The impact of anthropometric measures on plantar pressure distribution in male handball players and non-athletes: A cross-sectional study.

BACKGROUND: Increasing body anthropometry brings substantial spinal stress, which influences the spinal curvatures; this in turn may affect the foot plantar pressure distribution. OBJECTIVES: This study investigated the impact of body anthropometry on static plantar pressure distribution and their relationship among handball players and non-athletes subjects. METHODS: Thirty handball players aged from 21 to 26 years, and thirty age-matched non-athletes subjects aged from 21 to 28 years participated in this study. The spinal lordosis and kyphosis angles, trunk length, pelvic tilting, and pelvic rotation were evaluated using Formetric 4-dimensions and the Pedoscan device was used to assess the plantar pressure distribution. RESULTS: The handball players were significantly taller, heavier, and have a long trunk length than non-athletes group (p < 0.05), and a significantly increased thoracic kyphosis, forefeet pressure distribution compared to non-athletes group (p < 0.05). The handball players had a significantly increased forefeet pressure distribution compared to the rearfeet pressure distribution (p < 0.05), a high positive correlation between body height, and both trunk length and kyphosis angle (r = 0.932, 0.665 respectively), and the body height showed a high positive correlation with the forefeet pressure distribution (r = 0.665). There was a high positive correlation between the handball players' thoracic kyphosis and forefeet pressure distribution (r = 0.751). CONCLUSION: Increasing the handball players' body height was related to increased thoracic kyphosis and forefeet pressure distribution compared to non-athletes subjects. Additionally, the kyphotic posture of handball players is associated with increasing the total forefeet pressure distribution compared to the total rearfeet pressure distribution.

The effect of zinc supplementation on anthropometric measurements in healthy children over two years: a systematic review and meta-analysis.

BACKGROUND: Zinc deficiency is one of the most important micronutrient deficiencies in children that can affect the children's growth pattern. In this regard, different studies were conducted to assess the effect of zinc supplementation on growth patterns in healthy children. To the best of our knowledge, no systematic review has summarized the results of these studies. So, in the present study, we systematically reviewed the result of the studies that assessed the effect of zinc supplementation on anthropometric parameters in healthy, over 2-year-old children. METHODS: A systematic search was carried out in PubMed, Scopus, and Web of Science from inception to November 2021. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS: The pooled results of eight studies, including 1586 participants, showed that zinc supplementation significantly increases height [(WMD): 0.9, 95% CI: (0.27, 1.52), p < 0.001], weight [(WMD): 0.51, 95% CI: (0.06, 0.97), p < 0.001], height for age (HAZ) [(WMD): 0.07, 95% CI: (0.03, 0.10), p < 0.001]. Also, meta-regression analysis did not reveal any significant association between dose and duration of intervention and anthropometric parameters. CONCLUSION: The present study demonstrates the beneficial effects of zinc supplementation on weight, height, and HAZ.

Growth in height and body proportion from birth to adulthood in hereditary hypophosphatemic rickets: a retrospective cohort study.

PURPOSE: Patients with hereditary hypophosphatemic rickets are short and disproportionate and very little information is available on segmental growth, but the body disproportion at adulthood leads us to think that the growth velocity of legs is slower. METHODS: A total of 96 children were included and molecular testing was carried out in 42. Children who reached adult height were classified into two groups according to their compliance to conventional treatment (phosphate supplement and calcitriol). Individual growth records of height and sitting height/height were plotted using Argentine reference data in 96 children and growth curves were estimated by fitting Preece-Baines Model 1 in 19 of the children. RESULTS: Molecular testing revealed sequence deleterious alterations or large deletions in 36/42 patients. During childhood, 76% of children grew below - 1.88 standard deviation score (SDS) and 97% had body disproportion. During adolescence, the mean peak height velocity for the good and poor compliance to treatment groups was 7.8 (0.6) and 5.4 (0.4) cm/year in boys and 7.0 (0.7) and 5.2 (0.8) cm/year in girls, respectively. At adulthood, the median sitting height/height ratio was 2.32 and 6.21 SDS for the good and poor compliance to treatment groups, respectively. The mean pubertal growth spurt of the trunk was -0.8 (1.4) SDS, with a short pubertal growth spurt of - 1.8 (0.4) SDS for limbs in the good compliance group. Median adult height in 13/29 males and 30/67 females was -4.56 and -3.16 SDS, respectively. CONCLUSION: For all patients the growth spurt was slower, secondary to a short growth spurt of limbs, reaching a short adult height with body disproportion that was more prominent in the poor compliance group.

