Body mass index values in the Cuban adult population

An anthropometric study was carried out on 31,662 male and female adults from 20 to 60 years of age, living in Cuba's 14 provinces. Measurements were taken utilizing the methods and equipment recommended by the UN International Biological Programme. Weight/height, body mass index (BMI), Rohrer, Sheldon, Ponderal and Benn indices were registered as well as their correlation with height, weight and fat folds in order to obtain the suitable index for nutritional evaluation. The BMI was selected as the most appropriate and its values were recorded by sex, age, dwelling, educational level and type of occupation. The cut-off points of 'normal' BMI values were determined. Their range, based exclusively on anthropometric data, in general coincided with those defined by international actuarial data. The distribution of BMI values was very similar to that of developed countries with more overweight than underweight individuals, particularly in females. Rural populations were lighter than those in urban communities and had more underweight subjects. Lower educational levels were directly related to higher percentages of chronic energy deficiency (CED) in women; in men, there was no defined trend. On the contrary, in men CED was slightly more related to jobs that required light effort; in women there was no defined trend. Finally, a model of action against malnutrition is proposed.

Body mass index: a measure of the nutritional status in Indian populations

Anthropometric data available through National Nutrition Monitoring Bureau surveys/studies conducted by the National Institute for Nutrition were analysed to study body mass index (BMI:kg/m2) profiles of adults and relate them to various parameters such as the nutritional status of preschool children, socio-economic status, low birth weight and mortality. The results show that nearly one-half (49%) of adult Indian rural population is suffering from some grade of chronic energy deficiency (CED). The adults' household BMI and child's nutritional status are associated. Mean BMI values were lower in landless agricultural occupational groups and in low per capita income group households compared with cultivators, artisan and higher income groups. Mean birth weights showed definite differences between BMI classes (2500 g in grade III CED and 2800 g in the normal BMI group). The odds ratio for low birth weight (LBW) was found to be three times more in severe CED groups compared to normal BMI groups of mothers. The influence of BMI on the incidence of LBW was evident despite the confounding factors of parity and maternal age. The frequency distribution of BMI values of adults who had been malnourished at the age of 5 years was distinctly different from that of the well-nourished group. The mean BMI of the group who were malnourished as children was 16, while those who had been well nourished was now 21 on average. Data from affluent and well-grown Indians suggests that a cut-off point of 18 rather than 18.5 would be more appropriate to distinguish the nutritionally normal groups from the energy deficient group (CED).

Nutritional status, muscle composition and plasma and muscle free amino acids in renal transplant patients

To investigate the effects of renal transplantation (Rtx) on the nutritional status, muscle composition and the plasma and muscle free amino acid (AA) pattern, three groups of altogether 30 renal transplant patients (group I n = 10; 46 +/- 14 [SD] days after Trx), (group II n = 10; 13 +/- 2 months after Rtx) and (group III n = 10; 9 +/- 2 years after Rtx) underwent anthropometric measurements, blood sampling and percutaneous muscle biopsy. The immunosuppressive therapy consisted of prednisolone, azathioprine and cyclosporine-A. The results were compared with data from age-matched healthy subjects. Renal function was impaired in groups I, II and III. Serum albumin was decreased in groups I and II. The patients of group II had an increased percentage of body fat, triceps and subscapular skin folds and total sum of skinfolds. In group I the ratio alkaline-soluble protein (ASP) to DNA, which is a sensitive index of protein depletion on the cellular level, was decreased. Muscle magnesium content was decreased whereas the muscle DNA, sodium and chloride contents were increased. The mean plasma concentration of most essential AA (EAA) was essentially normal except phenylalanine which was increased in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)

Child health and nutritional status in Ulaanbaatar, Mongolia: a preliminary assessment

Over 85% of Mongolia's foreign trade and development aid, which formerly came from the USSR, have abruptly ceased causing shortfalls in almost all sectors. The UNICEF Mongolia Country Program and the East Asia and Pacific Regional Office (UNICEF/EAPRO) realized that Mongolian children are likely to suffer the most as reduced income and food availability aggravate problems associated with malnutrition. Hence, from 16 June-7 July 1992, a team from the Institute of Nutrition at Mahidol University, Thailand, collaborated with local UNICEF personnel and government health officials in designing and initiating the 1992 Mongolian Child Nutrition Survey. This paper presents the preliminary survey data of 342 randomly selected children aged 0-48 months in Ulaanbaatar. Results indicate that the four major health and nutrition problems are protein energy malnutrition (PEM), iodine deficiency disorders, vitamin D deficiency, and an unusually high rate of acute respiratory infections. Also requiring more in-depth study are low birth weight, iron deficiency anemia and vitamin A deficiency.

