Multiple micronutrient supplementation increases the growth of Mexican infants.

BACKGROUND: The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention. However, because multiple micronutrient deficiencies are common in children in developing countries, it is possible that more than one micronutrient may limit growth and, hence, the correction of a single deficiency may not be enough to improve growth substantially. OBJECTIVE: The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8-14 mo whose diets were poor in several micronutrients. DESIGN: Children were randomly assigned to 1 of 2 groups. One group received a multiple micronutrient supplement containing the recommended dietary allowance (RDA) or 1.5 times the RDA of vitamins A, D, E, K, C, B-1, B-6, B-12, riboflavin, niacin, biotin, folic acid, and pantothenic acid, and iron, zinc, iodine, copper, manganese, and selenium. The other group received a placebo. Supplements were administered 6 d/wk for an average of 12.2 mo. Body length was measured at baseline and monthly thereafter until the end of supplementation. RESULTS: Supplemented infants initially aged <12 mo had significantly greater length gains than did the placebo group, with a difference of 8.2 mm (length-for-age z score: 0.3) at the end of supplementation. In contrast, differences in length gains between the supplemented and placebo groups initially aged > or =12 mo were not significant. CONCLUSIONS: Micronutrient deficiencies limited the growth of the Mexican infants studied. Improving micronutrient intakes should be a component of interventions to promote growth in infants living in settings where micronutrient intakes are inadequate.

Effect of maternal lead burden on infant weight and weight gain at one month of age among breastfed infants.

INTRODUCTION: Transfer of lead from bone to the bloodstream increases during lactation. However, the effect of maternal lead burden on growth in breastfed newborns is still unknown. This study examined early postnatal growth in a cohort of healthy breastfed newborns in relation to maternal bone lead burden. METHODS: Lead levels were measured among 329 mother-infant pairs in umbilical cord blood at birth and in maternal and infant venous blood at 1 month postpartum. Maternal evaluations at 1 month postpartum included lead measures in blood and bone (measured in the tibia and the patella). Blood lead was determined by graphite furnace atomic absorption spectrophotometry. Bone lead was measured by (109)Cd Kx-radiograph fluorescence instrument. The primary endpoints were attained weight 1 month of age, and weight gain from birth to 1 month of age, which were analyzed in relation to lead biomarkers and relevant covariates by linear regression models. RESULTS: Infants studied had an average weight gain of 33.1 g/day (standard deviation [SD] = 11.6). Mean infant (at 1 month of age) and maternal blood lead levels were 5.6 microg/dL (SD = 3.0) and 9.7 microg/dL (SD = 4.1), respectively. Mean maternal bone lead levels were 10.1 microg of lead/g (SD = 10.3) and 15.29 microg of lead/g (SD = 15.2) of bone mineral for tibia and patella, respectively. Infant blood lead levels were inversely associated with weight gain, with an estimated decline of 15.1 g per microg/dL of blood lead. Children who were exclusively breastfed had significantly higher weight gains; however, this gain decreased significantly with increasing levels of patella lead. The multivariate regression analysis predicted a 3.6-g decrease in weight at 1 month of age per microg of lead per gram bone mineral increase in maternal patella lead levels. CONCLUSIONS: Maternal lead burden is negatively associated to infant attained weight at 1 month of age and to postnatal weight gain from birth to 1 month of age. Additional studies are needed to better understand this source of exposure and to develop interventions to minimize its impact.

Impact of food supplementation during lactation on infant breast-milk intake and on the proportion of infants exclusively breast-fed.

To evaluate whether milk production can be improved by increasing food intake, a randomized, double-blind, supplementation trial was completed among 102 lactating Guatemalan women. The subjects were undernourished, as indicated by their low values for calf circumference (CC) and the small size of their infants at birth. A high-energy (2.14 MJ/d, HES) and a low-energy (0.50 MJ/d, LES) supplement were distributed 6 d/wk from wk 5 to 25 of lactation. Data were evaluated using repeated-measures analysis of variance on the increments from initial values for each outcome variable with one-tailed tests of statistical significance. The maternal energy intake increased 1.18 MJ/d (P < 0.01) more among the HES than the LES women. Benefit from supplementation was more evident among the more undernourished (CC

[Accumulation of lead in bone and its effects on health]. / Acumulación de plomo en hueso y sus efectos en la salud.