Outcome of food intake and nutritional status after discontinuation of a cow's-milk-free diet post negative oral food challenge in infants and children.

OBJECTIVE: To evaluate the outcome of food intake and nutritional status post discontinuation of a cow's-milk-free diet after a negative oral food challenge. METHODS: This was a prospective, uncontrolled study that evaluated food intake and nutritional status of a cohort of 80 infants and children under 5 years of age. Food intake and nutritional status were evaluated on the day of the oral food challenge test and after 30 days. Weight and height were measured on the day of the test and after 30 days. RESULTS: The mean age of the patients was 18.7 ± 12.4 months, and 58.7% were male. After discontinuation of the elimination diet, the children showed daily intake increases in (P < 0.001), protein (P < 0.001), carbohydrates (P = 0.042), calcium from foods (P < 0.001), calcium from foods and supplements (P < 0.001), phosphorus (P < 0.001), and vitamin D from foods (P = 0.006). The Z-scores (n = 76) on the day of the oral food challenge test and 30 days after restarting the consumption of cow's milk were as follows: weight-for-age (P < 0.001) and height-for-age (P < 0.001), respectively. CONCLUSION: Cow's milk protein in the diet was associated with increased intake of energy, proteins, carbohydrates, calcium, phosphorus, and vitamin D, in addition to an increase in the Z-scores for weight-for-age and height-for-age.

Relationship between body mass index, waist circumference and waist circumference height ratio and bone metabolism markers in Yinchuan middle school students / 中国学校卫生

Objective@#To analyze the relationship between body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR) and bone metabolism markers.@*Methods@#By using the method of cluster sampling, a total of 1 084 adolescents aged 12 to 18 from one middle school in Yinchuan were investigated by questionnaire, physical examination and laboratory examination during sept. to Dec., 2018.@*Results@#BMI, WC and WHtR were significantly negatively correlated with Ca (r=-0.10, -0.15, -0.15, P<0.05), and WC was negatively correlated with β-CTX(r=-0.06 P<0.05). After adjusting for age, sex and vitamin D supplementation, WC had significant effects on Ca and β-CTX(β=-0.33, -0.22, P<0.05). Logistic regression analysis showed that there was no significant relationship between different types of obesity and the level of OC(P>0.05). The level of serum β-CTX in obese students was 1.93 times higher than that in normal students, Ca serum levels of obese students was 0.31 times higher than that in normal students that in abdominal obese students (defined as WC) was 0.54 times higher than that in normal students.@*Conclusion@#BMI, WC and WHtR were correlated with OC, β-CTX and Ca in adolescents in Yinchuan city, and WC was more closely related to Ca and β-CTX, suggesting that obesity has a negative effect on bone absorption.

Effects of Dairy Product Consumption on Height and Bone Mineral Content in Children: A Systematic Review of Controlled Trials.

There is a physiological basis for the roles of selected nutrients, especially proteins, calcium, and vitamin D, in growth and development, which are at a maximum during the pediatric period. Milk and dairy products are particularly rich in this group of nutrients. The present systematic review summarizes the available evidence relating dairy product intake with linear growth and bone mineral content in childhood and adolescence. A search was conducted in the MEDLINE (via PubMed) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included intervention-controlled clinical trials with dairy products in children from 1 January, 1926 to 30 June, 2018. The risk of bias for each study was assessed using the Cochrane methodology. The number of study participants, the type of study and doses, the major outcomes, and the key results of the 13 articles included in the review are reported. The present systematic review shows that supplementing the usual diet with dairy products significantly increases bone mineral content during childhood. However, the results regarding a possible relation between dairy product consumption and linear growth are inconclusive.

Decreased plasma l-arginine levels in organic acidurias (MMA and PA) and decreased plasma branched-chain amino acid levels in urea cycle disorders as a potential cause of growth retardation: Options for treatment.

