Frequent diarrhoeas in early childhood have sustained effects on the height, weight and head circumference of children in East Bhutan

Episodes of diarrhoea and nutritional status of 113 children in East Bhutan were recorded monthly from 7 to 36 months of age. A re-examination was carried out 20 months later. The load of diarrhoeal diseases in early childhood was negatively associated with the parameters of children's long-term nutritional status 20 months later. Also, when early nutritional status and socioeconomic factors are included in the model, the diarrhoea variable explains a significant part of the variation in height for age (p = 0.04, delta R2 = 0.035), weight for age (p = 0.03, delta R2 = 0.030) and head circumference (p = 0.0007, delta R2 = 0.077). This is not so for the variation in weight for height or mid-upper arm circumference (p > 0.1, delta R2 < 0.005). Stunting is widespread in the area, and the effects of diarrhoea on nutritional status are more likely to be sustained in settings where dietary intake is marginal.

Prevalence of malnutrition in Mexican CAPD diabetic and nondiabetic patients

Malnutrition is often present on continuous ambulatory peritoneal dialysis (CAPD), and contributes to morbidity and mortality. Diabetics (DM) have an increased risk for developing malnutrition. Our purpose was to assess the nutritional status (NS) of our CAPD population, to define NS differences between DM and nondiabetics (NoDM), and to identify NS-related factors. Patients were subjected to a nutritional assessment, which included a 24-hour dietary recall and a nutritional scoring system including anthropometric, biochemical, and subjective evaluation, and that classifies patients as: normal, and mildly, moderately, and severely malnourished. We studied 90 patients: 35 DM and 55 NoDM. In our whole population we observed a high frequency of malnutrition: NS was normal in 18%, and 20% had mild, 24% had moderate, and 38% had severe malnutrition. Ninety-one percent of DM and 76% of NoDM showed some degree of malnutrition. DM patients had significantly higher levels of malnutrition (p = 0.02), were significantly older, had more body fat, and spent less time on dialysis. There were 37 males and 53 females. Sex distribution was similar between DM and NoDM. Seventy-six percent of males and 86% of females had malnutrition. Moderate and severe malnourishment were more frequent in females. DM and female sex were the strongest predictors for moderate and severe malnutrition.

Validity of single-weight measurements to predict current malnutrition and mortality in children

In this cross-sectional study of a random cluster sample of 4238 rural Zairian children aged 0-5 y, we assessed underweight and wasting, defined as weight-for-age < 75%, and weight-for-height < 80% of the U.S. National Center for Health Statistics reference median, respectively. We determined the diagnostic validity of underweight and wasting for protein-energy malnutrition, taking a low arm circumference and clinical signs of muscle loss as criteria. Both underweight and wasting had low sensitivity in recognizing low arm circumference, any clinical muscle loss and even severe marasmus, especially in the weaning period of 12-30 mos. Receiver operating characteristic (ROC) analysis showed that the diagnostic validity of weight-for-height can be improved by using a cutoff for wasting at Z-score -0.75 instead of Z-score -2 or 80% of reference median. ROC analysis of 30-mo mortality revealed a poor prognostic validity of weight-for-height and weight-for-age and better performances of arm circumference (cm) and of age. These data suggest that nutritional intervention programs targeted at wasted or underweight children can have only a limited effect on the prevalence of protein-energy malnutrition in the community or on the long-term mortality associated with it.

Cottonseed protein: what does the future hold?

Cottonseed protein has the potential to increase the world's food supply while decreasing the incidence of malnutrition among the world's hungry. Nutritionally, cottonseed flour compares favorably to other animal and vegetable protein sources, as it is low in fat and contains a substantial amount of high biological value protein. Animal studies, as well as human research, using gossypol-free glandless cottonseed flour have shown that cottonseed protein promotes growth, increased weight gain, and a positive nitrogen balance. Cottonseed protein food products have been shown to be a healthy addition to the diets of children, college-age women, and the elderly. With its light color and bland flavor, cottonseed has many uses in the food processing arena. Baked goods, snack foods and candy, as well as pet and livestock feed are just a few successful products developed utilizing cottonseed protein.

Profile of protein energy malnutrition amongst children under four years in urban areas of Rivers State

The incidence of protein-energy malnutrition (PEM) in Rivers State children aged 0-4 years has been studied. The incidence rate for a period of 30 months investigated gave a range of 3.97 to 4.81% of the total number of patients examined while the point prevalence gave a range of 0.13 to 0.99% of the total urban population of children aged 0-4 years. PEM was found to occur at a very low rate in Rivers State and persisted throughout the period investigated. PEM occurred in both males and females. The mean difference between the two sexes was not significant (p > 0.05) suggesting a non-sex dependent PEM within this age range.

