Relation of socioeconomic and environmental indicators to the nutritional status of preschool children in a community of Sierra Norte de Puebla, México

A brief discussión on "the social" approach in nutritional research is presented. The relevance that socioeconomic factors have acquired in recent years for this type of studies, is also discussed. The main purpose of our communication was to identify and validate some socioeconomic and environmental indicators and their association with the nutritional status of preschool children in a Mexican indigenous community (Sierra Norte de Puebla). A total of 89 children below five years of age were studied and classified according to their nutritional status. A socioeconomic questionnaire was applied to their parents. Results revealed ample correlation between the degree of malnutrition of the preschool child and the following indicators: housing conditions, father's main occupation, land tenure, income, etc. It is argued that the analysis of these indicators is relevant, emphasizing the importance that the combination of anthropometrical, food consumption and socioeconomic data have for detecting population groups vulnerable to malnutrition. The obtention of these indicators is therefore highly recommended, but should not imply great obstacles; on the contrary, they should be highly sensitive and easy to detect.     

Helicobacter pylori infection (13C-UBT), and its relationship with nutritional and socioeconomic factors in low income school children from Valencia, Venezuela

Helicobacter pylori infection (Hp) is widely spread around the world, and it is considered one of the main causes of chronic gastritis, peptic and duodenal ulcers, and gastric cancer. Recent research has shown that it can be associated with nutritional disorders, mainly with iron and other micronutrient deficiencies. The objective of this study was to assess the prevalence of Hp infection, and infection pattern according to age, sex, nutritional status, and socioeconomic conditions in children who attended the Unidad Educativa "Valentin Espinal" in the city of Valencia. 170 children, between 3 and 14 years of age were studied to assess Hpylori infection (13C-urea breath test), age, nutritional status according to BMI and Height for age, hemoglobin (cianometahemoglobin), serum ferritin (ELISA), socioeconomic status (Graffar-Méndez-Castellano), housing conditions, number of families and of people cohabitating in the same household, and quality of services. 78.8% of the children were infected with Hp, witch was significantly correlated with age but not gender. 25.9% of the sample had undernutrition, and 46.5% were stunted. 98.1% of the families lived in poverty, and 98% of the households showed sanitary deficiencies. A mean of 6.0 +/- 2.4 persons lived in each household (range: 2-15), and an average of 3.2 person shared bedrooms. The odds of being infected were higher in those children who were stunted. Also, socioeconomic status, mother's education level, and poor hosing conditions were significantly associated to being infected. Hpylori is highly prevalent among socially and economically deprived children, and age, overcrowding, and a low education level of the mother increases the risk of being infected.     

Preschool child feeding, health and nutritional status in Gualaceo, Ecuador

Anthropologic, survey, dietary recall and anthropometric techniques were used to study the correlates of nutritional status of preschool children under five years of age in Gualaceo Ecuador. A widespread stunting was found among the children. Nutritional status was worst among infants comprised between 12 and 23 months old but it improved between April and August, thus suggesting seasonality changes of nutritional status. The correlates of nutritional status (expressed as Z score of weight-for-age) were dietary diversity, birth-spacing, fertility, migration, household income, material goods owned, and parental education. A regression model with these variables predicted 63% of the variability in weight-for-age. The prediction of height-for-age was similar, but only predicted 43% of the variability in height-for-age. Correlates of dietary diversity, birth-spacing, fertility, and migration were child age, maternal age and arm circumference, parental education, use of birth control, household food expenditure, material goods owned, and the raising of animals. Parental education was a correlate of dietary diversity, fertility and migration. Parental education was related to change in weight-for-age in the longitudinal subset. Pre-harvest time and a pathway of illness leading to decreased dietary diversity and to decreased nutritional status in April, were suggested as important to preschool child nutritional status. Hot-cold ideology--resulting in food withdrawal during illness and restriction of high-protein and high-calorie foods--appears to be an important mechanism determining preschool child nutritional status. Breast-feeding, sanitary, higienic, birth control, and drinking (alcohol) practices were suggested as areas that could be improved, in order to improve preschool child nutritional status. Communication between parents and western health care providers was also suggested as an area for improvement.     