BACKGROUND AND AIM: Patients with methylmalonic acidemia (MMA) and propionic acidemia (PA) and urea cycle disorders (UCD), treated with a protein restricted diet, are prone to growth failure. To obtain optimal growth and thereby efficacious protein incorporation, a diet containing the essential and functional amino acids for growth is necessary. Optimal growth will result in improved protein tolerance and possibly a decrease in the number of decompensations. It thus needs to be determined if amino acid deficiencies are associated with the growth retardation in these patient groups. We studied the correlations between plasma L-arginine levels, plasma branched chain amino acids (BCAA: L-isoleucine, L-leucine and L-valine) levels (amino acids known to influence growth), and height in MMA/PA and UCD patients. METHODS: We analyzed data from longitudinal visits made in stable metabolic periods by patients registered at the European Registry and Network for Intoxication Type Metabolic Diseases (E-IMD, Chafea no. 2010 12 01). RESULTS: In total, 263 MMA/PA and 311 UCD patients were included, all aged below 18 years of age. In patients with MMA and PA, height z-score was positively associated with patients' natural-protein-to-energy prescription ratio and their plasma L-valine and L-arginine levels, while negatively associated with the amount of synthetic protein prescription and their age at visit. In all UCDs combined, height z-score was positively associated with the natural-protein-to-energy prescription ratio. In those with carbamylphosphate synthetase 1 deficiency (CPS1-D), those with male ornithine transcarbamylase deficiency (OTC-D), and those in the hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome subgroup, height z-score was positively associated with patients' plasma L-leucine levels. In those with argininosuccinate synthetase deficiency (ASS-D) and argininosuccinate lyase deficiency (ASL-D), height was positively associated with patients' plasma L-valine levels. CONCLUSION: Plasma L-arginine and L-valine levels in MMA/PA patients and plasma L-leucine and L-valine levels in UCD patients, as well as the protein-to-energy prescription ratio in both groups were positively associated with height. Optimization of these plasma amino acid levels is essential to support normal growth and increase protein tolerance in these disorders. Consequently this could improve the protein-to-energy intake ratio.

Evidence on the Ability of a Pneumatic Decompression Belt to Restore Spinal Height Following an Acute Bout of Exercise.

OBJECTIVE: The purpose of this study was to evaluate the ability of a pneumatic decompression belt to restore spinal height lost following an acute bout of exercise that induced compression. METHODS: This study implemented a test-retest repeated measures design in which twelve participants (male = 10, female = 2) age, 21.5 ± 1.0 years; height, 179.0 ± 7.70 cm; weight, 84.0 ±11.5 kg; were recruited from a university population and acted as their own control. All participants were healthy with no previous history of disabling back pain, and were frequent weight trainers. A stadiometer was used to measure spinal height at baseline, then following an acute bout of exercise and then again following the intervention (use of a pneumatic decompression belt for 20 minutes) or control (lying supine for 20 minutes). A 2-way repeated measures ANOVA was performed on the change in spinal height in order to evaluate differences between measurement phases and intervention conditions. RESULTS: The use of the decompression belt increased spinal height gain (4.3 ± 3.0 mm) significantly more than the control condition (1.8 ± 1.2 mm) following an acute bout of weightlifting exercises known to elicit high compressive loads on the lumbar spine. CONCLUSION: The pneumatic decompression belt restored spinal height faster than a non-belt wearing condition in young healthy asymptomatic participants.

Spinal height change in response to sustained and repetitive prone lumbar extension after a period of spinal unloading.

OBJECTIVE: The purpose of this study was to investigate if differences in spinal height changes in healthy individuals were observed after a period of spinal unloading using repetitive as compared with sustained lumbar extension exercises. METHODS: This study used a pretest, posttest, crossover design. Asymptomatic participants were recruited using convenience sampling. Thirty-two participants (15 male; 17 female) without back pain were included in the data analysis (mean, 24.4 years; range, 20-41 years). Participants performed sustained or repetitive prone lumbar extension exercises after 1 hour of sustained spinal unloading. Spinal height was measured using a stadiometer before and after the repetitive and sustained prone lumbar extension exercises. RESULTS: Paired t tests revealed no significant difference in spine height after repetitive (P = .774) or sustained (P = .545) prone lumbar extension after a period of spinal unloading. No significant difference between spinal height changes occurred between sustained (mean [SD], -0.28 [2.59] mm) and repetitive (mean [SD], -0.12 [2.42] mm) lumbar extension (P = .756). CONCLUSION: In this group of asymptomatic individuals, sustained and repetitive lumbar extension exercises did not appear to affect spinal height after a period of spinal unloading.