[Nutritional and feeding status of preschool children in the semi-arid region of Bahia (Brazil): I. Anthropometric assessment]

A survey of 754 preschool children was undertaken in the urban areas of seven small towns of the semi-arid region of Bahia, Northeast Brazil. The study set out to determine the prevalence of weight and height deficits, as well as to correlate them with variables such as age, family income, mother's schooling and food consumption. A prevalence of 22.9% of Height for Age (HA) below -2.0 SD was found (stunting) and prevalence of 19.1% and 3.6% were determined, respectively for Weight for Age (WA) and Weight for Height (WH) below -2.0 SD (wasting). Regarding food consumption, only 6.8% of the children received a diet with an adequate energy supply for their age group in the previous day. There was a close association between inadequate HA and WA and family income per capita (p = 0.001 and p = 0.000, respectively). Children from families with income < 1/4 of the minimum wage per capita had twice the chance of being malnourished as compared with those from the > or = 1/2 minimum wage per capita stratum. The children included in this study showed prevalences of inadequate WH and WA significantly higher than those found in a national survey conducted in the same period (p = 0.047 and p = 0.000 respectively). This fact is surprising since in the last decade important reductions in child malnutrition and mortality were reported in the country as a whole; this may indicate that children from this region probably were not benefitted in the same way as the rest of the Brazilian child population.

Zinc status of Indian children

Zinc is a trace metal essential for human health and its deficiency is found to cause severe growth retardation in children. Information on the zinc status of Indian children is meagre perhaps due to lack of a reliable parameter. However, in view of the role of zinc in promoting growth, it has become common practice to prescribe zinc supplements to young children and newborns, particularly preterm infants. It is now clearly established that zinc confers no additional benefits to an individual with adequate zinc status while it can potentially lead to harmful effects by disturbing the milieu of other trace metals in the body. Estimation of thymulin levels in circulation is found to be a sensitive indicator of zinc status and using this parameter we found that apparently normal children have adequate zinc status. Children suffering from severe protein energy malnutrition however had very low levels of the hormone besides low leukocyte and plasma zinc levels indicating zinc deficiency. Such children showed improvement in their zinc status when zinc supplements were provided along with rehabilitation diets. Pregnant women and term newborns showed no evidence of zinc deficiency. Preterm infants had higher leukocyte zinc levels during early infancy and the breast milk of their mothers also had higher zinc content which could cater to the higher requirements of the rapidly growing preterm infant. All breast-fed infants showed decline in the zinc status gradually over the initial 4 months of life and regained adequate zinc status after appropriate weaning. These studies thus do not support the view of routine zinc supplements to pregnant women or children. However, Infants solely fed formula milk from birth had significantly impaired zinc status till the time of weaning. The functional significance of severe zinc inadequacy in such infants needs to be established.

The role of nutrition in increased morbidity and mortality

Up to 65% of the hospitalized elderly are protein-energy undernourished at admission or develop serious nutritional deficits while hospitalized. These undernourished patients are at an increased risk of developing serious in-hospital complications, the likelihood of developing a complication increasing in relation to the severity of the nutritional deficits. Several studies suggest that aggressive nutritional support targeted to these undernourished patients may be beneficial both in terms of rectifying their nutritional deficits and improving their clinical outcomes; however, these findings have not been confirmed. There must be a greater understanding of the nutritional needs in the hospitalized elderly to guarantee optimal care.

Seasonal variations in energy balance among agriculturalists in central Mali: compromise or adaptation?

OBJECTIVE

This paper considers whether seasonal variations in the energy balance of adult agriculturalists in Central Mali exceed acceptable risk, or whether they represent a short-term adaptive response without functional consequence.

DESIGN

Prospective/longitudinal study design.

SETTING

Agricultural village in rural Mali.

SUBJECTS

From a total population of 166 adults aged > or = 16 years, two cohorts of 63 men and 73 non-pregnant women with complete records were retained for analysis.

INTERVENTIONS

Over a 12-month period, monthly anthropometry and biweekly retrospective assessments of morbidity were made on every adult in the sample. Direct measures of household food consumption were collected twice in harvest, dry and rainy seasons respectively. Continuous 15-h observations of time-use and work intensity were conducted on a sub-sample of active adults and used to calculate mean seasonal energy expenditure.

