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.     

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.     

Use of the calculation of anthropometric values with microprocessors for nutritional diagnosis

The purpose of this work was to determine the possibility of establishing the most accurate nutritional diagnosis based on anthropometric information in school boys and girls (6 to 14 years), from Madrid (Spain). To carry out this work two well-trained anthropometrists obtained data of total and kneeling height, cephalic and thoracic circumference, and weight from an aleatory sample of 333 boys and girls who study at a national school in Madrid. The collected data presented and analyzed, served as a basis to calculate the fitting equations of each anthropometric variable according to age and sex, as well as some relation among them. Their use simplifies the obtention of the biometric reference values, and allows precise interpolations for concrete ages. All of these algorithms have been translated into BASIC sentences to facilitate its incorporation into any microprocessor. A first diagnostic pattern of the past and present nutritional history of children according to their age and sex, total and kneeling height and weight of each one of them is also presented. The BASIC program, necessary to incorporate it into computers, is included as well.     

Evolution of the nutritional status of Chilean children from preschool to school age: anthropometric results according to the source of the data

Because the results of the nutritional status released by Chilean institutions which collect anthropometric data on their population under control, show different increments in the prevalence of obesity between preschoolers and children in 1st grade, we decided to verify the real magnitude of this increase. This study is based on a longitudinal investigation which began in 2006 and included 1100, three-year old children, which we evaluated when they were 4, 5 and 6 y. The nutritional status was determined according to BMI Z and WHO References 2006/2007. The information was also used to determine the concordance between the anthropometric data collected on first graders by teachers from public schools in 2009 (JUNAEB data set) and the same children assessed in parallel by INTA (INTA data set). The sample included 474, six-year olds. No differences were found between the average BMI Z and HAZ of the two data sets, and the degree of concordance between the BMI Z's was good (rho = 0.73), however there were differences in the nutritional status, since the prevalence of low weight was significantly greater when assessed with JUNAEB's data (9.5% vs. 3.6% ), while that for obesity was lower with INTA's data, 17.5% vs. 19.2% (not significantly different). At 4 and 5 y, obesity prevalence of the children was 13.3% and 15.7% respectively (INTA's data). Considering the observed nutritional trajectory, it is likely that the rise in obesity between 4 and 6 y of age, was 4 percentage points and not 6, as was determined with INTA's data.     

Body height evolution of adults in a rural area of Bolivia (1829-1987)]

Mean adult height is an indicator of very long-term (centuries) socioeconomic and nutritional trends in homogeneous populations. At the same time, changes in height have also been shown to be an indicator of long-term (generations) living conditions in homogeneous populations, and thus, a good complement to the usual anthropometric indicators of the medium--and short-term changes. Existing data on rural Bolivia confirm that there has been no significant improvement in health, sanitation and, especially, nutritional conditions in the Aymara and Quechua regions since Bolivia's independence (1825), and that living conditions have rather deteriorated in Amazonia (Beni). From a comparison of generational changes in height it is inferred that during the last several decades, and that conditions have probably worsened for the Quechua population environmental conditions appear to have remained the same for the Aymara population. On the other hand, some recovery in the Amazonia and improvement in the Chaco populations are apparent.     

Nutritional status and land tenure. A study in adults of the rural area of the northeastern Brazil

The present study was carried out in the rural areas of four municipalities in the North-East of Brazil as part of a broader survey which covered a sample of families living in the area. A subsample of adults (453 women and 126 men) was obtained from individuals who attended the survey's post for clinical and anthropometric evaluation. According to land tenure, they were stratified into four categories: those with-without land (W.L.); small land owner (S.O.); medium land owners (M.O.); and large land owners (L.O.). Means for anthropometric variables (height, weight, middle arm circumference and skinfold thickness) were calculated for each stratum. The differences between groups were statistically significant (p less than 0.05). Findings revealed that the larger the property, the greater the mean value for height; extreme values attained a difference of 7 and 6 cm in men and women, respectively. Mean weight increased as land ownership grew reaching a difference of 9 and 11 kg in men and women, respectively (p less than 0.01). Skinfold thickness and middle arm circumference showed significant differences between strata. To evaluate their present nutritional status, the adequacy of weight to height was obtained. In spite of the low proportion of individuals who exhibited less than 90%, adequate improvement was detected as land tenure increased. The study discusses the precariousness of criteria and patterns for the nutritional evaluation of adults, and suggests the existence of a relationship between nutritional status and land ownership.     

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.     