Evidências do impacto da suplementação múltipla com micronutrientes no crescimento de pré-escolares: revisão sistemática / Evidence of the impact of multiple micronutrient supplements on the growth of pre-school children: a systematic review

Agregar evidências sobre o efeito da suplementação múltipla com micronutrientes no crescimento de crianças pré-escolares, com ênfase nos efeitos combinados ou isolados do zinco, ferro e vitamina A. Métodos: foi realizada uma busca por ensaios clínicos aleatorizados e artigos de revisão sistemática com metanálise na base de dados PubMed. Foram selecionados artigos publicados entre 1995 e maio de 2013, considerando a combinação dos descritores (child, preschool OR infant) AND (growth) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Resultados: foram selecionados 33 artigos para a presente revisão, 29 do tipo ensaio clínico e quatro de revisão sistemática com metanálise. A administração de suplementos nutricionais contendo combinações de zinco, ferro e vitamina A pode aumentar o potencial de crescimento das crianças, sendo mais evidente o efeito quando comparada a suplementação com múltiplos micronutrientes vs placebo ou dieta habitual, e com os esquemas de suplementação dupla e única. A combinação de zinco e vitamina A é a melhor opção de suplementação dupla. O efeito da suplementação tripla em relação às outras opções (placebo, única, dupla, múltipla), bem como os possíveis efeitos diferenciados da suplementação segundo a condição nutricional e/ou idade das crianças, ainda precisam de investigação mais aprofundada para orientar as estratégias de prevenção. Conclusões: a suplementação múltipla com micronutrientes tem efeitos positivos no crescimento linear que dependem do esquema de suplementação adotado...

To put together evidence of the effect of multiple micronutrient supplements on the growth of preschool children, with special emphasis on the effects in combination or in isolation of zinc, iron and vitamin A. Methods: the PubMed database was searched for randomized clinical trials and meta analytical systematic review articles. The selected articles were published between 1995 and May 2013, using a range of descriptors (child, preschool OR infant) AND (growth) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Results: thirty three articles were selected for the present review. Twenty nine were clinical trials and four meta analytical systematic reviews. The administration of nutritional supplements containing combinations of zinc, iron and vitamin A may increase the potential for growth in children and has a stronger effect than multiple supplements, a placebo or the child's habitual diet, or than single or dual supplements. The combination of zinc and vitamin A is the best dual supplement option. The effect of the three nutrient supplement compared with the other options (placebo, single, dual, or multiple supplements), as well as the various effects of supplementation according to the nutritional status and/or age of the children, still require more in depth investigation to provide a guide for prevention strategies. Conclusions: multiple micronutrient supplements have positive effects on linear growth the extent of which depend on the supplementation regimen adopted...

The Life-course Approach in Assessment of Dental Health: A Cross Sectional Study among Finnish and Turkish Pre-adolescents.

OBJECTIVES: Interest is growing on conceptualizing dental disease aetiology under the life-course approach. The aim of this study was to assess the association of dental caries experience with the major components of life-course approach, health- and behavioral capital, among Turkish and Finnish pre-adolescents, with different family-related characteristics, as this association has not been explored yet. METHODS: A cross-sectional study of Finnish (n=338) and Turkish (n=611) pre-adolescents was undertaken with questionnaires and oral health data. RESULTS: Turkish pre-adolescents, more dentally diseased (84%) than the Finnish (33%) (P<.01), had lower means of health (body height-weight) and behavioural (self-esteem, tooth-brushing self-efficacy) capital, (P<.01). Finnish pre-adolescents were less likely to live in two-parent families (P=.001) and spent less time with their mothers (P<.05). Turkish pre-adolescents with high levels of self-esteem were more likely to spend time with their mothers and less likely to live in families with three or more children (28%) than were their counterparts with low levels of self-esteem (41%). Such associations were not evident among Finnish pre-adolescents (P>.05). Health capital, in terms of body height, and family-related characteristics in differing patterns, contributed to DMFT, in common, among Turkish and Finnish pre-adolescents. Self-esteem, behavioural capital was explanatory variable for DMFT only for the Turks. CONCLUSIONS: Dental health of pre-adolescents was associated with health- and behavioural capital in different pathways under the influence of family-related characteristics. The cooperation of paediatricians and dentists is vital in assessment of general and dental health in a holistic context throughout the life-course, to enhance the well-being of pre-adolescents.