RESULTS

Energy balance as measured by body mass index (BMI; kg/m2) declines significantly in the rainy season (P < 0.01), corresponding to a seasonal weight loss of 2-3 kg. A similar seasonal trend in % body fat (P < 0.0001) suggests that most of this loss represents adipose tissue. A rainy season increase in arm muscle area (AMA) implies that there is no seasonal compromise in lean tissue. Among men and women with BMI > 18.5, seasonal fat loss is significantly greater than their leaner counterparts. Considering the likely determinants of variations in energy balance, an increase in the duration and incidence of adult morbidity is observed; however, no significant intercorrelations exist between it and seasonal nutritional indices. Comparing trends in energy expenditure and intake, a disturbance in energy homeostasis is apparent as energy expenditure increases in the rainy season relative to constant household food consumption across seasons. While seasonal variations in energy expenditure are not as dramatic in the female sample, they appear to have less opportunity to recover from so-called 'heavy' levels of expenditure experienced in successive dry and rainy seasons. Periods of 'light' activity in both harvest and dry seasons provide the male sample with a reasonable length of time in which to reconstitute energy stores after the physical demands of the rainy season.

CONCLUSIONS

In the year of study, the modest loss of body fat recorded in the rainy season (< 5% body mass) represents a successful physiological response to energy imbalance, and is unlikely to compromise adult productive and reproductive function.

Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients

Although malnutrition is not uncommon in continuous ambulatory peritoneal dialysis (CAPD) and maintenance hemodialysis (MHD) patients, there has never been a large-scale comparison study of nutritional status with these two dialysis modalities. We therefore assessed protein-calorie nutrition in 224 CAPD patients and 263 MHD patients who were treated in eight centers in Italy. The CAPD patients were slightly older than the MHD patients (60.2 +/- 14.2 years v 56.3 +/- 15.1 years; P < 0.01), had undergone dialysis for less time (2.32 +/- 2.10 years v 3.66 +/- 2.66 years; P < 0.0001), and had higher residual renal function (1.83 +/- 2.29 mL/min v 0.27 +/- 0.91 mL/min; P < 0.0001). Protein nitrogen appearance was 60.5 +/- 16.6 g/d and 61.9 +/- 16.5 g/d in the CAPD and MHD patients, respectively. In CAPD versus MHD patients, serum total protein and albumin tended to be lower; serum transferrin and midarm muscle circumference were similar; and relative body weight, skinfold thickness, and estimated percent body fat tended to be greater. These greater values in CAPD patients were particularly evident in those who were 65 years of age or older. Serum glucose, total cholesterol, and triglycerides also were greater in CAPD patients. The subjective global nutritional assessment indicated a significantly greater proportion of malnourished CAPD patients than MHD patients (42.3% v 30.8%). The greater prevalence of malnutrition in CAPD patients diminished with age. Maintenance hemodialysis patients older than 76 years were more likely to be malnourished than CAPD patients. In patients less than 65 years of age, protein-calorie malnutrition was more likely to be present in CAPD patients than in MHD patients.

Clinical and immunological features of the HIV infection associated with chronic hypertrophic parotitis in children

The study refers to children of 0-15 years of age, infected with HIV and who developed a chronic hypertrophic parotitis (CHP), admitted to the "Colentina" Clinic of Infectious Diseases--Paediatrics in Bucharest, between January 1, 1990 and May 15, 1993. Among the total number of 579 HIV infection cases hospitalized in the above-mentioned period, 135 were associated with CHP, hence an incidence of 23.3%. The HIV infection was defined by two ELISA-positive assays, confirmed by a Western-blot test. No specific laboratory test for the diagnosis of CHP in the course of HIV infection was available. The detection of a uni- or bilateral painless parotid enlargement, without signs of skin inflammation in HIV-infected children, was conclusive for the diagnosis of CHP. IgG type anticytomegalovirus antibodies were detected in 41.17% (7/17) and anti-Toxoplasma antibodies in 50% of the tested cases (4/8). The immunogram performed in 85 children showed increased IgG values in 92.94% of cases (79/85) and increased IgM values in 85.88% (73/85). There was recorded a significant increase in the levels of immunoglobulins, especially of IgM, which exceeded 13 times the normal values. The CD8 cells were frequently normal or increased (94.44%, respectively 34/36). CHP appeared before a marked deterioration of CD4 cells, simultaneously with the CD8 cells proliferation. CHP developed at a stage of the HIV infection when the medium-term prognosis was still considered favourable.

