The prevalence of diabetes in Central America was somewhat greater than in East Pakistan and Malaya, less
than in Uruguay and Venezuela, and substantially less than in affluent societies such as the United States. Differences in prevalence among Central American countries were modest but probably significant in some instances. In all Central American countries diabetes was more common in females but this difference was probably attributable to the greater adiposity of the women. Age-matched populations from eleven different countries of three continents have now been tested using standardized methods. Prevalence of diabetes varied greatly, and differences were more related to environment than to race. These results support the hypothesis that environmental factors can increase or reduce prevalence by several-fold.
300 patients (185 males, 115 females) were examined for intestinal parasites. About 40% of these patients was infected, 14% of which was heavily infected. The highest prevalence and intensity of infection with soil-transmitted helminths was found among Malays and Indians of different ages. Heavy infections with these helminths were also frequently encountered in young Chinese. Helminthic infections in patients over 60 years of age was significantly lower. There was no significant differences in the prevalence and degree of infection among males and females. The commonest helminth encountered was Trichuris trichiura, which usually occurred as trace single infections. Mixed infections with Ascaris and Trichuris, usually with the former as the predominating parasite, were also frequently observed.
Investigations in 30 healthy control subjects of Indian, Chinese and Malay ethnic origin, revealed that all the Chinese and about two thirds of the Indians and Malays had a normal capacity to absorb D—xylose, Vitamin A, Co58 labelled Vitamin B12 and dietary fat. About a third of the Indians and Malays were unable to absorb one or two of the four test substances used in the absorption studies. Jejunal biopsies did not differ in the 3 ethnic groups and were normal or mildly abnormal. 27 patients presenting with anorexia, a sore tongue and pallor were also investigated. Indians formed the majority of the patients. Diarrhoea occurred in only 51 % of the patients. All had a megaloblastic anaemia. Absorption studies revealed malabsorption of xylose, Vitamin A and Vitamin B12 in the majority but steatorrhoea occurred in only 26% of the patients. Jejunal biopsies were mildly abnormal in 8% and moderately or severely abnormal in 92 % of the patients. All responded to folic acid or Vitamin B12 therapy. 16 patients were restudied after 5 to 24 months therapy and the majority were found to have improved. Results of investigations and response to therapy indicate that these patients were suffering from tropical sprue. These studies indicate that tropical sprue in Singapore affects Indians mainly and can often present without diarrhoea and steatorrhoea.
The pattern and incidence of cardiovascular disease was studied in a general practice in an urban-rural area in the west coast of West Malaysia. Hypertension, rheumatic heart disease and congenital heart disease accounted for 85% of the 476 patients with evidence of cardiovascular disease. Ischaemic heart disease, arteriosclerotic heart disease and other conditions accounted for the rest. Emphasis is laid on the salient features of incidence in general practice. Comparison is made with previous clinical and pathological studies from this region.
Study site: General practjce clinic, Telok Anson [Teluk Intan], District of Lower Perak, Malaysia