The Influences of Herbal Medicines as a Growth-promoting Complimentary Therapy on Predicted Adult Heights of Children / 대한소아내분비학회지

PURPOSE: A lot of complementary therapies to increase final adult heights have been used in Korean children. We are going to investigate the effects of herbal medicines on predicted adult heights of children. METHODS: Subjects were 29 children (13 boys & 16 girls) who visited to the growth clinic of the department of pediatrics in Kyunghee East-West Neo medical center from June 1st 2006 to June 30th 2008 and treated with herbal medicines and followed up over 1 year. At first visit, their mid-parental target height standard deviation score (MPHSDS), bone age, height SDS, height SDS adjusted for their bone ages (BAHSDS) and predicted adult height SDS (PAHSDS) were checked. After 1 year of complementary therapy, they were checked those parameters again. The differences of their MPHSDS, BAHSDS and PAHSDS before and after the therapy were compared with Wilcoxon signed rank test using SPSS 12.0. RESULTS: The mean changes in BAHSDS after therapy in boys and girls were -0.17 and -0.05. The mean changes in predicted adult height SDS after therapy in boys and girls were -0.28 and 0.03. There were no significant differences between BAHSDS and PAHSDS before and after the therapy. CONCLUSION: There is little evidence that the use of herbal medicines to improve the final adult heights of the children was effective. It is necessary to evaluate the long-term effects or the side effects of these therapies on final adult heights in more children.

A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children.

Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

The growth and nutritional status of the breast-fed infant.

The literature on the relationship between early infant feeding and growth shows that after the first 3 or 4 months, breast-fed infants in the developed world are lighter than formula-fed infants with markedly lower adiposity. There is some evidence of a slightly lower rate of linear growth over the first year or so. These differences in weight and length do not apparently persist beyond the first few years of life. In the developing world the situation is very different. The growth curves of breast-fed infants of malnourished mothers may falter between the third and sixth month of life. However, the generally poor quality of the supplementary foods offered in the developing world and the increased risk of diarrhoeal infections mean that supplementary feeding before the age of 6 months is unlikely to lead to a growth advantage and may well lead to growth faltering.

PIP: A review of the research literature on the relationship between early infant feeding and growth indicates that, after the first 3 or 4 months, breast-fed infants in developed countries are lighter than formula-fed infants and have markedly lower adiposity. There is some evidence of a slightly lower rate of linear growth over the first year of life, but any differences in weight and height do not persist beyond this point. Very different trends are found in developing countries. The growth curves of breast-fed infants of malnourished mothers may falter between the third and sixth months of life. However, given the generally poor quality of the supplementary food offered in developing countries and the increased risk of diarrheal infections, supplementary feeding before 6 months of age is unlikely to produce a growth advantage and may well lead to growth faltering. After 6 months, the growth advantage of supplementary feeding will be dependent on the nutritional quality of the weaning food, the effect on the child's breast milk intake, and the risk of infection. It is probable that the observed association between prolonged breast feeding and malnutrition arises from confounding factors such as poverty and the delayed weaning of sickly children. Other issues addressed in this review include the energy requirements of breast-fed infants, colostrum feeding, and nutritional status in relation to vitamin and mineral intake.

Nutritional status of rural children in the Lesotho Highlands.

A baseline cross-sectional study was done to evaluate the nutritional status of the population of the Mohale Dam catchment area before construction of the dam commenced. In this article we report on the anthropometric, clinical and dietary assessment of the children less than 15 years of age in the study population. A two stage stratified sampling technique was used to randomly select 29 of the 83 villages in the study area. Children under 15 years of age from 395 households, representing approximately 50% of households in the selected villages, were included in the study. Anthropometric measurements of body height and weight in relation to age and sex indicated undernutrition varying, with few exceptions, from high to very high levels in children under 15 years. Stunting, indicating chronic undernutrition, was of particular concern in children, even from the first year of life. Very few clinical signs of nutritional deficiencies were found except for a goitre prevalence of 17.5% in 10 to 14 year old children. This was supported by the very low urinary iodine excretion (median 1.3 micrograms/dL) which indicated a severe iodine deficiency. Dietary evaluation showed high initiation rates of breastfeeding as well as a long duration of breastfeeding. Complementary foods were introduced at an early age, resulting in low exclusive breastfeeding rates. Regular meals were reported but qualitative analysis of the diet showed that a too small variety of foods were eaten, with an irregular intake of protein-rich foods and milk. Quantitative data on 3- < 5-year-old children showed that micro-nutrient intakes were low and that the energy intake of these children was inadequate. The results showed that these nutritionally vulnerable children should be monitored for the impact of the dam construction on their nutritional status.

