Maternal nutrition and fetal growth in developing societies. Socioeconomic factors

Determinants of School Performance in Guatemala: Family Background Characteristics and Early Abilities

The purpose of this study was to explore how two sets of antecedent variables contribute to variation in school enrolment and performance in four villages in rural Guatemala. Measures of preschool cognition and indicators of family socioeconomic status (maternal education level and house quality) predicted school enrolment for boys and girls. Similarly, for those who went to school, socioeconomic status and preschool abilities were associated with age-atentry, the number of grades passed and failed, and the maximum grade attained. Multivariate regression analyses indicate that preschool abilities, after controlling for indicators of family background, explain significant portions of variance in age of entry and other measures of school performance. The results are interpreted in the light of the cumulative deficit hypothesis which postulates that early environmental disadvantages increase over time. These data indicate that the school experience contributes to maintaining, rather than reducing, social class differences.

Effect of multivitamin supplements on weight gain during pregnancy among HIV-negative women in Tanzania

Multivitamin supplementation has been shown to reduce the risk of low birthweight. This effect could be mediated through gestational weight gain. However, the effect of multivitamin supplementation on weight gain during pregnancy has not been fully studied. The objective of this study was to examine the effects of multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam, Tanzania, in a randomised, placebo-controlled trial of multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of multivitamin tablets or a placebo and were weighed every 4 weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253 g (SE: 69, P: 0.0003) more, while the overall 4 weekly weight gain was 59 g greater (SE: 18, P: 0.005) among women who received multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030 g (SD: 524), while women in the highest quartile had babies weighing 3246 g (SD: 486), on average. Prenatal multivitamin supplements increased gestational weight gain, which was a significant predictor of birthweight.

Maternal supplementation differentially affects the mother and newborn

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life.

Prevalence of maternal and neonatal infections in a developing country: possible low-cost preventive measures

The frequency and duration of infectious illnesses in 408 pregnant rural women and 417 poor urban infants in Guatemala have been investigated, together with morbidity and mortality among the offspring of the rural women. Rural women suffered high rates of infection during the gestation period. Symptomatic illnesses, mainly acute respiratory infection and diarrhoeal disease, usually showed a higher incidence during the last months of pregnancy. Significant bacteriuria was identified in 21% of the women, though symptoms of urinary tract infection were found in about 25%. Vaginal infection was found in 38% of women at the beginning of pregnancy and in 79% at its end. Twelve per cent of women showed evidence of reactivated infections with cytomegalovirus, herpes simplex virus and Toxoplasma gondii. The neonatal mortality rate in the rural population was 37.7 per 1000 liveborn infants. Most deaths were among preterm babies. Significant bacteriuria was related to low birth weight. Morbidity in rural neonates was also high, but the illnesses were not severe and had a short duration. Neonatal morbidity in poor urban infants was also high. Breast-feeding had a protective effect: breast-fed rural and poor urban infants had a lower incidence of illness than urban babies who were not breast-fed. The influence of infection during pregnancy on the conceptus and some low-cost measures for reducing it are discussed. Measures for decreasing neonatal morbidity in rural and poor urban ureas are proposed.

[Changes in nutritional status of pregnant women assisted at the basic health network, Santo Andre, Brazil]

Nutritional conditions in the pre-gestacional period and during pregnancy were evaluated in 372 pregnant women based on the body mass index and Rosso's Graph. Approximately half (51%) the pregnant women presented normal pre-gestacional weight; however, 17.7% were underweight and 31.3% overweight. In the third trimester, 18.8% were underweight and 28.2% overweight. The weight at birth increased as nutritional conditions during pregnancy improved. These results show the importance of appropriate anthropometric control in order to prevent a bad neonatal prognosis and reaffirms the importance of such activity during the whole routine of pre-natal control.

Intergenerational studies of human birthweight from the 1958 birth cohort. 1. Evidence for a multigenerational effect

OBJECTIVE

To investigate possible multigenerational influences on birthweight.

DESIGN

Data from the longitudinal study of one week's births in 1958 up to the age of 23 years, the British National Child Development Study, were utilized. These provide socio-biological information on the parents of the cohort, on the cohort members from birth onwards, and on the pregnancies and the birthweight of any babies born to the cohort members.

