PP) for a healthy and sustainable diet. A lower risk of NCDs with a PP consumption above at least 40% was observed only in old individuals. A differential effect on TNF-α and IL-6 was observed for both TP and PP intake by gender and age class, whereas for leptin and IL-15 only significant interactions among sex and the class of age were found. Conclusion: Although our data suggest that consuming more than 40% of PP can reduce the risk of NCDs, the effect of gender differences on cytokine levels should be considered in larger studies.     

Beliefs on vitamin and consumption of vitamin supplements among university students in the city of São Paulo

A survey was conducted in a sample of 894 students entering a private university in S?o Paulo to examine the vitamin beliefs and to verify the relation between vitamin beliefs and vitamin supplements consumption. Nineteen statements about the relation between vitamins and health were developed to assess the beliefs; the respondents answered by means of a 5-point agreement scale. Cronbach's alpha coefficient of internal consistency was determined for the total scale. 94.5% of students believe that vitamin C prevents and cures the common cold and 72.5% consider vitamins as an energy source. Many students recognize the possibility of health risks associated to excessive vitamin consumption. Vitamin supplement users had a belief score higher than non-users (p < 0.001). The results indicate that several misconceptions about vitamin benefits are common among the students and suggest a relation between vitamin beliefs and supplements consumption.     

Evaluation of effectiveness of class-based nutrition intervention on changes in soft drink and milk consumption among young adults

Background

The repeatability of a risk factor measurement affects the ability to accurately ascertain its association with a specific outcome. Choline is involved in methylation of homocysteine, a putative risk factor for cardiovascular disease, to methionine through a betaine-dependent pathway (one-carbon metabolism). It is unknown whether dietary intake of choline meets the recommended Adequate Intake (AI) proposed for choline (550 mg/day for men and 425 mg/day for women). The Estimated Average Requirement (EAR) remains to be established in population settings. Our objectives were to ascertain the reliability of choline and related nutrients (folate and methionine) intakes assessed with a brief food frequency questionnaire (FFQ) and to estimate dietary intake of choline and betaine in a bi-ethnic population.

Methods

We estimated the FFQ dietary instrument reliability for the Atherosclerosis Risk in Communities (ARIC) study and the measurement error for choline and related nutrients from a stratified random sample of the ARIC study participants at the second visit, 1990–92 (N = 1,004). In ARIC, a population-based cohort of 15,792 men and women aged 45–64 years (1987–89) recruited at four locales in the U.S., diet was assessed in 15,706 baseline study participants using a version of the Willett 61-item FFQ, expanded to include some ethnic foods. Intraindividual variability for choline, folate and methionine were estimated using mixed models regression.

Results

Measurement error was substantial for the nutrients considered. The reliability coefficients were 0.50 for choline (0.50 for choline plus betaine), 0.53 for folate, 0.48 for methionine and 0.43 for total energy intake. In the ARIC population, the median and the 75^th percentile of dietary choline intake were 284 mg/day and 367 mg/day, respectively. 94% of men and 89% of women had an intake of choline below that proposed as AI. African Americans had a lower dietary intake of choline in both genders.

Conclusion

The three-year reliability of reported dietary intake was similar for choline and related nutrients, in the range as that published in the literature for other micronutrients. Using a brief FFQ to estimate intake, the majority of individuals in the ARIC cohort had an intake of choline below the values proposed as AI.     

Requirements of nutrients which participate in erythropoiesis

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.