Homes for the migrants: the pueblos jovenes of Lima--a study of socioeconomic determinants of child malnutrition

The family ecology of 68 preschool children attending a health care center in a pueblo joven (low-income peripheral settlement) of Lima, Perú, was investigated to determine its bearing on their nutritional status. Some of the variables studied included family income, income available to mothers, household composition, migratory history of mothers, child feeding practices and housing conditions. Nutritional status of the children was assessed through anthropometric and dietary means. Results indicated that chronic malnutrition was widespread. Breast-feeding was common, but the weaning diets had little diversity and low-caloric value. The family diet relied heavily on soups and starchy foodstuffs, and children participated fully in the family meals by the age of two. Child growth was negatively correlated with the number of preschool children and birth order, and positively correlated with income spent on water. In its turn, the children's diet was positively correlated with the income available to the mothers and the income spent on food.     

Breastfeeding, complimentary feeding practices and childhood malnutrition in the Bolivian Andes

Northern Potosi is one of the poorest parts of Bolivia with the highest indicators of rural poverty, malnutrition and food insecurity in the Bolivian Andes. The objective of this research was to characterize the levels of malnutrition and describe infant feeding practices in Potosi, Bolivia and use this information to develop an effective, gender sensitive and culturally relevant intervention encouraging good infant feeding practices. Standard methods were used to collect anthropometric data. Weight and height data were collected for 400 children under five years of age from 30 communities. In six of these communities, interviews and focus group discussions were conducted with 33 mothers and other families in addition to household observational data that were collected to describe infant feeding practices. Nearly 20% of children were underweight; stunting was widespread as well. 38% of mothers initiated breastfeeding 12 hours or more after birth. 39% of mothers initiated complementary feeding in the first three months following birth. The type of complementary food given to children was usually inadequate. With this research we could see that nutritional deficiencies often begin when the mother starts breastfeeding and when first introduced complementary feeding. Interventions aimed at improving maternal and child nutrition will require changes in parents' behavior, greater recognition and community support of the importance of child feeding, and the inclusion of strategies to reach young people, involve men, and make high quality nutrition promotion more widely available in the communities.     

Effect of mass communication media in food purchasing at the family level

The main purpose of this study was to determine the effect of mass media advertisement of food products (TV, radio and the press), particularly in pre-school and school-age children, as well as the concomitant impact these age groups have on the family food buying patterns. To test the hypothesis that the impact of mass media advertising on foods varied in the different socioeconomic levels of a community, a stratified sample of all children below 13 years of age, who attended the Francisco Fajardo school in the central coast of Venezuela, was drawn. Mass media contact, food and nutrition knowledge and other socioeconomic characteristics were related to the family's food-buying patterns. More specifically, the age, working status and educational level of the mother in regard to beliefs concerning the nutritional value of advertized food products, were related. A semi-structured questionnaire was designed, tested and applied to the housewife or whoever performed this role within the family. Findings revealed that families of low socioeconomic status are prone to be most influenced by mass media food product advertising. This is reflected not only in food purchasing practices but also in food consumption patterns at the family level. Chocolate drinks, cereals, jello, sausages, and ice cream are the most popular products among pre-school and school-aged children, without social class distinction. Furthermore, results revealed that the degree of exposure to mass communication media--television, radio and newspapers--is a determining factor in children's food preferences at all socioeconomic levels, and that television is the media exerting the greatest influence.     

Differentiation of the nutritional status of preschool children, according to socioeconomic levels, in a marginal zone

This article informs of a study carried out in an attempt to validate a new methodology to differentiate socioeconomic levels in a low income urban population group, as well as to correlate each level with the degree of malnutrition of preschool children, using the Gómez and Waterlow classifications. The socioeconomic indicators selected were: housing, main occupational activity and educational level of the head of the family, number of members per room, food expenditure per capita, per week, and ownership of a few household articles. A scale was constructed on the basis of the afore-mentioned indicators, and values were assigned on a point system, resulting in three levels: high, medium and low. Weight and height were determined in preschool children. In order to establish correlation of anthropometric data with socioeconomic levels, and to determine if such levels permitted to differentiate the degree of malnutrition, two types of nutritional classifications were used. Of the total of 187 families selected, 46 were evaluated as of high level, 72 medium and 69, low. Analysis of the weight-for-age and weight-for-height in children 24 to 47 months of age, and total preschool children, that is, from 12 to 59 months, revealed significant differences in both classifications, p less than 0.001. The authors conclude that the point scale applied to determine socioeconomic levels, was sufficiently sensitive in distinguishing the degree of malnutrition in preschool children, especially when analyzing the total population; though not significant in a few age groups, this was probably due to the reduced number of same. It is recommended that the Gómez classification be used permanently, particularly in cross-sectional surveys, and the Waterlow classification, because of its rapid diffusion in the world.     