MAIN OUTCOME MEASURE

The main outcome was the birthweight of babies born to the cohort members, for whom complete intergenerational data were available for 1638 firstborn. Multiple regression modelling was used to investigate any associations between their birthweight and characteristics of their parents and grandparents.

RESULTS

Significant positive associations were found between babies' birthweight and parental birthweight but not gestational age. For the babies born to female cohort members additional findings included associations between their birthweight and the height of the maternal grandmother and the social class of the maternal grandfather, even after adjustment for such strong predictors of birthweight as maternal weight, smoking habit in pregnancy and baby's sex and birth order.

CONCLUSION

These results thus offer support for a multigenerational influence on birthweight passed through the maternal line.

Arm/head ratio in the nutritional evaluation of newborn infants: a report of an African population

A total of 848 appropriate-for-gestational age (AGA) infants were recruited for the study, and fully analysed, from three hospitals in Benin City, Nigeria. They were examined in order to develop a standard of arm/head ratio for nutritional assessment of the newborn in an African population. The anthropometric measurements were correlated with gestational age and the standard was developed from the regression line of arm/head ratio and gestational age and the corresponding 95% confidence belt. There was a highly significant positive correlation between arm/head ratio and gestational age (r = 0.89; p less than 0.001). Using clinical nutritional status as the reference, the standard had a good sensitivity of 85.5% and a specificity of 92.9%. Comparatively, age, weight classification had a sensitivity and a specificity of 67.7% and 85.3%, respectively. The arm/head ratio is simple and reliable. It is recommended for routine use, particularly in an African population.

The effect of nutritional intake on outcome of pregnancy in smokers and non-smokers

The relationship between nutrient intake and pregnancy outcome (adjusted birth weight and gestational age) was investigated in randomly selected non-smokers (n97) and in heavy smokers (15 + cigarettes/d) (n72) booking for ante-natal care at a hospital in South London. Weighted dietary intakes (7d) were obtained at 28 and 36 weeks gestation. Birth weight was adjusted for gestational age, maternal height, parity and sex of infant. Compared with non-smokers, intakes of micronutrients and fibre were lower in smokers at both 28 and 36 weeks, and smokers reduced their intakes more in late pregnancy. The babies of smokers had a lower adjusted birth weight but there was no difference in length of gestation between smokers and non-smokers. After controlling for smoking, social class and alcohol consumption, nutrient intakes at 28 weeks were found to have no effect on adjusted birth weight. However, intakes of protein, zinc, riboflavin and thiamin at 36 weeks, and the change in intakes of these nutrients (plus iron) between 28 and 36 weeks, had independent positive effects on birth weight. Some of the effect of smoking on birth weight appeared to be mediated through differences in nutrient intakes. Smoking explained 14.3% of the variance in birth weight in this population and a further 2.4-7.2% was explained by change in nutrient intakes between 28 and 36 weeks. It is recommended that women in pregnancy do not reduce their dietary intakes in late pregnancy.

Routine testing and prophylaxis

Routine testing and prophylaxis is considered in terms of haematological disorders, biochemical testing, hormonal testing, screening for gestational diabetes and nutritional deficiencies. Within these headings the place of routine supplementation of pregnant women with iron, vitamins, trace elements and an increased protein/calorie intake is discussed. Screening for haemoglobinopathies, irregular blood group antibodies and gestational diabetes is dealt with in detail. The place for routine prophylaxis with anti-D is considered. Biochemical and hormonal testing is covered with particular reference to the use of biochemical and hormonal assays as placental function tests and their use in assessing fetal well-being. In this respect the use of biochemical and hormonal tests to screen a pregnant population for intrauterine growth retardation is also discussed.

Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight

The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight was tested in a controlled randomized trial in three villages in Madura, East Java. The high and low energy supplements provided 1.95 MJ (465 kcal) and 218 kJ (52 kcal) per day respectively. In the baseline period the home diet provided on average 6.28 MJ (1500 kcal) (SD 2.1 MJ (499 kcal] and 41 g (SD 13 g) of protein. The mean birthweight was 2835 g and the rate of low birthweight 12.2%. In the experimental period the home diet was better. The average intake ranged from 6.45 to 7.19 MJ (1541-1717 kcal) and 41.4-44.2 g per day, depending on the degree of compliance. Mean birthweight increased by 100 g and the rate of low birthweight dropped to 9.5%. There was no difference between the high and low energy supplemented group as a whole, probably due to the masking effect of the better home diet in the experimental period. It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and/or a low prepregnant weight. In this community targeting of supplementation to lean seasons and/or to women with a low prepregnant weight may be cost-effective.

Long bone lengths and gestational age distributions of post-contact period Arikara Indian perinatal infant skeletons

Prenatal growth is adversely affected by poor socioeconomic conditions where disease and chronic undernutrition prevail. Premature and small-for-gestational-age births occur at higher frequency. Post-contact Arikara Indian populations of South Dakota experienced a rapidly changing and disruptive environment that included deterioration of the subsistence base and increased morbidity. This research tests resulting fetal growth effects through comparative analysis of two perinatal infant samples of the early (A.D. 1600-1733) and the late (A.D. 1760-1835) post-contact period. Perinatal infants recovered from late cemeteries include a higher percentage of smaller skeletons, as determined using long bone diaphyseal lengths, than is documented for the earlier time period. This contrast shows that it is possible to detect fetal growth differences in samples of archaeological context.

[Evaluation of the impact of supplementary feeding to pregnant women in the control of low birth weight in the municipality of São Paulo, SP (Brazil)]

A partir de estudo realizado em oito grandes maternidades do Município de São Paulo, SP (Brasil) que atendem clientela predominantemente de baixo nível sócio-econômico, objetivou-se analisar o impacto da suplementação alimentar durante a assistência pré-natal sobre a incidência de recém-nascidos de baixo peso ao nascer (peso < 2.500 g). Foram envolvidos no estudo 1.060 recém-nascidos de mães que receberam suplementação e 664 recém-nascidos de mães que não a receberam. Ã incidência de baixo peso ao nascer foi de cerca de 11%, considerada elevada e semelhante em ambos os grupos de recém-nascidos. A análise multivariada, realizada para controlar eventuais diferenças entre os grupos, que não a condição de suplementação, descartou qualquer associação significativa entre suplementação e peso ao nascer e revelou, por outro lado, que tabagismo e morbidade na gestação e determinadas características antropométricas e reprodutivas da mãe, prévias à gestação, são importantes fatores de risco para o baixo peso ao nascer. A aparente explicação para a ausência de impacto da suplementação alimentar na população estudada parece residir não na quantidade insuficiente da suplementação alimentar oferecida (370 Kcal/dia), mas no predomínio de fatores não alimentares na determinação do baixo peso ao nascer. São formuladas recomendações quanto ao controle do baixo peso ao nascer no contexto estudado.

[Multivariate analysis of risk factors for low birth weight in live births in the municipality of São Paulo, SP (Brazil)]

Em casuística de 20.850 nascidos vivos não gemelares ocorridos em 31 maternidades do Município de São Paulo, SP, Brasil (parte da casuística total do Estudo Antropométrico do Recém-nascido Brasileiro), procurou-se identificar fatores de risco para o baixo peso ao nascer (peso < 2.500 g), tendo sido estipulados a priori, para estudo, os fatores escolaridade materna, estado marital, idade materna, paridade, peso pré-gestacional, tabagismo na gravidez e assistência pré-natal. A partir de análise multivariada pela técnica de modelos log-lineares, foram identificados quatro fatores de risco significativos: "ausência de assistência pré-natal", "peso pré-gestacional < 50 kg", "tabagismo na gestação" e "idade materna < 20 anos". O risco relativo associado a "ausência de pré-natal" foi de 2,2 nas mães de escolaridade inferior ao ginásio completo e de 3,4 nas de escolaridade igual ou superior àquele nível. Os riscos associados às características maternas de peso, tabagismo e idade foram respectivamente 1,9, 1,7 e 1,4 e independentes da escolaridade materna. Considerando-se além da magnitude dos riscos detectados a freqüência com que os fatores de risco se apresentaram na população, constatou-se que o peso pré-gestacional insuficiente, o tabagismo na gestação e a ausência de assistência pré-natal, particularmente em mães de "baixa escolaridade", são fatores cujo controle exerceria importante decréscimo na incidência de recém-nascidos de baixo peso. Assim sendo, tais fatores deveriam ser cuidadosamente considerados em programas de intervenção.