PIP: The nutritional status of children under 15 years of age, from South Africa's Mohale Dam catchment area, was investigated in a cross-sectional baseline study conducted before dam construction began. 323 children, from 29 of the 83 villages in the study area, underwent anthropometric, clinical, and dietary assessment. The mean Z-score of height-for-age varied between -1.39 and -1.93 in the different sex and age groups. The percentage of children with a height-for-age less than -2 standard deviations (SDs) below the median of the reference population (indicating stunting) was 38.5-44.9% among boys and 30.7-37.0% among girls. Weight-for-height scores below -2 SDs (indicating wasting) occurred in 0.7-3.4% of children under 10 years old. 15-17% of children under 10 years old were underweight, but this rate increased to 34.8% in boys aged 12-15 years, and declined to 7.7% in older girls. The prevalence of stunting increased from 21.5% in the first year of life to 38.5% in the second year, while that of underweight increased from 7.7% to 19.2%. Goiter was present in 17.5% of 10-14 year olds, consistent with a median urinary iodine excretion of only 1.3 mcg/dl (severe iodine deficiency). Although breast feeding was widespread and of long duration, complementary foods were introduced early (mean, 4.0 months for liquids other than milk; 4.5 months for solids). Dietary analysis revealed irregular intake of protein-rich foods and milk, as well as a lack of variety; fewer than 10 foods represented almost the entire selection. The energy intakes of children 3-5 years old were inadequate. The high prevalence of stunting in this population indicates a need for interventions such as increased food availability and quality, salt iodization, adequate supplies of potable water, and treatment and prevention of infectious diseases. The impact of dam construction and resettlement on these nutritionally vulnerable children should be monitored.

Undernutrition among young children in Sub-Saharan Africa.

PIP: This news brief identifies two primary sources of information on undernutrition: Africa Nutrition Chartbooks and Demographic and Health Survey Country Nutrition Reports. These sources argue that there are many biological and cultural indicators related to child nutrition and health in sub-Saharan Africa. It is argued in this article that undernutrition occurs among young children in sub-Saharan Africa due to poor infant and child feeding practices. Mothers provide supplemental liquids or solids instead of exclusively breast feeding. Mothers also wean too early (before 4 months of age). Child survival is threatened by undernutrition in combination with diarrhea, cough, and fever. Children under 2 years of age are at risk when weaned too early because their mothers are ill, undernourished, or pregnant. Many biocultural factors contribute to undernutrition. Women with high fertility, closely spaced births, inadequate prenatal care, and poor nutritional status frequently bear children with low birth weight, a condition which is more likely to be related to undernourishment and an increased risk of illness and death. The World Health Organization recommends exclusive breast feeding for the first 4 months, in order to provide the infant with all the necessary nutrition without risk of exposure to contaminants in food and liquids. Findings from Demographic and Health Surveys indicate that exclusive breast feeding is not common in sub-Saharan Africa. In eight sub-Saharan countries, less than 10% of infants were exclusively breast fed. In Ghana, Namibia, and Nigeria, 25%-33% of infants aged under 4 months were bottle fed. Children that were weaned early due to maternal pregnancy were more likely to be stunted and wasted than children weaned for other reasons.^ieng

Infant feeding and growth of Chinese infants: birth to 2 years.

A cohort of 174 healthy full-term Chinese infants was followed up regularly for 2 years for their weight, length, head circumference, triceps and subscapular skinfold thickness, and their feeding practice. The majority of babies (92% at 2 months) were bottle fed with full strength infant formula. The energy intake over the first year of life was comparable with that of healthy Caucasian infants. The mean protein intake during the weaning period exceeded fourfold that of the WHO recommendation. At 2 years, infants were -0.6 standard deviation score (SDS) lighter and -0.4 SDS shorter than the National Centre for Health Statistics (NCHS) reference.

