Well-nourished Children Research Articles

The Use Of Changes In Hair Root Morphology In The Assessment Of Protein-Calorie Malnutrition

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of Black West Indian children. Significant differences in mean shaft diameter, mean % anagen, and mean % telogen were found only between the well-nourished and the severely malnourished groups. No significant differences in mean % atrophy, and in mean diameter of anagen bulbs were found among well-nourished children, children with mild-moderate PCM, severely malnourished children, and children hospitalized for conditions with a secondary effect on nutritional status. The method was found to be time consuming; it can be used only for differentiating well-nourished from severely malnourished children; and it cannot be used for determining the prevalence of the different degrees of PCM. For these reasons, the method is not recommended for use in the field assessment of PCM.

Head and chest circumferences in rural Guatemalan Ladino children, birth to seven years of age

Growth patterns in head and chest circumferences are reported for a mixed-longitudinal sample of rural Guatemalan Ladino children from birth to 7 years of age. The sample is representative of a population with suboptimal nutrition. Both circumferences show similar rapid growth from birth through 9 months, after which chest circumference continues to increase more rapidly, while head circumference increases at a slower rate. Chest circumference provides nutritional information apparently not contained in length and weight. Compared to a sample of well-nourished children from Denver, the head circumferences of Guatemalan children are consistently smaller. Differences are relatively small at birth, are well established by 6 months, and become progressively greater through 24 months. After 2 years the mean smaller head circumference of the Guatemalan children also reflects stunted growth during the first 2 years of life. Similarly, among 5-year-old Guatemalan children of similar stature, head circumference at 5 years of age indicates which of these children were more stunted in stature at 2 years of age.

Timing of Neurological Development in Rural Guatemalan Children

This is a cross-sectional study of the anthropometric measurements and neurological evaluation of 559 children under 36 months of age (286 boys and 273 girls) from a rural area of Guatemala. Height and weight were compared with values from well-nourished Central American children which do not differ from North American standards. Head circumference was compared to standards from 14 different studies compiled from the world literature. The analysis of the data showed that the study population was far behind these standards in its physical growth characteristics. Results are presented for the timing of neuromotor skill development by calculation of the 16th, 50th and 84th percentiles for individual neurological functions by the probit method. Comparable data from other populations using the probit method of analysis are generally not available. One exception is the age of walking, which appeared to be delayed approximately four months in the rural Guatemalan children when compared to previous studies analyzed in this manner. These results should not be taken as patterns or norms but rather as a baseline for future studies.

Isolation ofCandidaspecies from the gastrointestinal tract in malnourished children

The rates of isolation of various species of c'andida from gastric and small intestinal contents were studied in three groups of patients: 27 relatively well-nourished Australian children of Caucasian extraction, and two groups in which malnutrition is endemic (30 Australian aboriginal children and 27 Indonesian children). The rate of isolation of C'andida sp. was significantly increased in the gastric and intestinal contents of the malnourished children (in each instance P < 0.025). There were considerable differences in the species of (J'andida found in the three groups: isolations of the known pathogen, C aihicans, were uncommon in the well-nourished children, whereas the species, C. tropicalis and C. parapsilosis, were predominant in the malnourished children. The reasons for these differences are obscure and may be related to genetic or environmental differences or to undetermined sequelae of malnutrition. It seems possible that the increased incidence of C'andida sp. in the gut of these children contributes to the common problem of diarrhea in malnutrition. A m. J. Cliii. Nutr. 27: 345349, 1974.

Protein intake of well-nourished children and adolescents

A number of dietary studies were made in order to learn the protein intake of children who were considered as being healthy and well-nourished while eating their customary diets. Observations of 480 boys and girls 1 to 20 years of age are reported. Individual diets for 1 to 2 weeks were weighed, and all foods were analyzed for nitrogen content. The findings indicate that protein intake varied with the rate of growth, age, and body size. The mean total intake of boys at any age or size was higher than that of girls of the same age or size. The total protein intake increased with age throughout the period of growth and with growth in size as measured by height, weight, and surface area. The highest correlation appeared between total intake of girls through pubescence and between that of both boys and girls and height throughout growth. The lowest was between total intake and age. There was a high negative correlation between protein intake per kilogram body weight and age. The total intakes referred to age were comparable to the earlier findings by Eppright and Burke but lower than some more recent reports and higher than the 1968 Recommended Daily Dietary Allowances.

