Milk lactoferrin (LF), lysozyme (LZ), and secretory IgA (sIgA) were measured cross-sectionally in 127 Zaïrean mothers, lactating greater than or equal to 18 mo. The 54 urban mothers were of marginal nutrition status [body mass index (BMI) 22.6 +/- 2.6 kg/m2 and albumin 33.1 +/- 4.5 g/L]. The neighboring rural mothers were of significantly (P less than 0.001) poorer nutrition status (BMI 20.5 +/- 2.2 kg/m2 and albumin 27.7 +/- 5.4 g/L). In both urban and rural mothers, as lactation progressed LF decreased by 33% and 55% whereas sIgA remained unchanged and LZ steadily increased. There was more LZ and sIgA in rural milk, contrasting with the poorer maternal nutrition. As calculated from individual milk yields, the urban infants were fed daily with twice as much LF and sIgA but with similar amounts of LZ as were the rural infants. In the early stage of lactation, the milk of both groups of Zaïrean mothers contains more sIgA than that of a group of west European (Belgian) mothers (n = 20), but the LF and LZ contents were rather similar.

Background: Total plasma homocysteine (tHcy) is an independent risk factor for cardiovascular disease in adults. Data for children and adolescents are lacking. Objective: The aim of this study was to provide a reference range for tHcy and to explore the relation between tHcy and nutritional indexes in a Belgian pediatric population. . We observed no significant differences in tHcy values between girls and boys in children aged < 15 y; in postpubertal children, however, concentrations were higher in boys than in girls. In the 3 age groups, folate was inversely correlated with tHcy; the negative relation between tHcy and vitamin B-12 was less strong. Familial cardiovascular disease was more frequent in children who had hyperhomocysteinemia. Conclusions: These observations suggest that in children, as in adults, genetic, nutritional, and endocrine factors are determinants of the metabolism of homocysteine. The significance of tHcy values in childhood and young adulthood in terms of predicting cardiovascular risk in adulthood should be investigated. Am J Clin Nutr 1999;69:968-72.

Drugs are approved by regulatory agencies on the basis of their assessment of whether the available evidence indicates that the benefits of the drug outweigh its risks. In recent years, regulatory agencies have been criticized both for being overly tolerant of risks or being excessively risk-averse, which reflects the challenge in determining an appropriate balance between benefit and risk with the limited data that is typically available before drug approval. The negative consequences of regulatory tolerance in allowing drugs onto the market that turn out to be unsafe are obvious, but the potential for adverse effects on public health owing to the absence of new drugs because of regulatory risk-aversion is less apparent. Here, we discuss the consequences of regulatory risk-aversion for public health and suggest what might be done to best align acceptance of risk and uncertainty by regulators with the interests of public health.