RESUMO
BACKGROUND/OBJECTIVES: Plasma zinc concentration is the preferred biomarker of zinc status, but the time of day and time since previous meals can modify the results. Measuring fasting plasma zinc concentration is not feasible among young children, so adjustments need to be developed for interpreting results. Our objective is to develop correction factors to adjust for the effects of time of day and interval since the previous meal when measuring plasma zinc concentrations of young children. SUBJECTS/METHODS: We measured plasma zinc concentrations among young Peruvian (n =297) and Ecuadorian (n=466) children, and constructed regression models adjusting for time of day, interval since previous meal and infections. RESULTS: Plasma zinc concentrations were positively related to the number of hours since the previous meal in the Peru trial (r =0.22, P<0.0001) and negatively related to the time of day of blood sampling in both Peru (r = -0.24, P<0.0001) and Ecuador (r = -0.18, P<0.001). In multivariate models, plasma zinc concentrations were ~2 µg per 100 ml less for each hour later in the morning when blood samples were collected, in both populations, and concentrations were ~1.0 µg per 100 ml greater for every hour since previous meal consumption in Peru. The percentage of children with low plasma zinc concentrations varied according to both these factors. CONCLUSIONS: The time of day and the interval since the preceding meal should be recorded when measuring plasma zinc concentration and incorporated into the statistical analysis and interpretation when assessing population zinc status.
Assuntos
Jejum/sangue , Estado Nutricional , Período Pós-Prandial/fisiologia , Zinco/sangue , Zinco/deficiência , Biomarcadores/sangue , Pré-Escolar , Ritmo Circadiano/fisiologia , Suplementos Nutricionais , Equador , Feminino , Humanos , Lactente , Masculino , Peru , Fatores de Tempo , Zinco/administração & dosagemRESUMO
OBJECTIVE: To determine the effects of dietary supplements containing bovine serum concentrate (BSC, a source of immunoglobulins) and/or multiple micronutrients (MMN) on children's growth velocity, rates of common infections, and MN status. DESIGN: Randomized, controlled, community-based intervention trial. SETTING: Low-income, peri-urban Guatemalan community. SUBJECTS: Children aged 6-7 months initially. INTERVENTIONS: Children received one of four maize-based dietary supplements daily for 8 months, containing: (1) BSC, (2) whey protein concentrate (WPC, control group), (3) WPC+MMN, or (4) BSC+MMN. RESULTS: There were no significant differences in growth or rates of morbidity by treatment group. Children who received MMN had lower rates of anemia and (in the group that received WPC+MMN) less of a decline in serum ferritin than those who did not, but there were no differences in other biochemical indicators of MN status by treatment group. CONCLUSIONS: MMN supplementation reduced anemia and iron deficiency in this population, but the MMN content and source of protein in the supplements did not affect other indicators of MN status, growth or morbidity.
Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Crescimento/efeitos dos fármacos , Micronutrientes/farmacologia , Estado Nutricional , Soroalbumina Bovina/farmacologia , Anemia/tratamento farmacológico , Anemia/epidemiologia , Anemia/mortalidade , Deficiências Nutricionais/tratamento farmacológico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/mortalidade , Método Duplo-Cego , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/mortalidade , Transtornos do Crescimento/prevenção & controle , Guatemala , Humanos , Lactente , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Masculino , Micronutrientes/administração & dosagem , Proteínas do Leite , Morbidade , Prevalência , Soroalbumina Bovina/administração & dosagem , Fatores Socioeconômicos , Resultado do Tratamento , Proteínas do Soro do LeiteRESUMO
BACKGROUND: The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention. However, because multiple micronutrient deficiencies are common in children in developing countries, it is possible that more than one micronutrient may limit growth and, hence, the correction of a single deficiency may not be enough to improve growth substantially. OBJECTIVE: The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8-14 mo whose diets were poor in several micronutrients. DESIGN: Children were randomly assigned to 1 of 2 groups. One group received a multiple micronutrient supplement containing the recommended dietary allowance (RDA) or 1.5 times the RDA of vitamins A, D, E, K, C, B-1, B-6, B-12, riboflavin, niacin, biotin, folic acid, and pantothenic acid, and iron, zinc, iodine, copper, manganese, and selenium. The other group received a placebo. Supplements were administered 6 d/wk for an average of 12.2 mo. Body length was measured at baseline and monthly thereafter until the end of supplementation. RESULTS: Supplemented infants initially aged <12 mo had significantly greater length gains than did the placebo group, with a difference of 8.2 mm (length-for-age z score: 0.3) at the end of supplementation. In contrast, differences in length gains between the supplemented and placebo groups initially aged > or =12 mo were not significant. CONCLUSIONS: Micronutrient deficiencies limited the growth of the Mexican infants studied. Improving micronutrient intakes should be a component of interventions to promote growth in infants living in settings where micronutrient intakes are inadequate.