The adverse effects of lead have been known for long since the metal affects practically all organs and systems of the human body. Recently, toxic effects have been reported in the cardiovascular and nervous systems at lead levels previously considered to be secure. The main lead storage site in the body is bone. The toxicologic significance of this fact has been clarified only recently. The present study analyzes the role of lead as an endogenous source of exposure, as a chronic exposure biomarker and as a target organ. Recent advances to measure bone lead through fluorescent X-Rays are discussed. Additionally, the importance of bone lead from a public health perspective in places with a chronic history of exposure such as Mexico City, and in some occupational environments is reviewed with particular attention placed on reproductive age women, who are potential lead sources for the fetus and lactating infant.

[Capacity of weight-for-age and length-for-age to predict stunting at 3 years of age]. / Capacidad de peso para edad y longitud para edad para predecir desmedro a los tres años de vida.

OBJECTIVE: To compare the capacity of two cut-off points of weight-for-age and length-for-age (-1 and -2 standard deviations) at different ages in the interval between birth and 30 months to predict stunting in three year old children. MATERIAL AND METHODS: Data from a longitudinal study in Guatemala were used to evaluate the hypothesis that the capacity of cut-off values of weight-for-age and length-for-age to predict stunting at three years of age varies according to age. RESULTS: Length-for-age at -1 standard deviation (SD) of the WHO/NCHS mean reference values is a satisfactory prognostic indicator of stunting at three years of age during the first semester of life, while the same index at -2 SD is adequate after 9 months of age. Weight-for-age at -1 SD is a suitable indicator only at 9 months and at -2 SD the indicator is satisfactory between 15 and 24 months of age. CONCLUSION: The capacity to predict stunting at three years of age, for weight-for-age and length-for-age cut-off values varies according to age.

[Length and weight at birth: the role of maternal nutrition]. / Longitud y peso al nacer: el papel de la nutrición materna.

OBJECTIVE: To identify determinants of weight (BW) and length at birth (BL). MATERIAL AND METHODS: We studied 481 mother-newborn pairs in three Mexico City hospitals. Multiple regression models were developed to identify statistically significant predictors of BW and BL with respect to a predetermined biological model. Independent variables included were: maternal anthropometry, age, smoking habits, and civil status, parental education, obstetric history, hypertension, and neonatal characteristics. RESULTS: In the group with calf circumference (CC), height and head circumference below the median BW was 133, 92 and 96 g lower (+/- 35 standard error -SE-, p < 0.01) than the group above the median, adjusting for socioeconomic, obstetric history, and neonatal characteristics (NC). In the group below the median CC or height, BL was 5.8 or 6.2 mm (+/- 1.9 mm SE, p < 0.01) respectively, adjusting for obstetric history and NC. CONCLUSIONS: Results suggest that maternal anthropometry is the most important predictor of birth size and that predictors for BW and BL differ.

Decrease in birth weight in relation to maternal bone-lead burden.

