RESUMO
Childhood malnutrition is widespread in the Sahel region of Africa. In Niger, the 1992 Population and Health Survey found that 32% of children under the age of five years had stunted growth and 16% had muscle wasting. Vitamin A deficiency and anemia are major health problems and it is thought that the rate of zinc deficiency is also high. However, very little is known about the dietary intakes of children. The aim of this study was to assess food consumption, energy and nutrient intake in weaned, preschool age children and to assess their risks of deficiency. Three surveys were conducted in periods of food shortage. Two of the surveys were carried out one year apart, in the rainy season (August to September). The third was conducted at the end of the subsequent dry season (July). Sixty children from rural areas (30 girls and 30 boys) aged 2 to 4 years of age at the start of the study (mean age 36.8 + 7.0 months) from the Ouallam district (western Niger) were studied in surveys 1 and 2, and thirty of these children were then studied in the third survey. Food intake was assessed using a modified weighed intake technique. All foods and beverages consumed by the child at each meal were recorded over three days. The raw ingredients of homemade family meals were weighed and the final cooked weight was also recorded. If the child ate from a shared bowl, the number of mouthfuls was counted and three mouthful samples were weighed. Total serving size was then calculated based on the number of mouthfuls and the mean mouthful weight. Snacks and meals eaten away from home were assessed by questioning the mother. Energy, protein, vitamin A, iron and zinc intakes were compared using the most relevant food composition data and the adequacy of the diet was determined from international recommendations for intake. Energy, iron and zinc requirements were adjusted for diets with a low level of digestibility. Protein requirements were adjusted according to the protein mix quality score (67%). The frequency of inadequate intake was calculated using the probability approach of Beaton (1985) or cutoff values roughly corresponding to the mean requirements for particular age/sex groups. Two overall diet scores were used: a nutritional quality score (NQS) and a diversity score (DS). The relationships between dietary intakes and scores, children's weights and heights were investigated. As expected, the children included in the study had monotonous diets, with few animal products, fats, fruits and vegetables other than green leaves (Figure 1). Cereals made up 80 to 90% of total energy, protein, iron and zinc intake. Green leaves supplied most of the vitamin A intake. Intakes were chronically inadequate, particularly during the rainy season, with only vitamin A intake being adequate (Table 1). Almost all the children were at high risk of zinc deficiency. Diet quality and diversity scores were correlated (Tables 2 and 3). About half the children had stunted growth (Table 4). Energy, protein and zinc intakes were highly and significantly correlated with the anthropometric status of the child one year later, particularly with height-for-weight Z scores, and with dietary NQS (Table 5). Both dietary scores were positively correlated with weight and height indices. However, only NQS was significantly associated with weight-for-height index, higher NQS scores being associated with higher growth indices. Diet quality also predicted the anthropometric status of the child one year later. Our findings suggest that both dietary scores are relevant but that the diversity of food eaten may be a better determinant of growth status if energy intake is close to meeting dietary requirements. Multiple dietary inadequacies are frequent among children from developing countries so scores of overall dietary quality may be more appropriate indicators than the intakes of specific nutrients. (ABSTRACT TRUNCATED)