Assuntos
Estatura/efeitos dos fármacos , Suplementos Nutricionais , Transtornos do Crescimento/etiologia , Crescimento/efeitos dos fármacos , Micronutrientes/administração & dosagem , Fatores Etários , Estatura/fisiologia , Desenvolvimento Infantil , Método Duplo-Cego , Feminino , Crescimento/fisiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Masculino , México , Micronutrientes/farmacologiaRESUMO
To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development, we examined data from two studies in Honduras: the first with 141 infants of low-income primiparous women and the second with 119 term, low birth weight infants. In both studies, infants were exclusively breastfed for 4 mo and then randomly assigned to continue exclusive breastfeeding (EBF) until 6 mo or to receive high-quality, hygienic solid foods (SF) in addition to breast milk between 4 and 6 mo. Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group (EBF) group than in the group(s) given solid foods (SF) in study 1 (-0.7 +/- 1.5 versus -0.1 +/- 1.7 kg, P < 0.05) but not in study 2. The estimated average additional nutritional burden of continuing to exclusively breastfeed until 6 mo was small, representing only 0.1-6.0% of the recommended dietary allowance for energy, vitamin A, calcium and iron. Women in the EBF group were more likely to be amenorrheic at 6 mo than women in the SF group, which conserves nutrients such as iron. In both studies, few women (10-11%) were thin (body mass index <19 kg/m(2)), so the additional weight loss in the EBF group in study 1 was unlikely to have been detrimental. Infants in the EBF group crawled sooner (both studies) and were more likely to be walking by 12 mo (study 1) than infants in the SF group. Taken together with our previous findings, these results indicate that the advantages of exclusive breastfeeding during this interval appear to outweigh any potential disadvantages in this setting.
Assuntos
Aleitamento Materno , Desenvolvimento Infantil , Recém-Nascido/crescimento & desenvolvimento , Destreza Motora/fisiologia , Fenômenos Fisiológicos da Nutrição , Estado Nutricional , Amenorreia , Feminino , Honduras , Humanos , Lactente , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Lactação/fisiologia , Masculino , Necessidades Nutricionais , Período Pós-Parto/fisiologia , Fatores de Tempo , Redução de PesoRESUMO
BACKGROUND: Reducing the phytate content in grains by genetic manipulation is a novel approach to increasing nonheme-iron absorption from mixed diets. Fractional iron absorption from a genetically modified strain of low-phytate maize (LPM) increased significantly, by 50%. OBJECTIVE: We assessed iron absorption from porridges prepared from the same LPM (lpa-1-1 mutant) and unmodified wild-type maize (WTM), both of which were fortified with either ferrous sulfate or sodium iron EDTA. DESIGN: Porridges providing 3.4 mg Fe were fortified with either ferrous sulfate or sodium iron EDTA to provide an additional 1 mg Fe/serving. In 14 nonanemic women, iron absorption was measured as the amount of radioiron incorporated into red blood cells (extrinsic tag method) 12 d after consumption of the study diets. RESULTS: No significant effect of phytate content on iron absorption was found when porridge was fortified with either sodium iron EDTA or ferrous sulfate. Fractional absorption of iron from WTM porridge fortified with sodium iron EDTA (5.73%) was 3.39 times greater than that from the same porridge fortified with ferrous sulfate (1.69%). Fractional absorption of iron from the sodium iron EDTA-fortified LPM porridge (5.40%) was 2.82 times greater than that from LPM porridge fortified with ferrous sulfate (1.91%) (P<0.0001 for both comparisons, repeated-measures analysis of variance). Thus, the previously identified benefit of LPM was no longer detectable when maize porridge was fortified with additional iron. CONCLUSION: Iron was absorbed more efficiently when the fortificant was sodium iron EDTA rather than ferrous sulfate, regardless of the type of maize.
