Serum Carotene Concentrations Research Articles

Serum Carotenoids Reveal Poor Fruit and Vegetable Intake among Schoolchildren in Burkina Faso.

The health benefits of fruits and vegetables are well-documented. Those rich in provitamin A carotenoids are good sources of vitamin A. This cross-sectional study indirectly assessed fruit and vegetable intakes using serum carotenoids in 193 schoolchildren aged 7 to 12 years in the Western part of Burkina Faso. The mean total serum carotenoid concentration was 0.23 ± 0.29 µmol/L, which included α- and β-carotene, lutein, and β-cryptoxanthin, and determined with serum retinol concentrations in a single analysis with high performance liquid chromatography. Serum retinol concentration was 0.80 ± 0.35 µmol/L with 46% of children (n = 88) having low values <0.7 µmol/L. Total serum carotene (the sum of α- and β-carotene) concentration was 0.13 ± 0.24 µmol/L, well below the reference range of 0.9–3.7 µmol carotene/L used to assess habitual intake of fruits and vegetables. Individual carotenoid concentrations were determined for α-carotene (0.01 ± 0.05 µmol/L), β-carotene (0.17 ± 0.24 µmol/L), β-cryptoxanthin (0.07 ± 0.06 µmol/L), and lutein (0.06 ± 0.05 µmol/L). These results confirm the previously measured high prevalence of low serum vitamin A concentrations and adds information about low serum carotenoids among schoolchildren suggesting that they have low intakes of provitamin A-rich fruits and vegetables.

Seasonal fertility differences in synchronised dairy cows: Ultrasonic, metabolic and endocrine findings

The aim of this study was to identify relationships among seasonal differences of fertility, metabolic parameters and appearance of irregular luteal forms in high-yielding dairy cows. Holstein-Friesian cows were put on the Provsynch regimen in winter (n = 10) and in summer (n = 10). Blood sampling (starting 35 days post partum) and rectal ultrasound examinations (starting post insemination) were carried out once a week in each examination period. Metabolic [plasma nonesterified fatty acid (NEFA) and beta-hydroxybutyrate (BHB) levels, ferric reducing ability of plasma (FRAP) and serum beta-carotene] and endocrine parameters [plasma thyroxine (T4), triiodothyronine (T3), insulin-like growth factor (IGF-I) and insulin levels] were measured. In summer, two cows were excluded from the study because of metritis and none of the remaining animals became pregnant, but 6 of the 8 cows had irregular luteal forms (ILF) on their ovaries. In winter, one cow was excluded because of metritis and 6 of the 9 cows became pregnant, while 2 of the 3 open cows had irregular luteal forms. In summer the mean plasma NEFA and BHB concentrations were significantly higher, while serum carotene and plasma IGF-I concentrations were significantly lower than in winter. The high plasma NEFA concentration found in summer seemed to be in association with the lower body condition score (BCS) caused by depressed appetite. In conclusion, statistical analysis supports the hypothesis that increased plasma NEFA and BHB and decreased plasma IGF-I concentrations may result in reduced fertility in summer. These changes may be associated with the more frequent appearance of ILFs and probably have a negative effect on ovarian function and/or oocyte quality.