OBJECTIVES: Birth weight predicts infant survival, growth, and development. Previous research suggests that low levels of fetal lead exposure, as estimated by umbilical cord blood-lead levels at birth, may have an adverse effect on birth weight. This report examines the relationship of lead levels in cord blood and maternal bone to birth weight. METHODS: Umbilical cord and maternal venous blood samples and anthropometric and sociodemographic data were obtained at delivery and 1-month postpartum. Blood-lead levels were analyzed by atomic absorption spectrophotometry. Maternal tibia and patella lead levels were determined at 1-month postpartum with use of a spot-source 109Cd K-X-ray fluorescence instrument. The relationship between birth weight and lead burden was evaluated by multiple regression with control of known determinants of size at birth. RESULTS: Data on all variables of interest were obtained for 272 mother-infant pairs. After adjustment for other determinants of birth weight, tibia lead was the only lead biomarker clearly related to birth weight. The decline in birth weight associated to increments in tibia lead was nonlinear and accelerated at the highest tibia lead quartile. In the upper quartile, neonates were on average, 156 grams lighter than those in the lowest quartile. Other significant birth weight predictors included maternal nutritional status, parity, education, gestational age, and smoking during pregnancy. CONCLUSIONS: Our results indicate that bone-lead burden is inversely related to birth weight. Taken together with other research indicating that lead can mobilize from bone into plasma without detectable changes in whole blood lead, these findings suggest that bone lead might be a better biomarker than blood lead. Because lead remains in bone for years to decades, mobilization of bone lead during pregnancy may pose a significant fetal exposure with health consequences, long after maternal external lead exposure has declined.

Dietary and environmental determinants of blood and bone lead levels in lactating postpartum women living in Mexico City.

Despite the recent declines in environmental lead exposure in the United States and Mexico, the potential for delayed toxicity from bone lead stores remains a significant public health concern. Some evidence indicates that mobilization of lead from bone may be markedly enhanced during the increased bone turnover of pregnancy and lactation, resulting in lead exposure to the fetus and the breast-fed infant. We conducted a cross-sectional investigation of the interrelationships between environmental, dietary, and lifestyle histories, blood lead levels, and bone lead levels among 98 recently postpartum women living in Mexico City. Lead levels in the patella (representing trabecular bone) and tibia (representing cortical bone) were measured by K X-ray fluorescence (KXRF). Multivariate linear regression models showed that significant predictors of higher blood lead included a history of preparing or storing food in lead-glazed ceramic ware, lower milk consumption, and higher levels of lead in patella bone. A 34 micrograms/g increase in patella lead (from the medians of the lowest to the highest quartiles) was associated with an increase in blood lead of 2.4 micrograms/dl. Given the measurement error associated with KXRF and the extrapolation of lead burden from a single bone site, this contribution probably represents an underestimate of the influence of trabecular bone on blood lead. Significant predictors of bone lead in multivariate models included years living in Mexico City, lower consumption of high calcium content foods, and nonuse of calcium supplements for the patella and years living in Mexico City, older age, and lower calcium intake for tibia bone. Low consumption of milk and cheese, as compared to the highest consumption category (every day), was associated with an increase in tibia bone lead of 9.7 micrograms Pb/g bone mineral. The findings of this cross-sectional study suggest that patella bone is a significant contributor to blood lead during lactation and that consumption of high calcium content foods may protect against the accumulation of lead in bone.

[Anemia in women of reproductive age. The results of a national probability survey]. / Anemia en mujeres de edad reproductiva. Resultados de una encuesta probabilística nacional.

Iron deficiency is one of the most prevalent forms of malnutrition which is clinically known as anemia. Functional consequences of anemia include impairment of cardiovascular performance, limitation in productivity, higher incidence of low birth weight and premature delivery, and increased maternal mortality. This paper presents a descriptive analysis of anemia in women of reproductive age in Mexico. Data were collected by the Ministry of Health through a National Nutrition Survey in 1988, which draw a representative sample from four regions: North, Center, South and Federal District. Anemia was more prevalent in pregnant (18.17%) than in non-pregnant women (15.38%). Those women living in predominantly indigenous communities had higher prevalence of anemia (24.02%) than non-indigenous women (14.67%). Anemia was more prevalent in urban areas (15.54%) than in rural (13.56%). Mean +/- standard deviation values for hemoglobin were lower in pregnant women (12.5 +/- 1.6 g/dL) than in non-pregnant ones (13.7 +/- 1.6 g/dL). Consistently, the Northern and Southern regions were worse off than the Center and the Federal District. These data indicate that anemia is a public health problem in Mexico. The functional consequences of this deficiency justify interventions to treat and prevent it.