Assuntos
Ácido Edético/farmacocinética , Compostos Férricos/farmacocinética , Compostos Ferrosos/farmacocinética , Alimentos Fortificados , Absorção Intestinal , Ferro da Dieta/farmacocinética , Zea mays/genética , Adulto , Análise de Variância , Anemia Ferropriva/prevenção & controle , Feminino , Humanos , Absorção Intestinal/efeitos dos fármacos , Quelantes de Ferro , Ácido Fítico/efeitos adversos , Zea mays/metabolismoRESUMO
Prospective and retrospective data on maternal attitudes and obstacles to exclusive breastfeeding (EBF) were collected from Honduran mothers of low birthweight (1500-2500 g), term infants who were enrolled in an intervention study to compare infant outcomes in those who were randomly assigned to breastfeed exclusively for either 4 or 6 months. Perceived advantages of EBF were that it was easier, more practical and economical, and resulted in better infant health and growth. Disadvantages included the perceived time demand, concerns that the infant would accept solids less readily, and fears that breast milk alone was insufficient. The majority of study participants said that they would choose to exclusively breastfeed their next infant to 6 months. Although there were many obstacles to EBF, particularly in the first few weeks, women who persevered became enthusiastic proponents of EBF. Messages to promote EBF need to target the entire community, not just mothers, and should focus on addressing common misconceptions and alerting women to potential problems before they occur.
Assuntos
Atitude Frente a Saúde , Aleitamento Materno , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Mães , Adulto , Atitude Frente a Saúde/etnologia , Aleitamento Materno/etnologia , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Feminino , Grupos Focais , Honduras , Humanos , Mães/educação , Mães/psicologia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
OBJECTIVES: This study assessed the effects of zinc supplementation in the prevention of diarrhea and pneumonia with the use of a pooled analysis of randomized controlled trials in children in developing countries. STUDY DESIGN: Trials included were those that provided oral supplements containing at least one half of the United States Recommended Daily Allowance (RDA) of zinc in children <5 years old and evaluated the prevention of serious infectious morbidity through household visits. Analysis included 7 "continuous" trials providing 1 to 2 RDA of elemental zinc 5 to 7 times per week throughout the period of morbidity surveillance and 3 "short-course" trials providing 2 to 4 RDA daily for 2 weeks followed by 2 to 3 months of morbidity surveillance. The effects on diarrhea and pneumonia were analyzed overall and in subgroups defined by age, baseline plasma zinc concentration, nutritional status, and sex. The analysis used random effects hierarchical models to calculate odds ratios (OR) and 95% CIs. RESULTS: For the zinc-supplemented children compared with the control group in the continuous trials, the pooled ORs for diarrheal incidence and prevalence were 0.82 (95% CI 0.72 to 0.93) and 0.75 (95% CI 0.63 to 0.88), respectively. Zinc-supplemented children had an OR of 0.59 (95% CI 0.41 to 0.83) for pneumonia. No significant differences were seen in the effects of the zinc supplement between the subgroups examined for either diarrhea or pneumonia. In the short-course trials the OR for the effects of zinc on diarrheal incidence (OR 0.89, 95% CI 0.62 to 1.28) and prevalence (OR 0.66, 95% CI 0.52 to 0.83) and pneumonia incidence (OR 0.74, 95% CI 0.40 to 1.37) were similar to those in the continuous trials. CONCLUSIONS: Zinc supplementation in children in developing countries is associated with substantial reductions in the rates of diarrhea and pneumonia, the 2 leading causes of death in these settings.