Stability of Serum Carotene at Various Light and Temperature Conditions

To the Editor.—Carotenoids are brightly colored plant pigments that are essential for several metabolic functions including cell growth regulation and immune response. Carotene (previtamin A) is a slowly absorbed, fat-soluble, carotenoid pigment normally present in the diet. Serum carotene levels are used to determine the possibility of absorption defects that can lead to malabsorption. Decreased carotene levels are seen in several malabsorption syndromes, including, but not limited to, some pancreatic diseases, sprue, post–small intestine resection, and celiac disease.1Fat-soluble vitamins, such as carotene, are generally considered highly unstable when exposed to light, air, and ambient temperature.2 Therefore, serum carotene samples that are referred to core laboratories from satellite sites are required to be shipped frozen and protected from light at all times of handling and analysis. Recent studies indicate that fat-soluble vitamins, including carotene concentrations in whole blood, change insignificantly when stored for up to 7 days at room temperature in dark or light conditions; however, stability data for serum carotene remain scarce.3,4We prepared 5 different serum pools from healthy adult volunteers and from 7-day-old leftover laboratory specimens within our laboratory. Aliquots of 600 µL from each pool were maintained at various light and temperature conditions: room temperature–dark, room temperature–light, refrigerated-dark, refrigerated-light, frozen (−30°C)-dark, and frozen (−70°C)-dark for durations of 1 to 14 days. At the end of the timed conditions (Day 0, 1, 3, 7, 10, 14), the appropriate aliquots were removed and stored at −70°C until analysis. Serum carotene was then extracted with petroleum ether and analyzed using spectrophotometry at a wavelength of 440 nm. The procedure was performed under minimal lighting conditions. The stability of carotene under each storage condition was determined by calculating the percentage change in concentration from those of day 0, then calculating the mean percentage change (and standard error of the mean) of the 5 pools at each time point. Data were analyzed by 1-way analysis of variance using SPSS (Chicago, Illinois) and a P value < .05 was considered statistically significant.The analytic imprecision of this carotene assay is 6.6% at levels of 96.6 µg/dL (1.8 µmol/L) and 155.7 µg/dL (2.9 µmol/L). Carotene levels of the 5 serum pools ranged from 134.2 µg/dL (2.50 µmol/L) to 230.9 µg/dL (4.3 µmol/L). Serum stored at −70°C for 14 days (the end of study controls) demonstrated a minimal average change of only 3.04% compared with those measured freshly at day 0. Samples stored in the room temperature–light condition for 10 and 14 days demonstrated a significant decrease of 24.5% (P = .02) and 28.3% (P = .01) respectively in carotene levels when compared with the end-of-study controls. Except for room temperature, storage conditions did not induce clinically significant changes in serum carotene (Table).In conclusion, serum carotene levels are stable when stored at 4°C (in dark or light) or in the freezer for up to 14 days. Carotene stability is also acceptable at room temperature–dark for 7 days or room temperature–light for 3 days. In addition, repeated freezing to −70°C and thawing has been demonstrated to have no significant effects (less than 1% per freeze-thaw cycle) on the serum and plasma carotene concentrations.5 These results allow for less stringent storage, shipping, and handling conditions for serum carotene specimens.

A community randomized controlled clinical trial of mixed carotenoids and micronutrient supplementation of patients with acquired immunodeficiency syndrome

This clinical trial aims to evaluate if natural mixed carotenoids supplementation can improve the health and survival of acquired immunodeficiency syndrome (AIDS) patients. A placebo-controlled, prospective, randomized, double-blind, multicenter clinical trial. Community, tertiary care human immunodeficiency virus (HIV) clinics of the Canadian HIV Trials Network (CTN). Three hundred and thirty-one adults with advanced AIDS on conventional management were recruited during routine clinic visits. All participants, including 166 controls, received daily oral specially formulated multivitamins including vitamin A and trace elements; 165 treatment group participants received additional daily oral natural mixed carotenoids, equivalent to 120,000 IU (72 mg) of beta-carotene daily. Follow-up was quarterly at routine clinic visits. Mean (s.d.) follow-up was for 13 (6) months. Thirty-six participants died by 18 months. Serum carotene concentration <1.0 micromol/l was present in 16% participants at baseline. Despite variation in carotene content of the treatment medication, serum carotene concentrations increased significantly to twice the baseline levels to 18 months follow-up in participants who received carotenoids treatment compared with controls (P < 0.0001). Although not statistically significant, mortality was increased in participants who did not receive carotenoids treatment compared with those who did (HR time to death 1.76, 95% CI 0.89, 3.47, P = 0.11). In multivariate analysis, survival was significantly and independently improved in those with higher baseline serum carotene concentrations (P = 0.04) or higher baseline CD4 T-lymphocyte counts (P = 0.005). Adjusted mortality was also significantly and independently increased in those who did not receive carotenoids treatment compared with those who did (HR time to death 3.15, 95% CI 1.10, 8.98, P = 0.03). Low serum carotene concentration is common in AIDS patients and predicts death. Supplementation with micronutrients and natural mixed carotenoids may improve survival by correction of a micronutrient deficiency. Further studies are needed to corroborate findings and elucidate mechanism of action.

Serum and breast-milk vitamin A in women during lactation in rural Chiang Mai, Thailand.

