RESUMEN
In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.
Asunto(s)
Trastornos de la Conducta Infantil/psicología , Países en Desarrollo , Enanismo/psicología , Desarrollo de la Personalidad , Desnutrición Proteico-Calórica/psicología , Niño , Trastornos de la Conducta Infantil/diagnóstico , Femenino , Humanos , Lactante , Jamaica , Masculino , Responsabilidad Parental/psicología , Determinación de la Personalidad , Carencia PsicosocialRESUMEN
Health, nutrition and behavioural determinants of school achievement, attendance and dropout were examined in 452 girls aged 13-14 years, randomly selected from grade 8 in nine schools in inner-city Kingston, Jamaica. Girls who were anaemic, sexually active or aggressive had worse achievement levels. Better achievement levels were associated with possession of school materials and access to reading material outside of school. Poor attendance, early sexual activity, and not living with both parents predicted school dropout in the subsequent year. Strategies to reduce anaemia, to improve sex education and reduce the levels of aggression may benefit school performance.
Asunto(s)
Logro , Adolescente , Escolaridad , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Jamaica , Modelos Logísticos , Estado Nutricional , Factores SocioeconómicosRESUMEN
A method is presented to estimate a cutoff for hemoglobin concentration appropriate for estimating the prevalence of iron deficiency anemia in poor Jamaican girls 13-14 y of age. Iron deficiency was determined from a three-variable model of iron status (serum ferritin, erythrocyte protoporphyrin, and mean corpuscular volume). The most appropriate hemoglobin cutoff was considered the one that minimized misclassification of iron deficiency: that yielding the maximum kappa coefficient for correctly classifying iron deficiency between 100 and 120 g/L, at 1-g/L intervals. By using this method, a hemoglobin cutoff of 107 g/L was considered most appropriate. This cutoff and the other indicators were used to estimate prevalence of iron deficiency and iron deficiency anemia in the Jamaican girls: 7.6% and 4.3%, respectively. This approach should be appropriate for determining hemoglobin cutoffs for iron deficiency anemia in other populations.
Asunto(s)
Anemia Ferropénica/epidemiología , Deficiencias de Hierro , Adolescente , Antropometría , Femenino , Estado de Salud , Hemoglobinas , Humanos , Jamaica/epidemiología , Prevalencia , Valores de ReferenciaRESUMEN
The long-term benefits of early childhood supplementation and the extent to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS references, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, controlled trial of supplementation beginning at ages 9-24 mo. A group of 32 non-stunted children from the same neighborhoods was also followed. Four years after the intervention ended, when children were 7 to 8 y old, there were no effects of supplementation on any anthropometric measure. From the end of the trial until follow-up, the children who had been supplemented gained 1.2 cm less (P < 0.05) than the non-supplemented children, approximately the same amount as they had gained during the trial compared with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increased from enrollment to follow-up by 0.31 Z-score (95% CI 0.17, 0.46). The height-for-age of the non-stunted children also increased (0.96 Z-score; 95% CI 0.70, 1.22). Our results suggest that some catch-up growth is possible even when children remain in poor environments. Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished.
Asunto(s)
Alimentos Fortificados , Trastornos del Crecimiento/dietoterapia , Crecimiento , Antropometría , Trastornos de la Nutrición del Niño/complicaciones , Preescolar , Femenino , Humanos , Lactante , Jamaica , Estudios Longitudinales , Masculino , Pobreza , Análisis de RegresiónRESUMEN
Height-for-age and weight-for-height are commonly used indicators of nutritional status; however, their precise interrelationship remains unclear. We examined the relationship between weight-for-height and linear growth in 127 stunted Jamaican children aged 9-24 months. The children were measured every 6 months over a 2-year period. The initial weight-for-height status was positively associated with linear growth in the following 6-month interval. The change in weight-for-height in the preceding interval was a better predictor of linear growth in the next interval than attained weight-for-height at the beginning of the interval. The results suggest that variations in weight-for-height may influence the rate of linear growth.
