Discriminant function of complement C3, serum albumin and anthropometric measurements in identifying malnutrition

A prospective study was conducted on 32 malnourished and 12 healthy pre-school children to study the role of certain variables, viz., supine length, weight-for-supine length, complement C3, weight-for-head circumference, serum albumin, weight and mid-arm circumference, in detecting the presence of malnutrition and to grade the severity of malnutrition. Out of 32 malnourished children 14 cases were re-investigated after 15 days of nutritional rehabilitation to find out the significant discriminator(s) of pre and post-treatment condition. Step-down discriminant analysis showed that supine length, weight-for-supine length and complement C3 were efficient discriminators in detecting cases of malnutrition. To transform the variables, viz., supine length, weight-for-supine length and complement C3 (each expressed as a percentage of standard-for-age) into score form, respective simplified weights, for multiplication, were found to be 0.9, 0.4 and 0.1. A dividing score (Z) of 123.1, with a bordering range () of 119.6 to 126.7 for 90% probability limits, separated malnourished from healthy children. For classifying children with respect to severity of malnutrition, weight-for-supine length and serum albumin concentration were found to be significant discriminators. Malnourished children with oedema (N=11) had higher weight-for-supine length ratio and lower serum albumin concentration as compared to non-oedematous malnourished children (N=21). While oedematous and non-oedematous malnourished children were almost equally stunted, higher weight for supine length ratio was attributed to accumulation of oedema fluid, in the former group. A subsample of 14 malnourished children who had received a 15-day nutritional therapy could be differentiated from their earlier condition (before treatment) by a significant rise in complement C3 and serum albumin levels.     

Analysis of the indications for routine lumbar puncture and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in East Africa

Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi District Hospital (KDH) in Kenya. Records of all children admitted to the paediatric wards of the two hospitals from 1st November 2004 to 30th April 2005 with suspected central nervous system infections and had LPs performed were analysed. Overall, 8,741 paediatric admissions were recorded in the two hospitals (Muhimbili = 6,228; Kilifi = 2,513). Of these, 607 (6.9%) had a LP performed; 154 out 6,228 (2.5%) in MNH and 453 out of 2,513 (18.0%) in KDH. LPs were performed less frequently in Muhimbili than in Kilifi Hospital. The most common indications for LP at MNH were convulsions (62.5%), neck stiffness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck stiffness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (23%) obtained on culture at both hospitals. Streptococcus pneumonaie and Salmonella species were the commonest causes of pyogenic meningitis. In conclusion, the rate of LP performance in the two hospitals is low. There is need therefore to improve the rates of LP and the isolation of bacterial pathogens from cerebrospinal fluid cultures. Other possible causes for meningitis such as viruses need to be investigated.     

Glutathione S-transferase polymorphisms may be associated with risk of oedematous severe childhood malnutrition

It has been estimated that more than 50 % of deaths before the age of 5 years have undernutrition as an underlying cause. Severe childhood malnutrition, an extreme form of undernutrition, occurs as oedematous and non-oedematous syndromes. The reasons why only some children develop oedematous severe childhood malnutrition (OSCM) have remained elusive, but the heterogeneity of clinical appearances among children from relatively homogeneous backgrounds suggests that interindividual variation in susceptibility to OSCM may exist. We investigated variants of four glutathione S-transferase (GST) genes in a retrospective study among subjects (n 136) previously admitted to the Tropical Metabolism Research Unit, Jamaica, for the treatment of either OSCM (cases) or non-oedematous severe childhood malnutrition (controls). We found that GSTP1 Val(105) homozygotes were significantly more common among the cases (odds ratio (OR) 3.5; 95 % CI 1.1, 10.8). We also found an association of borderline significance between non-deletion GSTT1 genotypes (i.e. +/+ or +/0) and OSCM (OR 2.4; 95 % CI 1.0, 5.9). There was no significant association between OSCM and any of the other GST variants. These preliminary findings suggest that genetic variation within the GST superfamily may contribute to the risk of OSCM. Additional, larger data sets and studies of variants in other candidate genes are required in order to properly assess the true contribution, if any, of genetic variation to risk of OSCM. Such studies may improve our understanding of the causes of clinical heterogeneity in malnutrition.     