Correlates of fetal growth and survival

Data on 36 611 singleton deliveries in Indonesia were used to contrast patient characteristics, obstetric history and pregnancy outcome for two birth weightgroups among women experiencing the best and poorest stillbirth rates, namely 3 000-3 499 g and less than 2 500 g, respectively. The low birthweight group was characterized by younger age at first marriage, rural residence, lower educational attainment, less antenatal care and poorer pregnancy outcome and infant survival. Both groups showed progressive anemia prevalence with increasing parity with lower hemoglobin levels for the low birth weight group. Stillbirth rates were particularly high (60.6 per 1 000 pregnancies) for the under 20 year olds in the lower birthweight group. The results suggest poorer maternal nutrition among women with lower educational achievement, higher energy expenditures among rural women, nutritional reserves depletion with increasing parity and competition between the teenager's nutritional needs for her own physical growth and fetal growth as factors in low birthweight and perinatal mortality.

Amniotic fluid endocrine changes during maternal hyperalimentation

Ten women with low estriol excretion received hyperalimentation prior to induction of labor. Six received an amino acid mixture (5% Aminofusin) and 25% dextrose, two received the amino acid mixture, and two received 25% dextrose. Amniotic fluid obtained before and after hyperalimentation was assayed for fetal surfactant production, thyroid, pituitary, and carbohydrate regulating hormones. In the combined amino acid/dextrose infusion group the amniotic fluid palmitic acid levels increased significantly post infusion; rT3 also increased significantly but T3 and T4 showed no significant change. The pituitary hormones growth hormone, prolactin, and ACTH showed no significant change, but beta-endorphin-like activity was significantly elevated. No thyroid-stimulating hormone was detected in any of the samples. All the carbohydrate regulating hormones, insulin, cortisol, and cAMP, showed significant increases but cGMP showed a significant decrease. The amino acid and dextrose only groups gave similar results. Seven of the infants showed some degree of intrauterine growth retardation but no neonatal complications attributable to the hyperalimentation.

The Bacon Chow study: effect of nutritional supplementation on maternal weight and skinfold thicknesses during pregnancy and lactation

Effects of a feeding programme on maternal weight, triceps and subscapular skinfolds during pregnancy and lactation were assessed in a marginally undernourished population of rural Taiwan. Mothers participated during two pregnancy and lactation periods. At 3 weeks after the delivery of the first infant, one group of 114 mothers began consuming a nutrient-dense supplement (A), while another group of 111 received a placebo (B). There was no significant A-B difference in pregnancy weight gain (A 7.52 kg, B 7.75 kg) or in mean maternal weight, triceps or subscapular skinfolds at any time during pregnancy or lactation. Despite a general trend toward moderate weight loss during lactation, one-third of mothers in both groups gained weight. Highly significant increases in weight and skinfold thicknesses from one lactation period to the next characterized both groups. The absence of demonstrable supplement-effects on maternal anthropometry concomitant with increments in infant birth weight supports the notion that infants can benefit from maternal supplementation without changes in maternal nutritional status.

The neurology of poverty

An intellectual deficit is known to exist in populations where extreme poverty is rife and is thus seen extensively in the lower socio-economic strata of underdeveloped nations. Poverty is a complex entity whose sociological and economic indicators often bear little relevance to the biological agents which can affect the central nervous system. An attempt is made to express poverty in terms of identifiable defects, physiological in nature. Thus adverse socio-economic factors are converted into specific biological entities which, though necessary for adequate development of the brain, are restricted where there is poverty. A number of causative deficiencies, including nutritional, visual, auditory, tactile, vestibular, affective, and other stimuli are postulated. These interact and potentiate one another. Each is capable of an independent action on the brain and examples are given of some sensory deprivations as well as malnutrition and their possible mechanism of action. If the various deficiencies can independently harm the brain, then a number of separate specific functions should be affected; examples are offered. The nature of this intellectual deficit is probably a non-fulfillment of genetic potential of certain specific functions of the brain, which may exhibit limited variations between one community and another, depending on cultural differences. The deleterious effect of this intellectual impairment is seen most clearly in figures of school desertion, for example in Latin America. Analogous data for adults is scarce.