[Sociodemographic conditions and nutritional status of children under 1 year old in peripherical areas of Guadalajara, México]

A random population sample was studied with a view to determining the proportion of children of less than on year of age whose weight is less than the minimum adequate weight (MAW) for their age, as well as to identifying factors of a socio-demographic nature that could be associated with this problem and the socio-sanitary importance of these factors. The sample studied was of children of less than one year of age, born between 05/01/1990 and 04/30/1991, whose mothers were entitled to the services of the Mexican Institute of Social Security, in Tlaquepaque and Tonalá, municipalities adjacent to the Metropolitan Zone of Guadalajara, the second most important city in Mexico. The ponderal assessment of the infants was performed on the basis of tables which the Latin-American Perinatology Center had developed for this purpose. Through the use of logistic regression, Odds Ratios (OR) were estimated, with 90% confidence intervals (CI). The model thus prepared was adjusted by means of the H* statistics. Likewise, the population's attributable risk (PAR) was calculated, as well as the probability that a child would not reach the MAW for its age, in the presence or absence of particular risk factors. The results indicate that nearly one fifth of the infants studied do not reach MAW.(ABSTRACT TRUNCATED AT 250 WORDS)

Localized extracranial infections in children with acute bacterial meningitis

Twenty-four of 66 (363.6 +/- 116/1000) post-neonatal children with acute bacterial meningitis treated between August 1991 and November 1992 at the Emergency Paediatric Unit, University of Maiduguri Teaching Hospital, Nigeria, had co-existing localized extracranial infections (LEI). Nineteen had bronchopneumonia (of which 14 were in combination with other infections), two had dysentery and one each acute otitis media, orbital cellulitis, and purulent conjunctivitis. LEI were significantly more frequent in children < or = 2 years, and in children with delayed presentation and delayed diagnosis after presentation. Mortality rate was higher in children with LEI (500 +/- 200/1000) than in those without (102.6 +/- 95.2/1000) (P < 0.001). There was no significant relationship between the incidence of LEI and the causative organisms of meningitis or nutritional status of children with meningitis. We conclude that co-existing LEI are not infrequent in children with acute bacterial meningitis; they contribute to delayed diagnosis and are associated with a poorer outcome.

Total body nitrogen in children with chronic renal failure and short stature

OBJECTIVE

To directly assess the body protein content of children with chronic renal failure (CRF) and short stature.

SETTING

A tertiary referral paediatric hospital.

SUBJECTS

There were: (i) 17 patients (10 male, nine pre-pubertal; mean age 12.90 +/- 3.20 years) with CRF and height standard deviation (SD) score < -2.00, and (ii) 43 normal children (18 male, 27 pre-pubertal; mean age 10.34 +/- 3.34 years).

INTERVENTIONS

CRF patients had the following measurements: anthropometry, total body nitrogen (TBN) by neutron capture analysis, 4 day weighed food record and serum albumin levels. Control subjects had TBN and anthropometric measurements only.

RESULTS

Although older than the controls, the CRF patients had significantly lower TBN values (645 +/- 265 vs 930 +/- 365 g, P < 0.01). Mean values for TBN and TBN/height (percentages of expected) in the CRF patients were significantly reduced to 54% and 63% respectively, when predicted from age. However, their TBN predicted from height was 100% of expected. %TBN (predicted from age) correlated significantly with height SD score (r = 0.79), weight SD score (r = 0.87), upper arm muscle area percentile (r = 0.62) and serum albumin (r = 0.62). Mean oral energy and protein intakes were 65% and 172% of recommended dietary intake respectively.

