ABSTRACT INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen’s criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented significantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were significantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not significantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were significantly higher for hyperhomocysteinemia (PR = 3.26; 1.84–5.80) and deficiency of all B vitamins: thiamine (PR = 1.89; 1.04–3.43), B-2 (PR = 2.85; 1.54–5.26), folate (PR = 3.02; 1.53–5.95), B-12 (PR = 2.21; 1.17–4.19), vitamin C (PR = 3.88; 2.12–7.10) and A (PR = 5.47; 3.26–9.17). In mild cognitive impairment, prevalence rates were significantly higher for hyperhomocysteinemia (PR = 1.42; 1.08–1.87), vitamin B-2 deficiency (PR = 1.70; 1.24–2.32) and vitamin A deficiency (PR =1.88; 1.05–3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin deficiencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies.

ABSTRACT Introduction: Non-healthy food habits boost chronic diseases that represent the main death causes in Cuba. Objectives: To assess the effects of a nutritional intervention on the changes in the knowledge of diet-nutrition and food habits of adolescents. Methods: It was carried out a participative nutritional intervention with adolescents from 12 to 15 years from Habana Vieja municipality during their 3 middle school years. From 604 adolescents that started the study, 155 formed the ´´promoter groups´´ which leadered the activities implemented. There were applied knowledge surveys on food consumption and habits before and after the intervention. For comparing the scores, it was used t-Student test for paired samples. It was used the analysis of simple variance for comparing among schools and the percentages of right answers in the knowledge questions, intake of vegetables and sugar before and after of the test for the estimation of differences among proportions. It was defined p<0,05 as the threshold of statistical signification. Results: The promoter groups showed significative increase of knowledge (p<0,001). There were found differences among schools for promoter groups (p<0,001) and for the rest of the students (p<0,024). In the promoter groups decreased the intake of sugar added to soft drinks (p<0,001) and to milk for all the adolescents studied (p<0,002). There were no changes in breakfast habits, liking fried food, or the consumption of soft drinks, fritters, sweets and pizzas. Conclusions: Nutritional education interventions are needed to reach healthier diet patterns and in this way contributing to stop the epidemic of non-communicable diseases; in addition, they allow adolescents to have an approach to food-nutrition topic.

RESUMEN Introducción: Los hábitos alimentarios no saludables potencian las enfermedades crónicas que constituyen las primeras causas de muerte en Cuba. Objetivos: Evaluar los efectos de una intervención nutricional sobre los cambios en los conocimientos de alimentación-nutrición y hábitos alimentarios en adolescentes. Métodos: Se realizó una intervención nutricional participativa con adolescentes de 12-15 años del municipio Habana Vieja, durante sus tres años curriculares. De los 604 adolescentes que comenzaron el estudio 155 formaron los “grupos promotores” que lideraron las actividades realizadas. Se aplicaron encuestas de conocimientos, consumo y hábitos alimentarios antes y después de la intervención. Para comparar la puntuación alcanzada se utilizó la prueba t de Student para muestras pareadas. Para la comparación entre escuelas se utilizó análisis de la varianza simple y para comparar los porcentajes de respuestas correctas de las preguntas de conocimientos, consumo de hortalizas y azúcar antes y después de la prueba de estimación de diferencias entre proporciones. Se definió como umbral de significación estadística p < 0,05. Resultados: Los grupos promotores mostraron aumentos significativos de los conocimientos (p < 0,001). Se encontraron diferencias entre escuelas para los grupos promotores (p < 0,001) y para el resto de los estudiantes (p = 0,024). Decreció el azúcar añadido a los refrescos para los grupos promotores (p < 0,001) y a la leche para todos los adolescentes (p = 0,002). No hubo cambios en el hábito de desayunar, en el gusto por alimentos fritos, ni en el consumo de refrescos, frituras, dulces y pizzas. Conclusiones: Las intervenciones de educación nutricional son necesarias para alcanzar patrones dietéticos más saludables y de esta manera contribuir a detener la epidemia de enfermedades no transmisibles, además permiten que los adolescentes tengan un acercamiento al tema alimentación-nutrición.

ABSTRACT Introduction: Non-healthy food habits boost chronic diseases that represent the main death causes in Cuba. Objectives: To assess the effects of a nutritional intervention on the changes in the knowledge of diet-nutrition and food habits of adolescents. Methods: It was carried out a participative nutritional intervention with adolescents from 12 to 15 years from Habana Vieja municipality during their 3 middle school years. From 604 adolescents that started the study, 155 formed the ´´promoter groups´´ which leadered the activities implemented. There were applied knowledge surveys on food consumption and habits before and after the intervention. For comparing the scores, it was used t-Student test for paired samples. It was used the analysis of simple variance for comparing among schools and the percentages of right answers in the knowledge questions, intake of vegetables and sugar before and after of the test for the estimation of differences among proportions. It was defined p<0,05 as the threshold of statistical signification. Results: The promoter groups showed significative increase of knowledge (p<0,001). There were found differences among schools for promoter groups (p<0,001) and for the rest of the students (p<0,024). In the promoter groups decreased the intake of sugar added to soft drinks (p<0,001) and to milk for all the adolescents studied (p<0,002). There were no changes in breakfast habits, liking fried food, or the consumption of soft drinks, fritters, sweets and pizzas. Conclusions: Nutritional education interventions are needed to reach healthier diet patterns and in this way contributing to stop the epidemic of non-communicable diseases; in addition, they allow adolescents to have an approach to food-nutrition topic.