Anthropometric and biochemical changes during pregnancy in Asian and European mothers having light for gestational age babies

An assessment of nutritional status using anthropometric and biochemical measurements was made during pregnancy in 8 European and 15 Asian women who produced babies which were light for gestational age. These results were compared with similar measurements in women of both races with normal or pathological pregnancies (hypertension or bleeding) who produced babies of normal size. European mothers of light for gestational age babies with one exception had pregnancies complicated by pathology. They were heavy and fat but apart from urinary peptide hydroxyproline (which was reduced), no other biochemical measurement was specifically associated with poor intrauterine growth. Asian mothers of light for gestational age babies mostly had pregnancies not complicated by obstetric pathology. They gained less weight and fat during the second trimester and during the third trimester, they had biochemical evidence of a poorer nutritional status. Some of the biochemical changes were also noted in pathological pregnancies even though the mothers gained weight and fat normally and had well grown babies.

Maternal nutrition, prolonged lactation and birth spacing in Ethiopia

Data from 375 Ethiopian mothers show lactations of between 25 and 30 months in the majority, very prolonged even by African standards. Maternal nutritional status, as shown by body weights, was low due to very low food energy intakes. With frequent suckling already raising prolactin levels, these very low energy intakes may also result in yet more prolactin secretion. New pregnancies are delayed and birth intervals extended beyond normal African standards by all these factors.

Nutritional supplementation of pregnant adolescents

Disadvantaged pregnant black teenagers have a higher proportion of low-birth-weight infants and their offspring have a lower mean birth weight. One hundred and fifty-seven pregnant adolescents enrolled in a Baltimore public school for pregnant teenagers were studied to determine the impact of a nutritional supplement on pregnancy outcome. Seventy-eight students voluntarily agreed to receive a nutritional supplement; 79 comparably matched students did not receive the supplement. The supplement Sustacal provided a mean intake of 8691 cal with 530 g of protein and additional vitamins and minerals over an average period of 15.1 weeks. This supplement was associated with a significant increase of 157 g in the mean infant birth weight (P less than 0.05). A significant increase in infant birth weight of 269 g was noted in the offspring of supplemented girls below 16 years of age compared with the nonsupplemented girls below this age (P less than 0.05). Significant differences in infant birth weight were also noted in the offspring of nonsmoking supplemented adolescents (P less than 0.05). The proportion of low-birth-weight infants was decreased in the supplemented subjects, but the difference was not significant.

[Birth-weight distribution in the city of São Paulo, Brazil]

Através de levantamento amostral dos nascimentos ocorridos nas maternidades do município de São Paulo, Brasil, em 1976, foi estimada a distribuição do peso ao nascer dos nascidos vivos em São Paulo. As incidências de nascimentos abaixo de 2.501 g. e entre 2.501 e 3.000 g., 9,7% e 28,4%, foram duas vezes superiores às esperadas em uma cidade desenvolvida e concentraram-se mais nas maternidades públicas do que nas privadas.

The effect of rehabilitation at different stages of development of rats marginally malnourished for ten to twelve generations

1. Rats which have been maintained for ten to twelve generations on diets of low protein value were rehabilitated in utero (group P), from birth (group F) and from 4 weeks of age (group W). 2. Group W showed little change in physique, behaviour or learning, indicating that for recovery to be effective refeeding must begin earlier. 3. Group F just failed to attain full physical recovery (90%) whereas group P overgrew by 18.6% in weight and 8.5% in length. 4. In a test designed to evaluate learning ability rehabilitated rats of groups P and F were significantly less successful than normal rats, but more successful than rats of group W or rats of the original undernourished colony. 5. Rehabilitation for a further two generations in groups F and P corrected any residual physical and behavioural defects but produced no further improvement on the Lashley (1938) jumping platform.

