Presentation Nutrition

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Growth Indices, Anemia, and Diet
Independently Predict Motor Milestone
Acquisition of Infants in South Central Nepal

Community and International
Nutrition

INTRODUCTION
Gross motor development is an
important aspect of the
development
of young children

Children begin to
explore their
environments
Engage in new
experiences that
promote learning and
development

INTRODUCTION
INFECTION

MALNUTRITION

Growth faltering

PREVALENT in developing countries

INTRODUCTION
Limited variety of
complementary foods

ASSOCIATED

Malnutrition and
developmental
delays

Low nutrient density
adequacy of the
foods

CA
US
E

INTRODUCTION
• Animal protein intake was positively associated
with earlier walking acquisition among
Guatemalan infants
• Delays in motor milestone acquisition, including
walking, were found among cohorts of:
Stunted,
underweight
Indonesian

Zanzibari
Infants,
Guatemalan
infants

Stunted
and wasted
Pakistani infants

INTRODUCTION
• Several controversies remain:
▫ Is there an ordinal relation between motor
milestones?
▫ Is linear growth the salient variable or is wasting
as important in walking acquisition?
▫ Do anemia and growth have independent effects
on walking in populations of children outside of
Zanzibar?
▫ Are dietary factors merely a proxy for anemia?

METHODS
• Study population
▫ Cross-sectional community based investigation of
baseline characteristics of children enrolled in:
 a substudy of a randomized, placebo-controlled,
clinical trial of zinc and/or iron-folic acid
supplementation on:
 Childhood mortality, morbidity,
 Growth, and development
Between January and March 2002 that occurred in the lowland Terai region of
south central Nepal in Sarlahi District, which borders Northern India

METHODS
• Motor development was evaluated using a 14-item, prospective, ordinal
pictorial scale of motor milestones.
• Blood was collected using a heel-prick method to extract 3 drops of blood
from each child.
▫ The first was wiped away
▫ The second and third were used for testing erythrocyte protoporphyrin (EP)4 and
hemoglobin with a Hemoglobin Photometer (HemoCue) and a
Hematofluorometer(AVIV Biomedical), respectively.

• Anthropometric measures included:





Weight
Recumbent length
Mid-upper arm circumference (MUAC)
Head circumference.

Data Analysis
• Data were entered into SQL Server 7.0 and
analyzed using SPSS 12.0.
• Stunting, wasting, and underweight were
defined, respectively as length-for-age, lengthfor-weight, and weight-for-age less than 2 Zscores.
• The definition of anemia used in this analysis
was a hemoglobin concentration 105 g/L.

METHODS
• A scale was created as a means of summarizing socioeconomic status
(SES); 12 of the 17 related items were retained for the scale.
• Principal components analysis was used to extract the factors for the scale
• The most comprehensive factor with the largest eigenvalue 1 was selected
for reliability analysis.
• Cronbach’s was used to assess the internal consistency of the selected
items. The reliability of the SES scale was good ( 0.78).
• A higherscore on the SES scale reflected a greater number of possessions.

RESULTS
• Among the 485 children
▫ One-third were stunted (33.7%)
▫ One-fifth were wasted (20.6%)
▫ More than onehalf were underweight (52.7%)

• Mean hemoglobin concentration was below both
the recommended cutoff values of 105 g/dL
• Anemia was prevalent, but not very severe: 2.1% of
the children had a hemoglobin concentration 70
g/L.

RESULTS





Could sit without support by 6 mo
Crawl by 7 mo
Walk with support by 11 mo
Walk without support by 14 mo

HALF OF THEM
CAN

NEPALI CHILDREN
ATTAINED
MILESTONE

1.5 LATER
THAN
WESTERN
POPULATIONS

1 MO EARLIER
THAN
INDONESIAN
CHILDREN

1 MO EARLIER
THAN
ZANZIBAR
CHILDREN

WALKERS AND NONWALKERS DIFFER
SIGNIFICANTLY

WALKERS WERE OLDER
WALKERS WERE LESS
UNDERWEIGHT
WALKERS ATE MORE
ANIMAL SOURCE FOODS

In multivariate regression models

AGE

LENGTH FOR
AGE

ANEMIA

WEIGHT FOR
AGE

MEAT
CONSUMPTION

Were significant predictors
of walking in the Nepali cohort

• Although there are occasional individual
children who show some transpositions in the
ordering of motor milestones, the acquisition of
these milestones is ordered across different
cultures and levels of nutritional risk in
different populations.

RESULTS
• There is an independent effect of 2
anthropometric indicators, anemia, and meat
intake on:
▫ Walking acquisition and contributes to earlier
evidence that motor development is sensitive to
nutritional factors.

RESULTS
• Caste, but not sex or SES, was predictive of
walking acquisition
• Nepali children who consumed meat were higher
than the odds of walking for children who
consumed animal source foods, including meat,
eggs, and nonhuman milk.

CONCLUSSION
• The present data indicate that the variability of
nutritional status among infants and toddlers
accounts for part of the variance in gross motor
development
• Nutrition factors affect a developmental system

Q1. Is there any new information you learn from this paper?
Please mention briefly

• There are new informations that we learn from
this paper. Nepali children who we thought are
living in rural areas have a better growth rate
than Indonesian children from the same age, and
it shows the lack of animal source food that
Indonesian children consume.
• And it’s quite new for us to learn that lower caste
children are able to walk faster than higher caste
children. Maybe there are more factors that
influence this result.

Q2. Is there any information which is not in
line with you? Please mention briefly.
• Yes there is, when we read it is reported that the
higher SES children have slower motor growth,
we thought that higher SES children were fed
better and the parents have higher education.
But it is not always promising that it will ensure
the growth speed. We thought that there are
more factors that contribute to the growth other
than foods.

Q3. What do you think the paper can help to improve
nutritional status of Indonesian children/people?
• It can help us by showing us that Indonesian children
growth is a lot more slower than advanced countries.
Leave alone the western counterpart, Nepali children
are even more well fed and have better growth than
Indonesian children, and it is a lesson for us to improve
the nutritional status of Indonesian children.
• Maybe It’s time to improve counseling to eat more
animal sourced foods for Indonesian children. And it
should be administered since younger age than what we
thought.

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