Vitamin A deficiency can occur during lactation and breast-milk vitamin A has been recommended for monitoring the vitamin A status of lactating women and their infants. This study aimed to investigate the vitamin A status of lactating women in relation to race, age, parity, duration of lactation and anthropometric status. A cross-sectional study was conducted among 262 lactating women in rural Chiang Mai, Thailand. Blood and breast-milk samples were collected. Serum retinol, carotene and breast-milk retinol concentrations were analysed by high-performance liquid chromatography. The results show that mean serum retinol and breast-milk retinol in hill tribes were significantly lower than in Thais, 1.91 (0.59) and 0.79 (0.52) compared with 2.10 (0.51) and 1.04 (0.58) mumol/L, respectively. Mean serum retinol and breast-milk retinol were highest during the 1st 3 months of lactation. Maternal age, parity and anthropometric status (BMI) were not associated with serum or breast-milk retinol concentrations. There was a significant relationship between serum and breast-milk retinol values in women who breastfed for 6 months or longer (regression co-efficients 0.30; 95% CI 0.16, 0.43). Breast-milk retinol levels declined significantly from 4 to 12 months after delivery, which could increase the risk of vitamin A deficiency in children who were exclusively breastfed or receiving inappropriate complementary foods during this period. Weaning foods which commence at 6 months and have an adequate vitamin A content should ensure that the vitamin A status of the young child is maintained.

Changes in plasma fatty acid profile in Japanese patients with chronic pancreatitis.

The serum zinc, prealbumin, retinol-binding protein and carotene concentrations and the plasma fatty acid composition were determined to assess the nutritional condition of 24 patients with chronic pancreatitis compared with that of 20 healthy controls. The daily food intake and faecal fat excretion of the two groups were also measured. In the chronic pancreatitis group, the calorie and fat intakes were significantly lower than those of the controls. Serum levels of zinc, prealbumin and carotene were also significantly lower than those of the controls. Percentages of plasma linoleic and arachidonic acids were low, while percentages of palmitoleic acid, eicosapentaenoic acid and docosahexaenoic acid were high. Fish oil intake correlated negatively with plasma linoleic acid concentration (P < 0.05). The above results indicate that the relatively high intake of fish oil and the relatively low intake of dietary fat in Japanese patients with chronic pancreatitis with a mild degree of steatorrhoea results in an abnormally low plasma level of linoleic acid.

Serum carotene deficiency in HIV-infected patients

To assess total serum carotene concentration in HIV-infected patients as an indicator of fat malabsorption in correlation with diarrhoea, secondary enteric infections, and blood lymphocyte subsets. Prospective study. Two referral-based tertiary care centres in Berlin, Germany. A total of 33 controls and 116 HIV-infected patients who had complete microbiological evaluation of stools and biopsies obtained at upper endoscopy because of diarrhoea (n = 54), or other symptoms (n = 62), were studied. Total serum carotene concentration was determined spectrophotometrically. Total serum carotene concentration was abnormal (< 0.88 mumol/l) in 77% of HIV-infected patients and significantly decreased compared with controls [0.47 mumol/l (range, 0.06-1.69 mumol/l) versus 1.37 mumol/l (range, 0.88-2.92 mumol/l); P < 0.0001]. Total serum carotene concentration did not differ between AIDS patients and patients at earlier disease stages, between patients with or without secondary enteric infections, or between patients with or without fever. In patients at earlier disease stages, but not in AIDS patients, total serum carotene concentration was lower for patients with than without diarrhoea. The percentage of CD4 lymphocytes (r = 0.364; P < 0.001), CD4 count (r = 0.28; P = 0.0013), and CD4/CD8 ratio (r = 0.38; P < 0.001) in the peripheral blood correlated with total serum carotene levels in HIV-infected patients. HIV-infected patients frequently have abnormal total serum carotene concentrations indicating fat malabsorption which may contribute to diarrhoea. Furthermore, total serum carotene concentrations correlate with immunologic abnormalities in HIV infection.

Effect of chronic octreotide treatment on intestinal absorption in patients with acromegaly

The adverse gastrointestinal effects of octreotide, a synthetic analog of somatostatin, have not been fully elucidated. Low-dose octreotide frequently causes adverse gastrointestinal symptoms in normal individuals. We investigated the adverse gastrointestinal effects of high-dose octreotide, which is required for the normalization of growth hormone hypersecretion in some patients with acromegaly. Patients with acromegaly (N = 8) were treated with octreotide, 450 micrograms/day, then 1500 micrograms/day for two months at each dosage. Carbohydrate absorption was assessed using the D-xylose test, and fat absorption using fecal fat excretion and serum carotene concentrations, at baseline, at each dosage of octreotide, and after one month of washout. Ultrasonography was used to monitor for cholelithiasis. Growth hormone and insulin-like growth factor-I concentrations were significantly suppressed at both dosages. Adverse gastrointestinal symptoms were mild and transient. D-Xylose absorption remained normal at each dosage and after one month of washout. Fecal fat excretion increased from 7 +/- 2 to 12 +/- 2 g/24 hr (P < 0.05) after the higher dosage and resumed baseline levels after the washout. Mean fasting serum carotene levels remained normal, and carotene loading test (15,000 units three times a day for three days) was unreliable in identifying patients with high fecal fat. No new cholelithiasis was detected by ultrasonography. One of two patients with preexisting cholelithiasis developed biliary colic several days after the treatment period. Although steatorrhea was common, small intestinal absorptive capacity was otherwise unchanged by four months of high-dose octreotide treatment, which significantly suppressed growth hormone secretion in acromegalic patients.