CONCLUSIONS

Children with CRF and short stature are significantly protein-depleted for age although not for height. Chronic energy deficiency may contribute to impaired protein deposition which, in turn, may be important in the pathogenesis of growth failure in CRF.

Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients

OBJECTIVE

The primary objective was to confirm the results of a prior study that demonstrated a strong independent correlation between the severity of protein-energy undernutrition and the risk of subsequent morbidity in a population of elderly rehabilitation patients. A second objective was to determine whether inadequate in-hospital nutrient intake is a co-contributor to the risk of subsequent morbidity.

DESIGN

Cohort study.

SETTING

Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

PATIENTS

Three hundred fifty randomly selected admissions to the GRU, of whom 99% were male, and 75% were white. The average age of the study patients was 76 years.

MEASUREMENTS

At admission, each patient completed a comprehensive medical, functional, neuro-psychological, socio-economic, and nutritional assessment. While remaining in the hospital, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre-complication daily nutrient intake was expressed as a percent of predicted requirements as determined using the Harris-Benedict equation.

RESULTS

Of the 96 variables evaluated, the strongest predictor of subsequent complications was the Katz Index of ADL score, followed by serum albumin, usual weight percent, number of prescription medications, presence of renal disease, individual income, the presence of decubiti, dysphagia, and mid-arm muscle circumference. When all nine of these variables were included in the logistic regression analysis, the final model had a sensitivity of 70%, a specificity of 71%, and an overall predictive accuracy of 71%. When tested using the data from the previous study, the model differentiated the patients who developed a complication from those who had not a sensitivity of 76.7, a specificity of 76.1, and an overall predictive accuracy of 76.3. There was no difference in the pre-complication average daily nutrient intake between the complication and the no-complication groups (79% vs 75% of predicted requirements, P > 0.2).

CONCLUSIONS

Protein-energy undernutrition appears to be a strong independent risk factor for in-hospital morbidity. However, in-hospital nutrient intake may not be a significant determinant of risk.

The state of world hunger

Three distinct but related concepts have been used to estimate the numbers of people affected by hunger and to analyze the global food situation: food shortage, food poverty, and food deprivation. They focus on different aspects of the phenomenon of hunger and different levels of aggregation involved in its study. Food shortage occurs when total food supplies within a designated area--the world as a whole or continents, countries, or regions within countries--are insufficient to meet the needs of its population. Food poverty refers to the situation in which households cannot obtain enough food to meet the needs of all their members. Food deprivation refers to inadequate individual consumption of food or specific nutrients, also known as undernutrition. The relationships between food shortage, food poverty, and food deprivation are complex. If a region suffers a food shortage, some households will be food poor, and at least one household member will suffer food deprivation. Conversely, food poverty also can (and does) occur within regions where there is no aggregate food shortage, and individual food deprivation can occur in households that are not food poor. The key factor in both cases is distribution.

Undernutrition in the nursing home: prevalence, consequences, causes and prevention

Approximately 5% of Americans over age 65, or 1.5 million individuals, currently reside in the nation's 20,000 nursing homes. The authors present material that lead to three conclusions about this population. First, nutritional deficiencies are common underlying causes of adverse clinical outcomes. Second, nutritional deficiencies are frequently not recognized. Third, opportunities for preventing or correcting undernutrition exist, provided that the significant and reversible nature of the nutrient deficiencies are identified.

The causes of children's institutionalization in Romania. The Children's Health Care Collaborative Study Group

A country-wide, cross-sectional survey was conducted to determine the causes of institutionalization of Romanian children aged 0-3 years. A total of 628 children were sampled at random. Interview were conducted with directors of institutions and records of each sampled child were reviewed. Each sampled child was given a brief medical and developmental evaluation. The children in Romanian institutions have one or more chronic health conditions. Their families have multiple, complex social problems. The referral to institutions usually involved a paediatrician (76% of children). Fifty-four per cent of children were referred primarily from paediatric and maternity hospitals. The majority of children currently interned are likely to remain in institutional care. Implications for policy and re-organization of health and social services are discussed.