Asunto(s)
Trastornos de la Nutrición del Niño/diagnóstico , Insuficiencia de Crecimiento/diagnóstico , Crecimiento , Evaluación Nutricional , Desnutrición Proteico-Calórica/diagnóstico , Síndrome Debilitante/diagnóstico , Factores de Edad , Estatura , Peso Corporal , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Análisis de RegresiónRESUMEN
There is little information on the nutritional status of adolescents in developing countries. In particular there is a lack of data concerning black adolescents. We measured height, weight, and triceps and subscapular skinfolds in 452 13-14-year-old girls, randomly selected from those attending nine schools in Kingston, Jamaica. The girls' heights and body mass indices were appropriate for their age. This suggests that undernutrition was not a significant problem in this population. However, the girls' skinfolds were smaller than the US references, both those for the total population and those for blacks only. The fat pattern (triceps/subscapular ratio) was similar to that reported for adult black women in the United States. It is possible that the levels of fat in the references are not appropriate for this population. Data from other black populations are needed for comparison.
PIP: To obtain further information on the anthropometry of Black female adolescents in developing country settings, height, weight, and skinfold measurements were recorded for 452 randomly selected 13-14 year old girls attending nine secondary schools in Kingston, Jamaica. Although the heights and body mass index values of the Jamaican girls were comparable to those of the US reference population, the Jamaican teens had less fat at both triceps and subscapular skinfold sites. 23% of girls in the Jamaican sample had triceps skinfold thicknesses below the 5th percentile of the American references. The median triceps skinfold of Jamaican girls was also less than that of US Black females. The fat pattern (indicated by the mean triceps/subscapular ratio) among Jamaican girls was similar to that reported for adult Black women in the US and smaller than that among US White adult women. A correlation of anthropometric values and housing ratings indicated that more affluent Jamaican girls were slightly taller and heavier than their poorer counterparts and had more fat. Overall, these findings suggest that undernutrition is not a significant problem among low-income adolescent girls in Jamaica. The data from this study can be used for comparison with other Black populations in developing countries.
Asunto(s)
Antropometría , Estado Nutricional , Adolescente , Adulto , Negro o Afroamericano , Estatura , Índice de Masa Corporal , Peso Corporal , Países en Desarrollo , Femenino , Humanos , Jamaica , Valores de Referencia , Grosor de los Pliegues Cutáneos , Factores SocioeconómicosRESUMEN
It is frequently assumed that undernutrition in young children leads to poor development through reduced activity. 3 groups of 26 1-year-old stunted children were studied: nutritional supplementation, supplementation with psychosocial stimulation, and controls. 26 nonstunted comparison children were also studied. Activity levels were measured by extensive observation in the homes, and development using 4 subscales of the Griffith's Mental Development Scales. Initially, stunted children were less active than nonstunted ones (p < .01), but after 6 months they caught up regardless of treatment. The mental ages of the stunted children were lower than those of the nonstunted children initially, and improved with either treatment. Initially, activity levels made a significant contribution to the variance in the locomotor subscale only, but not 6 months later. Activity did not predict change in development over 6 or 12 months, nor did change in activity over 6 months predict change in development over 12 months.
Asunto(s)
Trastornos de la Conducta Infantil/psicología , Países en Desarrollo , Enanismo/psicología , Alimentos Fortificados , Actividad Motora , Desnutrición Proteico-Calórica/psicología , Trastornos de la Conducta Infantil/dietoterapia , Terapia Combinada , Enanismo/dietoterapia , Intervención Educativa Precoz , Femenino , Estudios de Seguimiento , Humanos , Lactante , Jamaica , Masculino , Desnutrición Proteico-Calórica/dietoterapia , Medio SocialRESUMEN
To assess the long-term impact of nutritional supplementation on bone mineralization during adolescence, we studied 356 Guatemalan adolescents who participated from birth to 7 y of age in a controlled supplementation trial. Bone mineralization of the distal radius was assessed using single photon absorptiometry. Children who consumed more cumulative energy from the supplement during childhood had greater bone mineral content, bone width and bone mineral density during adolescence than those who consumed less energy. The associations remained after controlling for each subject's age and gender, and for the type of supplement consumed, but became statistically nonsignificant after adjusting for weight and stature. Because intake of supplement also was associated positively with weight and stature during adolescence, it is concluded that supplementing malnourished children can have a demonstrable long-term impact on bone mineralization, but that the effects are probably not beyond those due to improvements in overall somatic growth associated with supplementation.