Physical growth and menarche in Guatemalan adolescents

The relationship between anthropometric measurements and age at menarche was studied in a group of Guatemalan adolescents, from urban and rural areas. The data indicate that median age at menarche is significantly higher in Indian adolescents living in rural areas than in non-Indian, the lowest age at menarche being that of adolescents living in urban areas. The age at menarche is positively associated with anthropometric measurements (weight, arm circumference and height) and body composition (body mass index), suggesting that both physical growth and sexual maturation are interacting processes of the same phenomenon known as the development age.     

Socioeconomic and nutritional localization, quantification and characterization of functional groups in Panama

Even though there has been an increase in the coverage of governmental services and an adequate national food availability, malnutrition continues to exist in Panamanian children. In order to geographically and administratively identify those groups more seriously affected by this problem and orient governmental actions towards them, data from the National Nutrition Survey carried out in 1980 in 14 occupational (functional) groups were classified. Social, economic and cultural characteristics of each functional group were associated with food and nutrition problems. More than half of the malnourished children fall within the functional groups who work in the agricultural/sector. Within them, more than 40% of the malnourished live in homes where two-thirds of their income is derived from work performed outside their own farms. In urban as well as in rural areas low food availability exists at the family level in 25% of the families with inadequate diets studied. The food problem in the rural area is worsened due to limited access to health services and poor environmental conditions. Therefore, the malnutrition problem in Panama is linked to low incomes that prevent acquisition of sufficient foods and other goods and services, as well as to the difficulty of accessibility to public services by an important part of the population.     

Description of a methodology to identify and quantify groups of poor and malnourished families in the Republic of Panama

The methodology used to identify and quantify existing data on the magnitude of nutrition and health damage in different political-administrative areas and families of Panama, is described. The purpose of the present paper is to orient governmental actions of the social field toward the most affected areas and families facing food and nutrition problems. The existing information sources used were the National Nutrition Survey carried out in 1980, the National Census on School Children's Height, of 1980, and the Vital Statistics of 1982. A score determined according to the expected data reliability was applied, by district, to the preschool height retardation data of the 1980 survey, to the data compiled through the school children's height retardation census of 1982 and to the infant and one-to-four year-old children's mortality data. The districts with the highest health and nutrition damage received the lowest score. Following this procedure, 28 districts, 204 "corregimientos" and six priority family groups were selected for social action. The usefulness of this procedure to orient governmental resources toward the poor and malnourished populations is discussed, as well as the technical possibility of carrying it out, on periodical bases, in order to orient program planning and know the impact they have on health and nutrition of the population.     

Comparison of 2 anthropometric methods for the estimation of frame size in Venezuelan adults

The frame size improves the interpretation of the body mass in adult and its incorporation is very useful in the assessment of nutritional status. This study compared two of the anthropometric methods used to classify individuals according to frame size: Grant method (height (cm)/wrist circumference (cm)) and Frame index 2 (elbow breadth (mm)/height (cm) x 100) in order to identify coincidence, concordance and divergence between then. Data from two hundred and forty nine apparently healthy individuals, between the ages of 22 and 63, belonging to "Health Project: Administration employees of the Simón Bolívar University" were included. Results showed significant differences between the two methods, not only in the proportion of classified individuals in each frame size category, but also when contrasted the same method using one or another body hemispheres. When studying both methods, the divergence in frame size identification varied between 19% and 55% with a low concordance (k = < or = 0.40). Grant method, compared to Frame index 2 showed a greater association with the variables and indicators of total body mass and body fat; in the other hand, Frame index 2 revealed a lesser correlation with such variables and indicators specially in female (r = 0.17 with fat percentage). These results clearly show the differences that could be created in the frame size identification of an individual of group of individuals if different criteria are used; this could also lead to a wrong anthropometric diagnosis.     

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.     

Nutritional rehabilitation and evaluation of the nutritional state. Validity of anthropometric measures for following, in hospitalized patients, the course of nutritional status and of body compartments during nutritional recovery

A population suffering from a serious form of malnutrition was examined. The effectiveness of nutritional rehabilitation is demonstrated by the statistically significant changes observed in clinical and laboratory indicators. Several anthropometric measurements related to nutritional status are also compared with total body potassium (TBK) in patients with a positive nitrogen balance during the process of nutritional rehabilitation. It is concluded that weight (W), arm circumference (AC), middle arm muscle circumference (MAMC) and skinfold thickness (ST) measures are useful, and sufficiently accurate and precise to follow the evolution of nutritional status and body compartments.     