Assuntos
Diarreia/prevenção & controle , Suplementos Nutricionais , Pneumonia/prevenção & controle , Zinco/uso terapêutico , Criança , Países em Desenvolvimento , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To determine whether supplemental zinc, with or without additional micronutrients, affects the severity and duration of persistent childhood diarrhea and the rate of nutritional recovery. DESIGN: The study was a community-based, double-blind, randomized trial implemented in a shanty town in Lima, Peru. Children aged 6 to 36 months with persistent (>/=14 days) diarrhea received daily, for 2 weeks, a placebo (group P, n = 136) or a supplement of 20 mg of zinc, either with (group Z+VM, n = 137) or without (group Z, n = 139) additional vitamins and minerals. Symptoms of illness were recorded daily, and biochemical and anthropometric assessments were completed at baseline and on day 15. RESULTS: The treatment groups were similar at baseline with regard to the characteristics of the presenting episode, anthropometric data, and plasma zinc concentration. The children consumed, on average, 95% (group P), 94% (group Z), or 88% (group Z+VM) of the supplement (P <.001). The plasma zinc concentration did not change significantly from baseline to day 15 in group P (4 microg/dL) but increased by 38 microg/dL in group Z and 14 microg/dL in group Z+VM. The median duration of diarrhea after starting treatment was 1 day; among children who continued to have diarrhea, there was a significant effect of treatment on diarrheal duration (P =.04, analysis of covariance). Specifically, the duration of illness was significantly reduced by 28% in children in group Z (P =.01) and by 33% in girls in group Z+VM (P =.04). There were no differences in the severity of the episode by treatment group. CONCLUSION: There was a significant reduction in the duration of persistent diarrhea in selected subgroups of zinc-supplemented ambulatory patients in this population.
Assuntos
Diarreia/tratamento farmacológico , Suplementos Nutricionais , Micronutrientes , Zinco/uso terapêutico , Análise de Variância , Antropometria , Pré-Escolar , Diarreia/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Peru/epidemiologia , Zinco/sangueRESUMO
BACKGROUND: Results of prior studies of the effect of viscosity reduction of high-energy-density, starch-containing diets on young children's energy intakes are inconsistent, possibly because of differences in the characteristics of the unmodified diets with which the low-viscosity diets were compared. OBJECTIVE: Our objective was to determine the effects of dietary viscosity and energy density on total daily energy consumption by young, non-breast-fed children. DESIGN: We measured the amount of food consumed and the duration of meals during 3 substudies, in each of which 3 study diets were offered for 4 consecutive days each in random sequence: high energy density, high viscosity (HD-HV); high energy density, low viscosity (HD-LV); and low energy density, low viscosity (LD-LV). The viscosity and energy density of the unmodified starch-containing HD-HV diet were varied across substudies to determine whether the effect of amylase liquefaction was related to the initial characteristics of the HD-HV diet. The viscosity of the HV diets ranged from 79000 to 568000 mPa s; energy density of the HD diets ranged from approximately 4.18 to 4.93 kJ (1.00-1.18 kcal)/g. Viscosity of the LV diets was approximately 3000 mPa s and the energy density of the LD diets was approximately 2.47 kJ (0.6 kcal)/g. RESULTS: In each substudy, children consumed more of the LD-LV diet (g kg body wt(-)(1) d(-)(1)) than of the other diets and more of the HD-LV diet than of the HD-HV diet (P < 0.001). Energy consumption from the HD-LV diet was greater than from the other diets (P < 0.001), but the energy intakes from the latter diets were not significantly different. CONCLUSION: Amylase liquefaction of HD-HV porridges resulted in increased energy consumption by young children.
Assuntos
Ingestão de Energia , Preferências Alimentares , Alimentos Formulados , Alimentos Infantis , Distúrbios Nutricionais/dietoterapia , Antropometria , Proteção da Criança , Feminino , Humanos , Lactente , Masculino , Peru , ViscosidadeRESUMO
BACKGROUND: The optimal age at which to introduce complementary foods is a topic of considerable debate. OBJECTIVE: This study was designed to evaluate this issue in a nutritionally vulnerable population in Honduras. DESIGN: Mothers of low-birth-weight (1500-2500 g) term (ie, small-for-gestational-age) infants were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, mothers were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or to feed complementary solid foods (jarred rice cereal, chicken, and fruit and vegetables) twice daily from 4 to 6 mo while continuing to breast-feed at their initial frequency (SF; n = 60). At 4 and 6 mo, breast milk and total energy intake were measured for a nonrandom subsample (those who could stay overnight in a central unit: 32 EBF and 31 SF). RESULTS: At 4 mo, breast milk intake in the subsample was not significantly different between groups (EBF: 729 +/- 135 g/d; SF: 683 +/- 151 g/d: P >0.2); from 4 to 6 mo it increased (by 28 g/d) in the EBF group but decreased (by 39 g/d) in the SF group (P < 0.005). Nonetheless, total energy intake (including solid foods) increased more from 4 to 6 mo in the SF than in the EBF group. However, there were no significant differences between groups in weight or length gain during the intervention or subsequently (6-12 mo). CONCLUSION: There was no growth advantage of complementary feeding of small-for-gestational-age, breast-fed infants between 4 and 6 mo of age.
