Infant feeding practices in St. Vincent and factors which affect them

A survey was conducted in the summer of 1975 in 2 towns in St. Vincent--Layou and Georgetown--in the effort to obtain information regarding infant feeding practices and some of the factors which may influence them. Mothers of children from 1-2 years of age were interviewed in their homes. Complete data sets were obtained on 192 of the 216 eligible children in the 2 towns. For most children the period of exclusive breastfeeding (no other milk product given) was very short. About 1/2 of the children had received milk by 2 weeks of age, and 75% by 1 month. This was followed by a much longer period of "mixed" feeding--both breast and bottle--until breastfeeding was stopped at a median age of 6.8 months. Many types of milk were used for infant feeding. For 73% of the infants, infant formula was the 1st type of milk given. This was commonly replaced by a "heavier" full cream powdered milk at a few months of age. Prelacteal feeds were very common, predominantly glucose water. "Tonics," often consisting of vitamin preparations, were another common supplement during the early months of life. Among solid foods, arrowroot, "custard," and commercial infant cereals were the first to be introduced. Relatively inexpensive locally bagged staple foods and milk powders were available in both towns, but most mothers relied heavily on packaged brand name products for infant feeding even though the cost was 2-10 times higher. It was not possible to pinpoint the exact causes for the high levels of bottle feeding, nor for the possible recent decline in breastfeeding, but several important factors were identified. Part of the problem appeared to be due to poor health and nutritional status of the mothers. In addition, in several cases the mothers reported that they had wanted to continue breastfeeding but had received no support from health professionals, and in a few instances had been ordered to stop for seemingly trivial medical reasons.     

Factors involved in Schistosoma mansoni infection in rural areas of northeast Brazil

Two contiguous villages in Tracunhaém county (State of Pernambuco), endemic for schistosomiasis, were studied: Itapinassu (138 inhabitants) and S?o Joaquim (91 inhabitants). Agriculture predominates in the former region while ceramics is the main activity in the latter. Although no statistical difference was found regarding prevalence, severe infection (> 400 epg) predominated in Itapinassu, probably related to the kind of occupation. No association was found between parasite burden and severity of disease, in spite of the high infection rates for Schistosoma mansoni in both communities (approx. 60%). Typical epidemiological features of schistosomiasis such as age-related prevalences and intensities of infection (high in children, low in adults) were also mutual characteristics. Nutritional status determined through anthropometric evaluation was carried out by measuring specific anthropometric indicators. A deficit of energy intake, as well as vitamin A and riboflavin deficiencies were detected. The prevalence of moderate or severe undernutrition in patients under 18 years old was 21.9% in Itapinassu and 24.1% in S?o Joaquim. In this group an association was found between prevalence of schistosomiasis and chronic undernutrition. Similarly, for patients over 18 year old the prevalence of undernutrition was higher than 20%. However, in this case no association between nutritional status and either prevalence of schistosomiasis or parasite burden could be detected. The two communities had not been treated for eight years.     

Feeding and nutritional characteristics in children with moderate or severe cerebral palsy

This study was undertaken to characterize the current feeding situation and nutritional status of moderately or severely disabled children with cerebral palsy (CP). Thirty-five children with CP (17 with diplegia, 11 with dystonia, 6 with tetraplegia and one child with ataxia) were investigated at a median age of 8 years. Information was obtained from parental interviews, medical records and clinical and anthropometric examinations. Twenty-one of the 35 children (60%), most of whom were severely disabled, were reported by the parents to have current feeding problems. Anthropometric indicators of undernutrition were found in 15 children (43%) and of overnutrition in 3 children (9%), compared with reference values of healthy children. Severely disabled children in the youngest age group were most at risk for poor nutritional status. Early identification of children at nutritional risk requires regular assessments of feeding skills and nutritional status.     

Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines

The effects of not breastfeeding on mortality due to diarrhea and acute lower respiratory infection (ALRI) in children under 2 years of age were examined using data from a 1988-1991 longitudinal study of 9,942 children in Metro Cebu, The Philippines. Cox regression methods were used to study the magnitude of the risks, possible interactions with birth weight and nutritional status, and the effect of additional confounding factors. Not breastfeeding had a greater effect on diarrheal mortality than on ALRI mortality. In the first 6 months of life, failing to initiate breastfeeding or ceasing to breastfeed resulted in an 8- to 10-fold increase in the rate of diarrheal mortality. The rate of mortality associated with both ALRI and diarrhea was increased nearly six times by not breastfeeding, but the rate of ALRI mortality alone was not increased. The data also suggested that the risk of mortality associated with not breastfeeding was greater for low birth weight infants and infants whose mothers had little formal education. After age 6 months, the protective effects of breastfeeding dropped dramatically. These findings underscore the importance of promoting breastfeeding, especially during the first 6 months of life, and of targeting high risk groups such as low birth weight babies and those of low socioeconomic status.     

A prospective cohort study on the survival experience of under five children in rural western India

OBJECTIVE: To study the role of birth weight, nutrition, immunization and other medical as well as social factors in determining child survival. DESIGN: A prospective cohort study. SETTING: 45 villages in Shirur Development Block in Pune District in Maharashtra. METHODS: A cohort of 4129 children were followed from birth till 5 years of age. Weight and length/height of the child was measured at birth and at 3 monthly home visits. Information was also obtained on common childhood morbidities, immunization status and other bio-medical factors. Cause of death was ascertained by verbal autopsy. RESULTS: The neonatal, infant and underfive mortality was rates were estimated to be 37, 60 and 79 per 1000 live births, respectively. Diarrhea and ARI contributed to the major mortality burden. The Kaplan Meier Survival curve showed a sharp fall in the neonatal period, a less rapid decline in the post-neonatal period followed by a marginal fall in the post-infancy period till 5 years age. Girls had a better survival in the early neonatal period but the trend reversed in the late neonatal period. Normal birth weight children had better survival curves compared to low birth weight children. Survival improved with increasing birth order. Multivariate analysis revealed that birth weight, immunization status, and mother's and child's nutritional status influenced infant and under five mortality. CONCLUSION: Birth weight continues to exert its influence not only on survival/mortality in early life but even as late as 5 years of age. Strategies to improve child survival should include immunization and breastfeeding.     

High prevalence of obesity in low income and multiethnic schoolchildren: a diet and physical activity assessment

The objective of the study was to assess the prevalence of obesity and/or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population. A cross-sectional survey of 498 children aged 9-12 y from 24 schools in low income multiethnic neighborhoods in Montreal, Canada was undertaken. Height, weight, dietary intake, physical activity record, and lifestyle and demographic characteristics were measured. There was no evidence of undernutrition because linear growth was appropriate for age, but 39.4% of children were overweight (>85th percentile NHANES II). Dietary fat intake was higher in children from single-parent families (P < 0.001) and those with mothers born in Canada. Intake of vitamins A, C, iron and folate was directly related to income sufficiency. Children who did more physical activity had significantly higher intakes of energy, calcium, iron, zinc and fiber but were not heavier. Dietary intake was systematically underreported among overweight children, i.e., their reported intakes did not meet calculated energy needs. This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure.     

The results of epidemiological studies concerning iodine deficiency and goiter in Poznań Region (Poznań coordinating center)