Selection of the more adequate prediction index to estimate the frame size a group of institutionalized and free living elderly in Venezuela. (Preliminary study)

The objective of the study was to identify an easy to measure indicator of body frame size to allow refinement of anthropometric nutritional evaluation. Body dimensions and frame indices related to height, which might be potential frame size predictors in the elderly, were studied. In 307 subjects (163 women, 144 men) aged 60-99 years of whom 187 were institutionalized and 120 free-living outpatients, weight, height, mid-arm circumference; triceps, subscapular, midthigh and calf skinfolds; elbow, wrist, femur and biacromial widths, were measured. Body mass index, upper arm muscle area, upper arm fat area, fat percentage, sum of skinfolds and frame indices were calculated. Results were calculated in function of age, sex and life-style. Biacromial breadth, biacromial/height index, wrist breadth and wrist/height index gave variable correlations with indices of body mass and body fat. Femur breadth and femur/height index were significantly correlated with body fat indices. Elbow breadth, humerus/height index were not correlated to body fat indices, but were significantly correlated with weight, height and fat free mass. Elbow breadth and humerus/height index fulfilled most of the criteria of good predictors of body frame size in the group pf elderly studied.     

Body mass index in a group of Venezuelan pregnant women and its relationship with the newborns' anthropometry

To assess the relationship between maternal body mass index (BMI) at early gestation and the newborns' anthropometry, 105 mother-infant dyads from a public Maternity Hospital in Valencia Venezuela, were studied during 1998-2000. Weight and height of adult women between 10 and 15 weeks of gestation were used to calculate BMI according to Atalah's reference (Low weight, Normal, Over weight). Term newborns were assessed using gestational age calculated according to the Capurro method. Their weight, height, and head circumference were recorded, and were characterized using a Venezuelan reference. Newborns whose birth weight (BW) was pound 10th percentile were considered "small for gestational age" (SGA), and those with BW (3) 90th percentile as "large for gestational age" (LGA). One-way ANOVA and Tukey's Post Hoc test were used for group comparisons. There were 41.9% of "low weight" mothers, and 13.4% of SGA newborns. There were differences in the newborns' weight and height according to "Low weight" maternal BMI with "Normal" and "Over weight" maternal BMI (p < 0.05). A high prevalence of nutritional deficit was observed from the beginning of the gestational period, as well as a relationship between maternal BMI and the newborn's anthropometry.     

Comparative analysis of some anthropometric measurements

The main objective of this work is to determine what anthropometric method to use under field conditions, given the kind of mainutrition to be detected. In the first part of the work some criteria and procedures are given by which to compare the field perfomance characteristics (i.e. transportability, facility of use, etc.), of the most commonly used instruments. Then we extrapolate these characteristics to the respective methods like weight for age, weight for height, height for age, etc. In the second part we present a correlation matrix among the various methods and analyze it in order to associate with each method a specific typology of malnutrition.     

Anthropometric characteristics of school children graduated from basic and secondary education in the Metropolitan area of Santiago de Chile

An anthropometric assessment of the nutritional status and growth of students graduating from Basic (8th grade) and Secondary (4th grade) Education was carried out. A group sample of 522 students from the Metropolitan Area of Santiago, Chile, was randomly selected. The same number of students by sex, dependency (public and private schools) from high, medium and low socioeconomic levels (SEL) was chosen. SEL was measured through the Graffar Modified Scale, and the percentage of weight for age (% W/A), height/age (% H/A) and weight/height (% W/H) were evaluated in accordance with the National Center for Health Statistics (NCHS) reference pattern. The % adequacy of head circumference/age (% HC/A) was determined by the Tanner Tables, and the % of upper to lower segment ratio (% US/LS), by the Tables of Muzzo et al. Results revealed that the % of W/A and of H/A were diminished in students of both sexes, while the % of UP/LS, was increased in males of low SEL, from Basic Education; this impact is lost in males graduating from Secondary Education and persists only in the LSE females. No differences in the nutritional status (% W/H) of students according to SEL, were found. Females registered values over 110% of the WHO standard, a finding suggesting a high prevalence of overweight and obesity. We conclude that there is a growth retardation in students graduating from 8th Basic Grade, which persists only in females from 4th grade of Secondary Education. This finding indicates that, in addition to possible environmental factors, other factors, probably of genetic order, also influence the latter. Overweight and obesity, therefore, constitute an important problem that merits measures of preventive nature directed to avoid future consequences.     