Asunto(s)
Calcificación Fisiológica , Trastornos de la Nutrición del Niño/dietoterapia , Alimentos Fortificados , Trastornos del Crecimiento/prevención & control , Adolescente , Adulto , Factores de Edad , Peso Corporal , Densidad Ósea , Niño , Trastornos de la Nutrición del Niño/complicaciones , Preescolar , Femenino , Alemania , Trastornos del Crecimiento/diagnóstico por imagen , Trastornos del Crecimiento/etiología , Guatemala , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , CintigrafíaRESUMEN
The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales.
Asunto(s)
Desarrollo Infantil , Alimentos Fortificados , Trastornos del Crecimiento/dietoterapia , Crecimiento , Estatura , Femenino , Trastornos del Crecimiento/fisiopatología , Humanos , Lactante , Jamaica , Masculino , Fenómenos Fisiológicos de la Nutrición , Análisis de RegresiónRESUMEN
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.
Asunto(s)
Alimentos Fortificados , Trastornos del Crecimiento/dietoterapia , Estatura , Preescolar , Diarrea/epidemiología , Femenino , Trastornos del Crecimiento/epidemiología , Humanos , Lactante , Jamaica/epidemiología , Masculino , Morbilidad , Pobreza , Salud Pública , Infecciones del Sistema Respiratorio/epidemiologíaRESUMEN
Serum alkaline phosphatase activity (AP), stature and Tanner-Whitehouse-2 RUS skeletal age (SA) were determined for 873 rural Guatemalan youth and young adults 11-25 years of age. Mean AP decreases systematically with chronological age (CA) in girls, while an adolescent increase in mean AP occurs at 14 years in boys. When mean AP is calculated within SA groups, clear adolescent increases are apparent in girls, peaking at 11 years SA, and at 14 years SA in boys. Correlations between AP and relative skeletal age (SA-CA) decrease systematically from moderately positive at the youngest CA groups to moderately negative at the older ages, crossing zero at the chronological ages of maximum adolescent AP values. Analyses suggest the patterns of mean AP in adolescence follow closely the timing and patterns of growth velocity in stature in each sex, and are only indirectly related to SA as it is a proxy for the maturational timing of the adolescent spurt in stature.
Asunto(s)
Determinación de la Edad por el Esqueleto , Fosfatasa Alcalina/sangre , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Guatemala , Humanos , Estudios Longitudinales , Masculino , Caracteres SexualesRESUMEN
Children aged 9-24 mo were recruited by a survey of poor areas of Kingston, Jamaica. Stunted children were randomly assigned to supplementation or not. Weekly morbidity histories were taken for 2 y. Separate multiple regressions on each symptom for weight or length gain in 2-mo intervals showed significant reductions in weight gain with coughing, apathy, anorexia, diarrhea, and fever, ranging from -2.1 to -16.8 g/d ill. Apathy and diarrhea reduced gains in length (-0.26 and -0.20 mm/d ill). Significant reductions in linear growth with lower respiratory-tract infections (-0.16 mm/d ill) occurred only in nonsupplemented children. Growth over 4-mo intervals was reduced if diarrhea occurred in the first 2 mo of the interval but there were no long-term effects of apathy, fever, or anorexia. Some of the effects of morbidity on growth were therefore transient and morbidity is unlikely to be a major cause of growth retardation in this population.
Asunto(s)
Trastornos del Crecimiento/dietoterapia , Crecimiento , Morbilidad , Peso Corporal , Preescolar , Depresión/complicaciones , Diarrea Infantil/complicaciones , Fiebre/complicaciones , Trastornos del Crecimiento/etiología , Humanos , Lactante , Jamaica , Distribución Aleatoria , Vómitos/complicacionesRESUMEN
The benefits of nutritional supplementation, with or without psychosocial stimulation, on the growth of stunted children were evaluated. Children aged 9-24 mo with lengths less than -2 SD of the National Center for Health Statistics references (n = 129) were randomly assigned to four groups: control, nutritional supplementation, stimulation, and both interventions. A fifth group with lengths greater than -1 SD was also enrolled. Length, weight, head and arm circumferences, and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later. Multiple-regression analysis was used to determine the effects of the interventions in which age, sex, initial status, initial dietary intake, and several socioeconomic variables were controlled for. Stimulation had no effect on growth and there was no interaction between the interventions. After 12 mo supplemented children had significantly increased length, weight, and head circumference (all P less than 0.01). The effects of supplementation were not cumulative but occurred in the first 6 mo.