[Nutritional status of children under 5 years of age in indian villages of the Parakaña tribe in Brazil's eastern Amazonia]

The evolution of the nutritional status of children under 5 years of age living in two Indian settlements of the Parakanã tribe, Maroxewara and Paratininga, situated in the southeast of Pará State (Brazil), with less than 20 years of direct contact with our society, was studied. The main purpose of this study was to register the effects of the preventive and curative health activities of the "Parakanã Program" (created by an agreement between the National Indian Foundation- FUNAI and Northern Hydroelectric Project- ELETRONORTE), undertaken with the technical cooperation of the Tropical Medicine Center (Federal University of Pará). Anthropometric data were obtained in there cross-sectional studies (April 89; January 90 and October 91) for the purpose of evaluating the prevalence of malnutrition by means of Gomez's, Waterlow's and WHO criteria. The evolution of nutritional status was evaluated in the light of the rate of growth and accepting weight increments superior to those expected among well-nourished children as a goal. Seventy children (87.5% of all the 0-5 years-olds living there) were followed through throughout the studies. Prevalence of malnutrition was greater in Paranatinga than in Maroxewara, possibly because the former was more populous and had had longer inter-racial contact. Paranatinga's anthropometric indices (wt/age, ht/age and wt/ht) were the lower. Most of the severe forms of malnutrition were found there too. Children between six months and 2 years old were the most affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional assessment: the problem of clinical-anthropometrical mismatch

OBJECTIVE

To study risk factors for and prevalence and validity of clinical-anthropometrical mismatch (CAM) defined as the presence of clinical signs of protein-energy malnutrition despite normal weight-for-age (WFA).

DESIGN

A semi-longitudinal study of nutrition and morbidity with a longitudinal assessment of mortality.

SETTING

The rural health zone of Bwamanda in Northern Zaire.

SUBJECTS

4238 children of age 0-6 years enrolled by random cluster sampling.

INTERVENTION

Clinical nutritional staging, anthropometry, diagnosis of diarrhoea and severe respiratory infection in the rainy (first survey) and the subsequent dry season (second survey). Recording of mortality during 27 months after the second survey.

RESULTS

Prevalence of CAM was high above various cut-off levels of WFA and was accompanied by increased morbidity and long-term mortality. Of all the children with clinical signs of malnutrition, a high proportion had normal WFA. CAM was associated with weight loss within the limits of the international reference.

CONCLUSIONS

If a child has a normal weight but clinical malnutrition signs are present, the clinical diagnosis should prevail. Weight charts are not fully appropriate for nutritional classification purposes. The clinical nutritional staging used in this study is sufficiently reproducible and capable of identifying children with functional malnutrition.

Status of public health--Bosnia and Herzegovina, August-September 1993

Since 1991, civil strife in the former Yugoslav republics (Figure 1) has resulted in more than 150,000 war-related casualties, approximately 3.5 million displaced persons, widespread destruction of the health infrastructure, disruption of food production and distribution, and other increased risks to public health. The impact of the war has been especially severe in Bosnia and Herzegovina (1991 population: 4.3 million). To assist in targeting humanitarian aid to the region, in August 1993, the U.S. Agency for International Development's Office of Foreign Disaster Assistance asked CDC to assess the public health status and needs of Bosnia and Herzegovina. This report summarizes the results of that assessment and focuses on three central Bosnian regions.

Seasonal energy stress in an Ethiopian rural community: an analysis of the impact at the household level

The household integrated response to seasonal fluctuations in food availability and work load was assessed in a longitudinal study in two villages of southern Ethiopia. The household response to energy stress was estimated by pooling weight changes of all members of the family, accounting for the diverse biological and functional meaning of weight losses of different age and sex groups, and levels of nutritional status. On average, seasonal energy stress experienced by the households was modest (3.3%, P < 0.05 by Tukey test). The cumulative weight change of poor households was twice as large as that of rich ones, and evidence was obtained of their further deterioration over the following agricultural year. Household food availability fluctuated seasonally, with evident socio-economic gradient: in the early pre-harvest season food stocks of poor households were 6.5 times smaller than those of better-off families (P < 0.001 by ANOVA). Unlike rich households, poor families markedly decreased the time devoted to agriculture in the pre-harvest season. Crop selection, quality of land management and time employed in agricultural work might have synergistically concurred to cause the stress situation.

