280 Colombian infants at risk of malnutrition were randomly assigned to 1 of 4 experimental groups formed by the presence/absence of 2 interventions: (1) food supplementation for the entire family, from mid-pregnancy until the target child was 3 years old, and (2) a twice-weekly home-visiting program to promote cognitive development, from birth until age 3. All families received free medical care and were studied prospectively. At 3 years of age, children who had received food supplementation averaged 2.6 cm and 642 grams larger than controls. Home visiting and supplementation together reduced the number of children with severe growth retardation. 3 years after intervention (age 6), supplementation effects remained. Children in the home visit condition had become larger than controls, by 1.7 cm and 448 grams. The interactive effect to reduce stunting was marginally significant at this age, and the overall distribution of scores was improved. Other results suggest that changes in family functioning as well as biological mechanisms account for the observed pattern of results.

above the normal limit, was obtained. The Aminolevulinic acid, porphobilinogen, and other patient, a 54-year-old male with Hgb SC disease and infected leg ulcer, showed 9 total porphyrin values from 4 to 149 pg/24 hr and only one value, 208 pg/24 hr above the normal limit of 180 pg/24 hr.Discussion. Our findings reveal a rather consistent moderate, occasionally marked increase of urinary copro-, total, and uroporphyrins-in this order-and to a slight extent of porphyrin precursors ALA, PBG, and AA during painful and febrile sickle cell crises. Although the number of cases is small, it is our impression that total urinary porphyrin excretion generally parallels the severity of clinical symptomatology and is normal during recovery and the steady state.Of considerable interest is the close resemblance of prominent clinical features in sickle cell crisis and acute porphyria, particularly evident in cases with episodes of excruciating abdominal pain which in both conditions has led to unnecessary laparotomies (9,10,11) . Besides increase of urinary porphyrins there is evidence of vasoconstriction in both diseases(9,10,12,13).Summary. Porphyrin excretion in urine was studied in 18 patients with sickle cell disease, including multiple observations in 6 patients during 7 typical painful and febrile crises. With few exceptions there was moderate to marked elevation of copro-, total, and uroporphyrins at time of pain and fever. aminoacetone during crises were within range of normal variation or only slightly increased. Following subsidence of pain and fever, total porphyrin values returned toward normal. Similarities between clinical features of painful sickle cell crisis and acute porphyria are pointed out.

The object of the study was to assess the nutritional status of children 0-5 years, who were attending maternal and child health clinics in Basrah city, 6 months after the cessation of the Gulf War, and took the form of a cross-sectional study. The study population consisted of 723 children, the majority of whom were between 0 and 36 months of age, attending maternal and child health clinics (MCHC) in Basrah city for routine immunizations. Each MCHC was visited on a separate day and all children attending on that day were included in the study. A proportion (8 per cent) of the study population were wasted, most of them in the 12-24-month age category. Twenty-four per cent of the children were stunted. Stunting and low weight-for-age were significantly higher among children of low socio-economic households. Comparison of these data with an earlier nutritional survey in the area showed that the nutritional status of children in Basrah city has deteriorated as a result of successive armed conflicts. There is need to monitor the health and nutritional status of children, and take appropriate action in order to protect them.

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A multifaceted educational program was designed to maximize dietary adherence of twenty-three diabetic subjects in order to study two experimental diets for forty weeks. The results of the program showed that a high level of diet adherence was achieved in spite of the strict dietary guidelines. The success of the educational approach was also reflected in the high attendance rate (99 per cent of 270 subject visits) and the low voluntary attrition rate (4 per cent).Five aspects of the over-all design were felt to have been of major importance in gaining subject cooperation: (1) the small, grouporiented learning process; (2) frequent intervals of follow-up; (3) feedback on laboratory data; (4) individualization of diet prescriptions; and (5) family involvement.Since the majority of diabetics seen in medical clinics fail to follow their prescribed diets, the concepts and approach applied to this study may be applicable to the dietary management of diabetic patients. Such implications and specific recommendations are presented in this report. DIABETES 23:669-73, August, 1974.