The absence of adapted sodium and potassium transport in erythrocytes of cerebral palsied children with secondary malnutrition

Previous studies of erythrocyte ion (potassium and sodium) transport during marasmus and kwashiorkor have indicated increased passive permeation to both ions in both syndromes, and increased Na,K pump activity in kwashiorkor and reduced activity in marasmus. Children with severe cerebral palsy (CP) frequently suffer secondary protein energy malnutrition (PEM). Unlike marasmus and kwashiorkor, this PEM is uncomplicated by micronutrient deficiency, parasitism and infections. Because of deformities classification of PEM cannot be performed in these children by stature-based anthropometry, therefore we used triceps skinfold thicknesses less than the fifth percentile and absence of weight gain in the previous year as criteria for malnutrition. K influx data from well- and malnourished CP children, and from well-nourished controls reveal that ouabain-sensitive K influx is highest in malnourished CP, followed by well-nourished CP (P = 0.02), and lowest in controls (P less than 0.001, vs. malnourished). Determinations of ouabain-sensitive Na efflux, though less precise and therefore more variable, were consistent with this finding of no decrease of Na,K pump activity occurring during the development of this malnutrition. There were no statistically significant differences in ouabain-insensitive fluxes of either Na or K. Ion transport in undernourished CP children thus resembles that found in kwashiorkor rather than in marasmus; but oedema is rarely seen in this form of secondary PEM.     

Infections associated with severe protein-calorie malnutrition in hospitalized infants and children

One hundred Bangladeshi children admitted to hospital for treatment of severe protein-calorie malnutrition were systematically evaluated for the presence of infections. Ninety percent of children had some evidence of systemic infection at the time of admission and 75% had pneumonia, bacteruria, diarrhea in association with a known enteric pathogen, bacteremia, meningitis, or more than one of these major infections. Forty-nine percent of patients had pneumonia, including 14% of admissions with clinical evidence of pulmonary tuberculosis. Forty-three percent of admissions had diarrhea and 40% had evidence of enteric infections, most commonly shigellae or rotavirus. Bacteruria occurred in 30% of admissions, but bacteremia was identified in only 2% of patients initially. The prevalence of intestinal parasites increased with age, both among inpatients and comparison subjects with less severe grades of malnutrition. There did not appear to be important differences in the parasite loads or prevalences between the 2 groups.Twenty-one inpatients died; deaths were more common in younger children. The cause of death was most frequently related to infections. The identification and appropriate treatment of infections must be considered a major component of the rehabilitation of severely malnourished children.     

Morbidity and mortality of severe malnutrition among Sudanese children in New Halfa Hospital, Eastern Sudan

Medical files of children with severe malnutrition admitted at New Halfa hospital, Sudan during 2007-2009 were reviewed. A total of 1097 children (54.9%, 602 male) with severe malnutrition were admitted during the three year period. Oedematous severe malnutrition was found in 179 (16.3%) children. Of these 1097, 796 (72.6%) patients with severe malnutrition were children <2 years old. Out of these 1097 children, 780 (71.1%) and 112 (10.2%) had diarrhoea and malaria, respectively. Sixty-one (5.5%) of these children died, 237 (21.6%) discharged against medical advice and 799 (72.8%) were discharged. Of the 61 children who died 11 (18.0%) had septicaemia following diarrhoea and respiratory tract infections. The case fatality rate was not different with sex or with presence/absence of oedema.     

Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.     

