Plasma zinc and copper in infants with protein-calorie malnutrition

Forty-five marasmic infants were studied for plasma zinc and copper levels. They were selected from those children admitted to a nutritional recovery center. The mean plasma zinc level was 92.4 +/- 24 micrograms/dl (mean +/- SD); 7% of the infants had low zinc values as defined by zinc less than 70 micrograms/dl. Median copper was 90 micrograms/dl (range 27-172) and 49% of the children had copper levels below 90 micrograms/dl (established as our normal limit). Birth weight, breast feeding and prior hospitalization for acute diarrhea with dehydration were studied as antecedents related to low Cu and Zn. Children with prior diagnosis of acute diarrhea and hospitalization had lower copper levels than those sent from primary care centers. Breast feeding was associated with higher Cu levels. No relationship was found between zinc levels and those antecedents, but differences were found in regard to the degree of malnutrition, season of the year and Zn status. In this investigation no Zn deficiency was found in marasmus cases. Hypocupremia, however, is a very significant problem in marasmic infants, especially when associated with early weaning and the presence of previous hospitalization for acute diarrhea.     

Iron and vitamin A deficiencies and prevalence of anemia in boys and girls between 6 to 24 months of age in Chaco,Argentina

To determine the prevalence of anemia, and iron (ID) and vitamin A deficiencies aiming at their prevention, 414 children between 6 and 24 months of age, were randomly selected from the whole province of Chaco. A sociodemographic survey was implemented, and hemoglobin (Hb), plasma ferritin and retinol were measured. Anemia prevalence (Hb < 110 g/L) was 66.4%, without differences between age groups, and included 18% with Hb < 90 g/L. These cases were significantly less in children 6-8 month of age (5.1%) than in the others (approximately equal to 20%) (P: 0.007). Mean Hb was also higher in 6-8 months old children and was associated with lower prevalence of ID (ferritin < 12 micrograms/L) (p < 0.000) but not with age (p = 0.8865). ID already present, however, in 36.6% of children in this age group, reached a prevalence of 72.9% in children older than 18 months. Anemia prevalence was significantly higher in males, in children whose birth weight was < 3000 g, in those who had never taken iron supplements and among the poor, both structural and by income. Retinol values < 20 micrograms/dl occurred only in 5.1% of children. Iron nutrition prior to, during pregnancy and in children during the first 2 years of life must be improved by joining strategies based on community empowerment aimed at improving dietary iron, assuring effective preventive supplementation and promoting the opportune umbilical cord ligation.     

Vitamin A deficiency among preschool children: a re-emerging problem in Costa Rica?

Based on the 1996 National Nutrition Survey, this study shows the prevalence of Vitamin A deficiency (VAD) among 567 Costa Rican urban and rural 12-83 months old-children. In overall, the prevalence of VAD (plasma retinol < or = 20 micrograms/dl) was 8.8%. No difference was found even when data were analyzed by area and gender. Around 30% of preschool children were at risk of VAD (plasma retinol between 20.1-30 micrograms/dl). The proportion of children at risk for retinol deficiency was significantly higher in rural area in comparison with urban area (38.9% and 28.0% respectively, p < 0.05). Lineal regression analysis showed that plasma retinol levels were negatively related to the number of family members and positively related to mother's schooling. Our results suggest a possible impairment in vitamin A status of preschool children.     

Anemia and deficiency of vitamin A in children evaluated in a nutritional attention center from Caracas