PIP: The first in-depth study of nutrition and its impact upon growth in young Chinese children in Hong Kong was conducted in the 1960s and suggested that significant undernutrition of energy, protein, iron, calcium, and vitamin D with associated poor physical growth was common. Environmental and socioeconomic conditions in Hong Kong, however, have improved dramatically since the 1960s, with infant mortality falling from 42/1000 in 1960 to 8.5/1000 in 1985. The authors present findings from a 1984 study of infant practices and related growth among infants in Hong Kong. The weight, length, head circumference, triceps, subscapular skinfold thickness, and feeding practices of a cohort of 174 healthy full-term Chinese infants were regularly followed for two years. 92% at two months were bottle fed with full-strength infant formula, energy intake over the first year of life was comparable with that of healthy Caucasian infants, and mean protein intake during the weaning period exceeded four times that recommended by the World Health Organization. At two years, however, infants were 0.6 standard deviation score (SDS) lighter and 0.4 SDS shorter than the National Center for Health Statistics (NCHS) reference. Indeed, Hong Kong Chinese infants during the mid-1980s enjoyed a diet of energy and protein sufficient for their required growth. The authors believe that the smaller size of such healthy Asiatic children reflects genetic rather than environmental influences and question whether the NCHS references or any references based largely upon Caucasian populations are appropriate for young Chinese children.

A review of the epidemiology of nutrition and adolescent pregnancy: maternal growth during pregnancy and its effect on the fetus.

Maternal growth during adolescent pregnancy and its effects on pregnancy outcome have been a source of controversy. Maternal growth during pregnancy has been difficult to quantify because of the tendency of young and older women to "shrink" in stature with pregnancy. In the Camden Study, maternal growth during pregnancy was monitored with the Knee Height Measuring Device, which measures growth of the lower leg, a body segment less susceptible to "shrinkage." Attempts of other investigators to detect maternal growth during adolescent pregnancy are reviewed here. New data from the Camden Study, also presented, suggest that growing adolescents have infants that weigh less compared to nongrowing adolescents and mature controls (aged 19-29 years). Prior work had suggested that the effects of maternal growth on birth weight were confined to adolescent multiparas. However, with expanded enrollment it was found that infants of growing primiparas and multiparas were both affected. The hypothesis of the competition for nutrients between a still-growing gravida and her fetus is discussed.

PIP: This review of maternal growth during pregnancy and its effect on fetal development is based on the Camden study of US adolescent growth. The Knee Height Measuring Device (KHMD) is used to measure growth among a cohort of women during pregnancy and delivery in the period July 1987-January 1992. The KHMD is considered more reliable as a measure of growth, is less susceptible to shrinkage during pregnancy, and does not represent an increase in fat mass of the leg during pregnancy. Differences in growth between entry into care and six weeks postpartum indicate a mean increase for teenagers of 0.86 mm compared to a decrease in mature controls of -0.39 mm. Over 80% of adolescents identified as growing with the use of KHMD are truly growing during pregnancy, although only a fraction of the total number who are growing can be detected. Other studies of maternal growth are based on medical records of stature height. Bender observes that pregnancy at very young ages does not pose a threat to maternal nutritional status or fetal growth. Garth finds that young women with the largest weight gains have shrinkage and a downward bias of measured stature. Sukanich et al. also find adolescents with small changes in stature between pregnancies. Developing country adolescent growth patterns are different. Chronic malnutrition leads to later age at menarche, and adolescent growth continues for a longer period of time. Frisancho et al. find that over 40% of pregnant Peruvian adolescents aged under 16 years have not achieved their mother's height. Harrison et al. find that the stature among Nigerian Hausa women aged under 19 years increased by 2.9 cm with increased vitamin and mineral supplementation and prophylactic malaria regimens. Growth without the treatment was only 1.1 cm. Support was provided both for and against maternal growth being related to increased complications and poor birth outcomes. The Camden study finds growing teenagers have significantly smaller infants by 117 grams for primiparas and 206 grams for multiparas compared to mature controls and growing teenagers. Pregnant teenagers found not to be growing had larger infants. About 50% of pregnant adolescents in the Camden study were reported as growing. All studies suggest support for the maternal-fetal competition hypothesis.

Bone turnover in malnourished children.

Pyridinoline (PYD) and deoxypyridinoline (DPD) are cross-linking aminoacids of collagen that are located mainly in bone and cartilage. When bone matrix is resorbed these cross-links are quantitatively excreted in the urine and therefore represent specific markers. We have measured the urinary excretion rate of PYD and DPD in 46 severely malnourished boys to assess their skeletal turnover and to relate this to their subsequent rate of growth. The children were aged 13 months (SD 6), and height-for-age was -3.6 (1.6) Z-score, and weight-for-height was -2.4 (0.8) Z-score. PYD excretion when malnourished and after "recovery" was 11.2 (4.6) nmol h-1m-2 and 32.2 (10.8) nmol h-1m-2 and DPD excretion was 2.6 (1.3) nmol h-1m-2 and 7.5 (3.0) nmol h-1m-2, respectively. The ratio of the two cross-links did not change with recovery. These data show that cartilage and bone turnover is much lower in the malnourished than in the recovered child. There was no difference in the degree of depression of turnover between the children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain during recovery was significantly related to cross-link excretion, age, and weight-for-height on admission. These three factors accounted for 44% of the variance in the height velocity of the children. PYD and DPD excretion rate could be used to assess therapeutic interventions designed to alleviate stunting.