The studies concerning iodine deficiency and occurrence of goiter, being a fragment of the program covering different parts of Poland, included 2620 children of age between 7 and 12 years attending randomly chosen schools situated in towns and villages of Poznań, Pila, Leszno, Konin, Kalisz, Bydgoszcz and Zielona Góra districts. Among the children studied, 1009 children (522 boys and 487 girls) attended town schools, and 1611 (774 boys and 837 girls) country schools. All children were subjected to anamnesis by using a standard questionnaire. Also physical examination of the thyroid aimed at the evaluation of size and morphology of the gland was carried out by palpation (according to the obligatory WHO scale) and by ultrasonography. Urine samples were taken from the majority of children for the determination of urinary excretion of iodine. In 736 (28.1%) of the studied children an enlargement of the thyroid was found. Among these children 253 are inhabitants of towns (this number represents 27.8% of all urban children studied) and 483 are inhabitants of villages (30% of all rural children studied). In 92.7% of cases the goiter could be classified as type IB according to WHO and in 56 cases it was of nodular character. There was a clear relation between the incidence of goiter and the age of the children studied. Frequency distribution of goiter in the individual age groups was as follows: for urban children--21.8% in age group of 7-8 years, 23.5% in age group of 9-10 years and 29.7% in age group 11-12 years, and for rural children the corresponding values were 21.1%, 30.2% and 38.2%. Mean urinary iodine excretion was 96 micrograms/L (median 84 micrograms/L) for urban children, and 87 micrograms/L (median 64 micrograms/L) for rural children. Among 2620 answers concerning the use of iodized salt in the household, only 980 (37.1%) were positive. In towns, the use of iodized salt declared about 41% of families and in villages about 35%. Altogether, among 736 cases of goiter, 464 are children not using iodized salt. Only in 272 cases goiter appeared despite the use of iodized salt. The data concerning family occurrence of goiter and the type of iodized salt used can be treated as approximate because of subjective character. According to the results obtained, the region covered by the study falls according to the WHO and ICCIDD classification to the category of an area of mild iodine deficiency requiring more intensive iodine prophylaxis.     

Food intake, its relationship to body weight and age, and its apparent nutritional adequacy in New Guinean children

Previous nutritional investigations in New Guinea have shown low intakes of protein and of energy yet the nutritional status of children and their ability to thrive have been regarded as better than could be expected. To investigate this apparent paradox, the dietary intakes of 482 New Guinean children, aged 1-18 years, living in two contrasting environments near the coast (Kaul) and in a highland region (Lufa) were determined by a weighed individual inventory method over 5-7 consecutive days. Body weights and skinfold thicknesses were lower than those of European children of comparable ages. These findings are to be reported and discussed more fully in a separate publication. Roots and tubers provided most of the energy and protein in the bulky, vegetable diets. The contribution of foods bought in local trade stores was higher than has previously been reported. Fat intakes were low, supplying 17% of the dietary energy in Kaul and 10% in Lufa. Protein intakes were similarly low, representing only 6% of dietary energy. The chemical scores of the protein calculated using the latest suggested amino acid scoring pattern (FAO/WHO, 1973) were high, 75-95. Using the previous pattern, these were 57-64. The adequacy of the energy and protein contents of individual diets was assessed using the FAO/WHO (1973) standards. An energy deficit was more common than a protein deficit. A considerable proportion of the children (42% in Kaul and 20% in Lufa) had dietary intakes which were apparently deficient in energy or protein, but this finding did not correspond to other signs of undernutrition. This suggests that current standards may still be set too high for some groups or that adaptations to suboptimal dietary intakes occur that are not disclosed by the usual techniques of assessing nutritional status.     

Iodine deficiency in the Cirque of Salazie (Reunion Island). Analysis of nutritional causes and study of their consequences

Randomized subjects (n = 294), (35 young children, 6-30 months old--91 children 8.6 +/- 0.7 years, 116 teenagers 13.2 +/- 1.9 y--52 young women 28.5 +/- 6.1 y) leaving in a mountainous area of Reunion Island (Cirque de Salazie) were evaluated according to the following: a questionnaire related to food intake, cervical palpation for thyroid size evaluation and collections of urine and foods (natural and mineral water, breast and commercial milk and salt) for iodine measurement. Neonatal TSH of 308 new borns in Salazie were compared to TSH of 300 new-borns of Lille (France). The prevalence of goiter increases with age (0% in young children, 12.1% in children, 23.3% in teenagers, 38.4% in women) whereas median urinary iodine (microgram/dl) decreases in the same groups (12-7.8-5.6-4.2). The intake of milk and dairy products significantly decreases from children to adults. Neonatal TSH values are significantly higher in Salazie than in Lille (p < 0.005). Natural and mineral water, breast milk and salt contain little iodine. In conclusion iodine deficiency is present in this area of Reunion Island with a significant increment of neonatal TSH values.     

