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Malnutrition and neurodisability are both major public health problems in Africa. This review highlights key areas where they interact. This happens throughout life and starts with maternal malnutrition affecting fetal neurodevelopment with both immediate (eg, folate deficiency causing neural tube defects) and lifelong implications (eg, impaired cognitive function). Maternal malnutrition can also increase the risk of perinatal problems, including birth asphyxia, a major cause of neurologic damage and cerebral palsy. Macronutrient malnutrition can both cause and be caused by neurodisability. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirement. Specific micronutrient deficiencies can also lead to neurodisability, for example, blindness (vitamin A), intractable epilepsy (vitamin B6), and cognitive impairment (iodine and iron). Toxin ingestion (eg, from poorly processed cassava) can cause neurodisability including a peripheral polyneuropathy and a spastic paraparesis. We conclude that there is an urgent need for nutrition and disability programs to work more closely together.

Since 1876, developments in nutritional science have followed those in chemistry, physiology, biochem istry and medicine. The essential relationship between food and body energy has been elucidated. The aetiology of diseases long known in human his tory has been traced to deficiencies of specific nutri ents, the 'vitamins', required in very small amounts. These substances have been isolated, identified and synthesised. Research in infant malnutrition has led to the recognition that comparatively small changes in biochemical programming during growth and development may cause disease later in life. Dietary 'roughage' has been found to have significance in dis ease prevention and prospects for the very sick have been improved by the development of alternative feeds. Knowledge of the human genome promises exciting new advances for nutrition in relation to public health and clinical medicine.

Aborigines in remote Australia are living in profound socio-economic disadvantage and epidemiological transition. They are also experiencing an epidemic of cardiovascular disease, with deaths increased > threefold and renal failure increased > 20-fold. Dialysis costs pose a crisis, but premature death is the greater human catastrophe. In one high-risk group, we identified renal disease through the urinary albumin/creatinine ratio and assessed it distribution, its correlations, its associations with other morbidities and overall mortality and its natural history. We later introduced systematic antihypertensive and renal-protective treatment for afflicted persons. Albuminuria was detected in 55% of adults. It was inversely correlated with glomerular filtration rate (GFR) and generally progressed over time. It was strongly correlated with cardiovascular risk, and its intensity predicted not only renal failure but also all-cause natural death. Factors correlated with renal disease included increasing age, low birthweight and infant malnutrition, adult weight gain and its syndrome X metabolic accompaniments, skin infections, post-streptococcal glomerulonephritis, heavy drinking, multiparity and a family history of renal disease. Nephron endowment probably also influences risk, with birthweight being one important driving force. Ironically, improved health services have probably contributed to the epidemic of renal failure in at least two ways: increased survival of low-birthweight infants and increased longevity in adults, allowing the full progression or renal disease to its terminal state. The treatment programme was associated with swift and massive reductions in end-stage renal failure, overall mortality and costs. Renal disease is multideterminant, with the simultaneous operation of several risk factors amplifying the increase in albuminuria and decrease in GFR that accompany increasing age. While many risk factors and mechanisms remain to be identified, our findings provide ample grounds for immediate intervention in similarly afflicted communities, with expectation of excellent outcome. Improved services will probably result in additional ascertainment of disease and more opportunity for its expression, so that disease prevention and modification become even more pressing obligations. Major shifts in our political, social, academic and clinical priorities are needed to effectively address these issues for all Aboriginal communities.

Summary Background Infant malnutrition and mortality rates are high in less-developed countries especially in low-birthweight infants. Zinc deficienchy is also widely prevalent in these circumstances. We aimed to assess the effect of daily zinc supplements given to pregnant mothers on their infants' growth and morbidity. Methods We did a double-blind, placebo controlled, randomised trial in 199 and 221 Bangladeshi infants whose mothers took 30 mg daily elemental zinc or placebo, respectively, from 12 to 16 weeks' gestation until delivery. Infants were followed up until 6 months of age. We obtained data for morbidity every week by mothers' recall. Infants' anthropometric measurements were done every month, and their serum zinc was assessed at 1 and 6 months of age. Findings Infants of mothers who received zinc during pregnancy had at age 6 months reduced risks compared with those in the placebo group for acute diarrhoea (risk ratio 0·84; 95% Cl 0·72–0·98), dysentery (0·36; 0·25–0·84), and impetigo (0·53; 0·34–0·82). These reductions were seen in low-birthweight infants but not in those with normal birthweight. There were no differences in infant growth or serum zinc concentrations between treatment groups. Interpretation Maternal zinc supplementation during pregnanchy resulted in a reduction of the health risks in Bangladeshi low-birthweight infants, although this intervention did not improve birthweight. Whether zinc should be added to usual antenatal supplements in regions with high rates of low birthweight should be reviewed.

The metabolic derangements in severe protein-energy malnutrition (PEM) are only partially known, due to the limitations of blood collection in these patients. Urinary excretion of organic acids was studied by gas chromatography-mass spectrometry in 39 infants with four types of PEM: 1) upon hospital admission, as soon as eventual infections had been cleared, and salt and water deficits corrected, but before oral feeding was started; 2) after start of protein alimentation; 3) on the day of discharge. All of the patients showed an increased excretion of various organic acids at some point of their hospital stay, regardless of the clinical type of PEM. In nearly half of the malnourished children, results were suggestive of blocks in the pathways of propionate (15.4% with increased methylmalonate and 25.6% with 2-methylcitrate), of fatty acid beta-oxidation (30.8% with raised dicarboxylic acids with low or low normal 3-hydroxybutyrate), or of both pathways (12.8%). These abnormalities may have been caused by cofactor deficiencies (biotin, vitamin B12, riboflavin, carnitine, niacin). Dicarboxylic acids were excreted in high amounts since the initial sample, probably due to increased mobilization of fatty acids. Increased 2-methylcitrate and methylmalonate excretion was observed more frequently once patients started to be orally fed. The accumulation of potentially toxic acyl-CoA precursors of these compounds could contribute to the known clinical worsening of some malnourished infants after suddenly increased protein intake. Other less specific metabolites, such as 3-hydroxybutyrate, lactate, 4-hydroxyphenyllactate, fumarate, succinate, and 4-hydroxyphenylacetate, were also abnormally excreted in some patients. The analysis of urinary organic acids provides a new approach for the metabolic study of PEM and may have diagnostic and therapeutic implications.

OBJETIVOS: Conhecer a situação de saúde e nutrição de uma população favelada da cidade de São Paulo e identificar fatores de risco para a desnutrição infantil. DESENHO: Estudo de corte retrospectivo. PARTICIPANTES: Favelados menores de 72 meses de idade. MÉTODOS: Foram feitas visitas domiciliares e colhidas informações acerca de fatores de risco para a desnutrição. RESULTADOS: A prevalência segundo Gomez foi de 41,6%; para a desnutrição crônica encontraram-se níveis de 36,6%, segundo Waterlow, e de 17,6% segundo a OMS. Os fatores de risco de desnutrição segundo o índice peso/idade foram `peso de nascimento', `infecção atual em vias aéreas superiores', `nº de gestações', `nº de partos', `índice de massa corpórea da mãe', `naturalidade paterna' e `material de construção da casa'; para o índice peso/estatura foram `peso de nascimento' e idade materna ao parto'; para o índice estatura/idade `número de consultas no pré-natal', `peso de nascimento', `estatura materna', `índice de massa corpórea da mãe', `o pai não ser registrado no trabalho' e `naturalidade materna (mães nascidas em São Paulo)'. Construiu-se um instrumento para a triagem daqueles sob maior risco para desnutrição futura, possível de ser aplicado já entre recém-nascidos. OBJECTIVE: To investigate the health and nutritional conditions of people living in a shantytown in the city of São Paulo in order to identify risk factors for infant malnutrition. DESIGN: A retrospective cohort study. PARTICIPANTSs: Children living in a shantytown was conducted among children less than 72 months of age. METHODS: Home visits were made and information was collected regarding the risk factors for malnutrition. RESULTS: The prevalence of chronic malnutrition was 41.6% according to Gomez, 36.6% according to Waterlow, and 17.6% according to WHO. Risk factors for malnutrition, according to the weight-for-age index, included birthweight, presence of upper respiratory tract infections, number of pregnancies, number of births, maternal body mass index, birthplace of father, and home building material; according to the weight-for-height index, they included birthweight and maternal age at the time of birth; and according to the height-for-age index, they included the number of pre-natal medical visits, birthweight, maternal height, maternal body mass index, father's employment being unregistered, and maternal birthplace. An instrument for identifying children at risk of malnutrition was devised from these major risk factors for future malnutrition, which may then be applied to newly-born children. Universidade Federal de São Paulo (UNIFESP) UNIFESP SciELO