The incidence of bacteriuria and pyuria in Peruvian children with malnutrition

A group of 200 malnourished children and a control group of 118 well-nourished children were surveyed for bacteriuria and pyuria. The children were either ambulatory or hospitalized patients suffering from a variety of illnesses, but none had signs directly referable to urinary tract infection. Clean-voided specimens were obtained using a strict technique in the collections. Incidence of bacteriuria was found to be equally common in the two groups. Significant bacteriuria was found in 6 per cent of the malnourished group and in 4 per cent of the control group. The correlation between pyuria and bacteriuria was similar in the two groups.

Morphological aspects of the duodenojejunal mucosa in protein-calorie malnourished children and during recovery

The characteristics and evolution of different morphological and functional alterations present in the proximal small intestine of 11 severely protein-calorie malnourished children were studied in relation to nutritional status, diarrhea, and intestinal parasitic infection. Four healthy, not previously malnourished children whose background was similar to that of the PCM subjects, were also studied. None of the morphological characteristics examined correlated with either the presence or degree of intestinal parasitic or protozoa infection. Morphologically, the thickness of the duodenojejunal mucosa of the PCM patients as well as the heights of the epithelial cell and its brush border increased with nutritional recovery. Nevertheless, the presence of diarrhea adversely affected improvement and was associated with a decrease in the mitotic activity and an increase of the cell infiltrate in the epithelium. All other morphological characteristics, including the ridged appearance of the mucosa and the cell population of the lamina propria, remained unchanged and showed no relation to nutrition or diarrhea. The morphological characteristics of the upper GI mucosa of normal, well-nourished children, were no different from those observed in the recovered patients. PCM cannot be considered the only cause for the alterations found, as the presence and frequency of nonspecific diarrhea were also associated with several of those alterations; a frank interaction between PCM and diarrhea was frequently observed. It appears that the ecological situation characteristic of environments where poor hygienic conditions and diarrhea prevail plays an important ce:role in the genesis and persistency of the GI alterations observed in children with and without clinically evident PCM.

The effect of riboflavin supplementation on the urinary hydroxyproline: creatinine index in a resettlement village in rural Thailand.

I. The urinary hydroxyproline : creatinine index was measured in forty-one preschool children, ranging in age from IS months to 8 years, before and after they had received a supplement of 10 mg riboflavin/d for 7 d. It was found that the supplement increased the index in twenty-scven of the children. 2. The children were divided into two groups, those with indices C 1.5 and those with indices > I' 5 before supplementation. 3. The hydroxyproline :creatinine index was found to increase significantly (P 1.5. 4. There was no significant difference between the two groups, in either riboflavin status before supplementation or mean age. 5. The part played by riboflavin in protein utilization and growth is discussed. The urinary hydroxyproline : creatinine index was introduced by Whitehead (1965) as a criterion for USC in the early detection of marginal malnutrition. It was suggested that index values below 2-0 showed marginal malnutrition and Whitehead (1965) found that subjects with clinically recognizable signs of malnutrition usually had index values below 1.5. Studies carried out in two villages in north-east Thailand in 1969 showed that index values from below 1.0 to above 5.0 were found for the infants and preschool children in both villages but not one of these children was clinically malnourished (Migasena, Thurnham, Pongpaew, Jintakanon & Harinasuta, 1971). Subclinical malnutrition, however, was possibly present among the village children since their growth rates were below those of a group of well-nourished Thai children and Western standards (Migasena et al. 1971). In addition, evidence of inadequate dietary intakes in civilian diets were revealed by a nutritional survey carried out by the Interdepartmental Committee on Nutrition for National Defense (1962) which showed that, although protein and caloric intakes were probably adequate, vitamin intakes were generally low. Biochemical ariboflavinosis has been demonstrated among the preschool children in both villages referred to above (Thurnham, Migasena & Pavapootanon, 1970; Thurnham, Migasena & Vudhivai, 1971). A low dictary intake of riboflavin has been shown to reduce the growth rates of weanling rats on both high-protein and lowprotein diets (Sugioka, Porta, Corey & Hartroft, 1969). Thus, it was of interest to