Oral contraceptives alter circadian rhythm parameters of cortisol, melatonin, blood pressure, heart rate, skin blood flow, transepidermal water loss, and skin amino acids of healthy young women

This study investigated the usage consumption pattern and chemical composition of fermented foods consumed in 191 rural households (1030 individuals) in Emene. The result showed that fermented foods were widely used and consumed by most age groups (under 2 years to adults) because of poor socioeconomic status. Fermentation period varied with type of food and was mostly carried out as a means of detoxifying certain foods. Generally, fermented foods contributed substantially to the daily caloric (46.3 to 79.9% for males and 57.5 to 78% for females); calcium (33.8 to 63.5% for males and 48.3 to 55.4% for females); iron (34.4 to 58.6% for males and 47.4 to 74.6% for females); and thiamin (23 to 58.5% for males and 37.5 to 60% for females) intakes. The contributions of fermented foods to protein (10 to 40.7%) and ascorbic acid (1.9 to 18.7%) intakes were however, low. When compared with the FAO recommendations, the daily intakes of protein, calcium, riboflavin, niacin and ascorbic acid by the subjects were low due to large consumption of starchy root crops. Poor financial status was the most limiting factor to adequate nutrient intake. Such results point out the need for nutrition education related to improved methods of preparation and food selection.     

Evidence of poxvirus in dusky dolphin (Lagenorhynchus obscurus) and Burmeister''s porpoise (Phocoena spinipinnis) from coastal Peru

Infection and undernutrition in young children are thought to act synergistically. However, studies of the relationship between low height-for age (stunting) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplementation on morbidity. 129 stunted and 21 non-stunted children aged between 9 and 24 months, from poor Kingston neighbourhoods, identified from a house-to-house survey, were studied. The stunted children were randomly assigned to supplementation or no supplementation. Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness. Supplementation had no consistent effect on the incidence or duration of symptoms. The stunted children had significantly more attacks of diarrhoea, fever, anorexia and apathy than the non-stunted children. The differences remained after controlling for social background and previous attacks of diarrhoea. There was also some indication of more severe illness in the stunted than in the non-stunted children.     

Kashin-Beck osteoarthropathy in rural Tibet in relation to selenium and iodine status

BACKGROUND AND METHODS: Kashin-Beck disease is a degenerative osteoarticular disorder that is endemic to certain areas of Tibet, where selenium deficiency is also endemic. Because selenium is involved in thyroid hormone metabolism, we studied the relation among the serum selenium concentration, thyroid function, and Kashin-Beck disease in 575 subjects 5 to 15 years of age in 12 villages around Lhasa, Tibet, including 1 control village in which no subject had Kashin-Beck disease. Clinical, radiologic, and biochemical data were collected. RESULTS: Among the 575 subjects, 280 (49 percent) had Kashin-Beck disease, 267 (46 percent) had goiter, and 7 (1 percent) had cretinism. Of the 557 subjects in whom urinary iodine was measured, 66 percent had a urinary iodine concentration of less than 2 microg per deciliter (157 nmol per liter; normal, 5 to 25 microg per deciliter [394 to 1968 nmol per liter]). The mean urinary iodine concentration was lower in subjects with Kashin-Beck disease than in control subjects (1.2 vs. 1.8 microg per deciliter [94 vs. 142 nmol per liter], P<0.001) and hypothyroidism was more frequent (23 percent vs. 4 percent, P=0.01). Severe selenium deficiency was documented in all villages; 38 percent of subjects had serum concentrations of less than 5 ng per milliliter (64 nmol per liter; normal, 60 to 105 ng per milliliter [762 to 1334 nmol per liter]). When age and sex were controlled for in a multivariate analysis, low urinary iodine, high serum thyrotropin, and low serum thyroxine-binding globulin values were associated with an increased risk of Kashin-Beck disease, but a low serum selenium concentration was not. CONCLUSIONS: In areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.     