OBJECTIVE To test an instrument measuring the socioeconomic level, specially designed for low income urban populations, to be used in the identification of groups more vulnerable to infant malnutrition. POPULATION AND METHODS This is a cross-sectional study, with a sample of 477 children aged 12 to 59 months old living in low income census sectors at "Vila Grande Cruzeiro", in Porto Alegre, RS. The children were submitted to anthropometric evaluation and their families were stratified according to socioeconomic level measured through an instrument developed in Chile for urban poor populations and adapted to local conditions. Children with weight/age, height/age and/or weight/height below - 2 standard deviation from the median of the reference population (NCHS) were considered malnourished. RESULTS The children from families belonging to the lowest quartile in the socioeconomic classification had a 3.4 times higher chance of having low weight for age, a 2.7 times higher chance of being stunted and a 11.0 times higher chance of presenting low weight for height, controlling for potential confounders. CONCLUSION The instrument measuring poverty level was useful to identify those children with higher risk for malnutrition.

BACKGROUND: Vaccine failure is an important concern in the tropics with many contributing elements. Among them, it has been suggested that exposure to natural infections might contribute to vaccine failure and recurrent disease outbreaks. We tested this hypothesis by examining the influence of co-infections on maternal and infant measles-specific IgG levels. METHODS: We conducted an observational analysis using samples and data that had been collected during a larger randomised controlled trial, the Entebbe Mother and Baby Study (ISRCTN32849447). For the present study, 711 pregnant women and their offspring were considered. Helminth infections including hookworm, Schistosoma mansoni and Mansonella perstans, along with HIV, malaria, and other potential confounding factors were determined in mothers during pregnancy and in their infants at age one year. Infants received their measles immunisation at age nine months. Levels of total IgG against measles were measured in mothers during pregnancy and at delivery, as well as in cord blood and from infants at age one year. RESULTS: Among the 711 pregnant women studied, 66% had at least one helminth infection at enrolment, 41% had hookworm, 20% M. perstans and 19% S. mansoni. Asymptomatic malaria and HIV prevalence was 8% and 10% respectively. At enrolment, 96% of the women had measles-specific IgG levels considered protective (median 4274 mIU/ml (IQR 1784, 7767)). IgG levels in cord blood were positively correlated to maternal measles-specific IgG levels at delivery (r = 0.81, p < 0.0001). Among the infants at one year of age, median measles-specific IgG levels were markedly lower than in maternal and cord blood (median 370 mIU/ml (IQR 198, 656) p < 0.0001). In addition, only 75% of the infants had measles-specific IgG levels considered to be protective. In a multivariate regression analysis, factors associated with reduced measles-specific antibody levels in infancy were maternal malaria infection, infant malaria parasitaemia, infant HIV and infant wasting. There was no association with maternal helminth infection. CONCLUSION: Malaria and HIV infection in mothers during pregnancy, and in their infants, along with infant malnutrition, may result in reduction of the antibody response to measles immunisation in infancy. This re-emphasises the importance of malaria and HIV control, and support for infant nutrition, as these interventions may have benefits for vaccine efficacy in tropical settings.

Background: High prevalence of stunted children that indicates nutrition problem in Indonesia is a chronic problem associated with poverty, low education, and lack of service and environmental health. The low birth weight infant will have an impact on growth disorders in children. Objectives: To identify association between social economic aspect of the family, rearing pattern, eating pattern and stunting in elementary school children in Lut Tawar Subditrict Central Aceh Regency.Methods: The study were analytic observational with cross sectional design and qualitative method. Data were obtained through observation and interview using questionnaire. Samples were 378 children from 11 elementary school in Lut Tawar Subdistrict Central Aceh Regency. Samples were selected by proportional random sampling. Analysis used chi-square at confi dence interval 95%. Number of samples were 378 children.Results: There were association between maternal education and nutritional status (pConclusions: There were signifi cant association between rearing pattern, eating pattern, and nutritional status.KEYWORDS: stunting, rearing pattern, eating patternABSTRAKLatar belakang: Tingginya prevalensi anak pendek yang menunjukkan masalah gizi di Indonesia merupakan masalah kronis yang berkaitan dengan kemiskinan, rendahnya pendidikan, dan kurang memadainya pelayanan dan kesehatan lingkungan.Tujuan: Untuk mengetahui hubungan antara aspek sosial ekonomi keluarga, pola asuh, pola makan, dan stunting pada anak sekolah dasar DI Kecamatan Lut Tawar Kabupaten Aceh Tengah.Metode: Penelitian observasional analitik menggunakan rancangan cross sectional dan metode kuantitatif, jumlah sampel 378 anak, yaitu siswa sekolah dasar kelas I-III pada 11 sekolah dasar. Sampel diambil berdasarkan proportional random sampling, pengumpulan data melalui wawancara dengan menggunakan kuesioner, pengolahan dan analisis data menggunakan program komputer yaitu analisis univariat, bivariat, dan multivariat.Hasil: Tidak ada hubungan antara jenis kelamin dengan status gizi (p=0,39) OR=1,22, tidak ada hubungan antara umur dengan status gizi (p=0,25) OR=0,73, tidak ada hubungan antara akses pelayanan kesehatan dengan status gizi (p=0,78) OR=0,93. Ada hubungan antara pendidikan ibu dengan status gizi (pKesimpulan: Ada hubungan yang signifi kan antara pola asuh, penghasilan orang tua, pendidikan orang tua, dan pola makan dengan status gizi. Tidak ada hubungan antara jenis kelamin, umur dan akses pemanfaatan pelayanan kesehatan dengan status gizi.KATA KUNCI: stunting, pola asuh, pola makan

OBJECTIVE: Lifelong functional, adaptive, and economic outcomes of moderate to severe infantile malnutrition are not well known. We assessed social status and income at midlife in a cohort of Barbadian adults, hospitalized for protein-energy malnutrition (PEM) during the first year of life, with good nutrition and health thereafter, in the context of a 40-year longitudinal case-control study. We also examined to what extent childhood IQ mediated any group differences. METHODS: Educational achievement, occupational status, and standard of living were assessed by the Hollingshead scales and a site-specific Ecology Questionnaire in Barbadian adults (aged 37–43 years) with a history of malnutrition (n = 80) and a matched healthy control group (n = 63), classmates of the index cases. Malnutrition effects, adjusted for childhood standard of living, were estimated by longitudinal multiple regression analyses, with and without childhood IQ, in the models. RESULTS: PEM predicted poorer socioeconomic outcomes with medium to large effect sizes (0.50–0.94), but childhood IQ substantially attenuated the magnitude of these effects (adjusted effect sizes: 0.17–0.34). The gap in weekly household income between the PEM and control groups increased substantially over the life span (P < .001). CONCLUSIONS: Moderate to severe PEM during the first year of life with adequate nutrition and health care thereafter is associated with significant depression of socioeconomic outcomes in adulthood, mediated in part by cognitive compromise in affected individuals. This finding underscores the potential long-term economic burden of infant malnutrition, which is of major concern given the continued high prevalence of malnutrition worldwide.