Growth in length of children recovering from severe malnutrition

The linear growth of 369 children treated for severe malnutrition at the Tropical Metabolism Research Unit, University Hospital of the West Indies, was examined retrospectively. Mean age was 12.6 months and 58 per cent of the children were oedematous on admission. Mean length for age was the same at admission and discharge (SD score - 3.4). Therefore when the sample is considered as a whole there was no catch-up in length for age. A sub-group of 108 children began to show catch-up growth in length. This sub-group did not differ in age or sex from the total sample but contained a greater proportion of non-oedematous children. Children in the sub-group were also more stunted initially (P less than 0.0001) than the group as a whole. The absolute rate of linear growth was similar in oedematous and non-oedematous children. Change in length for age during recovery was significantly less in children who were oedematous on admission. Two-thirds of the children attained at least 85 per cent weight for length before they began to increase in length. Thus in most cases linear growth followed replenishment of body weight. The data point to the need for further investigations to determine why some children were capable of early catch-up growth in length while others, with similar characteristics, showed minimal or no linear growth during recovery.     

Plasma concentrations of N-acetylneuraminic acid in severe malnutrition

In rat studies, circulating concentrations of N-acetylneuraminic acid (NANA) have been shown to be an indicator of NANA concentrations in the brain and functional brain activity, in relation to nutritional state and stimulation. Abnormal behaviour can be improved with exogenous NANA. In the present study, the plasma NANA concentration has been measured in children with severe malnutrition and compared with that in controls. NANA was measured colorimetrically in the plasma of twenty-three severely malnourished children (mean age 11.43 (SD 6.05) months) before and after recovery, and in thirty-four controls (mean age 14.28 (SD 7.32)months). In thirteen of the malnourished children, NANA was measured after infections had been treated with a course of antibiotics. Mean plasma NANA concentration was significantly higher in protein-energy malnutrition (PEM) (2.89 (SD 0.58) mumol/ml; n 23) compared with controls (2.13 (SD 0.37) mumol/ml; n 34, P less than 0.001). The levels remained high in PEM after infections had been treated (2.87 (SD 0.43) mumol/ml, n 13) but returned to control levels at recovery from PEM (2.14 (SD 0.24) mumol/ml). In contrast to the findings in rats, in malnourished children plasma NANA concentrations were not reduced and did not relate directly to nutritional state or, by inference, brain function. These findings do not provide any support for the use of exogenous NANA supplements to improve brain function in humans.     

Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean±SD age 23.5±15.3 months) were admitted during June 2005–May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of ≥500 and ≥700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of −1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.Key words: Child nutrition, Child nutrition disorders, Healthcare cost, Infant nutrition, Infant nutrition disorders, Oral rehydration therapy, Severe acute malnutrition, Standardized protocol, Bangladesh     

Follow-up of children with moderate or severe malnutrition in the peripheral population (Brazil)]

What happens to children who develop moderate or severe malnutrition? What is done for them? Keeping in mind these questions, the present research was undertaken with the following objectives: to assess the nutritional status of children who develop moderate or severe malnutrition before the age of 5 years, after a period from 2 to 4 years after diagnosis; to assess the nutritional status of the under 5-year old siblings of these children; to study the influence of nutritional programs available in the community for the improvement of the nutritional status of the malnourished children; and to identify factors interfering with nutrition of these children during the study period. After a period of 2 to 4 years from the time of diagnosis of moderate or severe malnutrition the authors tried to locate the families of 61 malnourished children of Porto Alegre, RS (Brazil). The mothers their substitutes were interviewed and the children and siblings under 5 years of age were weighed and measured. Thirty-nine children were located. Of these, 4 (10%) died and 22 (56%) presented an increase of at least 10% in weight for age. Of the 35 children who survived, 29 (82%) still presented some degree of malnutrition (weight/age < or = 90% of the standard), 25 (71%) were stunted (height/age < or = 95%), and 5 (14%) were wasted (weight/height < or = 90%). The nutritional status of the 5-year old siblings was similar to that of the malnourished children.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children