[Prevalence of malnutrition in preschool children in Tabasco, Mexico]

Childhood malnutrition is an important and prevailing public health problem in Tabasco, Mexico, where precise information is still lacking. Tabasco Public Health Department has been working on this problem since 1991. The first nutritional survey was carried out to recognize the nutritional level of 935 randomly selected children between 1-4 years of age in 17 municipalities of the state. A proportion of 46% of childhood malnutrition level was found in this Mexican state (29.8 low, 12.8% moderate and 3.4% severe). Ninety percent of severe childhood malnutrition cases were located in the rural municipalities of Tacotalpa, Nacajuca, Jonuta, Macuspana and Centla. These municipalities were more affected, with a malnutrition prevalence of 63%, 62.2%, 60%, 59.5% and 59.4%, respectively. Results from these surveys identify high risk areas and may serve to advance specific proposals for nutrition interventions.

Serum amino acids and genesis of protein energy malnutrition

Twenty four patients of classical marasmus and kwashiorkor along with equal number of healthy controls were selected for the study. Their serum amino acid patterns analysis revealed a mean ratio of glutamate to alanine in fasting samples of normal individuals to be 0.33, while it as 9.3 in kwashiorkor and 1.6 in marasmus. This differences in controls, kwashiorkor and marasmus was statistically significant. This observation may explain evolution of marasmus and kwashiorkor in children with similar diets. On the basis of the present observation it is postulated that in kwashiorkor, the conversion of pyruvate to alanine in presence of glutamate, an aminogroup donor does not proceed normally, resulting in accumulation of glutamate and low alanine. Thus the development of marasmus and kwashiorkor may not be related to dietary inadequacy alone but also to the transaminase function. This could be genetic in origin.

Growth monitoring: the role of community health volunteers

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.

Prolonged breastfeeding without the introduction of supplementary feeding

A study on the determinants of nutritional marasmus (NM) and kwashiorkor (K) was conducted using Sudanese children aged 6-36 months. The hypotheses tested were related to the specific circumstances leading to the development of NM and K. Subjects consisted of 55 children with NM and 55 with K, admitted to the Children's Emergency Hospital in Khartoum. This paper presents the results of the association between NM and prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months. Mothers were interviewed in hospital, and information on duration of breastfeeding, age at introduction of supplementary foods, and weaning foods was obtained. Observations were made in 20 per cent of homes of study children. The results suggest a positive association between prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months, and NM. Using multivariate analysis the data show that late introduction of supplementary foods produces an increase of 1.4-fold the odds of developing nutritional marasmus, rather than kwashiorkor. In contrast the odds ratio is 1.9 for the two conditions in terms of age of cessation of breastfeeding, the kwashiorkor children breastfeeding for fewer months. Results suggest strategies to reduce the prevalence of NM and K, plus mild and moderate PEM.

Lung functions in malnourished children aged five to eleven years

Lung functions including FVC, FEV1, PEFR, %FEV1/FVC and Empey Index were measured using P.K. Morgan's pocket spirometer on 122 children of both sexes in the age group of five to eleven years. There were 80 (65.57%) malnourished children according to the Indian Academy of Pediatrics classification. FVC and FEV1 were significantly (p < 0.02) reduced in malnourished children. FVC (r = 0.67, p < 0.001), FEV1 (r = 0.68, p < 0.001) and PEFR (r = 0.53, p < 0.001) showed linear relationship with body surface area in all age groups. Empey index was less than 10 in both healthy and malnourished children. Abnormal respiratory functions should be interpreted with caution in malnourished children.

Body mass index defines the risk of seasonal energy stress in the Third World

A method has been devised to quantify the effect of seasonal environmental stress on nutritional well-being and to estimate the proportion of Third World populations at risk of functional deterioration. An Index of Agro-Climatic Seasonality, IACS--a measure of potential agricultural biomass availability--has been developed from agro-climatic data. IACS was found to be highly correlated with the seasonal weight loss of adults in rural Third World communities. This relationship was then used to predict the existence and severity of seasonal energy stress incurred by the adult population of Third World countries at any given body mass index (BMI). The average weight loss recorded in all seasonality studies was calculated; this value was used to specify, in combination with BMI, a condition of moderate seasonal energy stress. This grade of energy stress involved a loss of about 2% fat-free mass. The risk of greater energy stress, with larger losses of lean tissue, was specified as severe when predicted weight changes exceeded the maximum losses of weight recorded--at any given BMI--in Third World rural communities. The global dimensions of seasonality were then calculated by enumerating the individuals who--by the combined criteria of the BMI and the IACS of the habitat--fell into the categories of moderate and severe seasonality risk. On this basis, 65% of the rural adult population in the Third World run the risk of at least moderate seasonal energy stress, while 45% fall into the severe stress category. Of these 25% qualify as true seasonal 'casualties' because their body weight loss shifts their BMI from the normal range of nutritional status into the category of chronic energy deficiency.

