SUMMARY Previous work at this hospital and elsewhere has shown that anaemia in toddlers is common and is associated with psychomotor delay. It seemed unclear, however, whether this association was cause and effect or merely due to the same underprivileged environment. A double blind randomised intervention study was, therefore, performed. After an initial assessment 97 children with anaemia (haemoglobin 8-11 g/dl) aged 17-19 months received either iron and vitamin C or vitamin C only (control group) for two months and were then reassessed. The children who received the iron had an increased rate of weight gain and more of them achieved the expected rate of development. While iron deficiency anaemia is unlikely to be the only factor in the slower development of children living in underprivileged circumstances, it can at least be easily identified and treated. Routine child health surveillance in such areas should include a haemoglobin determination.

Dementia and depression among the elderly living in the Hobart community. PsycholMed 1985;15:771-8. 17 Lindesay J, Briggs C, Murphy E. The Guy's Age Concem survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. BrJPsychiatty 1989;153:317-29 Design-Retrospective cohort study. Setting-27 schools closest to University Hospital ofthe West Indies, Kingston, Jamaica.Subjects-2337 children aged 6-16 years who were born at university hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 ofthese were prepubertal.Main outcome measures-Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status.Results-Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their current weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P<0.001) and who had been shorter at birth (P=0.003). Serum cholesterol concentration was inversely related to current height (P=0.001) and to length at birth (P=0.09) and was directly related to triceps skinfold thickness and higher socioeconomic status (P < 0.001).Conclusions-Blood pressure in childhood was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity.

1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast.2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day.3. Pregnancy outcome in the two groups was comparable. 4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.An important aspect of the Muslim religion is the fast of Rosa during Ramadan. During Ramadan all healthy adults are obliged to fast from sunrise to sunset. The length of the fast therefore depends on the exact time of sunrise and sunset in the country where the person lives. The duration of the fast in temperate climates such as Britain averages about 18 h/d when Ramadan occurs during the spring and summer. This is dependent on the exact time of sunrise and sunset, but is approximately observed between 02.30 and 19.30 hours here. Pregnant women are allowed to postpone their fast until after delivery, but about three quarters of mothers attending this hospital continue to observe it for various reasons (Eaton & Wharton, 1982), for example, convenience when eating as a family, and social pressures. However, they often ask about the possible harmful effects of fasting both to themselves and their babies.Although there is some evidence of metabolic stress in Ramadan (Prentice et al. 1983), the work was carried out in the deprived conditions of the tropics where the prevalence of endemic malnutrition, tropical infection and drought may have compounded the effect of fasting during pregnancy. The better environmental conditions of the Muslim population in Britain provides an opportunity to study the metabolic effect of Ramadan fasting without these complicating factors. Moreover, a previous study in Birmingham of nonpregnant Muslim diabetics (Barber et al. 1979) concluded that fasting was safe. This study was designed to determine the metabolic effects of Ramadan fasting during pregnancy in healthy mothers living in Britain. M E T H 0 D S PatientsAs part of a larger study of glucose metabolism in pregnancy all mothers booking at this hospital in time were invited to attend a clinic at 17 weeks and again at 28 weeks for a more detailed assessment than is usually possible in a routine antenatal clinic. Some of these mothers were selected to take part in this Ramadan study as follows.

SUMMARY One hundred and forty five Asian children born at Sorrento Maternity Hospital, Birmingham, were reviewed at the age of 22 months. A significant association of iron deficiency and poor vitamin D state was found. Two fifths of the children were anaemic, two fifths had a low plasma concentration of vitamin D, and one fifth had both features. This was more than simple overlap of the two deficiencies; the children with low plasma vitamin D concentrations had significantly lower concentrations of haemoglobin and serum iron. On the other hand, the deficiencies were not merely individual features of generally poor nutrition; growth and other measures of protein energy nutrition were slightly better in these children, and their plasma zinc concentration was no lower than in the children without deficiencies. It seems, therefore, that child health surveillance as currently practised-for example, growth monitoring, clinical signs, etc-will not detect these problems unless a haemoglobin determination is included. In view of the association of poor iron and vitamin D state combined prophylaxis is desirable. At present, strategies for preventing rickets in this country are not combined with attempts to detect or prevent iron deficiency. In our opinion they should be and the options are discussed.

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