Investigations concerning the prevalence of nutritional defiencies and intestinal malabsorption among rural populations of the West Indies. I. Methodology

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A description and evaluation of the methods used in a clinical investigation of the relationship between nutritional status and intestinal malabsorption in a sample of asymptomatic rural residents in Puerto Rico and the Dominican Republic is presented. These countries were choosen for their contrasting nutritional status. The diet of the rural population in Puerto Rico is relatively good while the diet of Dominican Republic's rural residents is marginal. Household surveys were conducted in one small, rural community in Puerto Rico and in another such community in the Dominican Republic. A sample of 96 patients from the former and 42 patients from the latter were hospitalized for 6 days. Their diet was controlled and a series of tests were performed in order to assess intestinal absorption. The usefulness of the various clinical determinations was then evaluated. Folic acid absorption studies and fat and nitrogen studies were found to be too time-consuming. Determination of fecal excretion of nitrogen and B12 serum concentrations yielded sufficient information and were judged useful. As many tests as possible had to be performed in assessing jejunum and ileum function as the intestional abnormalities were not limited to one site. Some were in the jejunum only, others were in the ileum only, and others were scattered throughout the small intestine. Tables show 1) age-sex distributions and monthly family income for the studied communities; 2) nitrogen balance study results; and 3) daily intake of protein for Puerto Rican and Dominican Republican subjects.