Birth weight and psychomotor performance in rural Guatemala.
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Biomedical subjects
Publications and source records attributed to R E Klein.
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The relationship between morbidity and physical growth increments was investigated in 716 Guatemalan children ranging in age from 15 days to 7 years. The growth variables investigated were semestral and yearly increments in total body length and weight. The number of days ill with diarrhea, fever, and respiratory illnesses per semester or year was used as an indicator of morbidity. The morbidity data were collected through bi-weekly retrospective interviews of mothers. Children less ill with diarrhea had substantially larger increments in length and weight than children who were ill with diarrhea a greater percentage of the time. In contrast, fever and respiratory illnesses did not affect growth rates. These findings highlight the fact that diarrhea is a major public health problem in developing nations.
The present study reports 5,029 length and weight measurements as well as percentile distributions for a mixed longitudinal series of 1,119 rural Guatemalan Ladino children. The study sample, birth through seven years, is representative of children in clinically good health, but of suboptimal nutrition. Boys are longer and heavier than girls over the age range. Guatemalan children of both sexes are smaller than American white children from Denver. Differences are least at birth, and increase through two years of age. Between two and five years, differences between the rural Guatemalan Ladino and Denver samples are rather stable, but then increase through seven years. Despite these differences there is a linear weight for length relationship which is the same across all preschool ages, both sexes, and for both the Guatemalan and Denver populations. This implies that age, sex, ethnic differences between the two groups compared, and mild-to-moderate protein-calorie malnutrition do not affect the relationship between weight and length in preschool children.
The relationship between diarrheal diseases and growth increments in total body length and weight was investigated in 716 rural Ladino Gautemalan children. Data on diarrheal diseases were provided by the mothers through retrospective surveys carried out at 14-day intervals. Increments in length and weight, semestral from near birth at four years and yearly thence to seven, were related to days ill with diarrheal diseases during the same time interval. Because the data here reported were collected over a two year period, a child may have had information for more than one period. In total, 1,343 child periods were investigated. Days ill with diarrheal diseases were found to be significantly associated with reduced growth in length and weight. It was assumed that the average differences in growth by seven years of age between children in the present sample and children from well-to-do societies, are mainly a function of environmental differences and consequently, a measure of the extent of growth retardation. By expressing the growth retardation specifically associated with diarrheal diseases as a fraction of the above differences it was then estimated that around 10% of this growth retardation was associated with diarrheal diseases.
Measurement variability estimates for 18 different anthropometric dimensions were collected within the context of an ongoing longitudinal in vestigation of preschool Guatemalan children. Estimates of total measurement variance, intra-observer variance, and short-term intra-subject variance are presented for each variable. A simple procedure for the evaluation of measurement variance in cross-sectional and longitudinal investigations is described in which the total measurement variance is expressed as a percentage of the appropriate inter-subject variance. This statistic serves as an index of the relative reproducibility of anthropometric variables.
Habituation of the orienting response (OR) was used to assess possible attentional deficits associated with infantile malnutrition. The procedure involved the presentation of 40 trials of a pure tone stimulus to 8 marginally nourished and 8 malnourished 13 1/2-month-old male infants. The results showed that the initial OR to stimulus onset, as measured by the magnitude of cardiac deceleration, was significantly larger in marginally nourished than in malnourished infants. Within-group comparisons revealed that marginally nourished infants showed significant increases in OR magnitude to changes in tonal frequency whereas the malnourished infants did not. The results were taken as evidence of an attentional deficit associated with infantile malnutrition that is likely to interfere with subsequent learning.
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This paper discusses some conditions necessary to detect an effect of maternal nutrition on birth weight and the relative contribution of calories and protein to such an effect. The expected dose- and time-response relationships for nutritional interventions aimed at the improvement of birth weight are also discussed. There appears to be a minimal level of nutrients which must be available in order to obtain adequate birth weight. However, above this minimum level, pregnant women can adapt themselves to a wide variety of food intake, both in quantity and quality, without affecting birth weight. The relative contribution of calories and protein to an increase in birth weight depends on the limiting nutrients of the home diet in the population under study. Other factors like physical activity, prevalence of disease and magnitude of the maternal nutritional stores before pregnancy are also important determinants of the relative contribution of calories and protein to birth weight. The anticipated input of a nutritional intervention on birth weight should range between 25 and 84 g of birth weight/10,000 kcal ingested during pregnancy. This estimate was computed from analyses based on four sources of published data: weight gain during pregnancy, prepregnant weight, fetomaternal body composition, and food intake during pregnancy. The expected reduction in proportion of low birth weight (LBW less than 2.5 kg) babies following a nutritional intervention will depend not only on the estimated range of fetal weight increase but also on the total amount of supplemented calories ingested during pregnancy as well as on the existent proportion of low birth weight babies prior to the intervention. The offspring of women who have low prepregnant weight, poor diet, low level of replacement of the home diet by the supplement, low physical activity during pregnancy and good health status will show larger increase in birth weight per unit of supplemented calories. Finally, nutritional interventions during pregnancy as opposed to earlier in the life of the mother, should have the higher impact on birth weight. In consequence, interventions as of pregnancy are recommended.
The number of deciduous teeth in a sample of rural Ladino Guatemalan children was counted every 3 months through 24 months of age, and at 6-month intervals from 24 to 36 months. Nutritional status at birth, whether expressed as full-term birth weight or as maternal caloric supplementation during pregnancy, influences the timing of deciduous tooth eruption. Furthermore, the timing of deciduous tooth eruption seems more closely associated with postnatal weight than with birth weight. Although indices of nutritional deficiencies are associated with retarded tooth eruption, the use of mean number of deciduous teeth erupted as an estimate of mean chronological age in populations living under conditions of mild-to-moderate malnutrition is relatively accurate because errors of age estimation based on mean values for the present sample only vary between 1 and 2 months.
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.
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The high prevalence of low-birthweight (less than or equal to 2,500 gm) babies in many poor communities is a major public health problem. Studies in humans in situations of acute starvation suggest an effect of maternal nutrition on birthweight, but less clear results appear under situations of moderate maternal malnutrition. We studied the effects of food supplementation during pregnancy on birthweight in four rural villages of Guatemala, in which two types of supplements were distributed: protein-caloric and caloric. The caloric supplementation increased the total caloric intake during pregnancy. In both supplements, the amount of calories supplemented during pregnancy showed a consistent association with birthweight. In the combined sample the proportion of low-birthweight babies in the high-supplement group (G greater than or equal to 20,000 supplemented calories during pregnancy) was 9% compared with 19% in the low-supplement group (less than 20,000 supplemented calories during pregnancy). The relationship between caloric supplementation and birthweight (29 gm of birthweight per 10,000 supplemented calories) was basically unchanged after controlling for the maternal home diet, height, head circumference, parity, gestational age, duration of disease during pregnancy, socioeconomic status, and different rates of missing data. Moreover, a similar association was found in consecutive pregnancies of the same mother. We concluded that caloric supplementation during pregnancy produced the observed increase in birthweight.
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