Chronic low intakes of vitamin A-rich foods in households with xerophthalmic children: a case-control study in Nepal

Dietary patterns in 81 rural Nepali households with a 1-6-y-old child with a history of xerophthalmia were compared with dietary patterns of 81 households with an age-matched nonxerophthalmic control subject. Weekly food-frequency questionnaires were collected from case and control "focus" children, a younger sibling (if present), and the household 1-2 y after recruitment and treatment of cases. Control households and children were more likely than case households and children to consume vitamin A-rich foods during the monsoon (July-September) and major rice harvesting (October-December) seasons. Cases were less likely to consume preformed vitamin A-rich foods throughout the year [odds ratio (OR) = 1.2-4.5] with the strongest differences observed from October to December (OR = 2.0-4.2). Dietary risks were generally shared by younger siblings of cases, suggesting that infrequent intake of beta-carotene and preformed vitamin-A rich foods begins early in life and clusters among siblings within households, a pattern that is consistent with their higher risk of xerophthalmia and mortality. In developing countries where vitamin A deficiency is endemic, dietary counseling for children with xerophthalmia should be extended to their younger siblings. Moreover, dietary intake of preformed vitamin A may be as, or more, important as carotenoid-containing food consumption in protecting children and other members of households from vitamin A deficiency.     

Augmentation of nutritional intakes in children receiving long-term hemodialysis treatment

One of the major problems confronting children on long-term hemodialysis treatment is an inadequate intake of nutrients. The intake of calories, protein and minerals in children dialyzed for up to 3 years was documented in this study to be low. A simple method of augmenting the nutritional intake that has wide patient acceptibility is presented.     

Uniqueness of limit cycles in models for microparasitic and macroparasitic diseases

Understanding the sources of variation in a community's diet is vital for development work, as well as being a source of anthropological and cultural insights. Previous surveys in the South American Andes suggest that nutrient deficiencies may be widespread; however, such interpretations have remained tentative since variance in Andean populations' diet has not been thoroughly examined. In this paper we consider the variation in diet due to variation in age, sex, and socioeconomic status and variation attributed to inter- and intraindividual variation in the diet. One to six days of dietary data (mean = 3.1) were collected via 24 h recalls from 221 residents of a small, rural community in highland Ecuador. The contribution of various food groups to the diet varied with land holdings and age but not sex. For example, animal-derived foods contribute more and tubers contribute less to the diet of the households with > or = 5 Ha, and sweets contribute more to the diet of children. The interindividual variation in energy and nutrient intake was low and the intraindividual variation high relative to developed countries. The consequence are twofold. First, because interindividual variability is low, group mean intake can be estimated relatively easily, facilitating group comparisons. Second, because intraindividual variation is high, individual nutrient intake cannot be easily estimated, which will decrease the ability to detect associations between nutrient intake and health measures. This knowledge of the sources of dietary variation can lead to better study and survey designs in the rural Andes and elsewhere in the developing world.     

The incidence of anemia in residents of Missouri

A state-wide nutritional health survey of Missouri residents conducted in 1973 included hemoglobin, hematocrit, and serum iron determinations on approximately 1,164 persons and dietary iron intake estimates, based on a diet history, for 530 persons. Based on the criteria used for interpretation of the Ten-State Nutrition Survey data, over 19% of all preschool age white children and over 10% of the white children six to 10 years old had low or deficient hemoglobin levels. Between 8 and 17% of the white males between 10 and 60 years old and over 30% of the white males over 59 years old were anemic. Between 3 and 9% of all white females over 9 years of age had low or deficient hemoglobin levels. The levels of anemia for most age and sex groups of Negroes were at least twice as great as for corresponding groups of white persons. Low or deficient hemoglobin levels within the age and sex groups were associated with low hematocrit and serum iron levels; suggesting that some of the anemia was a reflection of iron deficiency. Estimates of the dietary intake of iron indicated that less that 20% of the females 10 to 35 years old and less than 60% of older females and boys under 17 years of age were consuming the Recommended Dietary Allowances. Over 35% of the preschool children and females between 10 and 60 years old were consuming less than two-thirds of their Recommended Dietary Allowances for iron. At least part of the iron deficiency was, therefore, indicated to be related to insufficient dietary intake.     