Nutrition education for mothers of Filipino preschool children

The Mothercraft Center concept has been utilized in the Philippines to help teach mothers, who cannot afford to buy milk, meat and eggs, how to cdequately feed their preschool children. EDITOR'S NOTE: Mrs. Suter's vivid portrayal of her personal experiences in nutrition ed­ ucation at a simple, rural level contains many points that apply to simple and com­ plex community programs. This article is a demonstration of the essentials - motiva­ tion, demonstration, and cooperation-with plenty of tender loving care for good mea­ sure. The Philippine Archipelago of more than 7,000 islands extends over 1,000 miles. Only 462 of the islands have an area of a square mile or more, and two of them have 68% of the total land area. The 1960 census reported a population of 27,455,799 (1). The present popula­ tion is approximately 38 million. Ac­ cording to recent World Health Organi­ zation reports, the Philippines has one of the highest birth rates in ,the world with 3.5% annual increase of popula­ tion. Engel pointed out a very serious prob­ lem the Philippines is facing: based on a weight survey of several thousand chil­ dren (2), he has estimated that half of the six million children aged six months to six years are undernourished or mal­ nourished. An indioation of how the problem hinders the growth of the chil­ dren is the fact that by the time the aver­ age Filipino child reaches the body stat­ ure of a well-fed 24 months-old child, he is already 40 months old. Engel also has shown that growth ,arrests take place early since the average nine-months-old Filipino is only 83% of the standard weight and is down to 75% of the stan­ dard weight by 18 months of age. The child maintains this subnormal level of development up until the time he begins school. This raises the question of whether he wOllld,be ready for school at six years of age when his developmental age is about three and a half years old (3). It is commonly thought that many Asians are of short stature because of genetic reasons. Surveys in the Philip­ pines, Indonesia, and Malaysia show that well-nourished, pre-school Asian children have essentially the same body weights for age as well-nourished chil­ dren in the United States and Europe. Scrimshaw noted that genetic differ­ ences are only a minor factor in physical growth and development when popula­ tions are considered (4). It has been pointed out repeatedly that every child has the right to be able to develop to his fullest physical and mental growth po­ tential within his genetic capacity (5). According to Philippines Department of Health statistics, the death rate for this pre-school aged group is 11 to 12 times higher than in the United States. Pneumonia kills more infants and chil­ dren below five years of age than any other disease in the Philippines during the cold rainy season. Many of the chil­ dren die from complications of flu and measles. Well-nourished children have these same diseases with few deaths re­ sulting from them. Malnourished chil­ dren are more susceptible to disease and infection (6). The literature contains publications of investigators from around the world who have been at work on the problem. Now enough technological and scientific knowledge has been developed; it is ap­ plicable for use in solving problems of

Energy Intake of Well-Nourished Children and Adolescents

Data are presented from studies of 715 well-nourished children and adolescents, 1-20 years of age, carried on at the University of Chicago. The oxycalorimeter was used to determine the energy values of diets. A set of factors is proposed for reducing total heat values obtained by the oxycalorimeter to their physiological equivalents. The data obtained by the oxycalorimeter averaged about 10% lower than those obtained by calculation. The mean total energy intakes of both boys and girls per day were found to increase with age and with increased body size, whether measured by weight, height, or surface area. The rate of increase appeared to coincide with the rate of growth. The mean energy intakes of boys were higher than those of girls at every age and in every size bracket. The relationships were definitely closer in every case between total intake and measures of body size than with age. Intakes of older adolescent girls were lower than those of the same age or size who were still growing. The energy intakes of children per unit of weight decreased with age, those per unit of height increased somewhat, and those per unit of surface area remained constant through puberty. The relationship between energy intake and body size was improved by adding age as a third factor in case of the intake per centimeter by girls and per square meter by boys. Total calories referred to height or calories per unit of height per age would seem to be the indices preferable for use in determining need. Children of the same age and size do not necessarily need time same amounts of food.

Protein-calorie malnutrition in Candelaria, Colombia. I. Prevalence; social and demographic causal factors.

This study examines the relationships of various sociodemographic factors (accident of birth factors; cultural; maternal; economic; family size) and the nutritional status of children. A survey was conducted and covered 506 families in which there were 1094 children under the age of 6 corresponding to 23% of the total population. Anthropometric measurements of children and data concerning mothers from all 506 families were collected as were complete socioeconomic data from a random sample of 354 families which included 721 of the children. Nutritional status of the children was evaluated using the system of Gomez et al from the Hospital Infantil in Mexico (1955). The Gomez system is a simple comparison of observed bodyweight and expected normal weight for age based on a standard derived from well-nourished children. More than 40% of the children were classified as malnourished with children between the ages of 12 and 36 months constituting the most vulnerable age-group. The commonly considered causal factors poverty and ignorance as well as other social and demographic factors interacted with each other in the complex web of causation. The findings also show that it is the mother who transmits these factors thus determining the nutritional status of the child. The mother too is affected by some of these factors. Nowhere is the interaction of social and biological factors in disease causation more apparent than in PCM (protein-calorie malnutrition). The problem is biological at the cellular level (cells require proper variety of nutrients if normal metabolism and growth are to be maintained) but becomes complicated when social and cultural factors affecting delivery of such nutrients becomes the issue. If the mothers in Candelaria can limit their family size and they have expressed their desire to do so evidence shows that the nutritional status of preschool children there would improve.