Malnutrition and poverty poses a major challenge to low-income families in developing nations and the twin issues are very critical for a growing infant. Commercially processed weaning foods are expensive for these categories of families; hence the objective was to formulate and evaluate the functional, antinutritional and protein quality of composite weaning food based on soybean and tigernut flour. Soybean and Tigernut seeds were processed into flour and three weaning diets: STF 1 (Tigernut; 75%, Soybean 15%); STF 2 (Tigernut; 65%, soybean 25%) and STF 3 (Tigernut; 55%, Soybean 35%) with 10% full cream milk powder (FCM) addition were produced according to FAO/WHO/UNU recommendations. Commercial weaning food (CB) was used as control. Effect of tigernut flour addition on the functional, antinutritional and protein quality of the formulated blends were evaluated using standard methods. The protein quality was evaluated using rat assay. The functional properties of the samples were significantly (P

Objectives: The purpose of this study was to compare the prevalence of conduct problems in a welldocumented sample of Barbadian adolescents malnourished as infants and a demographic comparison group and to determine the extent to which cognitive impairment and environmental factors account for this association. Methods: Behavioral symptoms were assessed using a 76-item self-report scale in 56 Barbadian youth (11–17 years of age) with histories of protein–energy malnutrition (PEM) limited to the first year of life and 60 healthy classmates. Group comparisons were carried out by longitudinal and cross-sectional multiple regression analyses at 3 time points in childhood and adolescence. Results: Self-reported conduct problems were more prevalent among previously malnourished youth (P < 0.01). Childhood IQ and home environmental circumstances partially mediated the association with malnutrition. Teacher-reported classroom behaviors at earlier ages were significantly correlated with youth conduct problems, confirming the continuity of conduct problems through childhood and adolescence. Discussion: Self-reported conduct problems are elevated in children and adolescents with histories of early childhood malnutrition. Later vulnerability to increased conduct problems appears to be mediated by the more proximal neurobehavioral effects of the malnutrition on cognitive function and by adverse conditions in the early home environment.

HIV-exposed uninfected (HEU) infants have higher infectious morbidity than HIV-unexposed uninfected (HUU) infants. We present the clinical outcomes from a pilot cohort study of 27 HEU and 28 HUU infants. In the absence of infant malnutrition or advanced maternal HIV, HEU infants experienced a 2.74 (0.85–8.78) times greater risk of hospitalization in the first year.

Infant malnutrition has long-term behavioural effects. We determined the long-term effects of infant malnutrition on reproduction in meadow voles (Microtus pennsylvanicus) and red-backed voles (Clethrionomys gapperi). Experimental animals received standard diets diluted with cornstarch (2:1) during a combination of the following periods: gestation, lactation, and for 3 weeks postweaning. Growth and reproduction of these animals were compared with those of control individuals. During the administration of starch-diluted diets growth was retarded but subjects experienced "catch-up" once they were put on normal diets. Effects on reproduction of individuals that had experienced malnutrition as infants were minimal. Litter size was greater (both species), the proportion of females reproducing was greater (meadow voles), and birth mass was greater (meadow voles), but the growth rate of offspring was slightly lower (both species), for females malnourished as infants. The ecological implications of infant malnutrition are discussed.

Background. Malnourished children are at increased risk for death due to diarrhea. Our goal was to determine the contribution of specific enteric infections to malnutrition-associated diarrhea and to determine the role of enteric infections in the development of malnutrition. Methods. Children from an urban slum in Bangladesh were followed for the first year of life by every-other-day home visits. Enteropathogens were identified in diarrheal and monthly surveillance stools; intestinal barrier function was measured by serum endocab antibodies; and nutritional status was measured by anthropometry. Results. Diarrhea occurred 4.69 ± 0.19 times per child per year, with the most common infections caused by enteric protozoa (amebiasis, cryptosporidiosis, and giardiasis), rotavirus, astrovirus, and enterotoxigenic Escherichia coli (ETEC). Malnutrition was present in 16.3% of children at birth and 42.4% at 12 months of age. Children malnourished at birth had increased Entamoeba histolytica, Cryptosporidium, and ETEC infections and more severe diarrhea. Children who became malnourished by 12 months of age were more likely to have prolonged diarrhea, intestinal barrier dysfunction, a mother without education, and low family expenditure. Conclusions. Prospective observation of infants in an urban slum demonstrated that diarrheal diseases were associated with the development of malnutrition that was in turn linked to intestinal barrier disruption and that diarrhea was more severe in already malnourished children. The enteric protozoa were unexpectedly important causes of diarrhea in this setting. This study demonstrates the complex interrelationship of malnutrition and diarrhea in infants in low-income settings and points to the potential for infectious disease interventions in the prevention and treatment of malnutrition.

Aflatoxins are toxic secondary metabolites produced by fungi and contaminate various agricultural commodities either before harvest or under post-harvest conditions. Acute aflatoxin poisoning leading to casepatients and deaths has continued to occur in several parts of Kenya. However, there is emerging evidence implicating chronic aflatoxins exposure as an important factor in infant growth stunting and immune suppression. The consumption of smaller dosages overtime produces no obvious symptoms as would happen with acute dosage. Thus, it has not attracted much attention in Kenya in terms of public health priorities. Aflatoxins have been detected mainly in the staple foods such as cereals and legumes commodities, which form the main gruel ingredients used to compose weaning foods in most rural households. This suggests that children may be more exposed to mycotoxins than the rest of the population and this could be the reason for increased cases of infant malnutrition and mortality in certain areas in Kenya. The extent to which stunted growth and immune suppression contribute to the overall burden of infectious disease merits consideration. Therefore, this paper discusses dietary chronic mycotoxins exposure in Kenya and emerging public health concerns of stunted growth and immune suppression as reported in various related animal and human studies. It also highlights several factors that may enhance the dietary mycotoxinsexposure especially amongst children and further explores various localized control measures and research areas within the context of food scarcity and extreme poverty experienced in rural Kenya. This paper aims at reinforcing that presence of mycotoxins within the food system should be addressed as an urgent food safety issue as they place a significant hindrance towards the attainment of the Millennium Development Goals (MDGs) 4 and 6 on reduction of child mortality and combating of diseases, respectively.

The prevalence of maternal depression and infant malnutrition is high in developing countries. Maternal depression can interfere with parenting behaviors and may negatively impact infant nutrition and growth. This review examines studies that look at the relationship between maternal depression and infant growth. A literature search was conducted in PubMed. Articles published that examined associations between maternal mental health, depression, and infant growth (ages 0–36 months) in developing countries were reviewed and summarized. Fifteen publications described 16 studies that met the above review criteria. Of these studies, nine examined the associations between maternal depression and infant growth and seven examined general maternal mental health symptoms and infant growth. Almost all studies of maternal depression/depressive symptoms found an association with poor infant growth (eight out of nine). Likewise, the majority of studies of general mental health symptoms and poor infant growth (five out of seven) reported a significant association. The review suggests that the relation between maternal depression and poor infant growth occurs at extremes of nutrition (e.g., underweight, stunting, or wasting) rather than along the nutrition continuum. Most publications examined relations with growth problems at the extremes; and nearly all (11/12) of these reported significant associations between maternal depression/mental health problems and some form of severe malnutrition (e.g., underweight, stunting, or wasting). Findings from two of the three publications that examined either mild malnutrition or growth along a continuum (e.g., weight-for-age or length-for-age on a continuous scale) reported no significant associations between maternal depression/depressive symptoms and growth. Inclusion of covariates in multivariable models generally attenuated the associations, emphasizing that there are many diverse determinants of maternal depression and infant growth. Only 3 of the 16 studies were longitudinal. The current review suggests that an association exists between maternal depression/depressive symptoms and poor infant growth in developing countries, especially when nutrition problems are severe (e.g., underweight, stunting, or wasting). Additional research is needed to better understand the relations between maternal depression/depressive symptoms and poor infant growth.