Acute lower respiratory infections (ALRI) are the main cause of death in young children worldwide. We report here the results of a study to determine the long-term survival of children admitted to hospital with severe pneumonia. The study was conducted on 190 Gambian children admitted to hospital in 1992-94 for ALRI who survived to discharge. Of these, 83 children were hypoxaemic and were treated with oxygen, and 107 were not. On follow-up in 1996-97, 62% were traced. Of the children with hypoxaemia, 8 had died, compared with 4 of those without. The mortality rates were 4.8 and, 2.2 deaths per 100 child-years of follow-up for hypoxaemic and non-hypoxaemic children, respectively (P = 0.2). Mortality was higher for children who had been malnourished (Z-score < -2) when seen in hospital (rate ratio = 3.2; 95% confidence interval (CI) = 1.03-10.29; P = 0.045). Children with younger siblings experienced less frequent subsequent respiratory infections (rate ratio for further hospitalization with respiratory illness = 0.15; 95% CI = 0.04-0.50; P = 0.002). Children in Gambia who survive hospital admission with hypoxaemic pneumonia have a good prognosis. Survival depends more on nutritional status than on having been hypoxaemic. Investment in oxygen therapy appears justified, and efforts should be made to improve nutrition in malnourished children with pneumonia.     

Biotin deficiency in protein-energy malnutrition

Several of the clinical and biochemical manifestations of biotin deficiency also occur in severe protein-energy malnutrition (PEM). Average plasma biotin concentrations were lower in 16 malnourished children (10 with marasmus, 3 with kwashiorkor and 3 with marasmic kwashiorkor) than in 31 controls. Lymphocyte mitochondrial carboxylase activities were studied in 11 controls and in 10 patients with PEM; on the average, they were lower in the patients. Their activation indices (the ratio of enzyme activity in cells incubated with biotin to activity in cells incubated without the vitamin) were higher in PEM. All these differences were statistically significant. None of these parameters were age-dependent in a range between 3 and 72 months. Carboxylase activities and plasma biotin levels increased to normal during nutritional recovery in two malnourished patients who were further studied. These results suggest that there is biotin deficiency in severe PEM. Urinary biotin concentrations, expressed per g of creatinine, were higher in the patients than in the controls; this may have been caused by increased renal clearance or by the reduced creatinine excretion which occurs in malnourished individuals. It will be important in future studies to determine the relative contribution of biotin deficiency to the malnourished phenotype.     

Leptin levels and IgF-binding proteins in malnourished children: effect of weight gain

OBJECTIVES: Although it is well known that leptin reflects body fat content in adults, the regulation of leptin levels during childhood malnutrition is poorly understood. Insulin-like growth factor I (IGF-I) and the IGF-binding proteins (IGFBPs) may play important roles in the regulation of body composition. We investigated the relation between leptin, IGF-I, and IGFBPs in children with protein-energy malnutrition (PEM; before and after recovering 10% of their initial body weights) in comparison with well-nourished children. METHODS: Fifteen PEM and 16 healthy children were studied on admission and after 10% weight gains in the malnourished group. Leptin was measured with radioimmunoassay, IGF-I and IGFBPs were measured with immunoradiometric assay. RESULTS: Patients with PEM had a significantly lower body mass index and percentage of body fat than did the control children. Before weight gain, leptin, IGF-I, and IGFBP-3 were significantly lower and IGFBP-1 was elevated in the malnourished group compared with the control group. Among PEM patients, after 10% weight gains, the levels of leptin, IGF-I, and IGFBP-3 were significantly higher and IGFBP-1 significantly lower compared with the control group. Leptin correlated significantly with IGF-I in the normal children (r(s) = 0.86, P < 0.005). On admission, no correlation was observed between leptin and IGF-I (r(s) = 0.08, P < 0.16) and between leptin and IGFBP-3 (r(s) = 0.02, P < 0.27) in the malnourished group, but those levels improved after 10% recovery of their body weights (r(s) = 0.47, P < 0.002 and r(s) = 0.42, P < 0.005, respectively). In the PEM group, IGF-I correlated significantly with IGFBP-3 when the children gained weight (before: r(s) = 0.006, P < 0.31; after: r(s) = 0.32, P < 0.01). Our study showed results similar to those of anorexia nervosa studies, but the normalization of study variables was obtained in considerable less time for the same weight gain. CONCLUSIONS: The main finding of this study was that, after refeeding with only a 10% weight gain, the PEM children normalized their leptin, IGF-I, and IGFBP-3 levels. These results provide evidence that leptin can function as link between this hormonal response and improved nutrition status.     

