Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.
Previous surveys suggested that young children in Northeast Thailand may benefit from vitamin A and/or zinc supplementation. One hundred thirty-three children aged 6-13 y with marginal plasma retinol (less than 1.05 mumol/L) and Zn (less than 12.2 mumol/L) concentrations participated in a double-blind study. They were randomly assigned and supplemented with either zinc (25 mg/d), vitamin A (1500 RE/d), zinc plus vitamin A, or placebo for 6 mo. Biochemical indices of vitamin A (plasma vitamin A, retinol-binding protein) and zinc status (plasma zinc, alkaline phosphatase) increased significantly. The children had adequate liver stores of vitamin A (relative dose response less than 20%). Zinc supplementation resulted in an improvement in vision restoration time (VRT) in dim light (dark adaptometry). Vitamin A and zinc synergistically normalized conjunctival epithelium as measured by conjunctival impression cytology (CIC). Both functional indices, VRT and CIC, showed significant correlations with plasma zinc and vitamin A, respectively. The data suggest that functional improvements in populations with suboptimal vitamin A and zinc nutriture can be accomplished by supplementation with less than two times the recommended dietary allowance of these nutrients.
Thiamin deficiency could result either from inadequate intake of thiamin or consumption of food containing antithiamin factors. Dietary surveys conducted in northeastern Thailand indicated that both thiamin and caloric intake of subjects under studies were sufficient. In Thailand, correlation exists between the consumption of food containing antithiamin factors and the prevalence of thiamin deficiency. Betel nuts and raw fermented fish possess antithiamin activity. Abstention from both betel nut chewing and raw fermented fish consumption resulted in a significant reduction of thiamin pyrophosphate effect. The thiamin pyrophosphate effect again increased significantly when the subjects resume their chewing habits. Cooking of fermented fish destroyed thiaminase, resulted in a significant decrease of thiamin pyrophosphate effect of the subjects. Thiamin supplementation (10 mg/day) could further reduce their thiamin pyrophosphate effect. This amount of thiamin could counteract the effect of raw fermented fish consumption but was not sufficient to neutralize the effect of betel nut chewing.
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