Maternal beliefs, feeding practices and nutritional status in Afro-Colombian infants

This study describes maternal practices and beliefs on children feeding and their relationship with nutritional status of Afro-Colombian children aged 6 to 18 months. We combined ethnographic and epidemiological data. We collected information using a food frequency questionnaire. Nine focus groups and 5 deep interviews to mothers of children less than 2 years of age were performed. Our data showed a prevalence of wasting of 2.6% (< -2 SD weight-for-length) and prevalence of stunting of 9.8% (< -2 SD height-for-age). These practices are characterized by a universal onset of breastfeeding, that lasted 10 months in average, and an early introduction of complementary food (mean: 3 months). Breastfeeding is a cultural norm. Weaning is related to new pregnancy, to low milk production and to negative effects of breast process on mothers' health. Early complementary feeding and bottle-feeding are highly valued due to their positive effect on nutritional status and adaptation of children to adult-type diets. The introduction of complementary food after 4 months, the quality of the first food introduced and the diversity of complementary food predicted better nutritional status (p < 0.05). We conclude that nutritional illiteracy and mothers' erroneous beliefs result in 50% of the mothers having inadequate feeding practices. We suggest focused interventions on those beliefs limiting good practices.     

Nutritional anthropometry and dietary intake of children from the Las Cuevas region of the Dominican Republic

A nutritional survey was conducted in the "Las Cuevas" watershed located in the southwestern region of the Dominican Republic to assess the nutritional status of preschool children. Height, weight, mid-arm circumference and triceps skinfold measurements were taken of 280 children between 6 to 54 months of age. Dietary recall was elicited from mothers or care givers. Results compared with the National Center for Health Statistics reference data indicate that these children: 1) experience growth failure and poor nutritional status as indicated by low weight for age; 2) suffer chronic malnutrition as revealed by low height for age and reduced muscle mass of the mid-arm; and 3) have appropriate weight for height measurements. A food frequency survey revealed that these children consume a diet high in carbohydrates and low in animal protein. Breast feeding is a common practice although cow's milk was introduced early in 25% of the sample. The mean age at weaning is 12 months. The results indicate that these children experience the greatest growth deficits in the second year of life and that these deficits are indicative of chronic undernutrition rather than acute food shortage or recent disease episodes. This study was carried out to establish baseline data for a resource management project initiated by the Secretariat of Agriculture of the Dominican Republic.     

The nutritional and health status of the Latin American woman

Latin America is a region where countries have various levels of socioeconomic development. Thus, the living standards and health status of its people differ significantly in the midst of a mosaic of social, ethnic, cultural and economic realities. Social inequalities and extreme poverty determine significant differences, not only in the magnitude of health indicators, but also in the type of pathology prevalent. People in the high socioeconomic levels are affected by nutritional diseases characterized by excessive food intake, while people from the low socioeconomic levels are affected by undernutrition and its associated pathology. Undernutrition occurs fundamentally among the age groups at higher risk in the population segments with low income, low food intake, illiteracy and poor access to the health care and preventive medicine centers. Among families exposed to undernutrition, women are usually in worse condition than men. This is due to the long working hours and the increased nutritional requirements caused by frequent gestations and prolonged lactation. It is estimated that one fourth of newborns in Latin America are affected by low birth weight, which has been associated to adolescent mothers, their excessive physical work, anemia, low maternal pregestational weight, low weight gain during gestation, and frequent maternal infections. Nutritional anemia due to iron deficiency is highly prevalent among pregnant women in Latin America. In some countries, the prevalence of folate deficiency during pregnancy appears to have increased significantly in the past 15 years and is becoming a nutritional problem that needs preferential attention. Diets generally are inadequate and, in the case of pregnant and lactating women, usually deficient in calories, protein, iron and folic acid. It is urgent that the health and nutritional status of Latin American women of low socioeconomic condition be given special attention, particularly mothers during gestation and lactation. Otherwise, women will not be able to altogether fulfill their important role in the home and within the family, nor will they successfully participate in the economic development of their countries.     