In order to determine the prevalence of anemia and the deficiency of vitamin A in children under 10 years, the concentration of hemoglobin, transferrin saturation, serum iron and the nutritional state of vitamin A were studied between 1999 and 2000, in 124 children with moderate malnutrition and 98 healthy children who attend triage consultation in the Centro de Atención Nutricional Infantil Antímano (CANIA, Caracas) by means of plasma retinol test (high performance liquid chromatography), relative dose response test (RDR) and conjunctival impression cytology (CIC). The dietary intake was analyzed by 24 hour recall. The Student t and Chi-square test were used for the statistical analysis of the data. The prevalence of vitamin A deficiency was approximately 10% in malnourished and healthy children, the CIC test discriminated a proportion of vitamin A deficient children superior to 25% and RDR test detected a significantly smaller percentage of deficiency in healthy children (p < 0.05). The prevalence of anemia was significantly higher in malnourished (34.2%) than in healthy children (19.2%). In children under 2 years the percentage of anemia reached 75.8% in undernourished children and 50% in healthy children. The consumption of macronutrients and micronutrients was inadequate; more than 40% undernourished children had caloric and macronutrients intake adequacy below 85%, whereas this level of adequacy in healthy children was around 30%. These results indicate there were problems of moderate anemia and moderate vitamin A deficiency in the studied infantile population, without significant differences between moderate undernourished and healthy children.     

影响居民户碘盐监测结果不稳定因素分析

通过对某县居民户碘盐中碘含量监测结果的多次比对分析,发现部分同一居民户样品在不同实验室、由不同的分析人员检验分析结果精密度较差,分析结果不确定度超出了标准要求。通过模拟居民户碘盐可能带入的其它食品、佐料、添加剂等,对模拟的样品进行比对监测分析,初步找到了影响居民户碘盐监测结果不稳定因素的原因,对保证居民户碘盐监测结果的准确性、代表性、公正性有一定的指导意义。     

Prevalence of overweight and obesity in northwest Mexico by three references of body mass index: differences in classification

The objective of this study was to compare the prevalence of overweight and obesity in children from northwest of Mexico based on BMI/age and three criteria of growth reference standards. Six hundred and four children, 6 to 10 years of age, from 17 municipalities of the state of Sonora were measured for weight and height and age established from birth certificate school records. The prevalence of overweight and obesity was determined by the new version of the US Centers for Disease Control and Prevention (CDC/NCHS), the International Obesity Task Force (IOTF) and the values proposed by The World Health Organization (WHO) that was utilized in the National Nutrition Survey of 1999 in Mexico (ENN). Using the WHO reference, prevalence of overweight and obesity was 39%. This was higher than the CDC/NCHS (20%) and IOTF (17%) references, respectively. Prevalence of overweight and obesity by CDC/NCHS and IOTF criteria, showed the best agreement (Kappa >80); this was not the case when prevalence from CDC/NCHS and IOTF were compared to the WHO criteria (Kappa <40). For overweight and obesity frequencies, no sex or urban-rural differences were observed (p>0.05). In conclusion, the use of these 3 reference values systems using BMI/ age did not show the same prevalence estimates of overweight and obesity. The use of the WHO method can overestimate the prevalence of obesity in children, therefore the use of these 3 references should be considered for future comparisons.     

Prevalence of thinness and excessive fatness in a group of school children of the city of Cordoba, Argentina

Findings of a nutritional evaluation study, using triceps skinfold, are reported. The study was carried out in 1,615 school-children from 5 to 12 years, pertaining to the low socioeconomic status of the city of Córdoba, Argentina. Measurements were done during the years 1983 and 1984 by Center's examiners with a Lange caliper, according to international anthropometric methodology. Interintra observer technical error was found to be within tolerance limits reported by other authors. Local standards were used to determine the prevalence of thinness and excessive fatness, by comparing them to tricep skinfold of each child, and selecting those children where this parameter presented values less than or equal to 10th percentile and fatness greater than or equal to 90th percentile. Furthermore, comparison between median triceps skinfold of the examined group, the local standards and Frisancho's norms for US population was also made. Results revealed that: a) the prevalence of thinness (19.9%) was almost twice the percentage expected for a normal population; in contrast, occurrence of excessive fatness (6.4%) was found to be below the expected value; b) prevalence of thinness was not statistically associated to age nor sex; c) frequency of excessive fatness was significantly higher in the 8-11 year-old male group (8, 9%, p much less than 0.0005) and in the girls group (10.8%), P much less than 0.005) the prevalence of fatness in girls increased with age, and figures revealed that from eight years onwards this exceeded the expected percentage, and d) median triceps skinfold of the group under study was generally below local and foreign norms. It is concluded that potential or real nutrition problems as those mentioned above, may be grossly identified using the triceps skinfold as the single anthropometric indicator.     