Epidemiology of iodine deficiency in the middle Ob regions

AIM: Epidemiological rvaluation of goiter endemia and iodine deficiency in population of the Middle Ob region. MATERIALS AND METHODS: Thyroid palpation and ultrasonic investigations, iodine measurements in the urine were made in 6256 children and adolescents aged 8-17 years. RESULTS: Euthyroid condition was clinically stated in all the examinees. Palpation discovered thyroid enlargement in 36.78% of the examinees. Age prevalence was: 27.3, 33.28, 42.8, 46.18% in children and adolescents aged 8-10, 11-12, 13-14 and 15-17 years, respectively. Ultrasound detected goiter in 30.6% of the examinees. The occurrence was 34.78, 31.68, 28.2, 19.8% in the above age groups, respectively. No significant differences by thyroid size existed in girls versus boys. Urinary iodine was low in all the age groups. CONCLUSION: The Middle Ob regions belong to zone of goiter endemia with mild to moderate iodine deficiency. This dictates the necessity of introduction of special programs of iodine deficiency control and prevention.     

Role of posture in mechanics of the lumbar spine in compression

Thirty-four foods were analyzed in order to determine the content of water-soluble dietary fiber (SDF) and insoluble dietary fiber (IDF). Using the results with the standard table for 227 foods, the intake ratio of IDF/SDF of an average Japanese was calculated for the period 1946-1990. The ratio was 3.22 in 1990 as calculated on the food intakes shown in the national nutrition survey, and the secular change was not detected since 1946 when the ratio was 3.30. The ratio was also shown to be well preserved between types of households including the age of the head. Using dietary records of 60 healthy city workers (average 42.8 years) for 4 weeks, however, the weekly average ratio for an individual was found to vary in the range of 2.25-5.13 although the total average for 60 individuals was 3.33. Thus, the well preserved IDF/SDF intake ratio for an average Japanese showed, on the contrary, a wide variation of food selection between each person.     

Protein energy malnutrition, vitamin A deficiency and night blindness in Bangladeshi children

The occurrence of night blindness and serum vitamin A concentrations among children in rural Bangladesh were studied in relation to protein energy malnutrition, dietary habits and intake of vitamin A capsules. In 1992, 124 night-blind children were registered in a cross-sectional survey in the northern part of Bangladesh, and age-, sex- and neighbourhood-matched controls were selected. Of these, the first reported night-blind child from a household (n = 105) and their controls were included in the analyses. Our results showed that night blindness was associated with protein energy malnutrition when using the mid-upper arm circumference (MUAC) as a measure of nutritional status. The odds ratio for a confirmed diagnosis of night blindness among children with a MUAC < 80% of the reference versus normal children was 5.4 (CI 1.9-15.5). Low MUAC was associated with low intake of beta-carotene-rich and vitamin A-containing foods as well as with low serum vitamin A in the total series of cases and controls. This may indicate that night blindness is only one aspect of the general protein energy malnutrition problems in this population. We therefore suggest that measures to prevent vitamin A-related morbidity and mortality should include improvement of the general diet with increased consumption of dietary vitamin A.     

Assessment of iodine deficiency in selected blocks of east and west Champaran districts of Bihar

OBJECTIVE: A survey conducted in 1964 reported a goitre prevalence of 40.3% in East and West Champaran districts of Bihar. No recent survey has been documented on the prevalence of iodine deficiency in these districts. The present study was therefore undertaken (i) to assess the prevalence of IDD in these districts, and (ii) to estimate the iodine content of salt consumed by population. METHODOLOGY: In each district, one block was selected. In each block more than 630 children in the age group of 6-12 years were included in the study and were clinically examined. Urine samples were collected from 261 children and were analyzed using standard laboratory procedures. A total of 456 salt samples were collected from children and 35 from traders from the two districts and analyzed using the standard iodometric titration method. RESULTS: The total goiter prevalence was 11.6%. The percentage of children with < 2, 2.0-4.9, 5.0-9.9 and > or = 10 mcg/dl of urinary iodine excretion level were 12.3, 13.4, 23.4 and 51.0, respectively. The median urinary iodine excretion of the children was 10.0 mcg/dl. None of the families were consuming salt with a nil iodine content and about 29.3%, were consuming salt with less than 15 ppm of iodine. Of the 35 salt samples collected from traders, all had iodine and about 17% had less than 15 ppm of iodine. CONCLUSION: The study stresses the need for strengthening the existing system of monitoring of quality of salt being provided in the East and West Champaran districts by Government of Bihar.