Twelve-year follow-up study of the impact of nutritional status at the onset of elementary school on later educational situation of Chilean school-age children.

OBJECTIVE: To determine the impact of nutritional status in a multicausal approach of socio-economic, socio-cultural, family, intellectual, educational and demographic variables at the onset of elementary school in 1987 on the educational situation of these children in 1998, when they should have graduated from high school. SETTING: Chile's Metropolitan Region. DESIGN: Prospective, observational and 12-year follow-up study. METHODS: A representative sample of 813 elementary first grade school-age children was randomly chosen in 1987. The sample was assessed in two cross-sectional studies. The first cross-sectional study was carried out in at the onset of elementary school in 1987 and the second was carried out in 1998, 12-years later, when they should be graduating from high school. In 1998, 632 adolescent students were located and their educational situation was registered (dropout, delayed, graduated and not located). At the onset of elementary school were determined the nutritional status, socio-economic status (SES), family characteristics, intellectual ability (IA), scholastic achievement (SA) and demographic variables. Statistical analysis included variance tests and Scheffe's test was used for comparison of means. Pearson correlation coefficients and logistic regression were used to establish the most important independent variables at the onset of elementary school in 1987 that affect the educational situation 1998. Data were analysed using the statistical analysis system (SAS). RESULTS: Logistic regression revealed that SES, IA, SA and head circumference-for-age Z score at the onset of elementary school in 1987 were the independent variables with the greatest explanatory power in the educational situation of school-age children in 1998. CONCLUSIONS: These parameters at an early school age are good predictors of the educational situation later and these results can be useful for nutrition and educational planning in early childhood.

[Fetal alcohol syndrome and fetal alcohol effects: importance of early diagnosis and nutritional treatment]. / Sindrome de alcoholismo fetal y efectos del alcohol sobre el feto: importancia del diagnóstico precoz y del manejo nutricional.

BACKGROUND: Fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) encompass a pattern of birth defects in persons whose mothers ingested alcohol during pregnancy. People with FAE display fewer of the FAS traits. AIM: To assess the prevalence and features of these affections in a secondary nutritional recovery centre. PATIENTS AND METHODS: All charts of children admitted between 1985 and 1995 were reviewed, and those children diagnosed as having a FAS or FAE by a geneticist were considered for this study. Birth, maternal, social and economic characteristics, psychomotor abilities (using Denver test) and response to nutritional treatment were assessed. RESULTS: During the study period, 1572 infants were admitted to the centre, and 1.97% (70% female) were diagnosed as having a FAS or FAE. These infants were admitted at 11.1 +/- 4.5 months of age and discharged after 96.7 +/- 58.1 months of hospitalisation. Mean mother's age was 33 +/- 7 years, and all belonged to low socioeconomic levels. Mean birth weight was 2048 +/- 431 g and 2469 +/- 619 g in children with FAS and FAE respectively (p < 0.03). Children with FAE performed better for gross and fine motor abilities than those with FAS. No differences were observed for language performance. Sixty five percent of children with FAS and 71% of children with FAE had an adequate weight and height increment during nutritional therapy. A multiple regression analysis showed that age at admission and gestational age were significant predictors of weight gain during therapy. CONCLUSIONS: Alcohol has teratogenic effects on the foetus that affect craneal size and psychomotor development. Alcohol also affects pre and post natal growth.

HLA-DR5 and DQB1*03 class II alleles are associated with cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) may present with eczematous lesions, mycosis fungoides (MF), or as exfoliative erythroderma with circulating atypical cells, Sezary syndrome (SS). The "malignant" T cells are epidermotropic and clonal, but whether they respond to antigen stimulation is unknown. Because CD4+ lymphocytes recognize antigen presented by histocompatibility locus antigen (HLA) class II molecules, and HLA association have been found in autoimmune skin diseases, we determined by allele-specific oligonucleotide typing whether HLA-DR or DQ alleles were associated with CTCL and its two variants MF (n = 47) and SS (n = 23). Phenotypic frequencies were compared by chi-square and Fisher exact test, and p values were corrected independently for either 12 DR or 15 DQ alleles. HLA-DR5, previously associated with MF, was significantly increased in all 70 CTCL patients (31.5%) versus controls (11%) (uncorrected p value [Pnc] = 0.000038, odds ratio [OR] = 3.9, 1.9 < OR < 8.1), in MF patients (34%) (Pnc = 0.000047, OR = 3.62, 1.9 < OR < 10), and in SS patients (26%) (Pnc = 0.03, OR = 3, 0.9 < OR < 9.3). HLA-DQB1*03 alleles (0301, 0302, and 0303) were increased in 72% of all CTCL patients versus 49% of controls (corrected p value [Pc] = 0.014, OR = 2.7, 1.4 < OR < 5.1), in SS (82%) (Pc = 0.05, OR = 4.7, 1.4 < OR < 5), and in MF (67%) (Pnc = 0.024, OR = 2.15, 1 < OR < 4.5). DQB1*0502 was strongly increased in SS patients (Pc = 0.045, OR = 7.75, 1.25 < OR < 48). Although HLA-DQB1*0603 and HLA-DR6 (1301, 1302, and 1402) were decreased in all groups, the decreases were not statistically significant. These data suggest that certain HLA-DRB and DQB1 alleles, also associated with other T-cell-mediated skin diseases, may participate in the pathogenesis of or susceptibility to CTCL.