Child morbidity patterns in two tropical seasons and associated mortality rates

Cross-sectional morbidity recorded during two successive quarterly survey rounds and subsequent 27-months mortality were studied in a random sample of 4238 preschool children in a rural Zairian area. Analysis focuses on morbid patterns, i.e. any combination of the principal signs and symptoms encountered in tropical areas (oedema, marasmus, cough, fever, diarrhoea and tachypnoea). Almost half the children (45-48%) had signs of morbidity, a very high rate. The 3-6 month age group emerged as particularly vulnerable with the highest prevalences of all morbid patterns except for isolated fever. Isolated cough was more prevalent in the dry season probably as an effect of nightly indoor woodburning. All other morbid patterns were significantly more prevalent in the rainy season. Diarrhoea with cough was found to constitute half of all cases of diarrhoea. The results show that with a few simple questions on major symptoms and a brief examination by paramedical health workers, children with an increased risk of death can be identified. The method can be applied at under-5 clinics. Prognosis is particularly bad in severe malnutrition, especially when associated with diarrhoea, in diarrhoea with cough, cough with fever/tachypnoea and for children who are found sick both in the rainy and the subsequent dry season.

The nutritional impact of seasonality in children and adults of rural Ethiopia

A survey of the nutritional status of subsistence farmers was conducted over 13 months in a rural area of Ethiopia characterized by moderate climatic seasonality and intensive land exploitation. Bi-monthly questionnaires on food consumption, time allocation, agricultural production and cash flow were administered to 203 households and anthropometry performed on 1407 individuals. Comparison of post-harvest and pre-harvest anthropometry was made on 672 individuals (48% of the sample). In children, seasonal changes in the Z-score of weight-for-height were small and not significant. Height growth velocity showed instead a marked seasonal pattern, with values close to normal (-0.2 SD units) in July to December, a period characterized by better food availability, and lower values (-3.0 SD units) in January to June, a period characterized by intensive farm labour and heavy rains. Among the adults, body weight was highest in the post-harvest season (December) and decreased by 1.5 +/- 2.3 kg in men and 1.3 +/- 2.6 kg in women to the yearly minimum in the pre-harvest season (June). The paper shows that in this area children and adults both suffer from exposure to seasonal energy stress. The change in weight-for-height Z-score observed in children and the body weight loss observed in adults was greater in individuals of low socio-economic status and, within the same socio-economic level, in individuals with better nutritional status.

Arm circumference v. arm circumference/head circumference ratio in the assessment of malnutrition in rural Malawian children

The arm circumference/head circumference ratio (AC/HC) was compared with arm circumference (AC) alone in the diagnosis of protein-energy malnutrition (PEM) in 685 Malawian children between the ages of 3 and 48 months. The AC/HC ratio correlates well, r = 0.6863 (P < 0.001), with weight-for-age (WA). The sensitivity and specificity were calculated for both indicators compared to the NCHS reference standard of WA. Compared to 80 per cent WA, the 0.310 AC/HC cut-off was 92 per cent sensitive and 41 per cent specific, while the 0.290 AC/HC cut-off was 75 per cent sensitive and 74 per cent specific. AC alone in the 6-12-month-old children was 75 per cent sensitive and 89 per cent specific at a cut-off of 12.5 cm. In the children from 12 to 48 months with a cut-off of 13.5 cm the AC was 82 per cent sensitive and 70 per cent specific. The AC alone was more sensitive than AC/HC at all levels of specificity. Adding the HC to AC offered no advantage in screening for PEM in these children. In fact, if one were to use the standard 0.310 cut-off for AC/HC, the resulting low (41 per cent) specificity would identify such a large proportion of false positives as to make this ratio impractical for field use where it is most needed--in primary health care programmes with low resources which serve populations with high prevalences of PEM.

Factors contributing to protein-calorie malnutrition in older adults

Protein-calorie malnutrition, a common problem of older adults, is frequently overlooked by nurses. The physiologic changes of aging, as well as changes in living conditions and income, all contribute to the problem. Recognition of this problem by nursing staff can reduce many of the health problems which are exacerbated by or result from malnutrition in this patient population.