Salt iodination and excessive iodine intake among schoolchildren

The objective of the present study was to evaluate the urinary excretion of iodine and relate it to the amount present in salt for human consumption. The study involved 145 children from two schools: a rural one and an urban one. We performed anthropometric measurements and collected a urine sample and a kitchen salt sample from each child. In the rural school, 3.38% of children had iodine deficiency. However, most of the values of urinary iodine were above 300 microg/L (62.03%) and 59.49% of the kitchen salt samples contained 20 to 60 mg iodine per kilo of salt. In the urban school, 3.03% of the children had urinary iodine excretion of less than 100 microg/L and 90.91% of the children had urinary iodine values exceeding 300 microg/L. Ofthis total, 84.85% of the kitchen salt samples contained 20 to 60 mg iodine per kilo of salt. Iodine deficiency is controlled in this population, with the current reality showing a high prevalence of excess urinary iodine.     

Serum zinc in Brazilian children of families of low income

Serum zinc was measured in 103 Brazilian children from low income families, 3 months to 6 years of age, with the purpose of characterizing their zinc nutritional status. Serum albumin was determined in some of the children studied. They were grouped in three categories according to the adequacy of height for age and weight for height indices related to the growth curves determined for Brazilian children. There were 30 normal, 18 acutely malnourished and five chronically malnourished children. This criteria was complemented by the Gomez criteria. Thirty healthy adults of both sexes served as a reference group for the analytical procedures. In the adults, serum zinc was 107.5 +/- 14.5 micrograms/dl, similar to values observed by other investigators, and significantly higher than in all of the children studied. Serum zinc of normal children was 98.3 +/- 15.7 micrograms/dl. It decreased with the degree of malnutrition, being significant for second degree acutely malnourished (87.8 +/- 9.2 micrograms/dl; p less than 0.05) and chronically malnourished children (68.7 +/- 8.9 micrograms/dl; p less than 0.001). Serum zinc and albumin correlated significantly (r = 0.51; n = 37; p less than 0.01), particularly in the severely malnourished children (r = 0.63; n = 8; p less than 0.05).     

Prevalence of anemia, iron and folate deficiency in children 7 years smaller. Costa Rica, 1996

In 1996, were studied in Costa Rica 961 children with ages between one and six years, with representation for metropolitan, urban and rural zones of the country. The classification approaches applied were emitted by the Pan-American Health Organization and the World Health Organization. The preschooler population presented in the national environment a prevalence of anemia of 26.3% (children from 1 to 4 years with hemoglobin < 11.0 g/dL and those from 5 to 6 years old with hemoglobin < 12.0 g/dL). The prevalence of Iron depletion (Ferritin < 12 ng/mL) and iron deficiency (Ferritin < 24 ng/mL) were 24.4% and 53.8%, respectively. The folate deficiency (< 6.0 ng/mL) was 11.4%. The iron deficiency was higher in children smaller than 4 years, being the maximum deficiency in the 1 year-old (75%). More than 40% of the preschool children presented sub-clinical deficiency of iron; of them, 10% showed severe deficiency of iron without presence of anemia. The children from the rural area presented the highest prevalence of anemia and iron depletion, while the metropolitan area met more frequency with iron deficiency. The nutritional anemias still constitute a moderate problem of public health in Costa Rica. The main cause is iron deficiency, associated in small proportion with folate deficiency and other factors associated with the erythropoiesis.     