[Birth weight and increase of infant mortality in São Paulo]

A influência que a distribuição do peso ao nascer exerceu sobre os coeficientes de mortalidade infantil de São Paulo em 1976 foi estudada através do ajuste destes coeficientes a uma distribuição ideal do peso ao nascer. Diferentemente de outros contextos de excessiva mortalidade, o excesso de óbitos infantis de São Paulo não parece dever-se fundamentalmente ao peso ao nascer. Algumas evidências sugerem que os fatores de mortalidade do ambiente físico e social do município poderiam ser mais vulneráveis a ações destinadas a reduzir a mortalidade infantil do que o seriam os fatores ligados à vitalidade do recém-nascido.

Effect of maternal nutritional status and infant supplementation during lactation on postpartum amenorrhea

This paper explores the effects of maternal nutritional status and food supplementation ingested by the infant on the duration of postpartum amenorrhea. A significant negative association was found between the nutritional status of the mother during the third trimester of pregnancy and the length of postpartum amenorrhea. A negative association was also found between infant supplementation and duration of postpartum amenorrhea. Each of these associations remained significant after controlling for the other, suggesting that both factors independently affect the length of postpartum amenorrhea.

Observations on intrauterine growth in urban Ethiopia

A total of 3144 deliveries comprising a wide range of socio-economic groups in Addis Abeba were investigated. A positive correlation was found between family income and birth weight, with a difference of nearly 500 g between the extremes of socio-economic classes. A seasonal variation in mean birth weight was also observed. The mean length of gestation was 7.4 days shorter, and the anthropometric measures at birth were significantly lower in the Ethiopian infants as compared with the Swedish norm. The median weight and length development in relation to gestational age in the Ethiopian newborns was similar to the Swedish standard up to approximately 34--35 weeks of gestation. After that time there was very little further intrauterine growth in Ethiopian infants. The possible reasons for the observed pattern of growth are discussed.

Influence of maternal nutritional status on prenatal growth in a Peruvian urban population

Anthropometric measurements were made on 4,952 mothers and their neonates from a Peruvian urban population. Based on age-specific percentiles, the mothers were separated into categories of short and tall stature, high and low fat, and high and low muscle. The study indicates that: (1) tall and short mothers characterized by similar subcutaneous fat and upper arm muscle area (whether high or low) had newborns with similar birth weight and recumbent length; (2) mothers characterized by high subcutaneous fat had heavier and fatter, but not longer, newborns than mothers with low subcutaneous fat; (3) mothers characterized by high upper arm muscle area had heavier, leaner and longer newborns than mothers with low upper arm muscle area; (4) mothers characterized by high muscle and high fat had heavier and longer newborns than mothers with high muscle and low fat; but (5) mothers characterized by high muscle and low fat had heavier and longer newborns than mothers with low muscle and high fat. Considering that subcutaneous fat and arm muscle area reflect calorie and protein reserves respectively, it is concluded that an increase in maternal calorie reserves results in increased infant fatness, but a lesser increase in linear growth. In contrast, an increase in maternal protein reserves does enhance both birth weight and prenatal linear growth.

Interaction of nutrition and infection in clinical practice

Resistance to infection is determined by a great many interralted factors, but one of the most significant variables is nutritional status of the host. The interaction between nutrition and infection has been described as synergistic, with malnutrition reducing resistance to infection, and infection, in turn, negatively affecting nutritional status. There are qualitative if not quantitative similarities between the evidence that has been gathered from studies of children living in vast areas of the developing countries, in which high rates of both severe malnutrition and infectious diseases are linked with high mortality rates, and evidence from studies of disadvantages children living in the United States in economically depressed migrant camps, Indian reservations, or rural and urban poverty, or children compromised by debilitating chronic diseases. Maternal nutritional status during pregnancy must receive more attention as a factor in the newborn's resistance to infection. Intrauterine malnutrition may cause impaired cellular immune function in the small-for-date infant which persists throughout the first year of life. Further research is needed to clarify this relationship. The optimal management of infections includes management or maintenance of nutritional status, and, in turn, management of nutritional deficiencies include prevention and treatment of infections.