The effect of severe early malnutrition on cellular growth of human brain.

Extract: In ten ‘normal’ brains, obtained from well-nourished Chilean children who died accidentally, weight, protein, and DNA and RNA content were all normal when compared with those values derived from similar children in the United States. Table I demonstrates the values obtained in these children. In nine infants who died of severe malnutrition during the first year of life, there was a proportional reduction in weight, protein, and RNA and DNA content. The actual values for these determinations are given in table II. The number of cells was reduced but the weight or protein per cell was unchanged Three infants who weighed less than 2,000 grams at birth (Infants 2, 3, and 4, table II) were the most severely affected. These data are similar to previous data in animals and demonstrate that in children, severe early malnutrition can result in curtailment of the normal increase in brain cellularity with increase in age.Speculation: At present there is growing concern that malnutrition early in life may retard normal development. Studies conducted in Africa, in South America, in Mexico, in Guatemala, and in our own country suggest that this is true. Retarded brain growth has also been suspected in malnourished children. The decreased head circumference often noted has been cited as evidence for retardation in brain growth. Although numerous chemical changes secondary to undernutrition have been shown in brain of animals, similar studies have not been available in human brain. This study demonstrates such changes and establishes that cell division is curtailed in human brain by severe early malnutrition. The data provide yet another link in the ever lengthening chain of evidence linking malnutrition to faulty brain growth and development.

Nutrition and infection field study in Guatemalan villages, 1959-1964. VII. Physical growth and development of preschool children.

This paper evaluated and compared the growth and maturation of preschool children in 3 study villages in Guatemala. Specifically this study sought to determine the extent to which the observed growth responses could be attributed to the nutrition program in the feeding village or to the program of environmental sanitation and health services in the treatment village. Sequential measurements of height weight skinfold over triceps and head circumference were made for all preschool children but those of height and weight were the ones concentrated on for the 5 years of the study. Head circumference although equal at the start of the study increased for the boys faster than for the girls in the 3 villages. Preschool children of both sexes in the feeding village had greater head circumferences than their counterparts in the treatment or control villages. However in all 3 cases these measurements were significantly smaller than for comparable groups in the US. Increase in skinfold measurements with age was similar for boys and girls in all 3 villages. For gain in height with age the general patterns in the 3 villages were similar although children in the feeding village tended to grow faster in height than those in the other 2 villages. Rates of gain in weight with age followed a similar pattern. Average age-specific gains in height and weight were less among children in the treatment and control villages than in the feeding village. The maximum growth potential was generally greater for boys than girls although differences were not significant. Estimates for maximum growth potential for both sexes do not differ among the villages. For weight gain in children under age 1 there were no significant differences between the sexes among the 3 villages in maximum growth potential or growth acceleration. Boys and girls (ages 1-4) in the feeding village have significantly higher rates of gain in height and weight. No significant relationship was found between days of illness and height or weight gain. Clearly children in the feeding village displayed superior nutritional status as seen from growth curves and data on bone maturation and head circumference. However they were still significantly retarded when compared to well-nourished children. Actually the nutritional status of children even in the feeding village was far from optimal due to the irregular consumption of the food supplement. Their better growth performance may have been due to the nutrition education program rather than the supplementary feeding. The 1st hypothesis that the nutrition in the feeding village would improve nutritional status was supported by moderate gains in height weight bone age skinfold thickness and head circumference. The 2nd hypothesis was not supported; that the introduction of environmental sanitation disease prevention and medical care would reduce frequency and severity of disease to allow for an improvement in nutritional status.

Calorie intake of children withDown's syndrome (mongolism)

The total calorie intake of each of 23 institutionalized children with Down's syndrome was measured for 14 days. Children with this condition are typically short for their age; the heights of 20 of the subjects in this study were in the 0 to third percentile. None of these short but well-nourished children consumed the number of calories recommended by the national Research Council (NRC) for their age group, but they did consume a normal number of calories per unit of body weight, height, and surface area. Calorie allowances of these children are estimated most effectively in terms of body height. The total calorie intake of each of 23 institutionalized children with Down's syndrome was measured for 14 days. Children with this condition are typically short for their age; the heights of 20 of the subjects in this study were in the 0 to third percentile. None of these short but well-nourished children consumed the number of calories recommended by the national Research Council (NRC) for their age group, but they did consume a normal number of calories per unit of body weight, height, and surface area. Calorie allowances of these children are estimated most effectively in terms of body height.