Nutritional correlates of acute respiratory infections

During October 1992 to June 1993 in eight villages covered by the Primary Health Center Machhra in Meerut District, India, interviews with mothers and examinations of 1600 children aged less than 5 years (under-fives) were conducted to examine the relationship between acute respiratory infection (ARI) and malnutrition. 42.25% of all children had an ARI within the last 15 days. Most ARIs (73.4%) were considered mild (cough and cold with no pneumonia). Pneumonia accounted for 19.5% of all ARI cases, which were considered moderate. The remaining ARI cases were severe (severe and very severe pneumonia). 57.5% of all children suffered from protein energy malnutrition (PEM). 78.6% of children aged 12-14 months had PEM. ARI was more common among malnourished children than well-nourished children (52.2% vs. 28.8%; p 0.001). The incidence of ARI increased as the nutritional status deteriorated (p 0.05). It also increased as the midarm circumference decreased (p 0.001). These findings confirm the synergistic action between malnutrition and infection, in this case ARI. Malnourished children suffer considerable impairment in immunity, especially cellular immunity, which makes them more prone to ARI. These findings reinforce the need to strengthen the quality, quantity, and accessibility of nutritional services, particularly promotion of breast feeding and vitamin A supplementation.     

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care

OBJECTIVES: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM). DESIGN: Cross-sectional study with consecutive selection of residents aged >or=65 y. SETTING: A municipality in the south of Sweden. SUBJECTS: During a year, starting in October 1996, 148 females and 113 males, aged >or=65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study. RESULTS: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished. CONCLUSIONS: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.     

Malnutrition as an independent predictor of clinical outcome in critically ill children

ObjectiveTo determine the nutritional status of a cohort of children admitted to a pediatric intensive care unit (ICU) and to assess the effect of malnutrition as an independent risk factor affecting outcome in this patient group.MethodsIn a prospective cohort study, 385 children admitted to the ICU of a teaching hospital over a 2-y period were assessed for nutritional status at admission and clinical outcome. The outcome variables were 30-d mortality, length of ICU stay, and length of mechanical ventilation. Potential exposure variables were gender, age, diagnosis (clinical versus surgical), septic shock, malnutrition, and scores on the Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction. Nutritional status was determined using z scores of weight for age, height for age, and body mass index, based on the World Health Organization child growth standards. Patients with z score < ?2 of anthropometric indexes were considered malnourished.Results175 patients (45.5%) were malnourished on admission. Sixteen patients of the malnourished group (9.14%) and 25 patients (11.9%) of the non-malnourished group died. Malnutrition was associated with greater length of mechanical ventilation and length of ICU stay, but not with mortality on univariate analysis. Malnutrition was associated with greater length of ventilation on the multiple logistic regression model (OR 1.76, 95%; CI 1.08-2.88; P = 0.024).ConclusionMalnutrition is common among children admitted to an ICU. This factor was not a predictor of mortality but showed independent association with length of mechanical ventilation.     

Jamaican studies in nutrition and child development, and their implications for national development.