Assuntos
Aleitamento Materno , Alimentos Infantis , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Adulto , Fatores Etários , Peso ao Nascer , Ingestão de Energia , Feminino , Nível de Saúde , Honduras , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Classe SocialRESUMO
BACKGROUND: Subclinical alterations of small intestinal function have been reported frequently in tropical countries. Studies of small intestinal permeability to lactulose and mannitol were therefore completed in Guatemalan infants from a low-income, periurban community to assess the prevalence of altered intestinal function and the factors associated with this condition. METHODS: Two hundred studies were successfully completed in 158 infants who had been free of diarrhea for at least 1 week before the day of study. Urinary concentrations of lactulose and mannitol during the 5-hour period after ingestion of 400 mg/kg body weight of lactulose and 100 mg/kg body weight of mannitol were measured by gas-liquid chromatography and compared by age group, feeding practices, anthropometric indexes, and serum iron and zinc concentrations. RESULTS: The overall prevalence of altered intestinal permeability (defined as a ratio of urinary recovery of lactulose to mannitol [L/M] > or =0.07) was 30%. The urinary L/M recovery ratio was positively associated with age; low weight for age; and, in infants less than 6 months of age, non-breast-feeding. Children with serum iron concentrations less than 7.16 microM/l (40 [microg/dl) had higher median L/M ratios (L/M = 0.068; 95% confidence interval [CI], 0.054, 0.085) than those with iron levels higher than this cutoff (L/M = 0.052; CI = 0.046, 0.058; p = 0.038). The median urinary L/M recovery ratio in 10 currently asymptomatic infants who had diarrhea during the week before testing (0.087; CI = 0.49, 0.154) was higher than that in children who had been free from diarrhea for at least 1 week (0.052; CI = 0.048, 0.056; p = 0.01). CONCLUSION: Age, feeding practices, low weight-for-age, low serum iron concentration, and recent diarrhea were all associated with altered intestinal function in this group of Guatemalan infants.
Assuntos
Absorção Intestinal , Enteropatias/epidemiologia , Lactulose/farmacocinética , Manitol/farmacocinética , Envelhecimento , Aleitamento Materno , Permeabilidade da Membrana Celular , Diarreia/metabolismo , Guatemala/epidemiologia , Humanos , Lactente , Enteropatias/metabolismo , Mucosa Intestinal/metabolismo , Intestino Delgado/metabolismo , Ferro/sangue , Lactulose/urina , Manitol/urina , Fatores de Risco , Clima Tropical , Zinco/sangueRESUMO
BACKGROUND: Genetically modified, low-phytic acid strains of maize were developed to enhance mineral absorption, but have not been tested previously in humans. OBJECTIVES: We evaluated the mineral and phytic acid contents of a low-phytic acid "flint" maize (LPM, the lpa-1-1 mutant) and its parent, wild-type strain (WTM) and measured iron absorption from tortillas prepared with each type of maize and from a reference dose of ferrous ascorbate. DESIGN: Proximate composition and mineral and phytic acid contents were measured by standard techniques. Iron absorption from tortillas was evaluated by using the extrinsic tag method and was measured as the incorporation of radiolabeled iron into the red blood cells of 14 nonanemic men 2 wk after intake. RESULTS: The phytic acid content of LPM was 3.48 mg/g, approximately 35% of the phytic acid content of WTM; concentrations of macronutrients and most minerals were not significantly different between strains. Iron absorption results were adjusted to 40% absorption of ferrous ascorbate. Iron absorption was 49% greater from LPM (8.2% of intake) than from WTM (5.5% of intake) tortillas (P < 0.001, repeated-measures analysis of variance). CONCLUSION: Consumption of genetically modified, low-phytic acid strains of maize may improve iron absorption in human populations that consume maize-based diets.