Cholinesterase Activities in the Serum of Healthy British Children

IN the course of some work which was being done in Germany on the effect of a liberal diet on the serum cholinesterase levels in under-nourished children1, it was realized that there were no corresponding figures for healthy, well-nourished children available for comparison. It was therefore decided to measure the pseudo-cholinesterase activity of the serum of normal girls and boys. Blood was taken from 111 healthy children attending schools in Cambridge. These children were all between five and fifteen years old and so far as possible each year of age was represented by five girls and five boys. Preliminary experiments had shown that the activities of sera from blood obtained by ear puncture did not differ significantly from the serum activities in the same subjects when the blood was taken by venepuncture. Blood samples, therefore, were obtained by puncturing the lobe of the ear with a piece of capillary tubing and allowing the blood to fall directly into an agglutination tube, which was then quickly closed with a rubber stopper. The serum was separated in the usual way. Cholinesterase determinations were carried out in duplicate in a Warburg apparatus by the method used by McArdle2, with acetylcholine chloride as substrate. Activities were expressed in c.mm. carbon dioxide/ml. serum/min.

Feeding Problems of Ill Children

THE nurse who is caring for sick children in a hospital ward may be compared to the old woman in the shoe who had so many children she didn't know what to do, the emphasis being placed on the last clause when one is referring to the eating problems of the sick institutional child. The majority of hospital procedures are definitely established by organized nursing research and by doctors' orders, but the question of the correct psychological method of presenting food in order to stimulate the sick children to eat remains a problem. Appetite which is the stimulus to eating in the case of well children is often absent in the sick children. Other stimuli ordinarily associated with eating must be magnified and utilized to encourage the children to take sufficient nourishment. Pediatricians vary somewhat, but all agree that fever inhibits the flow of gastric juice and that the diet should be reduced during the critical stage of the disease. Some pediatricians believe that well-nourished children may be permitted to refuse nourishment for a number of days until the acute stage of the disease is passed, providing the destructive process is not too rapid. During this time, however, fluids must be taken by all children either by mouth or by artificial means. Again, the motor ability of some children may suffer to the extent of extreme prostration or convulsions, and mental ability may suffer to the degree of delirium and unconsciousness which inhibits any response to offered food. One noted pediatrician states that, contrary to most rules, small amounts of salty and wellseasoned foods may be offered, as they stimulate the flow of the gastric juice and hence the appetite. There is also the complication that the children who have come to the hospital have been forced to make many critical changes. From the former associations of the home, parents, friends, health and diet, they are experiencing strange faces, institutional food, hospital environment, and pain. Among the disturbing procedures to which they are submitted upon entrance are spinal punctures, venipunctures, blood counts, nose and throat cultures, and tuberculin tests. All these, however, are new and trying experiences to sick children and therefore when they are offered food they frequently react favorably as this situation is much more pleasant than others that have preceded. The eating situation has been entirely altered when they change from home to hospital. Here they must stay in their cribs and have their meals served to them on individual trays with unfamiliar dishes and utensils and without favorite foods; also without the stimulating presence of members of the family. The foods which are served in the patients' homes are as varied as the number of nationalities which are represented in a crowd watching the passing of an Independence Day parade. It is not unusual for the three-year-old Italian baby to inspect his tray and, without tasting any of the food, ask for spaghetti; for the Mexican child to wail for his chili or tamales, and the colored child his favorite pork and beans. Far be it from the thought of any mother to anticipate the unfortunate hospitalization of her offspring and avail herself of the hospital menu. The influence of home routine may or may

FLATFOOT IN INFANTS AND CHILDREN.

The subject of flatfoot in children has received but little attention and the condition is often overlooked. The former opinion that all children were flatfooted at birth has been rendered untenable by the investigations of Dane, who demonstrated that a normal arch exists at birth, but that in well-nourished children a pad of fat is present in the sole of the foot which fills up the natural hollow of the foot and leads to the appearance of flatfoot. In thin children this pad does not exist and the imprint of the foot then resembles the adult type. Section of the bones shows that the arch of the foot exists from birth. FLATFOOT IN INFANTS. Heavy children who walk early, and especially if they have any grade of rickets present, are apt to show soon after beginning to walk a tendency to tread on the inner border of the foot, which is likely to attract attention.