In a hospital in Jamaica, a study compared the developmental levels of 18 children suffering from severe protein energy malnutrition (PEM) with those of 15 sufficiently nourished children. Even though both groups had low scores on the Griffiths' test, the malnourished children had a significantly lower score than the controls. Upon recovery, both groups improved at the same speed, resulting in a continual deficit of the malnourished group. Another study in Jamaica involved longterm psychosocial stimulation at the hospital and then at home with children with severe PEM. They were compared with another severely malnourished group who received no intervention and with an adequately nourished group. The case group caught up with the adequately nourished group within 2 years. 6 years after intervention, their school grades in spelling and reading were significantly higher than those of the non- intervention malnourished group. Another study in Jamaica showed that factors associated with stunting, and not an acute episode of malnutrition, accounted for poor developmental levels in severely malnourished children. Studies with children suffering from mild to moderate undernutrition suggested that food supplementation improves stunted children's development and that a link exists between their underlying nutritional status and short-term food deprivation. None of the aforementioned studies confirmed a causal association between reduced activity and poor development. Since these studies indicated that nutritional status is linked to educational success or failure and other studies have demonstrated a link between education and individual or national development, Jamaica should promote nutritional interventions to increase equity and improve life chances, thereby benefiting national development.     

Anthropometric measurements,deficiency signs and their relationship under drought conditions

In October-November 1987 in India, the Desert Medicine Research Centre in Jodhpur conducted a rapid anthropometric survey of 555 preschool children in 4 districts of Rajasthan which had been severely affected by drought (Jodhpur, Jalore, Nagpur, and Barmer districts) to determine the association between anthropometric measurements and various nutritional deficiency signs and infections. Based on weight for age, 82.3% of the children were undernourished. 13.3% of all children were severely malnourished (grade III undernutrition). Anemia, protein energy malnutrition (PEM), and upper respiratory infections occurred significantly more often as one digressed from the normal nutrition grade. These 3 conditions were also closely linked to weight status. Based on height for age, 62.4% of the children were chronically undernourished. 11.9% of all children were severely so. PEM was the only deficiency sign or infection associated with height status (6.2% of children with normal nutrition had PEM vs. 15.% for grade I undernutrition and 34.8% for grade II undernutrition; p .001). Vitamin A deficiency, anemia, and PEM occurred more frequently as one went from normal nutrition to grade II undernutrition based on fat fold at triceps (FFT) measurements. PEM and upper respiratory infections were significantly associated with weight for height status. Weight correctly identified 84% of all nutritional deficiency signs and infections. The corresponding figures for height, FFT, and weight for height were 64.2%, 75.4%, and 31%. Thus, weight was the most sensitive screening measurement in identifying nutritional deficiency signs and infections. Based on weight alone, the odds ratio of undernourished children developing Vitamin b-complex deficiency, PEM, and upper respiratory infections was 1.58, 3.25, and 1.77, respectively. Weight for height was the most specific screening measurement (88.2% vs. 44.7% for height, 29.3% for FFT, and 26.1% for weight).     

Outcomes of older and younger malnourished and well-nourished patients one year after hospitalization

The purpose of this study was to determine the relationship between malnutrition and later health status in old and young patients after hospitalization. Men were evaluated by nine criteria of malnutrition and classified as older (age 65 and older) and younger (younger than 65). About 32% of the younger and 45% of the older men were malnourished. At base-line, malnourished patients had more diagnoses (p less than 0.01) and depressed lymphocyte response to phytohemagglutinin (p less than 0.05). Older malnourished patients also had more depressed chemotaxis results (p less than 0.05). One year later, the malnourished patients still had more markers of malnutrition (p less than 0.001), more diagnostic problems (particularly infections) during the follow-up (p less than 0.01), and depressed lymphocyte response to phytohemagglutinin (p less than 0.05) and increased IgA levels (p less than 0.01). The only deaths (n = 4) occurred among the malnourished older men. Alcoholism in the malnourished young men may have contributed to their continued or recurrent status of protein energy malnutrition. The malnourished old patients could have had less recuperative powers and continued poorer diets. The study suggests malnourished hospitalized patients are at high risk for long-term health problems probably through continued or reoccurring episodes of malnutrition.