PIP: The Tropical Metabolism Research Unit at the University of the West Indies in Jamaica made anthropometric measurements of 46 13-month-old male infants to assess changes in bone resorption during malnutrition by measuring the urinary excretion rate of pyridinoline (PYD) and deoxypyridinoline (DPD) and to determine whether bone turnover is associated with recovery. Unit staff used standard methods to treat the malnourished boys, including an energy dense diet (cow's milk formulated from Perlargon and corn or coconut oil). Before treatment, their height-for-age stood at -3.6 Z-score and their weight-for-height was -2.4 Z-score. The rate of excretion of PYD and DPD in malnourished children was only about 33% of that after they recovered (11.2 nmol per hour per sq. meter vs. 32.2 nmol per hour per sq. meter and 2.6 nmol vs. 7.5 nmol per hour per sq. meter, respectively; p .001). Therefore, cartilage and bone turnover was considerably lower in the children when they were malnourished than when they recovered. Recovery did not alter the ratio of these 2 cross-link amino acids, however, suggesting that changes in endochondral growth relative to bone remodelling did not occur. The extent of depression in bone turnover was basically the same between children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain of the children during recovery from malnutrition was significantly associated with age (p .001), PYD excretion at admission (p = .003), and weight-for-height at admission (p = .01), all 3 of which explained 44% of the variance in the rate of height gain of the children. Since this study demonstrated that PYD and DPD are associated with longitudinal growth in children recovering from malnutrition, more research on the effect of dietary manipulation on longitudinal growth should be done, which should define requirements for longitudinal growth and identify needed steps to prevent stunting.

Birthweight and sociobiological factors in Ilorin, Nigeria.

Social and biological factors influencing birthweight of 3053 Ilorin babies were studied. The mean birth weights were 2.998 kg +/- 0.133 (SD) for males and 2.932 kg +/- 0.154 (SD) for females. Multiple regression analysis showed that maternal weight, height, age, education and ethnicity, and child's sex, significantly affected birthweight of infants. Some quadratic and interaction terms also contributed significantly to the prediction of birthweight. The strategies to control the incidence of low birth weight are discussed.

PIP: This study fills in the gap in data for Nigeria on distribution and correlates of birth weight among ethnic groups in the northern region, principally in Ilorin, the capital city of Kwara State. Data were taken from 50% of the records of normal live births from University Hospital during 1986, and may not represent those rural births delivered by traditional birth attendants. The population constitutes 80% of all city hospitals births and those referred for complications. Data included birth weight in metric units, maternal weight, age, height, parity, occupation, ethnic group, and education. Incidence of low birth weight was 18.2% (males) and 20.8% (females) and did not differ significantly by weight and sex. The mean birthweight 2.998 kg for males and 2.932 kg for females is slightly lower than those reported for southwestern Nigeria infants (3.162 kg for males and 3.015 kg for females in Ibidan). This is also lower that the mean birthweights of 3.145 kg recorded in southeastern Nigeria. The Ilorin babies, however, are considerably above northern Nigeria figures in southern Zaria (2.235 kg for males and 2.170 kg for females. Ilorin figures are similar to other equatorial Africa; i.e., rural Cameroon of 3.119 kg, Tanzania of 3.009 kg or 2.850 kg. British and American babies are higher at 3.415 kg and 3.400 respectively. The sex ratio was M:F 1.05:1. For male births, there is tendency for birthweight to rise with maternal height. There is a consistent rise in birthweight with maternal weight, and maternal education; there were significant differences by maternal occupation but not ethnicity. 68% of the variance was accounted for in the multiple regression by maternal weight, age education, height and ethnicity, and child's sex; this confirms the results of other investigators. The introduction of quadratic terms such as maternal weight and age improved the equation. Other variables such as length of gestation, maternal smoking improvement in the nutrition of pregnant women, sex education in school, and encouragement to defer marriage along with nutritional education for teenagers and reproductive age women. These measures may enhance the birthweight and hence survivability of children.