[Stunting and emaciation in children under 5 in distinct regions and strata in Mexico]. / Déficit de talla y emaciación en menores de cinco años en distintas regiones y estratos en México.

Data from a National Nutrition Survey conducted in 1988 in a probability sample of 13,236 households and 17,426 children under five, representative at the national level and for four regions (North, Center, South, and Mexico City), were analyzed. Risks for wasting and stunting and odds ratios were obtained by region, by district according to proportion of indigenous population and by level of urbanization, by level of education of both parents, by gender, and by various combinations of the former strata. A high risk of stunting and a low risk of wasting were found. The risk of stunting is greater in predominantly indigenous and rural districts, in the South and Center, and in families of mothers with low education and poor housing conditions. The results can be used for food and nutrition policy planning and for targeting nutrition intervention programs.

The effect of caloric supplementation on selected milk protective factors in undernourished Guatemalan mothers.

The level and avidity indices of specific antibodies against tetanus toxoid, Escherichia coli O6 and a pool of 10 common E. coli O antigens, as well as the concentration and daily output of lactoferrin and total secretory IgA (SIgA), were evaluated in the milk of moderately undernourished mothers who were in a random blind design divided into two groups and given different caloric supplementations. Group A received a high caloric supplement (500 kcal/d), and group B received a low caloric supplement (140 kcal/d). Determinations were done using ELISA in various modifications, except for lactoferrin, which was quantified by single radial immunodiffusion. The avidity indices were investigated as an evaluation of the antibody quality. In all the parameters evaluated, the only difference found between the two groups at the end of the supplementation period was in the content of total SIgA, which was lower in group B, both in concentration and daily output. However, the SIgA remained within the normal range. Increases as well as decreases in the levels of specific IgA antibodies occurred within both groups. Avidity was decreased in group B only against one of the antigens tested. We conclude that moderate undernutrition does not impair the levels of milk antibodies, and supplementation does not enhance them but prevents the decrease in the content of total milk SIgA. There is a suggestion that the avidity of certain antibody specificities could be hampered.

Maternal nutrition and birth weight.

PIP: Low birth weight (LBW) babies (2500 gm or less at birth) are more likely to die and suffer sequelae. Intrauterine growth retardation (IUGR) babies also weight the same, but they are born at 37 weeks or over. Small for gestational age (SGA) is a related term used for babies weighing less than expected. 20.6 million LBW babies were born in 1979, most of then in developing countries. In the US, 12.1% of nonwhites vs. 6% of whites had LBW babies in 1980 (50% of infant deaths were attributed to LBWs). A study in Guatemala showed that LBWs accounted for 88% of neonatal deaths. 15-21% of the US decline in neonatal mortality since the 1960s was due to birth weight distribution. 50% of the decline in Alabama was attributable to improved obstetrical care from 1970 to 1980. 12,000 Finnish children were followed up for 14 years, and those born with weights below the mean had significantly higher mortality than normal weight children. The saving of very LBW babies by medical technology has raised ethical questions, as many have mental and physical retardation and the expenses are enormous. SGAs have smaller stature IUGR/low ponderal index infants had 2.9-5.7 times the mortality of full-term normal infants, and they also had poorer academic progress, but IUGR/adequate ponderal index babies fared even worse. Such afflictions carry across generations, as evidenced by a Seattle study on 748 white women indicating impaired reproductive performance of female infants. Some of the components producing LBW are: maternal genetic, social, cultural, and nutritional factors, smoking, and dieting during pregnancy, wars and famines (e.g., Leningrad and Wuppertal during and after World War II). Anthropometric studies indicate that mothers with greater body size have larger babies, but genetics also play a role here. Intervention studies confirmed the importance of nutrition: in a Mexican study and increase of 180 gm of birth weight and 29.6% reduction of LBW was produced by supplementation during pregnancy. Ethnic differences in the development of the newborn are worth studying after discounting confounding factors.^ieng