Assuntos
Ferro/farmacocinética , Ácido Fítico/farmacologia , Zea mays/genética , Adulto , Análise de Variância , Manipulação de Alimentos , Humanos , Fosfatos de Inositol/análise , Absorção Intestinal/efeitos dos fármacos , Deficiências de Ferro , Masculino , Ácido Fítico/administração & dosagem , Ácido Fítico/análise , Zea mays/químicaRESUMO
To evaluate the effect of introducing complementary foods before 6 mo of age, we randomly assigned 164 infants who had been exclusively breast-fed for 4 mo to continue being exclusively breast-fed until 6 mo (EBF group) or to receive iron-fortified foods in addition to breast milk from 4 to 6 mo (BF+SF group). At 6 mo, the BF+SF group had higher mean iron intake (4 mg/d compared with 0.2 mg/d in EBF infants) and higher hemoglobin, hematocrit, and ferritin values than the EBF group (P < 0.05). The percentage with low hemoglobin (< 103 g/L) did not differ significantly between groups, but fewer infants in the BF+SF group had a low hematocrit (< 0.33; 21.4% compared with 32.0%, respectively; P < 0.05). The percentage of infants with ferritin concentrations < 12 microg/L at 6 mo was lower than the percentage with low hemoglobin or hematocrit, raising questions about the validity of the cutoffs at this age. Infants at greatest risk for anemia and low ferritin were those with birth weights < 2500 g; no infant with a birth weight > 3000 g had a low ferritin value at 6 mo. We conclude that the risk of iron deficiency is low among infants with birth weights > 3000 g who are exclusively breast-fed for 6 mo. Iron drops are recommended for low-birth-weight infants; for breast-fed infants with birth weights between 2500 and 3000 g, further research is needed to determine whether iron drops are more effective than complementary foods for preventing iron deficiency before 6 mo.
Assuntos
Fatores Etários , Aleitamento Materno/etnologia , Ferritinas/sangue , Alimentos Infantis , Peso ao Nascer , Alimentação com Mamadeira , Proteína C-Reativa/efeitos dos fármacos , Proteína C-Reativa/metabolismo , Ingestão de Energia , Feminino , Ferritinas/efeitos dos fármacos , Alimentos Fortificados , Hematócrito , Hemoglobinas/efeitos dos fármacos , Hemoglobinas/metabolismo , Honduras , Humanos , Lactente , Ferro/administração & dosagem , Masculino , Análise Multivariada , Análise de RegressãoRESUMO
The impact of zinc supplementation on the growth and body composition of Guatemalan infants was assessed in a community-based, double-blind intervention trial. Infants aged 6-9 mo were assigned randomly to receive 4 mL of a beverage containing 10 mg of zinc as zinc sulfate (n = 45) or a placebo (n = 44) daily (7 d/wk) for an average of 6.9 mo. The children's weight, length, mid-upper arm and head circumferences, and triceps skinfolds were measured at baseline and at 1-2 mo intervals until the end of supplementation. Midarm muscle area (MMA) was derived from the mid-upper arm circumference and triceps skinfolds measurements. Maternal anthropometry and family socioeconomic and demographic characteristics also were obtained. Zinc supplementation was associated with an overall increase of 0.61 cm2 in MMA (P = 0.02). Children who received zinc supplements had a mean length increment that was 0.75 cm greater than those who did not (P = 0.12). However, there was a significant interaction between treatment group and initial length-for-age status (P = 0.04), such that supplemented children who were stunted at baseline (length-for-age Z score less than -2) gained 1.40 cm more than stunted children who received the placebo. We conclude that zinc supplementation of these rural Guatemalan infants during 6. 9 mo increased accretion of fat-free mass and enhanced the linear growth of those who were stunted at baseline. Further research is required to determine whether zinc supplementation during longer periods of time may achieve larger and more generalized effects on physical growth.
Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Transtornos do Crescimento/tratamento farmacológico , População Rural , Zinco/administração & dosagem , Composição Corporal/efeitos dos fármacos , Método Duplo-Cego , Transtornos do Crescimento/patologia , Guatemala , Humanos , Lactente , Análise de Regressão , Zinco/uso terapêuticoRESUMO
BACKGROUND: Specially collected, spray-dried bovine and porcine blood plasma have been incorporated previously in feeds of weanling farm animals, resulting in increased dietary intakes and greater rates of weight gain than observed in control animals. Before conducting similar trials in human populations, preliminary studies have been completed to assess the acceptability, safety, and digestibility of processed animal plasma in young children. METHODS: Masked study diets were provided sequentially to each of ten young, Peruvian children recovering from severe protein-energy malnutrition during three randomly ordered 7-day dietary periods. The control diet was prepared from rice, milk, vegetable oil, and sugar; the two study diets included spray-dried, bovine serum concentrate to replace either 25% or 50% of the milk protein of the control diet. Urine and feces were collected quantitatively during the last four days of each diet period to assess stool weight, apparent absorption of macronutrients, and retention of nitrogen. RESULTS: All children consumed the entire amounts offered of each of the diets. The mean number of daily bowel movements and mean apparent absorption and retention of nitrogen and mean apparent absorption of carbohydrate were similar for each diet. Fractional absorption of dietary lipid and of total energy increased significantly in relation to the amount of bovine serum concentrate in the diet, although this might be explained by the simultaneous replacement of milk fat with additional vegetable oil. CONCLUSIONS: Each of the diets was well accepted by the study children, and there was no evidence of any adverse effects of bovine serum concentrate.