[Growth after early severe malnutrition]. / Crecimiento después de desnutrición grave precoz.

In order to investigate growth following early severe malnutrition, two groups of 40 children and their mothers were studied, one of patients recovered from early protein energy malnutrition (PEM) at a closed center for nutritional recovery and another one of children under the same socioeconomic condition but who had never been malnourished. Both groups were matched for sex and age, and were followed by the same professional team for 9 years. A significant difference in mother's size (154.8 +/- 5.2 vs. 150 +/- 3.6 cm) and in patients size at birth (males 3,453.5 +/- 522.3 vs. 3,018.2 +/- 490.3 and females 3,328.4 +/- 563.4 vs. 2,654.6 +/- 579.6 g) was found in favour of the control group (p < 0.01). There were significant differences in height for age (H/A) and weight for age (W/A) (p < 0.001) but not in weight for height ratios between children for both groups (fig. 1 and 2). No differences were detected in bone age. Growth velocity was similar in both groups of boys (10.40 +/- 2.3 vs. 9.81 +/- 1.40 cm and 12.94 +/- 2.53 vs. 12.80 +/- 1.64 cm from 5 to 7 and 7 to 9 years of age respectively) but it was significantly greater in control girls (11.22 +/- 2.70 vs. 9.30 +/- 1.60 and 15.60 +/- 1.66 vs. 12.80 +/- 2.20 cm 5 to 7 and 7 to 9 years respectively, p < 0.01). These findings show that malnutrition before 2 years of age may produce long term effects on growth in children of low socioeconomic condition specially if, after treatment, they are turned back to the same unfavourable environment.

[Social environment in marasmic malnutrition]. / Microambiente de la desnutrición marásmica.

Undernutrition is associated with precarious sociocultural conditions. Concerned to break the vicious circle of undernutrition and poverty, Chile has developed programs to solve this problem, among these are the Closed Nutritional Recovery Centers (CNRC), where undernourished infants are treated and their families are educated, in order to improve their quality of life and to sustain, after treatment, the nutritional status achieved by their children at the center. We have followed up for the past 9 years of 283 children who were admitted at age 9.96 +/- 4.97 (mean +/- SD) months, (weight/age 63.05 +/- 8.4% NCHS standards), for treatment in a CNRC. Only 13% of them sustained the nutritional status achieved before discharge, which proceeded at age 13.42 +/- 5.1 months, (weight/age 81.64 +/- 8.9). We also studied, in two transversal points along follow up, the socio-cultural factors that influence nutrition after discharge from the CNRC: father's alcoholism, the presence of another malnourished infant at home, and low socio-economic status at admission were significantly related to bad nutritional long term evolution, while higher educational level and marital stability favored better outcomes.

Physical growth and bone age of survivors of protein energy malnutrition.

Early postnatal malnutrition produces delay in growth and developmental processes, and children from a low socioeconomical level where undernutrition is prevalent are shorter than those from higher socioeconomic levels. We examined the effects of severe and early protein energy malnutrition on growth and bone maturation. We studied 40 preschool children who had been admitted to hospital in infancy with protein energy malnutrition and 38 children from the same socioeconomic level, paired for age and sex, who had never been malnourished. Growth measurements were made over a period of 4-6 years, and bone age was determined in a subgroup through wrist roentgenograms. Results showed a correlation between protein energy malnutrition, birth weight of infants, and mother's height and head circumference. The group with protein energy malnutrition showed a significant delay in stature after four years, especially the girls (p less than 0.001). Weight:height ratio was reduced in boys compared with controls but not in girls. Both groups showed a delay in bone maturation, but there were no significant differences between them. We found a positive correlation between bone age and arm fat area in control boys and between bone age and height for age in boys with protein energy malnutrition. The finding that rehabilitated children were shorter than the control group but had similar bone age at follow up suggests that genetic or prenatal factors were important in their later poor growth, and this suggestion is supported by their smaller birth size and the smaller size of their mothers.

[Influence of nutrition on the bone development of children]. / Influencia de la nutrición en el desarrollo óseo del niño.