2004～2011年黑龙江省流行性腮腺炎流行特征分析

目的了解黑龙江省流行性腮腺炎(简称流腮)的发病水平,并分析其流行病学特征,为制定流腮防治策略、加速控制流腮流行提供科学依据。方法对黑龙江省2004～2011年中国疾病预防控制信息系统报告资料进行流行病学特征分析。结果 2004～2011年黑龙江省共报告流腮病例39 236例,年平均发病率为16.10/10万;全年均有发病,但存在两个发病高峰期,分别为4～7月和11月～次年1月,12月和6月是发病最多的月份;13个地市均有流腮病例发生;该省流腮病例主要集中在20岁以下人群,2岁以下儿童发病较少,5～9岁组发病最多,且主要集中在中小学生和托幼儿童。结论进一步了解了黑龙江省流行性腮腺炎的流行特征,并提出了加强流行性腮腺炎疫情的防控措施。     

Requirements of nutrients which participate in erythropoiesis

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.     

Profile of nutritional risk in pregnant adolescents

A sample of 215 adolescents (16.9 +/- 0.7 y; 13-18 y) from a low socioeconomic level of Valencia, Venezuela, at their first trimester of pregnancy were studied in order to identify nutritional risk. Socioeconomic, anthropometrical, hematological and dietary characteristic were assessed. Pregestational weight, actual weight, height, arm circumference (AC), triceps skin fold (TS), fat and muscle area (FA/MA) and pregestational body mass index (PBMI) were determined. Hemoglobin (Hb) and ferritin were measured by colorimetric and ELISA methods. Two 24 hour recalls were obtained. According to age, two groups were created. Pregnant adolescents were grouped by age: Group 1, 13 to 15 years old and Group 2, 16 to 18 years old. Nutritional risk was defined as: Gynecological age lower than 4 years since menarche. PBMI < 19.8 kg/m2, height below 10th Percentile of reference, Hb below 11 g/dL and ferritin < 12 micrograms/L. Almost all the adolescents (96.3%) were in poverty. 83.3% were single, 83.3% were at elementary school before pregnancy but 84.1% were attending house chores at the time of exam. There were significant differences (p < 0.001) for gynecological age and menarche age, but not for anthropometrical, hematological and dietary variables when Group 1 was compared to group 2. 35.3% of the adolescents had a gynecological age lower than 4 years, 23.3% were below 10th percentile for height, 36.3% had a PBMI lower than 19.8 kg/m2, 26.5% were below 10th percentile for arm circumference, anemia was present in 13.7% and low levels of ferritin in 18.4% of the adolescents. Calorie intake was below recommendation in 87.3% and adequacy for vitamin A and C, calcium and zinc were below 2/3 of recommendation in 36.3%. 25.9%, 88.7% and 73.5% of the adolescents respectively. Studied adolescents had a high prevalence of risk factors for nutritional deficiencies (short age, poverty, low weight, anemia and deficient intake). Early assessment of this conditions allows to identify the risk, to establish interventions and to monitor pregnancy evolution.     

Nutritional status of children under 6, according to land tenure, in rural areas of the State of Pernambuco, Northeast of Brazil

The purpose of this investigation was to analyze the distribution of protein-energy malnutrition, anemia and hypovitaminosis A in relation to accessibility and size of rural lands. About 689 families from the Agreste rural area (Pernambuco, North-East Brazil) were studied. A total of 1,257 children under 6 years of age were distributed in four groups according to the size of the land. The nutritional status was assessed according to the criteria of Gómez, Ariza-Macías and Seoane-Latham, modified by Batista Filho. In accordance with the Gómez' method, 55.1% of the children suffered from some degree of malnutrition. About 67.0% of the landless families suffered from malnutrition, in contrast to 25% of the landowners who had 50 or more than 50 hectares of land (p less than 0.01). Hemoglobin was determined in 976 children; 38.9% of them suffered from anemia. No significant differences were detected among the several groups of land tenants. Serum retinol levels were measured in 412 children and a high incidence of hypovitaminosis A was detected: 24% had serum retinol levels below 20 mcg/100 ml. No significant association was found in relation to the different land tenure groups. These data demonstrate a high prevalence of protein-energy malnutrition, anemia and hypovitaminosis A. A significant correlation between protein-energy malnutrition and the size of the land was also found, demonstrating that this region is one of the most affected by food and nutritional problems.     