Severe malnutrition early in life has well known neurodevelopmental sequelae, with potentially lifelong functional consequences. Adverse clinical outcomes can involve cognition, behavior and affect1,2. Pre-clinical studies have established an impact of pre- and post-natal malnutrition on neurochemistry and brain structure, affecting glial and dendritic development in a regionally specific fashion 3,4, 5. Prefrontal cortical and hippocampal structures are especially vulnerable, with permanent changes detectable into adulthood, even in animals rehabilitated after the neonatal exposure 6, 7. The potential for regionally specific impact of malnutrition on the prefrontal cortex and hippocampus in the developing brain is of particular interest because of their pivotal role in human learning and memory 8,9 as well as emerging links to depressive disorders 10, 11. The Barbados Nutrition Study (BNS) is a now 40-year longitudinal study that has evaluated children who had been hospitalized for moderate to severe malnutrition in the first year of life and a comparison group from the same classrooms and social milieu12. Because the malnourished children were successfully rehabilitated nutritionally and followed until 12 years of age to assure adequate nutrition and normal growth and development, the episode was restricted to the first year of life, without ongoing undernutrition 13. Participants were evaluated three times in a 7-year period between 1977 and 1984, spanning grammar school age to late adolescence. Data are currently being collected on these same individuals, now entering their fifth decade. At the first evaluation, when the children were 5 to 11 years of age, the previously malnourished group exhibited lower IQ, more attention problems and poorer grades in school12, 14, 15. Performance on the Common Entrance Examination (CEE), a standard academic achievement test administered to all Barbadian children at 11 years of age to determine high school placement, was also lower in the previously malnourished children, referable largely to their lower IQ and problems with attention and self-regulation as measured in the primary grades by a teacher questionnaire designed for the study 16. Maternal depression can also adversely affect child development, including cognition and mood17 and may in fact contribute to the initial episode of malnutrition18, 19. Significantly, in the BNS, mothers of previously malnourished children reported more depressive symptoms when the children were school age and adolescent. These symptoms were associated with negative child outcomes, including poorer school grades and teacher reported hygiene. These previously malnourished children themselves also reported more symptoms of depression than their adequately nourished peers as adolescents. Although maternal depressive symptoms predicted adolescent depressive symptoms, their effect was independent of the effects of malnutrition and standard of living 20. Depressive symptoms in adolescence have similarly been reported in other long-term follow-up studies of children malnourished early in life21. Developmental psychopathologists have advanced the core concept of the developmental cascade. According to Masten and colleagues, a developmental cascade occurs when “functioning in one domain of adaptive behavior spills over to influence functioning in other domains in a lasting way (p. 735).” 22 Thus, importantly, a deviation or early insult having a direct effect on one functional domain may indirectly impair functioning in other domains, ultimately affecting development and adaptive success far more broadly. The relevance of this developmental framework to the problem of early nutrition has been previously discussed by Wachs, who observed that “Models based exclusively on nutrition and CNS pathways do not provide sufficient explanations of how nutritional deficiencies translate into maternal and child mental health problems (p. 937S).”23 Thus, although some neurodevelopmental consequences are likely the direct result of the nutritional insult to the immature brain, a developmental perspective argues that such consequences are not necessarily direct sequelae, but may be epiphenomena arising indirectly in the course of the child’s developmental adaptation to and interaction with the environment. Along these lines, it is well established that children with learning impairment are vulnerable to internalizing symptoms as they become aware of their struggles. Ackerman et al.24, for example, found that poor readers from disadvantaged environments exhibited an increase in internalizing symptoms between the 3rd and 5th grades as a consequence of their reading problems. These symptoms were thought to be triggered by normative developmental advances in self-awareness as the children approached adolescence and became more cognizant of their struggles. In the present context, academic struggles resulting from cognitive compromise related to the malnutrition could lead to depressive symptoms in the setting of academic and other adaptive challenges, potentially mediating the relationship between malnutrition and the depressive symptoms detected in adolescence. The goal of the present report is to integrate findings from the BNS within the framework of a developmental cascade, extending from infancy, when the episode of malnutrition and thus the original presumptive neurological insult occurred, to adolescence, when the elevated level of depressive symptoms was observed. The primary hypothesis is that the association between early malnutrition and adolescent depressive symptoms is mediated by the cognitive impairment that ensues from the malnutrition. Figure 1a shows the simple, direct effect model; that is, early malnutrition leads directly to depressive symptoms in adolescence. Figure 1b shows the more elaborated developmental model to be evaluated. Here, the episode of early malnutrition has a presumed direct neurological impact, manifest in lowered IQ and increased attention problems. These cognitive sequelae serve to impair school achievement, measured by performance on the CEE. Poor school functioning in childhood then leads to depressive symptoms in adolescence. In the model, academic performance is included as a proximal mediator between the cognitive impairment and depressive symptoms because it is presumably the more salient experiential indicator of the impairment for the child. The model also includes a potential direct effect of early malnutrition on depressive symptoms since the cognitive symptoms may not fully mediate the association. Because of the known association between maternal and child depression, and also because of the known associations of both maternal depression and socioeconomic conditions with malnutrition in our sample, we controlled for the household standard of living in all analyses and include maternal depressive symptoms as a predictor in the final model. Figure 1 (a) Simple model showing early malnutrition leads to depressive symptoms in adolescence. (b). Hypothetical model showing that malnutrition affects IQ and school behavior (attention) which in turn affects performance on the CEE which then affects depressive ...

A prospective, four-year longitudinal study of 209 Peruvian children was conducted to evaluate the effect of a single malnutrition episode occurring at infancy (i.e.,1 year of age) on dental caries in the primary teeth. Children were recruited into the study at age 6-11 months after they had suffered from a malnutrition episode and were thus classified by anthropometry as either: (1) Normal; (2) Wasted (low weight for height); (3) Stunted (low height for age); or (4) Stunted and Wasted (S and W). Eruption of the primary teeth was significantly delayed in all malnourished children; however, the effect of stunting--that is, retarded linear growth--was more pronounced and lasted longer than that of wasting or acute malnutrition (i.e., 2.5 vs. 1.5 years, respectively). By age 4 years, children from group 4 (S and W) showed a significantly higher caries experience in the primary teeth than did those in any of the other three groups. In summary, this longitudinal study has confirmed previous studies in animals and indirect epidemiological evidence which had suggested a cause-effect relationship between early malnutrition and increased dental caries.The study was conducted from 1986 through 1990 among 209 children residing in Canto Grande, a poor community located north of Lima, Peru. The children were recruited as infants, aged 6-11 months, from the outpatient population of the Canto Grande Health Center, or from two other hospitals. All children were of full-term gestation and normal birth weight ( 2500 g). Each child was assigned to 1 of 4 study groups ascertained by weight and height measurements, with the National Center for Health Statistics standards used as the reference: 1) normal; 2) wasted, indicating current acute malnutrition; 3) stunted, indicating past or chronic malnutrition; and 4) stunted and wasted, indicating malnutrition soon after birth. The data, composed of 2700 examinations, were analyzed by the Statistical Analysis System (SAS) General Linear Models (GLM) program for computation of ANOVA tables. The mean numbers of teeth at ages 1 and 1.5 years for normal children were significantly higher than those of the children who were either wasted, stunted, or stunted and wasted as infants. At age 2, normal children had significantly more teeth in the mouth than did stunted children and stunted and wasted children. At age 2.5, the number of teeth in the normal children was still significantly higher than in stunted children. At age 4, all 4 groups had their full 20 teeth. At age 4, children who were stunted and wasted during infancy showed a significantly higher number of decayed, extracted, and filled teeth (def) compared with that of the other 3 groups. When grouped into 4 def categories of low, moderate, high, and very high caries experience, the distribution of the 4th group was distinctly different from that of the other 3 groups. 17.2% of stunted and wasted children had a very high caries experience (i.e., def 13) at age 4, significantly higher than that in any of the other 3 groups (i.e., normal 9.8%, wasted 4.4%, and stunted 3.6%, respectively; p 0.001).

The thrifty phenotype hypothesis holds that intrauterine malnutrition leads to an adaptive response that alters the fetal metabolic and hormonal milieu designed for intrauterine survival. This fetal programming predisposes individuals to several diseases in adulthood. Fetal nutrition is an important key regulator of fetal growth and thus an obvious candidate as a possible programming influence. Fetal overexposure to maternal glucocorticoids triggers programming events in utero; these effects appear to be relevant to changes in utero because there are strong correlations between birth weight, plasma cortisol concentrations, and the development of hypertension and type 2 diabetes. Malnutrition, an important cause of immunosuppression and undernutrition during critical periods of gestation, neonatal maturation, and weaning, can lead to clinically significant immune deficiency and infections in children. Micronutrients have a relationship to antibody formation and the development of the immune system, and micronutrient deficiencies are related to poor growth, impaired intellect, and increased mortality, and susceptibility to infection.