4] Association of carotenoids with human plasma lipoproteins

Publisher Summary This chapter discusses the association of carotenoids with human plasma lipoproteins. The majority of circulating carotenoids are associated with lipoproteins, which serve as plasma transport vehicles. The spectrum of carotenoids found in plasma is also present in a variety of human tissues, indicating that there is an effective transfer of carotenoids from plasma lipoproteins to tissues. The apolipoprotein components of lipoproteins provide the specificity that is required for the transfer of lipoprotein components to specific tissues, and the array of apolipoproteins varies among the lipoprotein classes. Various apolipoproteins serve as recognition ligands for lipoprotein receptors on tissues, enabling lipoprotein uptake and catabolism at specific sites. The apolipoprotein components also serve as cofactors for certain enzymes, such as hepatic and extrahepatic lipases, which are intimately involved in lipoprotein metabolism, and hence in regulating the transfer of lipoprotein components to tissues. Plasma carotenoids are associated predominantly with low-density lipoproteins (LDL), the major cholesterol-transporting lipoprotein. This view is supported by correlations of serum carotene concentrations with total cholesterol and LDL cholesterol levels but more definitively by the analysis of various carotenoids from lipoprotein classes.

Serum Carotene Concentrations in Normal Infants and Children

The blood of 444 healthy Canadian children (246 males and 198 females) aged 6 days to 18 years was analyzed to determine the concentration of serum carotene. The serum carotene concentration was very low in the first six months of life. In the first three months of life, breast fed infants had significantly higher serum carotene concentration than infants who were formula fed. Infants 7 to 12 months of age had the highest serum carotene concentration. The serum carotene concentration dropped off after the age of one year and remained low until two years of age. After two years of age, the serum carotene concentration showed a progressive and small rise until the age of six to seven years and then fell until the age of 14 to 18 years. The serum carotene concentration did not appear to vary according to the sex of the child except for infants 7 to 12 months of age. In infants 7 to 12 months of age, girls had a higher serum carotene concentration. The measurement of the serum carotene concentration is a simple screening test for fat malabsorption. Our study provides the normal range of serum carotene concentration for children of various age groups.

Serum Carotene Concentrations in Normal Infants and Children

Serum Carotene Concentrations in Normal Infants and Children

Determinants of total serum carotene concentrations in institutionalized elderly.

The current analysis was designed to examine further the association between total serum carotenoids and a series of preselected variables (dietary intakes, anthropometric parameters, serum cholesterol, vitamin A, transport proteins, and others) using 85 elderly patients. Simple correlation between serum carotene and carotene intake, as estimated by a three-day weighed method, was 0.19 (P = 0.08), which was substantially increased (r = 0.29, P = 0.01) after adjustments for a selected set of variables. Standardized coefficients of multivariate regression indicated that the most important predictors of serum carotene were serum cholesterol (beta = 0.38), total serum proteins (beta = -0.35), and sex (beta = 0.34), followed by carotene intake (beta = 0.28) and midarm circumference (beta = 0.20). These variables accounted for 46% of the variance. Results suggest that serum carotene may be related to protein-energy status in hospitalized elderly, but further investigation should be directed to serum carotene in undernourished elderly. Nevertheless, total serum proteins could be an important factor in any attempt to correlate carotene intake and blood concentration.