Comparison in the dietary intake of preschool children, attending national daycare centres (Junji), in the eastern area of Santiago, Chile

The objective of this study was to evaluate the energy intake of obese and normal nutritional status preschoolers, from four to five years old, attending several day care centres (JUNJI), in the eastern area of Santiago. The sample comprised 85 normal nutritional status and 35 obese children, representative of a population of 450 children. The food intake was evaluated twice a week and on one weekend day. At the day care centre, food intake was measured by food weighing and at the home; it was measured by food-recording. FAO 2001 energy requirements were used to calculate the energy requirements of the children. In both obese and normal nutritional status, energy intake was similar in the educational institution and home, although this energy intake corresponds to there meals time at JUNJI and only one serving at home. In respect to energy requirements of preschool children, both obese and normal nutritional status boys are at energy balance during the week (90 versus 110%). In the corresponding female groups, energy intake exceeds their energy requirement (116 and 111% respectively). In conclusion, energy intake at home, is greater and of minor quality, situation that worsens over the weekend in all preschoolers, independently of their nutritional condition (energy adequacy > 114%).     

Assessment of the nutritional impact of the complementary feeding program of Panama in children under five years old

To evaluate the nutritional impact of the Complementary Feeding Program of Panama in children under 5 years old. A retrospective cohort of children beneficiaries of the program was studied and compared with others of the same age and districts not involved in this intervention. Weight for age (W-A), height for age (H-A), and weight for height (W-H) was calculated in each control and the nutritional status determined according to Ministry of Health norms. Every beneficiary received six pounds/month of a food supplement containing cereals, legumes, calcium, iron and vitamin A (350 Kcal and 12 g of protein by 100 grams). Most of the children enter into the program in their second year of life with an average W-A and W-H of -1.5 +/- 1.2 and -0.6 +/- 0.9 respectively; both indicators were declining before the intervention (-0.6 +/- 1.2 y -0.3 +/- 1.3 respectively, p < 0.01). In 9 months of intervention an average change in W-A of 0.0 +/- 1.1 and H-A of - 0.1 +/- 1.1 was observed (NS). Weight gain was higher in children with lower W-A, in families with less children or mother with better education level (p < 0.05). In 35% of malnourished children and 24% of children at risk nutritional status improved during the intervention. Children with higher nutritional deficit at the beginning of the program have significantly better nutritional improvement (p < 0.001), encouraging the importance on focusing this program in malnourished children.     

Development of a methodology for the assessment of the nutritional status at the level of household units

The results of statistical analysis may be questionable when data measured by different units are compared. This is the case when nutritional status, which is quantitated individually, is compared with social variables (such as family income, patterns of education, housing, etc.), measured by households. In a nutritional anthropology study, the anthropometric measures of children have to be plotted against these social factors. Therefore, a method to evaluate the nutritional status of children at household level was devised; this procedure reduced the variables to one single unit. The "Analysis of Main Components" (ACP) was found satisfactory, using the family average of the following indexes: weight/height, weight/age and height/age. Also, two new indexes were created by giving a numerical value to the slightly modified Waterlow's classification. As a result, households were automatically divided into three groups: 1) households with well-nourished children, 2) households with children at risk of malnutrition, and 3) households with malnourished children. This was accomplished using the "ANADA" package created by PRIAD, University of Costa Rica, and a Burroughs B6920 computer. The method is useful for nutritional anthropology programs as well as for nutritional surveillance activities.     

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.     

Lymphocyte subpopulations in preschool Venezuelan children of high socioeconomic status

Nutrition is a critical determinant of immune response being the most common cause of immunodeficiency in the world. 104 preschool children, apparently healthy, from a private school were chosen to determine lymphocyte subpopulations and to evaluate its relationship to the anthropometric nutritional status and serum zinc. Nutritional status was measured by the indicator weight for height, lymphocyte subpopulations by flow cytometry and serum zinc by atomic absorption spectrophotometry A high percentage of the population (87.5%) belonged to socioeconomic level II (Graffar). Nutritional deficit was present in 9.5 percent of the studied children, while 16.2% were overweight. Values for lymphocytes subpopulations and serum zinc were within reference ranges, similar to other reports and there were no significant differences by sex, age or nutritional status. Low concentrations of serum zinc were present in 6.7% of children. There was a tendency to lower values of the T lymphocyte populations in hypozincemic children but it did not reach statistical significance. As there are not reference values for lymphocyte subpopulation in Venezuelan children, these results could be used as reference for future investigations. Continuity of research is needed to understand relationship of micronutrients levels and immune response.     

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.     