Several studies on laboratory mice and rats have shown that malnutrition during infancy has a variety of long-term effects extending into adulthood. These effects are manifested in reproduction, including reduced litter sizes, reduced growth rates of the young, and skewed sex ratios, and in behaviour, including increased nervousness, decreased problem-solving ability, and reduced pup retrieval to the nest by the mother. This study investigated the effects of early malnutrition on behaviour in adult meadow voles, Microtus pennsylvanicus. Experimental animals received a standard diet diluted with pure cornstarch (1 part standard diet to 2 parts pure cornstarch) through their mothers during lactation and directly for 3 weeks postweaning. Control individuals always received the standard diet ad libitum. The cumulative duration of 13 behaviours was measured in 10-min trial periods and compared between experimental and control animals. Experimental females differed from control females in a number of behaviours, especially those involving high activity levels, whereas experimental and control males showed little difference in the behaviours performed. The behaviour profile of previously malnourished females was similar to those of both control and experimental males. Increased activity, resulting from poor nutrition, may have consequences for dispersal and spacing behaviour.

OBJECTIVE: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.

Brazil is surrounded by cultural and socioeconomic disparities. Thus, it is known that one of the causes for malnutrition is the lack of food, which is resultant of this reality, many times disguised by other illnesses such as influenza or diarrhea. It was aimed to identify the children awareness on health food; investigate the parameters on infant malnutrition at school, and develop health education strategies that could be used at the school as prevention on infant malnutrition. It is a qualitative study of ethnographic approach carried out in a private school of the Fortaleza periphery, with 45 children. Data collection initiated with the measurement of children weight/height, followed by playful activities, using the participant observation as an instrument. The data analysis was performed through description and documentation of the talks which generated 3 general topics of thematic nature: Healthful Feeding, Corporal and Feed Hygiene, Knowledge about Influenza and Diarrhea. The results revealed that the children enlarged their knowledge on the subject, reaffirming the need of health educative strategies in the school scenario aiming at the health promotion and improvement on the quality of life of the children and their family.

This paper argues that indicators of anthropometric shortfall - especially low height and low weight-for-age - are uniquely suited for assessing absolute deprivation in developing countries. Anthropometric indicators are relatively precise, readily available for most countries, reflect the preferences and concerns of many poor people, consistent with reckoning the phenomenon directly in the space of functionings, intuitive, easy to use for advocacy, and consistent over time and across subgroups. Anthropometric indicators can therefore complement (but not replace) standard indicators of income/consumption poverty, especially for comparisons across subgroups, within households, across countries, and in the long run. In addition, the paper analyses spells of change in malnutrition over time, finding that the association between economic growth and chronic child malnutrition is very small (but statistically significant) and much lower than the elasticity of growth on poverty. The policy implication of this finding is that direct interventions aimed at reducing infant malnutrition are required.

Many nutritional intervention programmes throughout the world have targeted food supplements towards women during the "at risk" periods of pregnancy and lactation. Some of these programmes, together with a number of small-scale scientific studies, have attempted to evaluate the efficacy of supplementation in terms of birth outcome or lactational performance. After reviewing the available evidence it is concluded: (a) that supplementation during late pregnancy can have a significant beneficial effect on birthweight in women who are genuinely "at risk" due to an inadequate home diet; (b) that statistical projections would predict that the increase in birthweight should be accompanied by a significant decrease in neonatal mortality; (c) that supplementation during lactation is most unlikely to increase breast-milk output or significantly improve its composition except perhaps in extremely malnourished women. Since pregnant women form a small and easily identifiable target group, and since the potential benefits of extra food may be substantial, it is recommended that future efforts are focussed in this direction. Large-scale effectiveness and cost-benefit trials are required with neonatal mortality as the primary outcome.Research conducted in the Gambia suggests that food supplementation exerts a significant effect on infant health when administered to at-risk women during late pregnancy, while supplementation during lactation is not as effective. In the Gambian study, all pregnant women in 1 village were provided with groundnut biscuits and vitamin-fortified tea 6 days a week throughout the pregnancy. The effectiveness of this regimen was evaluated through comparison of 4 years of supplemented births and 4 years of preintervention births. This comparison indicated that, during the harvest season, the supplement had no effect on birth outcome. However, outside of the harvest season, the food supplement program was associated with a 200 gm increase in birth weight and the prevalence of low birth weight was reduced from 23.7% to 7.5%--gains that are, in turn, associated with a 37% decline in neonatal mortality. The same supplements were provided to lactating women in the Gambian village, and breast milk output from 1 year of supplementation was compared with that from the previous preintervention year. Here, there was only a minimal increase (7%) in fat content, no change in energy content, and a disturbing reduction in serum prolactin levels (associated with an earlier return to fertility). It was concluded that supplementation of the diet of pregnant women can have a beneficial impact on birth outcome in cases where there is a genuine nutritional deficit within an entire population, within selected subgroups, or at certain times of the year. Needed to persuade government health officials of the cost-effectiveness of such an intervention are large-scale studies that use neonatal mortality as the major outcome variable.

Infants with congenital heart disease (CHD) have a high prevalence of feeding difficulties and malnutrition. Early intervention decreases morbidity and long-term developmental deficits. The purpose of this study was to develop and establish the content validity of a screening checklist to identify infants with CHD at risk of feeding difficulties or inadequate nutritional intake for timely referral to a feeding specialist or dietitian. The Delphi method was used, and expert participants reached consensus on 24 risk indicators. This study is the first step in establishing the validity and reliability of a screening tool for early intervention of feeding difficulties and inadequate nutritional intake in infants with CHD.

Despite the importance of breastfeeding (BF) there are surprisingly few studies on the subject in India. However the literature that is available reveals that this practice is almost universal but many customs surrounding BF and weaning are not conducive to the health of the child. Initiation of BF is generally quite late and colostrum is discarded. Moveover prelactation feeding is generally unhygienic. Although BF is universal there are signs that in certain population segments such as the urban and the educated the duration of BF is becoming shorter. It is recommended that the infant start to breastfeed preferably within 6 hours of birth. Generally newborn Indians are breastfed for the 1st time 48 to 72 hours after birth. Successful lactation can be started at this time in India. Prelactation goods include boiled water tea sugar honey jaggery (a course brown sugar made from palm sap) or glucose with plain water and diluted animal milk. Often the mode of feeding is not hygienic. It is generally good for babies to be exclusively breastfed for 4 months after birth. However in India particularly out of the cities women breastfeed exclusively for up to 8 months and in some cases for 12 months. This delay is a major cause of infant malnutrition. When Indian children are very young (0-3 months) they are usually fed on demand. For children aged 3-6 months frequency of suckling episodes does not go down significantly among nonworking women; however it drops considerably among those working women who do not take their children to work. The mean age at which children are given solid supplemental food varies considerably across India. The common solid foods include rice rice with milk and ghee biscuits roti (unleavened bread) and boiled potatoes. 99% of women in urban areas; and 89% of those in rural areas believe that human milk is better than commercial milk or animal milk. It is nutritional and has antibodies. About 1/5 of the rural women said that it is good because it does not coast anything. women are generally unaware of contraceptive properties of breast milk. The duration of lactation foes down to almost 1/2 if the women goes back to work and leaves the child home. (authors modified)

More than 90% of women in developing countries and 50 to 90% of women in industrialized countries now initiate breast-feeding, a marked improvement from 25 y ago. The duration of breast-feeding has lengthened, but fewer than 35% of infants worldwide are still exclusively breast-fed at 4 mo of age. Considerable progress has also been made in combating infant malnutrition. In 1980, 47% of under-5-y-old children in developing countries were stunted. This percentage declined to 29% in 2005. Major advances in formula use and composition include the introduction of formulas tailored to the perceived needs of low-birth-weight infants and the development of fortifiers to overcome the nutritional deficits of human milk for the preterm infant. More recently, postdischarge formulas were introduced and are now being used widely, often in combination with breast-feeding. Formulas for term infants also have undergone a number of changes in the past 25 y to better reproduce the composition of human milk and/or the response of the breast-fed infant. The use of whey-predominant rather than casein-predominant formulas has increased, as has the use of iron-fortified formulas. Cow's milk is introduced into the infant's diet much later than 25 y ago. Despite the progress that has been made in promoting breast-feeding and in the quality of infant formulas, further improvements in the duration of breast-feeding and in the composition of infant formulas are needed.

Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-15T12:16:38Z No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-26T10:59:33Z (GMT) No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Made available in DSpace on 2013-05-26T10:59:33Z (GMT). No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Previous issue date: 2007 O objeto central da tese é o perfil antropométrico das crianças na faixa etária de 0 a 5 anos do povo indígena Kiriri, assim como suas condições de saúde e práticas alimentares cotidianas. O percurso metodológico para a apreensão dessas três dimensões privilegiou o método da observação participante com registro etnográfico, ao abrigo do qual foram utilizadas também técnicas de caráter quantitativo. Das 365 crianças de 0 a 5 anos residentes na Terra Indígena Kiriri, 306 (83,83%) participaram do estudo. Os resultados evidenciaram, notadamente, uma elevada prevalência de processos crônicos de Desnutrição pelo Indicador Altura/Idade (19,9%), cuja prevalência está muito além da aceitável pela Organização Mundial de Saúde, que é de 2,3 % (OMS, 1995). Do ponto de vista nutricional, a alta relevância de Desnutrição crônica representa reduzida garantia de segurança alimentar infantil, não só ao nível doméstico mas também comunitário, assim como precárias condições de prevenção e manutenção da saúde. Visando melhor conhecer e descrever a situação nutricional na Terra Indígena Kiriri, os indicadores Peso/Estatura, Peso/Idade e Estatura/Idade foram cruzados com variáveis consideradas importantes no quadro multicausal da Desnutrição. As variáveis selecionadas foram sexo, idade, escolaridade materna e aleitamento. Em relação às variáveis sexo e aleitamento, não se observou associação entre elas e a ocorrência de Desnutrição. Destacada a questão do déficit de crescimento, observou-se que das 60 (20,3%) crianças que apresentaram Desnutrição pelo indicador Estatura/Idade, aproximadamente 87,0% possuem mães com escolaridade até a 4ª série. Constatou-se, também, que crianças entre 24 e 59 meses de idade representam 57,4% do total de crianças desnutridas. Em uma perspectiva comparativa entre os dois Grupos em que está dividida, hoje, a população indígena, a Desnutrição tem uma distribuição geográfica específica, sendo que no Grupo liderado pelo cacique Lázaro, a prevalência da Desnutrição crônica é maior (24,6%) do que no Grupo liderado pelo cacique Zenito (13,0%). Um estudo focal foi realizado entre as famílias com crianças Desnutridas no grupo local de Mirandela, de modo a melhor compreender alguns fatores envolvidos na determinação do Déficit de crescimento. As formas de cuidado e cura que conformam o sistema de saúde local foram observadas numa perspectiva relacional, identificando-se um campo complexo onde diferentes demandas são articuladas a órgãos oficiais e conhecimentos locais, de modo a atender às necessidades materiais, relações de poder e prestígio, motivações históricas, etc. As observações sobre as práticas alimentares Kiriri demonstram uma dieta alimentar baseada no feijão e farinha de mandioca, e complementada por tubérculos e cereais (batata-doce, pão, arroz e farinha de milho). De modo geral, a marca dessa alimentação cotidiana é a monotonia. Entre as carnes, a preferência incide sobre a de boi. Atenção foi, igualmente, dirigida para as técnicas culinárias, a cozinha, a comida e o comer. A observação do sistema alimentar Kiriri se constitui em elemento fundamental para o respeito à sua especificidade cultural e elaboração de políticas públicas que contribuam para o equacionamento do seu problema de (in) segurança alimentar. Salvador

Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-15T12:16:38Z No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-26T10:59:33Z (GMT) No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Made available in DSpace on 2013-05-26T10:59:33Z (GMT). No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Previous issue date: 2007 O objeto central da tese é o perfil antropométrico das crianças na faixa etária de 0 a 5 anos do povo indígena Kiriri, assim como suas condições de saúde e práticas alimentares cotidianas. O percurso metodológico para a apreensão dessas três dimensões privilegiou o método da observação participante com registro etnográfico, ao abrigo do qual foram utilizadas também técnicas de caráter quantitativo. Das 365 crianças de 0 a 5 anos residentes na Terra Indígena Kiriri, 306 (83,83%) participaram do estudo. Os resultados evidenciaram, notadamente, uma elevada prevalência de processos crônicos de Desnutrição pelo Indicador Altura/Idade (19,9%), cuja prevalência está muito além da aceitável pela Organização Mundial de Saúde, que é de 2,3 % (OMS, 1995). Do ponto de vista nutricional, a alta relevância de Desnutrição crônica representa reduzida garantia de segurança alimentar infantil, não só ao nível doméstico mas também comunitário, assim como precárias condições de prevenção e manutenção da saúde. Visando melhor conhecer e descrever a situação nutricional na Terra Indígena Kiriri, os indicadores Peso/Estatura, Peso/Idade e Estatura/Idade foram cruzados com variáveis consideradas importantes no quadro multicausal da Desnutrição. As variáveis selecionadas foram sexo, idade, escolaridade materna e aleitamento. Em relação às variáveis sexo e aleitamento, não se observou associação entre elas e a ocorrência de Desnutrição. Destacada a questão do déficit de crescimento, observou-se que das 60 (20,3%) crianças que apresentaram Desnutrição pelo indicador Estatura/Idade, aproximadamente 87,0% possuem mães com escolaridade até a 4ª série. Constatou-se, também, que crianças entre 24 e 59 meses de idade representam 57,4% do total de crianças desnutridas. Em uma perspectiva comparativa entre os dois Grupos em que está dividida, hoje, a população indígena, a Desnutrição tem uma distribuição geográfica específica, sendo que no Grupo liderado pelo cacique Lázaro, a prevalência da Desnutrição crônica é maior (24,6%) do que no Grupo liderado pelo cacique Zenito (13,0%). Um estudo focal foi realizado entre as famílias com crianças Desnutridas no grupo local de Mirandela, de modo a melhor compreender alguns fatores envolvidos na determinação do Déficit de crescimento. As formas de cuidado e cura que conformam o sistema de saúde local foram observadas numa perspectiva relacional, identificando-se um campo complexo onde diferentes demandas são articuladas a órgãos oficiais e conhecimentos locais, de modo a atender às necessidades materiais, relações de poder e prestígio, motivações históricas, etc. As observações sobre as práticas alimentares Kiriri demonstram uma dieta alimentar baseada no feijão e farinha de mandioca, e complementada por tubérculos e cereais (batata-doce, pão, arroz e farinha de milho). De modo geral, a marca dessa alimentação cotidiana é a monotonia. Entre as carnes, a preferência incide sobre a de boi. Atenção foi, igualmente, dirigida para as técnicas culinárias, a cozinha, a comida e o comer. A observação do sistema alimentar Kiriri se constitui em elemento fundamental para o respeito à sua especificidade cultural e elaboração de políticas públicas que contribuam para o equacionamento do seu problema de (in) segurança alimentar. Salvador

The widespread problem of infant malnutrition in developing countries has stirred efforts in research, development and extension by both local and international organizations. As a result, the formulation and development of nutritious weaning foods from local and readily available raw materials, which are cost effective has become imperative in many developing countries. Thus, the local and readily available raw materials were used to compound and develop nutritious new infant formulae. The materials used for this study include maize, millet, cowpea, pumpkin, fingerlings and fish bone. The materials were dried and blended to powder. The powders were weighed in the ratio of 4:4:4:3:1:1 respectively and were then mixed properly. Analysis of nutritive value was performed on the formulae and compared with NAN-2 (control) and results revealed that the formulae had reasonable amount of moisture, lipids, carbohydrate, protein and fibre. Although NAN-2 was superior in carbohydrate and protein, our infant formula was higher in mineral elements, vitamins, fibre and lipids. All the essentials vitamins and both macro and micro minerals were found in appreciable quantity capable of meeting the biochemical and physiological demand of the body while the anti-nutrients composition were significantly (p

