Change in body water distribution index in infants who become stunted between 4 and 18 months of age

OBJECTIVE

To evaluate body composition changes using bioelectrical impedance analysis and skinfold thickness measurements in infants from tropical areas who become stunted between 4-18 months of age.

DESIGN AND MEASUREMENTS

Follow-up study. Extracellular water to total body water ratio index (length(2)/resistance at low to high frequency), peripheral fat (tricipital and subscapular skinfold thickness), and length-for-age index were studied at 4 and 18 months of age.

SETTINGS

Low-income areas in four tropical regions (Congo, Senegal, Bolivia and New Caledonia).

SUBJECTS

Infants were included in the analysis provided they were neither stunted nor wasted at 4 months. Two groups of infants were compared, those that were stunted at 18 months (n=61) or not (n=170).

RESULTS

The extracellular water to total body water ratio index and the sum of skinfold thickness measurements were similar in the two groups at 4 months, and only the extracellular water to total body water ratio index was significantly different at 18 months. When no stunting appeared between 4 and 18 months, the change in the extracellular water to total body water ratio index was not linked with variations in length-for-age, and presented the expected pattern of variation in body water compartments. When stunting occurred, variation in length-for-age was related to significant changes in the extracellular water to total body water ratio index, the biggest increase in the proportion of extracellular water being found in the most stunted infants. Variations in the sum of the two skinfold thickness measurements presented the expected pattern for the 4-18 months growth and did not differ between the two groups.

CONCLUSIONS

Multifrequency resistances suggested that stunting was associated with a lack of the expansion of the intracellular compartment that is expected during normal growth of cell mass, together with preserved fat mass.

SPONSORSHIPS

Supported by grant 92L0623 from the French Ministry of Research, and by Institut de Recherche pour le Développement (IRD).

Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude

OBJECTIVE

To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude.

DESIGN

Double blind iron supplementation trial including a placebo control group.

SETTING

A socioeconomically disadvantaged district of La Paz, Bolivia (altitude of 4000 m).

SUBJECTS

Anemic (hemoglobin concentration < or = 144 g/L), 3.3-8.3 y old children of both sexes.

INTERVENTION

Children received a placebo (n = 57) or a dose of 3-4 mg of elemental iron per kg body weight (FeSO4 tablets) 1 d per week (n = 58) or 5 d per week (n = 58) for 16 weeks.

RESULTS

Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group. Changes in hemoglobin during the study were not significantly different between supplemented groups (weekly group: 15.2 +/- 6.9 g/L and daily group: 18.6 +/- 11.1 g/L) but were different from the placebo group (0.5 +/- 7.1 g/L, P < 0.001). At the end of the supplementation period, the hemoglobin distribution was Gaussian, and similar in both supplemented groups. Adjusting for the initial hemoglobin concentration, final hemoglobin and its changes were similar in both supplemented groups.

CONCLUSION

Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude.

SPONSORSHIP

Program supported in part by ORSTROM, the French Ministry of Foreign Affairs and the National Secretary's Office of Health, Bolivia.

Definition and prevalence of anemia in Bolivian women of childbearing age living at high altitudes: the effect of iron-folate supplementation

This paper discusses the effect that high altitudes have on iron metabolism and summarizes the results of an iron-folate supplementation trial. The two main objectives of the trial were to determine hemoglobin cut-off values for the diagnosis of anemia in Bolivian women of childbearing age living at high altitudes, and to estimate the prevalence of anemia in this population. The study showed that nutritional anemia is an important public health problem in such populations and that many methods of assessing it lead to an underestimation of prevalence. The cut-off values defined through this study, one of the few iron supplementation trials conducted at high altitudes, confirm the need to establish revised hemoglobin values for the diagnosis of anemia in populations living at high altitudes.

Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial

The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.

Effect of altitude and socioeconomic status on VO2max and anaerobic power in prepubertal Bolivian girls

The aim of this work was to evaluate the effects of high altitude and low socioeconomic status (SES) on aerobic and anaerobic power in 11-yr-old Bolivian girls. At both high (3,600 m) and low (420 m) altitudes, low-SES groups of girls were compared to similarly aged, high-SES girls. At low altitude, low-SES girls were also compared with younger high-SES girls with the same anthropometric characteristics. Anthropometric data were similar between high-SES and low-SES girls at both altitudes, but low-SES girls showed a 9-mo growth delay. Maximal O2 uptake was significantly lower for low-SES girls at both altitudes. Values did not differ when expressed relative to body weight at high altitude for high-SES vs. low-SES girls (37.6 +/- 1.2 vs. 39.3 +/- 1.0 ml.min-1.kg body wt-1), but a difference persisted at low altitude between high- and low-SES girls (37.5 +/- 1.0 vs. 34.7 +/- 0.7 ml.min-1.kg body wt-1). Anaerobic power (Pmax, force-velocity test; Pwing, Wingate test) was reduced for low-SES girls at both altitudes, whatever the mode of expression. For a given SES, the relative anaerobic performances were lower at low altitude. At low altitude, low-SES girls developed lower anaerobic power than did younger high-SES girls with similar anthropometric characteristics. In conclusion, at both altitudes, the reduction of anaerobic performances observed in girls of low SES could not be totally explained by anthropometric factors. Structural and/or functional muscle alterations are suggested. Moreover, at low altitude, tropical and other factors may have contributed to differences in performance between low- and high-SES girls.

Circulating proteins and iron status in blood as indicators of the nutritional status of 10- to 12-year-old Bolivian boys

The purpose of the present study was to evaluate the nutritional status of children based on anthropometric measurements, biochemical indicators of protein energy malnutrition as well as hematological variables. The subjects were 93 10- to 12-year-old Bolivian boys: 12 HAHSES, 28 HALSES, 36 LALSES, and 17 LALSES (see Introduction to this Supplement). The overall nutritional status of the boys was evaluated by anthropometric indicators (weight for age [W/A], height for age [H bd, and weight for height [W/H]). The biochemical indicators included proteins total, albumin, prealbumin, orosomucoid and protein C-reactive (for MPE) as well as hematocrit (Ht), hemoglobin (Hb), serum iron, serum ferritin, and transferrin saturation (TS). The prevalence of growth retardation of LSES boys at HA as well as at LA was found to be high when the 3rd percentile was used as the cutoff point. The corresponding prealbumin levels were found to be lower in LSES than in HSES boys at both altitudes. The study shows that LSES boys at both altitudes have significantly lower prealbumin levels than HSES boys. The socioeconomic factor seems to be more critical for the nutritional status of prepubertal boys than altitude. The study also shows that all the boys had hematological parameters within normal range. The HA boys of both SES had higher hemoglobin concentration and hematocrits than the LA boys, a fact that is explained by high-altitude hypoxia. The hematological data do not provide evidence of malnutrition among the boys.