Asunto(s)
Alimentos Fortificados , Trastornos del Crecimiento/dietoterapia , Terapia Ocupacional , Ludoterapia , Femenino , Trastornos del Crecimiento/rehabilitación , Humanos , Lactante , Jamaica , Masculino , Distribución Aleatoria , Análisis de RegresiónRESUMEN
There is little unequivocal evidence that nutritional supplementation of undernourished children has a beneficial effect on their mental development. The effects of nutritional supplementation, with or without psychosocial stimulation, of growth-retarded (stunted) children aged 9-24 months were assessed in a study in Kingston, Jamaica. 129 children from poor neighbourhoods were randomly assigned to four groups--control, supplemented only, stimulated only, and supplemented plus stimulated. A group of matched non-stunted children (n = 32) was also included. The supplement comprised 1 kg milk-based formula per week for 2 years, and the stimulation weekly play sessions at home with a community health aide. The children's development (DQ) was assessed on the Griffiths mental development scales. Initially the stunted groups' DQs were lower than those of the non-stunted group, and those of the control group declined during the study, increasing their deficit. Stimulation and supplementation had significant independent beneficial effects on the children's development. Estimates of the supplementation effect ranged from 2.2 (95% confidence limits-1.4, 5.7) for the hand and eye subscale to 12.4 (5.4, 19.5) for the locomotor subscale and those for the stimulation effect from 6.4 (2.8, 10.0) for hand and eye to 10.3 (3.3, 17.3) for locomotor. The treatment effects were additive, and combined interventions were significantly more effective than either alone. These findings suggest that poor mental development in stunted children is at least partly attributable to undernutrition.
Asunto(s)
Trastornos del Crecimiento/psicología , Discapacidad Intelectual/dietoterapia , Femenino , Trastornos del Crecimiento/dietoterapia , Humanos , Lactante , Jamaica , Masculino , Análisis de RegresiónRESUMEN
Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.
Asunto(s)
Antropometría/métodos , Composición Corporal , Trastornos del Crecimiento/fisiopatología , Crecimiento/fisiología , Pletismografía de Impedancia/métodos , Agua Corporal , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
The effects of maternal supplementation during pregnancy and lactation on bone growth of infants were investigated in 272 mother-infant pairs who participated in the Guatemalan Longitudinal Study of Nutritional Supplementation, Growth and Development. Mothers received one of two nutritional supplements according to village of residence, and bone growth was determined from dimensions of the second metacarpal measured directly from hand-wrist radiographs of 3-month-old infants. Multiple regression analyses indicated significant supplementation effects on cortical bone dimensions related to the volume of supplement intake. These findings were independent of maternal characteristics and attendance at the supplementation centres, and the infant's gender, size, gestational age and morbidity experience. The nutrient composition of the supplements and the patterns of the supplementation effects eliminate proteins, energy, calcium and phosphorus as the nutrients potentially responsible for the bone-specific response. Candidate nutrients for the observed effects are vitamin A, ascorbic acid, niacin, thiamin, iron or fluorine. Presumptive evidence suggests the effects may be due to vitamin A supplementation. These findings suggest opportunities for nutritional intervention in pregnancy and the early postpartum period to prevent osteopaenia in infancy.
Asunto(s)
Desarrollo Óseo , Alimentos Fortificados , Minerales/administración & dosificación , Embarazo/fisiología , Vitamina A/administración & dosificación , Enfermedades Óseas Metabólicas/prevención & control , Femenino , Guatemala , Humanos , Lactante , Lactancia , Estudios Longitudinales , Estado Nutricional , Salud RuralAsunto(s)
Estatura , Crecimiento , Adolescente , Adulto , Determinación de la Edad por el Esqueleto , Canadá , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Valores de Referencia , Estados UnidosRESUMEN
Weight, stature, arm circumference, and the triceps skinfold were measured in 1,410 school children, 6 through 14 years of age, from two urban colonies in the city of Oaxaca de Juarez (n = 479), and from two rural Ladino (n = 467) and two rural Zapotec (n = 464) communities in the Valley of Oaxaca in southern Mexico. Children from rural Ladino communities and urban colonies are significantly taller, heavier, and more muscular than children in rural Zapotec communities. The differences between rural Ladino and urban colonia children favor the former, particularly for weight and stature. These observations thus suggest 1) that children in the rural, indigenous communities in the Valley of Oaxaca are relatively undernourished compared to children in Ladinoized and urban communities, and 2) that rural-to-urban migration does not necessarily result in improved growth status.