Assuntos
Digestão/fisiologia , Alimentos Formulados/normas , Desnutrição Proteico-Calórica/dietoterapia , Soroalbumina Bovina/metabolismo , Soroalbumina Bovina/normas , Animais , Carboidratos/farmacocinética , Bovinos , Pré-Escolar , Gorduras na Dieta/normas , Suplementos Nutricionais , Ingestão de Energia/fisiologia , Fezes/química , Humanos , Lactente , Absorção Intestinal/fisiologia , Rim/fisiologia , Fígado/fisiologia , Masculino , Nitrogênio/análise , Peru , Desnutrição Proteico-Calórica/fisiopatologia , Soroalbumina Bovina/efeitos adversos , Aumento de Peso/fisiologiaRESUMO
Zinc deficiency has been associated with growth deficits, reduced dietary intake and appetite, and has been hypothesized to result in reduced activity. This randomized, double-blind, placebo-controlled study examined whether 10 mg of oral zinc as zinc sulfate, given daily for up to 7 mo, affected activity patterns of 85 Guatemalan infants recruited at 6-9 mo of age. Infant activity was assessed by time sampling-observation method at 10-min intervals during a 12-h data collection period, at base line, 3 and 7 mo follow-up. Motor development and the percentage of time infants were observed in various positions (being carried, lying down, sitting, crawling, standing or walking) and engaged in various activities (eating, sleeping, resting, crying/whining or playing) were compared by treatment group. No differences in motor development were observed by treatment group. However, at follow-up 2 (after 7 mo of supplementation), zinc-supplemented infants were significantly more frequently observed sitting up compared with lying down, and were playing during 4.18 +/- 1.95% (P < 0.05) more observations than unsupplemented infants. They were also somewhat less likely to be observed crying or whining (P < 0.10) compared with those receiving the placebo. These effects are independent of other factors including infant age, motor development, sex, maternal education, family socioeconomic status and nutritional status at base line. Further research must be conducted to determine the long-term developmental importance of these differences in activity patterns associated with zinc supplementation in this setting.
Assuntos
Atividade Motora/efeitos dos fármacos , Sulfato de Zinco/farmacologia , Zinco/deficiência , Administração Oral , Desenvolvimento Infantil/fisiologia , Diarreia Infantil/epidemiologia , Método Duplo-Cego , Comportamento Alimentar/fisiologia , Feminino , Alimentos Fortificados , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Estilo de Vida , Masculino , Atividade Motora/fisiologia , Estado Nutricional , Saúde da População Rural , Sono/fisiologia , Classe Social , Fatores de Tempo , Zinco/administração & dosagem , Sulfato de Zinco/administração & dosagem , Sulfato de Zinco/uso terapêuticoRESUMO
OBJECTIVE: A community-based, randomized, double-blind intervention trial was conducted to measure the impact of zinc supplementation on young Guatemalan children's morbidity from diarrhea and respiratory infections. METHODS: Children aged 6 to 9 months were randomly assigned to receive 4 mL of a beverage containing 10 mg of zinc (as zinc sulfate) daily (7 d/wk) for 7 months (n = 45) or a placebo (n = 44). Morbidity data were collected daily. Diagnoses of diarrhea, fever, and anorexia were based on mothers' definitions. Respiratory infections were defined as the presence of at least two of the following symptoms: runny nose, cough, wheezing, difficulty breathing, or fever. RESULTS: High rates of diarrhea and respiratory infections were reported. Children from the placebo group had a 20% episodic prevalence of diarrhea, with 8 episodes/100 d, and a 7% episodic prevalence of respiratory infections, with 3 episodes/100 d. The median incidence of diarrhea among children who received zinc supplementation was reduced by 22% (Wilcoxon rank test), with larger reductions among boys and among children with weight-for-length at baseline lower than the median of the sample (39% reductions in both subgroups). Zinc supplementation also produced a 67% reduction in the percentage of children who had one or more episodes of persistent diarrhea (chi2 test). No significant effects were found on the episodic prevalence of diarrhea, the number of days per episode, or the episodic prevalence or incidence of respiratory infections. CONCLUSIONS: The large impact of zinc supplementation on diarrhea incidence suggests that young, rural Guatemalan children may be zinc deficient and that zinc supplementation may be an effective intervention to improve their health and growth.