Vitamin A deficiency in preschool children of Recife, Northeast of Brazil

The purpose of the study was to evaluate the extent of vitamin A deficiency (VAD) among preschool children in the city of Recife, Northeast Brazil. The sample comprised 344 children of both sexes, 24 to 60 months old, in 18 public day care centres in the city of Recife, in 2007. The nutritional status of vitamin A was assessed by biochemical (serum retinol) and dietetic (vitamin A rich-food consumption) indicators and the pondo-stature status through anthropometric indicators weight-for-age, height-for-age and weight-for-height. The prevalence of hyporetinolemia (< 0.70 micromol/L) was 7.7% (IC 95% 4.88 - 11.81), which characterizes the VAD as a light-type public health problem, according to World Health Organization criteria. On the other hand, 29.6% (IC 95% 24.22 - 35.63) of children had acceptable or marginal levels (0.70 to 1.04 micromol/L) of retinol. Regarding the vitamin A rich-food intake, values below the EAR (Estimated Average Requirement) - 210 microg/ day for children of 1 to 3 years old and 275 microg/day for children of 4 to 8 years old - were 8.1% and 21.3% respectively. The prevalence of anthropometrical deficits (< -2 scores -Z) in preschool children were 2.5% for the indicator weight-for-age, 8.6% for height-for-age and 1.5% for weight-for-height. The research findings point out to the importance of institutionalization for the appropriate nutritional status of children and maintenance of adequate reserves of vitamin A. However, more studies are needed focusing on non-institutionalized preschool, or children living outside the privileged environment of public day care centres.     

Iron deficiency and anemia in pregnant women from Chaco,Argentina

Aiming at their prevention, to determine the prevalence of gestational iron deficiency and anemia, considering access to health care and associations with social and biological variables in the Province of el Chaco, Argentina. Three hundred and sixty four, randomly selected pregnant women from the whole province participated. Mean Hemoglobin (Hb) +/- SD dropped progressively from 118.4 +/- 11.0 to 112.1 +/- 11.5 g/L (p = 0.015) between the 1st and the 3rd gestational trimesters. Anemia prevalence (Hb < 110 g/L) was 17.4, 26.5 and 35.8%. From the 1st to the 3rd trimesters. Second trimester prevalence was 14.1% using Hb < 105 g/L as recently suggested. The ferritin geometric mean during the progressive gestational trimesters were 28.9; 16.0 and 11.1 micrograms/L. 21.7, 40.5 and 60.5% had ferritins < 12 micrograms/L, and 39.1, 58.9 and 83.2% had ferritins < 20 micrograms/L in these respective trimesters (p < 0.004 between trimesters in both cases). Both iron deficiency and anemia were significantly greater in women with unfinished primary education and with interpregnancy interval < 1 year. Seventy five percent of women had adequate number of antenatal visits but only 23% were taking iron supplements and 10% had stopped taking them. The prevention and correction of gestational iron deficiency and anemia must focus on the preconceptional period (inter-pregnancy spacing and increasing iron intake using all available means) as well as during pregnancy improving adherence to iron supplements by means of motivation of health workers and community.     

Dietary assessment of pre-school children from Federal District Brazil

The objective was to assess food consumption among children attending non-profit nurseries in the Federal District, Brazil.A representative sample was obtained and stratified by income. Food intake among 678 children, between 4 and 82 months old, was analyzed in nine nurseries using the 24-h dietary recall and direct food weighing methods. In children under 13 months old mean intake was above AI between 93.6 to 100% for carbohydrates, proteins, vitamins B1, B2, B12, B6, and zinc. In children from 7-12 months 56.5% presented iron consumption below EAR. Calcium intake was above AI for 35.4% of children over 1 year old. For vitamins with EAR values, the prevalence of inadequate consumption was 53.2% for vitamin E, and 90% for folate for children over 12 months old. Iron and zinc intake was above UL for 6.4% and 32.5% of children under 1 year old, and 1.5% and 5.3% for the remaining children, respectively. Lipid percentage distribution range among children between 13 and 47 months old was within the acceptable range for only 16.2%. Nonetheless, children between 36 and 82 months of both genders presented mean intake below energy requirements. Inadequate consumption observed for some nutrients points to the need for improvements in the standard of meals and nutritional assistance offered to children enrolled in charitably run nurseries in the Federal District.     