Lipid profile in Venezuelan preschoolers by socioeconomic status

Epidemiological studies have shown that unfavorable serum lipids levels in childhood are predictors of development of atherosclerosis lesions in adulthood. We assessed the lipid profile of 297 Venezuelan preschool children (4-7 years old) from two socioeconomic levels in order to compare them by this characteristic. Their social level was determined according to modified Graffar method, and two groups were obtained: high socioeconomic status (HSES, n=103) and low socioeconomic status (LSES, n=194). Nutritional anthropometric evaluation was performed by weight to height, and NCHS/OMS cut-off point was used. Lipid profile was determined by colorimetric biochemical methods and atherogenic risks factors were calculated. Underweight for HSES was 5.8% and for LSES: 14.9%, while normal status was 78.6% and 70.1%, and overweight was 15.5% and 14.9%, respectively. Mean values for triglycerides were 0.66 +/- 0.27and 0.76 +/- 0.31 mmol/L, total cholesterol (TC): 3.61 +/- 0.65 and 2.98 +/- 0.71 mmol/L, HDL-C: 1.04 +/- 0.18 and 0.62 +/- 0.16 mmol/L, LDL-C: 2.27 +/- 0.61 and 2.01 +/- 0.71 mmol/L, TC/HDL-C: 3.5 +/- 0.78 and 5.0 +/- 1.5; LDL-C/HDL-C: 2.0 +/- 0.71 and 3.4 +/- 1.4 with significant differences between HSES and LSES as shown respectively. A significant association was found (p < 0.01) between lipid values and socioeconomic status, being the LSES preschoolers those with the higher atherogenic risk. Its pattern was of lower HDL-C levels, and higher TC/HDL-C and LDL-C/HDL-C ratio. Comparisons of lipid profile by nutritional status or gender did not show significant differences. Findings indicate that children from low socioeconomic status are at a higher risk for cardiovascular disease and atherosclerosis than children from high socioeconomic status.     

Increase of physical activity by improvement of the nutritional status

Physical activity is affected by nutritional modifications and, in turn, influences growth, cognition, social behavior, work performance and other functions. Studies in preschool children showed that: 1. A decrease in energy intake during four to seven days reduced the time allocated to energy-demanding activities and increased sedentary activities. 2. Children with mild weight deficit were more sedentary than well-nourished counterparts. 3. Children became more active when nutritional status improved. 4. A 10% reduction in energy intake reduced total energy expenditure by 15% without affecting weight gain nor basal metabolism. Studies of men working in non-mechanized agriculture showed that: 1. Dietary improvements led to faster salaried work, reduction of napping time and greater physical activity after work. 2. An increase in energy intake increased total daily energy expenditure, tending to maintain energy balance and relatively stable body weight within the cyclic variations of the agricultural year. 3. Food supplementation did not necessarily improve productivity. Other labor incentives without dietary improvements increased energy expenditure during working hours, which resulted in weight loss. In conclusion, good health and nutrition provide the biological basis for adequate physical activity that may improve cognitive development, social interactions, economic productivity and the quality of life of an individual or a population, but other incentives are required for the optimal expression of that biologic potential.     

Household food distribution behavior in periurban communities of Guatemala: lessons for food distribution programs

Do mothers of undernourished children recognize their offspring's needs? How do they feed these target children compared to other households members when food supplements are available? Which cultural principles of intra-household food distribution are associated with feeding behavior? How do household members perceive and use food supplements that are donated for undernourished target children? Answers were sought in a dietary-ethnographic study of 45 households receiving supplements for a low-weight child between one and five years, of age in two periurban low-income communities of the City of Guatemala. The central hypothesis was that we would find four cultural principles of food distribution: contributions, need, equity, and demand. The dietary survey combined direct measure and recall techniques and was done twice for all 230 individuals conforming these households. Ethnographic interviews were carried out with mothers of all target children. T-tests determined the relation between food distribution behavior and cultural rules. Findings revealed that the cultural principles of contributions, needs, and demand are present, but instead of the equity principle, we found one of equality. In the great majority of the feeding events observed, the child's mother prepares and distributes the food. The target child does not receive preferential treatment in the intra-household distribution of food supplements and other foodstuffs. Donated milk is destined principally for the children in the household; all other supplements are distributed among all members. Adult males are favored in the distribution of kcal at regular mealtimes. Children are favored in the distribution of kcal when total daily consumption is calculated. There are significant associations between the expressions of the cultural principle favoring equal distribution and that of contribution which favors adult men, and actual food distribution behavior. These principles seem to operate at formal meal events only. It was found that feeding behavior between meals (snacks, nibbling, etc.) is not subject to these salient principles and tends to compensate those household members who are not given preferential treatment in food distribution at formal mealtimes.