Assuntos
Diarreia Infantil/prevenção & controle , Alimentos Fortificados , Infecções Respiratórias/prevenção & controle , Zinco/uso terapêutico , Deficiências Nutricionais/epidemiologia , Diarreia Infantil/epidemiologia , Método Duplo-Cego , Feminino , Guatemala , Humanos , Incidência , Lactente , Masculino , Morbidade , Infecções Respiratórias/epidemiologia , População Rural , Zinco/deficiênciaRESUMO
Lactational amenorrhea (LA) is associated with postpartum infertility and is known to be related to breast-feeding frequency and duration, but the exact role of complementary feeding of the infant has not been clearly defined. Data on LA were collected during and after a 2-mo intervention trial in which low-income Honduran women who had breast-fed fully for 4 mo were randomly assigned to one of three groups: continued full breast-feeding until 6 mo (FBF, n = 50), introduction of complementary foods at 4 mo with ad libitum breast-feeding from 4 to 6 mo (SF, n = 47), or introduction of complementary foods at 4 mo with maintenance of baseline breast-feeding frequency from 4 to 6 mo (SF-M, n = 44). Women were followed up until the infant was 12 mo of age, or later if menses had not occurred by then. All but six of the women continued to breast-feed for > or = 12 mo. With the exclusion of those whose menses returned before 18 wk postpartum (which could not have been due to the intervention), the proportion of women who were amenorrheic at 6 mo was 64.5% in the SF group, 80.0% in the FBF group, and 85.7% in the SF-M group (chi-square test = 4.13, P = 0.02; one-tailed test with the latter two groups combined). The total duration of LA did not differ significantly among groups. The most significant determinant of LA was time spent breast-feeding (min/d), which was in turn negatively associated (P = 0.06) with the infant's energy intake from complementary foods in regression analyses. These results indicate that there is a significant effect of introducing foods at 4 mo on the likelihood of amenorrhea at 6 mo postpartum, but not thereafter, and that this effect is not seen in mothers who maintain breast-feeding frequency.
Assuntos
Fatores Etários , Amenorreia , Alimentos Infantis , Lactação , Período Pós-Parto , Desmame , Adolescente , Adulto , Aleitamento Materno , Ingestão de Energia , Feminino , Honduras , Humanos , Lactente , Masculino , Análise de Regressão , Fatores de TempoRESUMO
The large within- and between-sample variability in breast milk lipid content greatly complicates the collection of representative samples in field studies. The main purpose of this study was to validate the ability of individual daytime samples to predict the 24-h lipid concentration of breast milk. We also studied maternal, child, and other factors (time of day and interval between feeds) associated with the within- and between-mother variability in milk lipid content. Fifty-two primiparous urban Guatemalan women between 1 and 4 mo postpartum were studied. Milk samples were collected during six 2-h intervals from 0600 to 1800, and throughout the night when the child breast-fed. On average, the 24-h pooled milk samples contained 4.2 +/- 0.92% (mean +/- SD) lipids and the best concordance with this value was obtained with samples collected between 0600 and 0800 (concordance correlation coefficient = 0.60, P < 0.05). None of the regression equations to predict the 24-h lipid content of breast milk based on daytime samples reached a sufficiently high predictive power to be recommended for the estimation of individual child intake. Time of day and time elapsed since the last feeding were significant determinants of diurnal variations in milk lipid content, whereas between-mother variability was explained by maternal weight (P = 0.05) and body mass index (P < 0.05). For the collection of milk samples in surveys and pre-post studies, we recommend standardization of time of day and interval between feeds.