RESUMEN Introducción: Los hábitos alimentarios no saludables potencian las enfermedades crónicas que constituyen las primeras causas de muerte en Cuba. Objetivos: Evaluar los efectos de una intervención nutricional sobre los cambios en los conocimientos de alimentación-nutrición y hábitos alimentarios en adolescentes. Métodos: Se realizó una intervención nutricional participativa con adolescentes de 12-15 años del municipio Habana Vieja, durante sus tres años curriculares. De los 604 adolescentes que comenzaron el estudio 155 formaron los “grupos promotores” que lideraron las actividades realizadas. Se aplicaron encuestas de conocimientos, consumo y hábitos alimentarios antes y después de la intervención. Para comparar la puntuación alcanzada se utilizó la prueba t de Student para muestras pareadas. Para la comparación entre escuelas se utilizó análisis de la varianza simple y para comparar los porcentajes de respuestas correctas de las preguntas de conocimientos, consumo de hortalizas y azúcar antes y después de la prueba de estimación de diferencias entre proporciones. Se definió como umbral de significación estadística p < 0,05. Resultados: Los grupos promotores mostraron aumentos significativos de los conocimientos (p < 0,001). Se encontraron diferencias entre escuelas para los grupos promotores (p < 0,001) y para el resto de los estudiantes (p = 0,024). Decreció el azúcar añadido a los refrescos para los grupos promotores (p < 0,001) y a la leche para todos los adolescentes (p = 0,002). No hubo cambios en el hábito de desayunar, en el gusto por alimentos fritos, ni en el consumo de refrescos, frituras, dulces y pizzas. Conclusiones: Las intervenciones de educación nutricional son necesarias para alcanzar patrones dietéticos más saludables y de esta manera contribuir a detener la epidemia de enfermedades no transmisibles, además permiten que los adolescentes tengan un acercamiento al tema alimentación-nutrición.

ABSTRACT INTRODUCTION Iron deficiency is the main cause of anemia, but infections, inflammation and other factors also play a role. Anemia in women of childbearing age is a risk for pregnancy, childbirth and childhood development during the first two years of life. In Cuba, per WHO definition, anemia is a moderate public health problem in the third trimester of pregnancy and in preschoolers, with a prevalence of 21.6%, in both cases. OBJECTIVE Estimate prevalence of anemia and iron deficiency in women of childbearing age and assess its relation to inflammation, overweight, central adiposity, H. pylori infection and ingestion of iron-rich foods and enhancers of iron absorption. METHODS A cross-sectional, analytical study was performed in 391 women aged 18–40 years in four municipalities of Havana, Cuba, from February through June 2014. Variables (indicators in parentheses) were anemia (hemoglobin), iron deficiency (ferritin), nutritional status (body mass index and waist circumference), inflammation (C-reactive protein, acid alpha 1-glycoprotein and interleukin 6), H. pylori infection and ingestion of iron-rich foods. SPSS 20.0 and Epi Info 7.1.2.0 were used for statistical analysis. RESULTS Anemia prevalence was 24.6% (96/391); iron deficiency, 68% (266/391); H. pylori infection, 47.1% (184/391); inflammation detected by C-reactive protein, 8.4 % (33/391) and by alpha-1-gly-coprotein, 19.9% (78/391). Limited results are included for interleukin 6, which was determined in fewer cases (96). Excess body weight was found in 38.7% (150/388) and increased central adiposity in 26.7% (101/378). Iron deficiency was the main cause of anemia (OR 2.68). Central adiposity, excess body weight, and iron deficiency were positively associated with inflammation (OR of 1.77, 1.23 and 1.72, respectively), whereas H. pylori infection was negatively associated with iron deficiency and anemia (OR 0.75 and 0.94, respectively). Low consumption of meat (OR 1.17) and vegetables (OR 1.36) showed discrete limited positive associations with iron deficiency, as well as low consumption of eggs (OR 1.69) and vegetables (OR 1.56) with anemia. CONCLUSIONS Anemia is a moderate public health problem in the studied group, but with iron deficiency present in two thirds of the population and associated with anemia. Risk factors for anemia and iron deficiency, such as menorrhagia and bacterial or viral infections, should be assessed in women of childbearing age, to support interventions needed to reduce risks in pregnancy and childbirth.