Vitamin A Status in 137 Patients with Crohn’s Disease

Serum retinol and serum carotene concentrations were determined over a 6-month period in 137 outpatients with Crohn's disease. Serum retinol measurements were within the reference range for all patients at each assessment period, while serum carotene levels were low in about one quarter of the patients. Of the 56 patients who completed 48-hour stool collections, 41% had stool fat values exceeding the reference value. Serum retinol concentrations were not significantly correlated with the serum carotene concentrations, with the 48-hour stool fat content, or with the Crohn's disease activity. In contrast serum retinol concentrations were correlated with the dietary levels of vitamin A. Serum carotene concentrations were inversely correlated with the stool fat content but were not related to Crohn's disease activity or dietary levels of carotene or total vitamin A. Thus: (1) serum retinol concentrations were normal in this moderately large group of patients with Crohn's disease and did not reflect a low dietary vitamin A intake by 34% of the population; (2) serum carotene levels were frequently low in patients with Crohn's disease, possibly due to the presence of steatorrhea, but were not related to low dietary intakes of carotene or to active Crohn's disease, and (3) a low serum level of carotene does not indicate that the patient is at risk of developing vitamin A deficiency.

Comparative Reliability of d‐Xylose Absorption and Serum β‐Carotene Measurements in Small Intestinal Disease

Summary:Comparative reliability of d‐xylose absorption and serum β‐carotene measurements was studied in 63 healthy and sick children suspected of having proximal small intestinal disease. Group 1 included children with newly diagnosed celiac disease (CD) who were on a normal diet (xylose, n = 46; carotene, n = 43); group 2 included children with CD in remission (xylose, n = 17; carotene, n = 15); group 3 included children with CD in remission, but who were exposed to a gluten‐containing diet for an average of 1.4 years (xylose, n = 19; carotene, n = 17); and group 4 included 17 healthy children, insofar as this study is concerned, in whom serum carotene was examined. The means of serum xylose of groups 1 and 3 were significantly lower than the mean of group 2 (p &lt; 0.001 in both cases). d‐Xylose had a sensitivity of 76.9% and a specificity of 100%. The mean serum carotene concentration for group 2 patients with CD in remission was equal to the mean of group 4, which included healthy children. The means of groups 1 and 3 were significantly lower than the means of groups 2 and 4 (p &lt; 0.001 in all cases). Serum β‐carotene had a sensitivity of 95% and a specificity of 87.5%. The use of these two serum tests in combination would give a specificity of 100% and a sensitivity of 94.1%. Although 1‐h serum xylose was as efficient as serum β‐carotene in newly diagnosed children with CD, carotene was superior to xylose in patients with CD who were challenged with gluten (group 3), and therefore the measurement of carotene, which has the higher sensitivity, may be useful in the detection of children with CD who lack strict adherence to the gluten‐free diet.

Comparative Reliability of d-Xylose Absorption and Serum β-Carotene Measurements in Small Intestinal Disease

Comparative reliability of D-xylose absorption and serum beta-carotene measurements was studied in 63 healthy and sick children suspected of having proximal small intestinal disease. Group 1 included children with newly diagnosed celiac disease (CD) who were on a normal diet (xylose, n = 46; carotene, n = 43); group 2 included children with CD in remission (xylose, n = 17; carotene, n = 15); group 3 included children with CD in remission, but who were exposed to a gluten-containing diet for an average of 1.4 years (xylose, n = 19; carotene, n = 17); and group 4 included 17 healthy children, insofar as this study is concerned, in whom serum carotene was examined. The means of serum xylose of groups 1 and 3 were significantly lower than the mean of group 2 (p less than 0.001 in both cases). D-Xylose had a sensitivity of 76.9% and a specificity of 100%. The mean serum carotene concentration for group 2 patients with CD in remission was equal to the mean of group 4, which included healthy children. The means of groups 1 and 3 were significantly lower than the means of groups 2 and 4 (p less than 0.001 in all cases). Serum beta-carotene had a sensitivity of 95% and a specificity of 87.5%. The use of these two serum tests in combination would give a specificity of 100% and a sensitivity of 94.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative Reliability of d-Xylose Absorption and Serum β-Carotene Measurements in Small Intestinal Disease