Prevalence of sub-clinical vitamin A deficiency and malnutrition in slum children in Maraicabo - Venezuela

The present cross sectional study was carried out to estimate the prevalence of vitamin A deficiency among children by means of clinics and conjunctival impression cytology (CIC), and nutritional status by anthropometric indicators H//A, W//A, W//H. The study population included 157 children 2-6 y old, from urban and rural slums of Maracaibo, Venezuela, Conjunctival impression cytology was performed by ICEPO standard procedure. Z-score was applied to anthropometric data with reference values of NCHS-WHO. No evidence of clinical or ophthalmologic signs of vitamin A deficiency were detected. The prevalence of subclinical vitamin A deficiency, as detected by abnormal CIC, was 35.4%, being higher in rural children (48.3%). These prevalence values are higher than the criteria laid down by WHO/UNICEF to indicate a public health problem (> 20%). Mild or moderate protein-energy global malnutrition and stunting were detected in 36.1% and 44.6% of children, respectively. Abnormal CIC was indistinctly observed (approximately equal to 35%) as much in children with adequate nutrition as in malnourished ones. There was no significant difference in the distribution of the CIC results in relation to nutritional status. The findings indicate that CIC and Z-score of nutritional anthropometric data are useful to characterize the risk of vitamin A deficiency and of malnutrition in communities. Beside the implementation of an integral nutritional program which includes supplementation, food fortification and dietary diversification, improvement of socio-economic and sanitation conditions and also the educational level, with emphasis on nutritional and health education, are highly recommended.     

Intake of dietary fiber in the Central American isthmus: nutritional implications

Mean intakes of dietary fiber (DF) were estimated in the population of Central America and Panama, using the results of dietary surveys conducted in 1969 and 1986 both in rural and urban areas, as well as data on the DF content of foods as consumed in the region. Data on preschool children were also estimated. The results indicated that DF intake in urban areas is lower than that of rural areas, particularly in Costa Rica and Panama. In 1969, intake varied from 32g in El Salvador to 15g in Panama in urban areas, while in rural areas intake was from 45g in El Salvador to 13g in Panama. The foods which contributed most to the total intake in Guatemala, El Salvador and Honduras were tortillas and beans, while in Costa Rica and Panama, beans provided the largest intake. In preeschool children, intake was 12.5g in El Salvador and 5.4g in Costa Rica in 1969, which is the same tendency as that found for adults. From more recent data on food intake, it was found that DF intake had decreased in the rural areas of El Salvador, Honduras and Costa Rica, being between 4 and 9% in the first two countries and 12% in Costa Rica. In the urban area of the latter, from 1969 to 1986 a decrease in DF intake of around 20% has taken place.     

Short stature and food habits as determining factors for the low productivity of sugarcane labourers in the State of Alagoas, north-eastern Brazil

Undernutrition, especially in the prenatal period and/or until 5 years of age, can cause stunting. Adults with short stature resultant from this process show a series of functional deficits, amongst which is a reduced capacity to do physical work. The aim of this investigation was to evaluate the dietary pattern, nutritional status and stature of sugarcane cutters, and to determine possible associations with worker productivity. Sixty-two male sugarcane cutters (18-50 y) were selected randomly from a population of 600 workers from a plantation in Alagoas (Brazil), and classified as underweight, normal weight or overweight according to BMI (BMI = 21.5, 21.5 to = 25 and >25 kg/m2, respectively). Body fat composition (%) was estimated by electrical bioimpedance and dietary intake by the direct weighing of food consumed. Whilst the average productivity was 8.13 ton/day, labourers with normal BMI values were more productive (9.12 ton/dia) and ingested significantly (p<0.05) greater amounts of energy (16506.4 kJ/dia) than their underweight (7.48 +/- 1.5; 12380.7 +/- 4184.1) or overweight (9.12 +/- 1.5; 16506.4 +/- 6360.0) counterparts, respectively. There were associations (p<0.05) between productivity, stature, energy intake and age. The tallest individuals (= 170 cm) had higher productivity and tended to have a higher energy intake, whilst those with the shortest stature (= 160 cm), had a significantly lower productivity, however ingested a similar quantity of energy, and tended to have a large accumulation of body fat. Multiple regression analysis identified stature as the parameter most associated with productivity, independent of age and body fat percentage. Productivity of the tallest individuals was 1.87 ton/day higher than that of the shortest individuals. The results emphasise the importance of good nutritional status throughout life for full development of working productivity.