Risk factors associated with hemoglobin levels and nutritional status among Brazilian children attending daycare centers in Sao Paulo City, Brazil

Like many other developing countries, Brazil has been going a nutritional transition which presence both malnutrition and overweight. Stunting and overweight are the major public health problems in Brazilian children. The objective of this study was to document the prevalence of stunting, overweight and anemia in preschool children and examine if those nutritional problems are related; also identify if these nutritional problems have the same risk factors. Data from the "Efficient Daycare Center Project" which include 270 children attending nurseries of eight daycare centers in Sao Paulo city, Brazil were used for this study. Data on height and weight were converted to z-scores using WHO anthro software. Hemoglobin (Hb) concentrations were determined on finger-prick blood samples. The co-occurrence of stunting, overweight and anemia was investigated by contingency tables a log-linear model. Univariate and multiple regression analyses were performed to estimate the association of HAZ, WAZ, WHZ and Hb levels with their risk factors. The results showed high prevalence of overweight (22.2%), risk of stunting (22.6%) and anemia (37%). Percent of daycare attendance, age, number of siblings under 5 years old and per capita income are associated with Hb levels. This study provides evidence that Brazil is going through a nutritional transition and suggest that the adoption of public policies to expand and improve services in daycare centers may help to prevent multi-nutritional problems in preschool children.     

Anemias in preschool children: diagnosis, treatment and evaluation, Recife-PE, Brazil]

The diagnosis and the effects of treatment of anemia were assessed in children aged 6-71 months. A total of 1,161 preschool children from a health center of INAMPS (Instituto Nacional de Assistência Médica e Previdência Social) in Recife, Pernambuco, was studied. Hemoglobin was determined by the method described by Hainline. WHO criteria were used to identify anemia. According to their age, nutritional status and family income, the children were divided into groups, and those with anemia were treated with ferrous sulphate and an anti-helminthic (mebendazole). Anemia prevalence was substantially higher in children aged 2 years, and a statistically significant association (0.01 level) was found between anemia and nutritional status and family income. After treatment, hemoglobin values were normal in 40% of the anemic children; simultaneously, mean hemoglobin values increased from 9.11 to 10.3 g/dl which was statistically significant (p less than 0.001). This investigation is part of a collaborative study performed in four Brazilian states to offer "know-how" to a national program for combating iron deficiency anemia.     

Height deficit in school aged children: a multivariate analysis of possible risk factors, Pernambuco-1997

The nutritional status and some risk factors in 894 school children (ages 6 to 12) in the State of Pernambuco, Brazil, were analyzed based on the data collected by the Second State Research on Nourishment, Health and Nutrition carried out in 1997. The cutoff point used in the nutritional evaluation was the limit referring to -2 score-Z, being the NCHS the reference standard. The prevalence of stunting in the state was of 16.9%. Rural areas were more affected, reaching 27.1%. Bivariate analysis showed that the low socioeconomic level of the children and their families is associated with the occurrence of stunting. The logistic regression model pointed the variables: residence location, gender, access to treated potable water, low education, and per-capita income as the main determinants in stunting. The conjunct analysis of all the factors that explain the malnutrition found among the school children studied showed that the probability of a school-aged child to present height deficit varied from 1.5 to 60.3% depending on the risk factors taken into account, therefore showing different epidemiological "scenarios." The study also concluded that in the State of Pernambuco the height deficit constitutes a public health problem especially for school children in rural areas, showing two very different epidemiologic realities between urban and rural areas.