Summary: Comparative reliability of d-xylose absorption and serum β-carotene measurements was studied in 63 healthy and sick children suspected of having proximal small intestinal disease. Group 1 included children with newly diagnosed celiac disease (CD) who were on a normal diet (xylose, n = 46; carotene, n = 43); group 2 included children with CD in remission (xylose, n = 17; carotene, n = 15); group 3 included children with CD in remission, but who were exposed to a gluten-containing diet for an average of 1.4 years (xylose, n = 19; carotene, n = 17); and group 4 included 17 healthy children, insofar as this study is concerned, in whom serum carotene was examined. The means of serum xylose of groups 1 and 3 were significantly lower than the mean of group 2 (p < 0.001 in both cases). d-Xylose had a sensitivity of 76.9% and a specificity of 100%. The mean serum carotene concentration for group 2 patients with CD in remission was equal to the mean of group 4, which included healthy children. The means of groups 1 and 3 were significantly lower than the means of groups 2 and 4 (p < 0.001 in all cases). Serum β-carotene had a sensitivity of 95% and a specificity of 87.5%. The use of these two serum tests in combination would give a specificity of 100% and a sensitivity of 94.1%. Although 1-h serum xylose was as efficient as serum β-carotene in newly diagnosed children with CD, carotene was superior to xylose in patients with CD who were challenged with gluten (group 3), and therefore the measurement of carotene, which has the higher sensitivity, may be useful in the detection of children with CD who lack strict adherence to the gluten-free diet.

Alterations in vitamin A and thyroid hormone status in anorexia nervosa and associated disorders

Vitamin A and thyroid hormone status was investigated in 27 patients with anorexia nervosa. Subjects were divided into three groups based on eating behavior and serum carotene concentrations: anorexic (dietary restriction), normal carotene; anorexic, elevated serum carotene; bulimic, elevated serum carotene. All bulimic subjects fulfilling selection criteria were hypercarotenemic (weight loss and reduced metabolic rate). Data were compared to normal healthy volunteers. Serum retinol and retinol-binding protein levels were normal in all subjects whereas retinyl esters were elevated in the hypercarotenemic groups. Hypercarotenemia was primarily a result of elevation of vitamin A active carotenoids, especially beta-carotene. Diet was excluded from the etiology of hypercarotenemia. Thyroid hormones T4 and T3 were significantly depressed in hypercarotenemic groups and rT3 increased. A concomitant alteration in vitamin-hormone status is observed with progressive metabolic alterations: low T3, T4, and elevated retinyl esters in subjects with the hypercarotenemia associated with anorexia nervosa.

The association of lipoprotein cholesterol with vitamin A.

Several studies have linked total serum cholesterol concentrations below 200 mg/dl with increased cancer risk, especially among men. Cancer risk appears to be associated primarily with low concentrations of total cholesterol and of low-density lipoprotein cholesterol but not of high-density lipoprotein cholesterol (HDL). It has been suggested that low concentrations of total cholesterol are associated with increased cancer risk indirectly by virtue of their association with low concentrations of carotene and/or retinol. The relationship between serum carotene and cholesterol in a biracial group of 146 first-year college students was investigated. White men and women had similar carotene concentrations. Blacks had higher serum carotene concentrations than whites. There was a significant relationship between carotene concentrations and total cholesterol, which was most evident in men, both black (r = +0.72; P less than 0.01) and white (r = +0.49; P less than 0.01). The correlations for the women were significant, but of lower magnitude than for the men. Significant carotene-HDL relationships were observed among black men (r = 0.31; P less than 0.05) and among women (r = 0.35; P less than 0.05 and r = 0.31; P less than 0.05, black and white, respectively). Furthermore, the women also demonstrated a significant carotene-HDL2 association. The results are consistent with the hypothesis that the association between low serum cholesterol concentrations and cancer may be the result of a relationship between lipoprotein cholesterol concentrations and vitamin A metabolism.

Nutritional status of African populations predisposed to esophageal cancer.

Nutritional status indicators were assessed chemically in blood and urine taken from 625 Transkeians drawn from three age-groups in each of two regions: one with a moderate risk for esophageal cancer and one with a very high risk. Aggregate mean values for protein, albumin, vitamin A, and phosphorus were generally acceptable, but many subjects had inadequate (though not necessarily deficient) values for nicotinic acid (74% of subjects), magnesium (60%), vitamin C (55%), carotene (53%), riboflavin (41%), calcium (35%), and zinc (27%). Groups at highest risk for esophageal cancer had markedly lower serum magnesium and carotene concentrations and mildly depressed hemoglobin and hematocrit values, but such findings are not necessarily associated with esophageal cancer etiology. Possible intestinal malabsorption in the populations at highest risk may be associated with the unusually high fiber and phytate intake of the high-risk populations as well as with exposure to necrotizing mycotoxins. Thus, while protein and energy nutriture seem generally adequate, both the high- and moderate-risk populations had high incidences of multiple micronutrient malnutrition.

Anorexia nervosa: some observations on "dieters" and "vomiters", cholesterol and carotene.

Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between "dieters' and "vomiters' were less pronounced than those reported elsewhere. However, the "vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown-Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.