Nutritional Supplement Program Research Articles

The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6-24-month-old children.

Mutans streptococci (MS) are the primary pathogens involved in the development of early childhood caries. However, factors that may affect their acquisition in the mouths of young children are not well understood, and the period of initial colonization remains controversial. This study investigated the relationship of age, number of teeth, and bottle usage/content with regard to the isolation of MS in 6-24-month-old children. A total of 122 children from low-income families attending a nutritional supplement program, and their mothers, participated in this study. Children were examined for dental caries and number of erupted teeth and were sampled for MS. Mothers were administered a questionnaire to obtain details of baby bottle use, including what food items were put in the bottle during the last week. MS was detected in more than one-third of the 6-24-month-olds. Unlike some studies that suggest a later period of infectivity, approximately 20% of children under 14 months of age, including 4 of 22 infants aged 6-9 months, were colonized with MS. When examined separately, age, number of teeth, and bottle usage/content were each found to be related to the presence of MS. Mutans streptococci colonization was more likely with increasing age and number of teeth, and children whose bottles contained sweetened beverages were more likely to be colonized than children whose bottles contained milk. Logistic regression models that controlled for both age and number of teeth indicated that children who consumed sweetened beverages in their baby bottle had a statistically significant, four-fold increase in the odds of colonization by MS relative to children who consumed milk. The finding that approximately 20% of the children under 14 months of age were infected with MS indicates that colonization in this sample of low-income preschool children may begin earlier than suggested by some investigations. Additionally, the risk of MS colonization appears lower among infants who consume milk rather than sweetened beverages in the bottle.

Maternal Mortality in Rural Bangladesh: The Tangail District

A study was conducted from September 1982 to August 1983 in the Tangail district of Bangladesh to estimate the maternal mortality level there and identify its causes and correlates. A rate of 56.6 per 10,000 live births was found, with abortion-related deaths contributing nearly 10 deaths per 10,000 live births. The major causes of maternal mortality were found to be obstructed labor and sepsis caused by improperly performed abortion. Those at high risk were mothers below age 20 and above age 30 and those above parity four. No inverse relationship was found between maternal mortality and socioeconomic status, as might be expected. Community-level pregnancy monitoring programs, increased attention on the part of family planning workers toward teenaged, older, and high parity mothers, and nutrition supplement programs for anemic mothers are recommended.

Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

III Studies of Maternal Nutrition and Infant Outcome: Statistical Versus Biological Significance

ABSTRACT: Nearly all of the nutritional supplementation programs for malnourished pregnant women have resulted in statistically significant increases in birthweight. To tell whether these gains are biologically or socially significant we must factor in the effects of infections, other nutrient deficits, secular changes in health care, and stress. We must reexamine assumptions about 2,500 grams dividing low from normal birthweight, and the increase in protein in the U.S. Recommended Daily Allowance (RDA) for pregnant women. Most studies have raised questions about the mechanism of nutritional adaptation to pregnancy and methods of evaluating the nutritional status of pregnant women.

Nutritional supplementation—whom does it benefit most?

Two hundred eleven preschool children who had received a food supplement and a group of 82 children who had not received any supplement were classified into various nutritional groups. Data on their increments in height and weight were analyzed to determine whether different groups behaved differently. The results indicated that those who were most severely malnourished benefited the most from the nutritional supplementation program and also that following on such programs nutritional dwarfs would have a chance to move toward normalcy.

Some statistical considerations on the use of anthropometry to assess nutritional status.

Although nutritional differences between individuals or populations may lead to anthropometric differences, the existence of anthropometric differences between individuals or populations does not necessarily imply the existence of nutritional differences. One cannot, for example, in a nutritional supplementation program, use anthropometric status in a simple minded way as a criterion of nutritional success. Rather, the question that must be asked is how well, if at all, we can use anthropometry to predict nutritional status. What is required is some function, or functions, of anthropometric and other relevant measurements that predict either specific or general nutritional states.