In different circumstances such as infant malnutrition, old age or chronic disease, decline of muscular strength, particularly anaerobic power, is shown. In this context, our laboratory, has demonstrated a decrease in anaerobic glycolytic power in pre-pubertal Bolivian children living at low and high altitude and suffering from marginal protein malnutrition. To bring molecular support to the relationship between protein malnutrition and anaerobic glycolytic metabolism, we studied the impact of prolonged protein malnutrition on lactate metabolism in different muscles of growing rats. Lactate dehydrogenase (LDH), monocarboxylate transporters (MCT1, MCT4) and membrane protein CD147 were chosen as specific markers of anaerobic glycolytic metabolism. Two groups of 10 weaning male rats were fed for 10 weeks either ad libitum with a well-balanced diet containing 18% protein or an isocaloric-diet containing 8% protein. LDH activity and mRNA amounts of LDH isoforms, MCT, CD147 were measured. Protein deprivation during rat growth induced a decrease of LDH specific activity in skeletal muscles (mean value of −41%), accompanied by isoform distribution modifications in soleus, but not in glycolytic muscles (extensor digitorum longus (EDL) or plantaris). A reduction in mRNA amounts encoding the LDH A and B subunits was observed in EDL. A decrease in LDH B mRNA amounts was monitored in plantaris, whereas no modification in both LDH isoform mRNA quantities was observed in soleus. MCT1 mRNA quantities were decreased in EDL but MCT4 mRNA quantities remained stable. CD147 mRNA amounts were unchanged except for EDL with a 42% increase. The global decreases of LDH activity, LDH and MCT gene expressions in growing rat skeletal muscles support the observed alterations of lactate metabolism associated with lowered muscular anaerobic performances in protein malnutrition.

The relationship between malnutrition and social support was first suggested in the mid-1990s. Despite its plausibility, no empirical studies aimed at obtaining evidence of this association could be located. The goal of the present study was to investigate such evidence. A case–control study was carried out including 101 malnourished children (weight-for-age National Center for Health Statistics/WHO 5th percentile) aged 12–23 months, who were compared with 200 well-nourished children with regard to exposure to a series of factors related to their social support system. Univariate and multiple logistic regressions were carried out, odds ratios being adjusted for per capita family income, mother's schooling, and number of children. The presence of an interaction between income and social support variables was also tested. Absence of a partner living with the mother increased risk of malnutrition (odds ratio 2·4 (95 % CI 1·19, 4·89)), even after adjustment for per capita family income, mother's schooling, and number of children. The lack of economic support during adverse situations accounted for a very high risk of malnutrition (odds ratio 10·1 (95 % CI 3·48, 29·13)) among low-income children, but had no effect on children of higher-income families. Results indicate that receiving economic support is an efficient risk modulator for malnutrition among low-income children. In addition, it was shown that the absence of a partner living with the mother is an important risk factor for malnutrition, with an effect independent from per capita family income, mother's schooling, and number of children.

Young infants admitted to hospital for diarrhoea were studied to identify and understand the reasons for early complementary feeding and to examine its effect on nutritional status. Of 132 infants, 71 percent were being breastfed, 24 percent had already stopped, and 5 percent had never been breastfed. Complementary feeds were started by the mothers when infants' median age (range) was 27 (1-180) days. Mothers' perceptions regarding breastmilk being insufficient (53 per cent) or causing diarrhoea (19 percent), were the major reasons for complementary feeding. The mean weight-for-age of the infants given complementary feeds before the age of 2 months was 72 percent of the National Centre for Health Statistics (NCHS) standards, compared to 82 percent in those starting after 2 months of age (P = 0.01). Similarly, the mean weight-for-length in these two groups were 86 and 91 percent, respectively (P = 0.04). Initiation of early complementary feeding is associated with infant malnutrition and this alarming trend should be strongly discouraged.

CONTEXT: Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE: To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY: Case-control study. SETTING: Two public hospitals in Recife, Brazil. PARTICIPANTS: The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS: Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS: The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION: The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS: In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.

Aims: To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. Methods: In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. Results: Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. Conclusion: There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6–12 months.

A screening test for infant malnutrition detection was performed using lhe arm circumference measurement on children between six months and five years of age in lhe district of Itaquera, periphery of lhe city of Sao Paulo, Brazil, during lhe Poliomyelitis vaccination national day, June 1991. Screened children had name, age and address noted down for location in a map of lhe district previously divided by arcas covered by the district’s basic health units and by socio-economic risk arcas, designed by the units’ technical staff. Obtained data were compared with the supplementation feeding program map of the same period of time, June 1991. Tried children were distributed by the entire region, concentrating on the micro arcas that had the biggest socioeconomic risk. It was found that 25.81% of the tried children received milk powder from the supplementation programs in that period. The conclusion leads to the simplicity of the screening method in order to virtually find the universe of malnourished children of ~e district in order to extend the program to those children that have no access to the health units of the region.

Systematic detection of inborn errors of metabolism (IEM) has usually encountered difficulties in developing countries. We present our experience in a high-risk population in Mexico between 1973 and 1998 with particular reference to the last 10 years, during which time infrastructure and support were considerably improved. Only disorders of intermediary metabolism were sought. The total number of patients studied is not available, but in the last 10 years, patients numbered 5,186. Routine metabolic screening was performed on all patients, with additional tests according to the clinical picture and screening results. The referral criteria have increasingly diversified, one-third being neurological conditions. Of the referrals, 33.8% were from pediatricians (31.1% of whom were at critical medicine departments) and the remainder from specialists. The number of diagnosed patients has increased to 1 per 43.9 patients studied. Amino acid defects have been the most prevalent, the proportion of organic acid and carbohydrate disorders having increased in the last 10 years, associated with improved diagnostic facilities. The most frequently diagnosed diseases were PKU, type 1a glycogen storage, and maple syrup urine disease (MSUD), their frequency apparently varying among different regions of Mexico. Other results of our program include training of specialists and technicians, development of the Latin American Metabolic Information Network, a procedure to locally prepare a special food product low in phenylalanine for the treatment of PKU patients, and extension of approaches for these disorders to the investigation metabolic derangements of infant malnutrition. This work demonstrates that inherited metabolic diseases constitute a significant load in pediatric pathology and that their study can and should be pursued in developing nations.

Background.Experimental undernutrition in animals, during the critical brain development period, produces retardation of brain growth as well as a number of different morphologic and functional abnormalities in neurons, mainly in the dendritic synaptic apparatus. These alterations are the cause of the poor neurointegrative development that occurs in experimental malnutrition. Severe malnutrition during early postnatal life in humans is known to produce similar neurointegrative disorders as well as mental retardation, but there are very few studies describing the morphology of the dendritic apparatus in infants suffering from this condition.Objective.To study the dendritic spine density and morphology in dendrites from cortical neurons in infants dying from severe malnutrition.Methodology.Brain sections from the somestesic, motor, and occipital cortical areas of 13 infants who died of severe malnutrition and 7 eutrophic infants who died of other causes were studied by means of the rapid Golgi method. Apical dendritic spines from neurons of the fifth cortical layer were studied and counted in all sections.Results.Apical dendrites were significantly shorter in malnourished infants than in the control group (581.54 ± 54.32 μm in severe malnutrition vs 846.3 μm in normal infants). The number of dendritic spines per dendrite was also significantly diminished (185.3 ± 36.1 in malnourished vs 374.3 ± 41.6 in eutrophic infants). There were marked morphologic abnormalities in the dendritic spines of infants dying of severe malnutrition that were classified as dysplastic.Conclusions.Short apical dendrites, fewer spines, and dendritic spine abnormalities occur in severe infant malnutrition. These anatomic anomalies might be related to the neuropsychological deficits that occur in these children.

