Premature complementary feeding is associated with poorer growth of vietnamese children.

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breast-fed infants grew more quickly in both weight and length, followed by predominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infants gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partially breast-fed infants. In the older period (6-12 mo), exclusively and predominantly breast-fed infants grew in length more quickly than partially breast-fed and weaned groups. However, there was no difference in weight gain among groups. Morbidity from diarrhea and acute respiratory infections was significantly lower for the >/=3 mo exclusively breast-fed group (chi(2) and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term deterioration of physical growth in infants who received premature complementary feeding and confirm the importance of exclusive breast-feeding for infants for at least 3 mo.

Utilisation of wartime nutrition survival experiences.

In protracted and recurrent conflict, Vietnamese people have learned to minimize food insecurity through governance, mutual social responsibility, infrastructure development, ecological sensitivity, agricultural diversification and emphasis on family needs and traditional food patterns. Drawing on this experience, in 1992 a National Plan of Action for Nutrition was devised. Its goals include increasing energy intake and reducing childhood malnutrition.

Mid-upper-arm circumference development and its validity in assessment of undernutrition.

As part of a prospective, longitudinal study that was carried out in Hanoi, Vietnam (as from 1981), mid-upper-arm circumference (MUAC) measurements, and the weight and height of children were taken from children for the first year of life. These measurements were recorded monthly, 12-36 months: 3-monthly, 36-72 months: 6-monthly and yearly for children beyond 72 months. The aim of this study was to observe development of MUAC of children on a longitudinal basis. Mid-upper-arm circumference increases by about 1 cm for boys and 1.5 cm for girls between 1 and 5 years. To recognise malnutrition, the cut-off level of MUAC 13.5 cm gave high values for sensitivity and specificity only for children aged 6-12 months. The cut-off levels of 14.0, 14.5 and 15.0 cm were more appropriate for children aged 13-24, 25-36 and 37-60 months. These results suggest that a single cut-off point of MUAC 13.5 cm cannot be used in screening moderate malnutrition for all children under age 5 but should be elevated with the increasing age of children.

Effect of nutrition improvement project on morbidity from infectious diseases in preschool children in Vietnam: comparison with control commune.

OBJECTIVE: To evaluate the effect of a nutrition improvement project based on home garden production and nutrition education on morbidity from acute respiratory infection and diarrhoeal disease in preschool children. DESIGN: The morbidity survey comprised five data collections undertaken by trained interviewers to ascertain the incidence and severity of respiratory infections and the incidence of diarrhoeal disease in children in two communes. SETTING: A project commune and a control commune in Vietnam. SUBJECTS: Preschool children to 6 years of age living in the project commune Khai Xuan (average 469 children) and the control commune Ching Cong (average 251 children). MAIN OUTCOME MEASURES: Differences between the two communes over time in the incidence and severity of respiratory infections and the incidence of diarrhoeal disease. RESULTS: In Khai Xuan there was a significant reduction (P < 0.0001) in the incidence of respiratory infections (from 49.5% to 11.2%) and diarrhoeal infections (18.3% to 5.1%); the incidence of pneumonia and severe pneumonia was also significantly reduced (P < 0.0001). In Ching Cong there was no significant change in the incidence and severity of respiratory disease nor in the incidence of diarrhoeal disease. CONCLUSIONS: These findings emphasise the successful health outcome of a nutrition project based on household food production and nutrition education and the value of evaluating nutrition projects by reference to measurable health outcomes.

PIP: A nutrition program based on home garden food production and nutrition education for mothers of young children was associated with significant reductions in morbidity from acute respiratory infection and diarrheal disease in preschool children in Viet Nam's Vinh Phu province. The nutrition program was implemented in Khai Xuan commune during 1991-93; Ching Cong commune, which did not receive the intervention, served as the control community. In Khai Xuan, the incidence of respiratory infections among children under 6 years of age decreased from 49.5% to 11.2% during the study period, while that of diarrheal disease dropped from 18.3% to 5.1%. The nutrition project was also associated with significant declines in severe pneumonia. No changes in morbidity occurred in the control commune. The intervention resulted in significantly higher intakes of vegetables, fruit, energy, protein, vitamin A, and iron by project children compared with controls. It is recommended that nutrition improvement be adopted as an infectious disease control strategy in international and national development programs, especially those in countries where respiratory and diarrheal infections are the major cause of child morbidity and mortality.

Longitudinal observation of growth of Vietnamese children in Hanoi, Vietnam from birth to 10 years of age.

OBJECTIVE: To investigate the physical growth of Vietnamese children on a longitudinal basis and with regard to any secular trend. DESIGN: A longitudinal study with four birth cohorts: 1981, 1982, 1983 and 1984 followed up in their homes from birth to 10 y. SUBJECTS: Two-hundred twelve children (128 boys and 84 girls) from two (Hai Ba and Hoan Kiem) out of the four districts in Hanoi. MONITORING OF PHYSICAL GROWTH: Weight, height, feeding practices and diseases were recorded monthly from birth to 12 months, three monthly from 12-36 months, six monthly from 36-72 months, and annually thereafter until 10 y of age. RESULTS: Mean body weight and height of the children at birth was reduced and after the first 3-4 months were comparable to NCHS reference data. Thereafter weight and height fell progressively from the NCHS reference. The most intense period of growth retardation was 15-36 months. The highest proportion of stunting occurred at 21 months (59.4% of males and 58.3% of females). Anthropometric data of Vietnamese children living 1981-1995 in Hanoi were lower than from those living at the same time in Paris but higher than from those living in earlier decades in Vietnam. CONCLUSIONS: The longitudinally-followed children showed growth retardation at birth due to the poor nutritional and health status of their mothers. Children grew well during the first 3-4 months of age, then growth faltering was observed due to inadequate complementary feeding practices. There was a positive secular trend among Vietnamese children.

Use of food intake and body mass index (BMI) in the assessment of adult nutritional status in Viet Nam including a maternal-child analysis.

The authors have used food intake and Body Mass Index (BMI) to assess Vietnamese adult nutritional status. Chronic Energy Deficiency (CED) is prevalent in Vietnamese adults with an average percentage about 40%. The mean value of BMI in the 26-40 year old age group is 19.7 but it decreases thereafter except in urban areas. The change in the BMI curve distribution varies among adults living in rural, urban and mountainous areas. There seems to be a relationship between the BMI of mothers and the nutritional status of their children underthe age of 5. Some findings revealed a relationship between maternal BMI and birth weight and between CED and health status. The proposed cut-off point of Ferro-Luzzi-James in the classification of CED was applied to data from Vietnam.

Use of body mass index in the assessment of adult nutritional status in Vietnam.

The authors have used body mass index (BMI: kg/m2) to assess the Vietnamese adult nutritional status and classified the population into different grades of chronic energy deficiency (CED). CED is prevalent in Vietnamese adults (average 40%). The mean value of BMI of the age group 26-40 years is 19.7 but it decreases thereafter except in urban areas. The BMI curve of distribution is different between adults living in rural, urban and mountainous areas. There seems to be a relation between BMI of mothers and the nutritional status of their < 5-year-old children. The survey also revealed a relation between maternal BMI and birth weight, and between CED and the health status of the population.