The effect of nutrition on infant bone age was studied. Bone age was examined in children with different degrees of malnutrition using wrist X-Rays and comparing them with Greulich and Pyle Atlas. There were no differences in the socioeconomic level of the different groups. In obese children bone age was advanced, while in under-nourished, it was retarded. The more severe the undernutrition the more delayed the bone age. A positive correlation between the percentage of variation of bone age and chronological age, and percentage of height for age was found. A greater delay in bone age was detected in undernourished children who had been small for date infants.

Fundoplication as treatment for gastroesophageal reflux in children.

Esophageal stricture resulting from gastroesophageal reflux is common among children in Ecuador. The sequence of events is vomiting, recurrent pneumonia, failure to thrive and stricture with resulting malnutrition. The diagnosis is confirmed by barium meal and esophagoscopy. The age of the affected population ranges from one month to 12 years. In the past, surgical treatment included esophageal replacement but the most appropriate current treatment is Nissen fundoplication to restore the gastroesophageal sphincter function.

Postprandial metabolism in infants of low birth weight.

Postprandial metabolic rate (MR) was measured after a standard test meal in 15 preterm appropriately grown (AA) infants, 11 small-for-gestational age (SGA) infants, and five fullterm normal infants. Resting MR before the feed was highest in SGA infants (228 kJ/kg/d, s.d.20) and lowest in AGA infants (181 kJ/kg/d, s.d. 30). The normal infants were intermediate. Postprandial MR increased by 18 per cent in the AGA group, 11 per cent in the SGA group, 4 per cent in the normal infants and not at all in sham-fed infants. There was a significant correlation between weight gain and the magnitude of the increase in postprandial metabolism. 'Specific dynamic action' may therefore reflect synthetic processes in these infants.

[The influence of the milieu in child malnutrition]. / Influencia del medio en la desnutrición infantil]

Both socioeconomic and cultural characteristics of families were studied as conditioning factors of malnutrition in 63 infants born at term. The sample studied included 45 infants, small for their gestational age (SGA) as experimental group, and 18 infants with adequate weight for gestational age (AGA), as the control group. These infants were studied during their third year of age, and significant differences between both groups were found in the following parameters: size, social personality, parasitic infestation and duration of lactation. A correlation between socioeconomic and cultural level, and incidence of malnutrition in infancy is postulated.

Energy retention, energy expenditure, and growth in healthy immature infants.

Energy balance studies were done during 10-29 days on 15 immature infants of mean birth weight 1581 g. Mean gross energy intake was 757 kJ/kg (181 kcal) and 79% of this was retained, so that metabolizable energy was 602 kJ/kg (143 kcal). Mean resting metabolic rate was 244 kJ/kg (58.1 kcal), and it increased with advancing maturity. Minimum resting metabolism averaged 199 kJ/kg (47.5 kcal). Energy expended in activity increased with maturity, but amounted to less than 17% of the total energy turnover. Postprandial metabolism caused the mean VO2 to rise by 17% in the hour after a feed, and during 24 hr resulted in consumption of energy equivalent to about 10% of the resting metabolism. Stored energy amounted to 230 kJ/kg (55 kcal) and was linearly related to weight gain (r = 0.92). Energy cost of weight gain was 24 kJ/g (5.7 kcal) and energy stored in new tissue was 16.8 kJ/g (4.0 kcal). Maintenance energy requirement at zero growth rate was about 270 kJ/kg (64 kcal).

Fetal growth in different racial groups.

Three racial groups of mothers and their newborn babies-- North European 75, Negro 75, and "Indian" Asian 37--were matched for parity, gestational age, sex, maternal age, maternal smoking habits, and social class. Multiple anthropometric measurements, including skinfold thickness, limb circumferences, and various linear measurements were made on the mothers and their infants to determine the effects of race and smoking on fetal size. Indian-Asian mothers, though shorter and lighter than Europeans and Negroes, had similar skinfold thickness and weight: height2 ratios and gained as much weight during pregnancy. Their infants, however, were lighter than the others, and had smaller head and limb circumferences, although their linear measurements were the same. Negro and European infants were almost identical in size. We found no effect on any of the fetal measurements which could be attributed to smoking.

Fetal growth in different racial groups

Three racial groups of mothers and their new born babies - North European 75, Negro 75, and "Indian" Asian 37 - were matched for parity, gestational age, maternal age, maternal smoking habits, and social class. Multiple anthropometric measurements, including skin fold thickness, limb circumfrences, and various linear measurements were made on mothers and their infants to determine the effects of race and smoking on fetal size. Indian-Asian mothers, though shorter and lighter than Europeans and Negroes, had similar skin fold thickness and weight:heightý ratios and gained as much weight during pregnancy. Their infants however, were lighter than the others, and had smaller head and limb circumfrences, although their linear measurements were the same. Negro and European infants were almost identical in size. We found no effect on any of the fetal measurements which could be attributed to smoking. (Summary)