The body mass index of Chinese adults in the 1980s

Patterns and trends in the body composition of Chinese adults are studied with data from the 1982 China Nationwide Nutrition Survey (CNS-82) and the 1989 China Health and Nutrition Survey (CHNS-89). The CNS-82 showed rural inhabitants were approximately 3 kg lighter than urban residents and approximately 2.2 cm shorter. Males were heavier (55.2 +/- 7.4 vs 50.7 +/- 8.0 kg) and taller (165.3 +/- 7.3 and 153.5 +/- 6.3 cm). Using a cut-off for underweight of a body mass index (BMI: kg/m2) < 18.5 and for obesity of > 25, 11.6% and 12.9% of the urban and rural sample were underweight and 9.8% and 6.9% respectively were overweight. The CHNS-89 surveyed 5138 adults aged 20-45 in eight selected provinces. The proportion of underweight in both urban and rural samples declined slightly (approximately 1.3%) but the proportion of obesity increased considerably (4.8% for the urban sample and 2% for the rural one). Increased income was significantly associated with reduced low body mass index (BMI: kg/m2) in the urban sample while, for the rural and overall samples, the opposite was found for obesity. Provincial patterns in energy intake were not associated with the distribution of BMI while occupation was. In particular, government officials and housewives were much more likely to be obese as also were subpopulation groups consuming greater proportions of energy from animal sources. Over 80% of the population fell in the normal BMI range (18.5-25). This may relate to the relatively even distribution of food in China during the past several decades.

Maternal body mass index and pregnancy outcome in the Nutrition Collaborative Research Support Program

This paper uses data from the Nutrition CRSP in Egypt, Mexico and Kenya to examine relationships between maternal BMI and pregnancy outcome. Women were studied from the periconceptional period up to 6 months of lactation. No women in Egypt or Mexico, and only two in Kenya where periods of food shortage occurred, had a BMI < 18 at conception. Women with a lower BMI in Mexico and Kenya gained more weight and fat in pregnancy and lost more weight and fat during lactation. These counter-intuitive relationships affect the interpretation of weight and body composition measures used to assess energy adequacy during pregnancy and lactation. Lower pre-pregnancy BMI predicted lower infant weights at birth and was a risk factor for low birthweight in Kenya. At 3-6 months post partum, maternal BMI was less strongly related to infant size, and the lean body mass component of BMI appeared to be a more important predictor than fatness.

Use of body mass index in the assessment of adult nutritional status in Vietnam

The authors have used body mass index (BMI: kg/m2) to assess the Vietnamese adult nutritional status and classified the population into different grades of chronic energy deficiency (CED). CED is prevalent in Vietnamese adults (average 40%). The mean value of BMI of the age group 26-40 years is 19.7 but it decreases thereafter except in urban areas. The BMI curve of distribution is different between adults living in rural, urban and mountainous areas. There seems to be a relation between BMI of mothers and the nutritional status of their < 5-year-old children. The survey also revealed a relation between maternal BMI and birth weight, and between CED and the health status of the population.

Is body mass index sensitively related to socio-economic status and to economic adjustment? A case study from the Congo

Several nutritional surveys based on representative samples from various urban and rural situations show that the Congo presents a situation of nutritional transition. There is a large prevalence of low body mass index (BMI) in adults from rural zones and this increases with age. There is, however, a large prevalence of high BMI in urban populations despite the persistence of some degree of chronic energy deficiency (CED), particularly at younger ages. Correspondence analysis and logistic regression were used to construct a socio-economic index and measure adjusted risk factors for CED. In rural areas, the major risk factors were old age, sex (women) and the absence of schooling; low economic status, a commonly shared factor, did not differentiate between households for CED. In Brazzaville, CED was linked to a young age (< 30 years) and, clearly, to poverty. The change in the prevalence of CED in mothers from the capital city during a period of economic adjustment showed an increased incidence in young mothers, and also showed that the disparity between low and high economic levels regarding CED had grown. Finally, there was a high level of correspondence between the mean values for the weight-for-height of children and the BMI categories of the mothers. There is a parallel evolution during the period of economic adjustment between the increase of wasting in infants and the increase of CED in mothers. Therefore BMI appears to be a potential core indicator for use in nutritional surveillance in the Congo.