Infants from households participating in the Mahatma Gandhi National Rural Employment Guarantee Act are less likely to suffer from undernutrition compared to those from non-participating households, a recent study has found.1 The act provides for a guaranteed minimum of 100 days’ employment a year for those households in which the adults volunteer for unskilled manual work. The study was conducted in the Dungarpur district of Rajasthan, India, using a mixed methods design comprising both cross-sectional study and focus group discussions. A total of 528 households and 1056 participants (infants aged less than 12 months and their caregivers) were included in the final sample, …

Malnutrition is a major contributor to the death of children under 5 years of age in sub-Saharan Africa. Furthermore, poor nutrition causes stunting and underweight in infants and children while at the same time putting at risk normal neurologic and cognitive development. A recent study of rural Fulani infants up to age 2 years in northern Nigeria found that more than one-quarter were stunted and underweight. The nutritional status of these infants was relatively sound at birth but progressively declined over the following 2 years. While insufficient dietary macronutrients such as protein and carbohydrate and micronutrients such as iodine, zinc, vitamin A and iron may well have contributed to their post-natal growth retardation, in this report we raise the possibility that inadequate intake of essential long.chain ω-3 fatty acids, docosahexaenoic acid (DHA) in particular, by infants during the first few years of life may play a role in childhood malnutrition in this part of the world, especially in populations like the Fulani pastoralists who live far-removed from the ocean which would otherwise provide access to DHA-rich seafood. We conclude this piece bysuggesting several approaches for improving the DHA status of pregnant and lactating Fulani women and their offspring in Nigeria.Key words: Docosahexaenoic acid, fatty acids, Fulani, malnutrition, Nigeria

Three-wk-old genetically lean or obese pigs were used in two experiments to determine the changes in body composition, visceral organs and brain in response to severe protein deficiency. In Experiment 1, 16 obese pigs were fed an adequate (A, 21% protein, 3% fat) or a protein-deficient (D, 5% protein, 23% fat) diet for 7 wk. One-half of each group was killed at 7 wk, and the remainder of each group was fed the A diet for an additional 8 wk. At 7 wk, pigs fed D contained a higher percentage of fat than those fed A (P < 0.01); after 8-wk of repletion, body composition of the two groups was similar. Duodenum, jejunum, and ileum of the protein-deficient pigs had severely atrophic villi, submucosal edema, and atrophic muscle layers; after 8 wk of repletion, however, microscopic architecture of the gastrointestinal tract was restored to normal. Absolute cerebrum weight at 7 wk, but not after 8 wk repletion, in the pigs fed D were significantly less than in pigs fed A, indicating reduced brain cellularity after 7 wk of protein restriction, but not after 8 wk repletion. In Experiment 2, genetically obese (O, n = 8) and lean (L, n = 8) pigs consumed the A or D diet ad libitum for 10 wk. L and O pigs responded similarly to protein deficiency; D pigs were fatter than A pigs and plasma constituents, bone mineral content, bone mineral density and most organ weights revealed no interactions between diet and genotype. The pig model system used in these experiments enabled the isolation of protein deficiency from infectious disease, parasites and social environmental stimulation that may confound interpretation of human infant malnutrition experiments. The data suggest that genetically controlled body fatness is not a major determinant in the response of the infant pig to severe protein deficiency.

Background Malnutrition is a major risk factor for mortality in children aged 1–12 months in India. Macroeconomic and social policies are determinants of both health and health inequalities. Therefore, policies targeting poverty and food insecurity might reduce infant malnutrition. The Mahatma Gandhi National Rural Employment Guarantee Act, a wage-for-employment policy of the Indian Government, targets deprivation and food insecurity in rural households. The Act could prevent malnutrition in children by improving household food security or increase the risk of malnutrition by reducing the time devoted to infant care or feeding if mothers are employed. We analysed the effect of household's and mother's participation in the scheme on malnutrition of children aged 1–12 months and studied how this effect occurred. Methods We did a quantitative cross-sectional study (single-stage cluster sampling) and qualitative focus group discussions (nested sampling) in Dungarpur district in Rajasthan, India. We randomly selected (with Stata; version 10.1) 44 villages from the five administrative blocks of the district. All households with infants aged 1–12 months (identified with records of the local village nurse and community health worker) in each of these villages were asked to participate in the study. We measured three indicators of malnutrition: underweight, stunting, and wasting (WHO criteria). We used multivariable logistic regression modelling with a hierarchical approach. We analysed focus group discussions to generate themes, and quantified theoretical pathways by path analysis. Findings We included 528 households with 1056 participants. Between August, 2010, and September, 2011, 281 households took part in the scheme, and 247 did not. Mothers were employed in 51 (18%) households in the scheme. Prevalence of wasting was 39% (n=206), stunting 24% (n=129), and underweight 50% (n=266). Households in the scheme were less likely to have wasted infants (odds ratio [OR] 0·58, 95% CI 0·38–0·90; p=0·016) and less likely to have underweight infants (OR 0·47, 95% CI 0·30–0·74; p=0·002) than were households not in the scheme. Stunting did not differ significantly between groups (OR 0·79, 95% CI 0·54–1·16; p=0·222). We did 11 focus group discussions with 65 mothers. Although the scheme reduced starvation, it did not provide the amount of benefit claimed by the programme because of lower than standard wages and delayed payments. Participants generally agreed that mother's employment was detrimental to infant care and feeding because of a lack of facilities at worksites for child care and breastfeeding. Results from path analysis did not support existence of an effect through household food security and infant feeding but did suggest a pathway of effect through low birthweight. The probability of being born with low birthweight ( Interpretation Participation in the wage-for-employment programme was associated with reduced malnutrition, possibly mediated indirectly by improved birthweight rather than by improved infant feeding. Provision of child-care facilities at worksites could mitigate the negative effects of mother's participation in the scheme. Although the scheme seems to reduce risk of low birthweight, ensuring timely and adequate payment could improve food security, and augment the protective effect of the programme against infant malnutrition. Funding Weidenfeld Scholarship and Leadership programme, University of Oxford.

An important outcome of the Kennedy Hearings was to shift the locus of policy action in the infant formula controversy to the World Health Organization (WHO) in Geneva. The first step by the WHO was to co-sponsor, with UNICEF, an international meeting on Infant and Young Child Feeding in Geneva, Switzerland, on October 9-12, 1979. The objective of the meeting was to stimulate discussion among participants leading to “affirmative actions to be implemented” for improving infant malnutrition and mortality.1

Auditory evoked potentials (AEPs) to click and name stimuli were recorded for 23 malnourished infants on admission to and 17 on discharge from hospital, together with those from age-matched controls. The number of peaks on the AEPs and the amplitude were examined. The malnourished infants' AEPs to click stimuli differed from the controls' on admission but not on discharge. The malnourished infants had smaller AEP amplitudes to name than to click stimuli on discharge while the controls did not. The data show that cortical AEPs in infants are affected by malnutrition.

The authors compared growth dietary intake and morbidity of infants breastfed for 12 months or longer from 2 populations: Davis California (n=46) and Huascar Peru (n=52). When compared against WHO reference data (based primarily on formula-fed infants) Huascar infants appeared to falter as early as 3-4 months but when compared with Davis breastfed infants the curves for weight and length were very similar in girls until 10-12 months and in boys until 6-9 months. Thereafter Huascar infants grew less rapidly than did Davis infants. Breast milk intake was very similar between groups but in Huascar the amount and nutrient density of complementary foods consumed after 6 months were lower and morbidity rates were much higher than in Davis. These results indicate that growth faltering of Huascar infants when judged against breastfed infants in the US occurs primarily after the first 6 months of life and is not due to poor lactation performance. (authors)

The World Summit on Food Security is failing to make progress, say aid organisations, after its meeting this week in Rome. Campaigners say that the meeting of the summit, organised by the Food and Agriculture Organization of the United Nations, produced no pledges of extra money, failed to prioritise the problem of infant malnutrition, and allowed the summit’s 2025 deadline for ending world hunger to “quietly wither away.” The lack of Western leaders came in for particular criticism. The only leader present from the G8 (the group of eight most industrialised countries) was the Italian president, Silvio Berlusconi. Matthew Grainger, …