Lisa Villanueva’s research while affiliated with Georgia Southern University and other places

Feeding pattern and dietary diversity was evaluated in 339 stunted children (HAZ < ‐1) 6‐36 mo of age from Retalhuleu using a food frequency questionnaire (Food and Nutrition Technical Assistance protocol). Dietary assessment was utilized to determine the frequency of food consumption for 7 consecutive days and was considered adequate if the food was included a minimum of 3x/wk in 75% of the population. Results indicated breast milk consumption was not adequate; 73% of children 0‐6 mo were breastfed at least 3x/wk and consumption decreased to 61% in children 19‐24 mo. The primary source of vitamin A was fortified sugar resulting in 88‐96% of the age groups having adequate vitamin A consumption patterns; vegetables rich in vitamin A were not consumed (0%). Meat and poultry had adequate consumption in the 25‐30 mo age group (80%), while younger children had intakes less than 75%. Consumption of cereals and grains increased with age and adequate consumption averaged 84% for infants and 86% for children 25‐36 mo. Hen eggs were the most frequently consumed food item (97%) as were instant soups, bean broths and other liquids (84%). In conclusion, diet diversity is poor in infants and young children from Retalhuleu, Guatemala. Fortified sugar and hen eggs were the only items consumed adequately across all age groups. Opportunities exist to increase breast feeding and improve complimentary feeding practices.

A community‐based feeding study was undertaken in Retalhuleu among 939 malnourished 6‐72 mo old children (HAZ <‐1). Children resided in 18 villages in an impoverished region of southwest Guatemala. Children were randomly assigned to two groups to compare effects of two nutritional interventions on growth and micronutrient status. Group A (n=667) children received 18.75 g of Chispuditos®, a corn/soy atole fortified with 21 vitamins and minerals (delivering 12.5 mg of iron and 9 mg of zinc per day). Group B (n=272) children received an equivalent portion by weight of lactose free milk (diets were isocaloric and isonitrogenous). At the conclusion of 12 mo, the average HAZ score of Group A children increased 12.0% from ‐2.76 to ‐2.43 (p<.01) and by 7.3%, from ‐2.87 to ‐2.66 (p<0.01) in Group B. Children from both dietary groups exhibited improvements in linear growth, with Group A having a greater increase in HAZ than Group B (p=0.01). Formative research conducted with the micronutrient‐fortified corn/soy atole revealed the product was well accepted by both primary caretakers and children. During the study time period Chispuditos was one‐third the cost of lactose free milk and provided a greater linear growth benefit. In conclusion, Chispuditos® is a culturally accepted, fortified atole that improves the health and nutritional status of children from 6‐72 mo of age in a more cost‐efficient manner compared to milk powder. Grant Funding Source : The Mathile Institute for the Advancement of Human Nutrition®

As part of a feeding study undertaken in Retalhuleu, 6 HIV positive and 41 HIV exposed children 6‐72 mo of age attending a Nutritional Attention Unit in Coatepeque were nutritionally evaluated. Anthropometric and biomarker data were collected to calculate the prevalence of acute and chronic malnutrition, muscle mass depletion, chronic inflammation, anemia, and deficiency of iron, zinc, folic acid, vitamin B 12 and iodine. Feeding patterns for children under 36 mo was also established. The results revealed that 23.5% of the children presented with acute malnutrition (WAZ < ‐1) and 78.2% had chronic malnutrition (HAZ < ‐1). Muscle mass depletion, using WHO standards for MUAC, was found in 33.2% and anemia in 20.3% of the children. Nutritional deficiencies were noted for serum folic (45%), erythrocyte folic acid (5.4%), vitamin B 12 (8.7%), zinc (50%), iodine (41.3%) and iron (34.1%). The prevalence of chronic inflammation (AGP > 1g/L) was 11.3%. The feeding pattern of these children consisted of: corn tortilla, noodles, rice, oranges, bananas, sausage, chicken, eggs, black beans, sugar, water, coffee and natural beverages. In conclusion, HIV positive and exposed children in this region of southwestern Guatemala are at high risk of developing malnutrition. Nutritional compromise may burden an already challenged immunes system, decrease quality of life and decrease the likelihood of a favorable prognosis. Grant Funding Source : The Mathile Institute for the Advancement of Human Nutrition®

An anthropometric assessment was conducted on 1238 children (age 6 mo–7 yr) from 18 rural communities in Retalhuleu, Guatemala. The anthropometry scan included collection of weight, height or recumbent length, mid‐arm circumference, age and gender. The data was processed using WHO Anthro, WHO Anthro Plus and Epi Info. 907 children (73.21%) had a height‐for‐age Z score (HAZ) of −1.0 or lower. Of these, 429 children had a HAZ of −1 to −1.99, 335 had a HAZ score of −2.0 to −2.99 and 143 had a HAZ of <−3.0. For weight‐for‐height Z scores (WHZ), 800 children (64.6%) were within the normal range (WHZ −0.99 to 0.99), 27 (2.2%) were overweight (WHZ 2.0 to 3.0) and 14 (1.1%) were obese (WHZ >; 3.0). 231 children (18.7%) had WHZ of −1.0 or lower. Of these, 159 children had WHZ of −1.0 to −1.99, 51 had WHZ of −2.0 to −3.0, and 21 had WHZ <−3. The assessment demonstrates widespread stunting in this population and suggests a potential underlying malnutrition problem. This region in southwestern Guatemala is not generally recognized as an area afflicted with extensive nutritional inadequacies or food insecurity. Further evaluation of nutritional status in this population is warranted. This study was supported by the Mathile Institute for the Advancement of Human Nutrition®.

A long term feeding study was undertaken in the Guatemala City municipal nurseries in February 2010 to evaluate the effects of micronutrient supplementation on iron status, growth and morbidity. Chispuditos®, a corn/soy atole beverage mix providing 21 vitamins and minerals (12 mg iron and 9 mg zinc per day) was fed to 317 children under the supervision of nursery staff. In children (n=55) that entered the study with HAZ<−2, HAZ scores improved from −2.59 at inception to −1.93 in June 2012 (P<0.01). The proportion of children with HAZ<−2 decreased from 16.5 to 8.20% (P=0.013) during this time period. The incidence of anemia at study initiation was 11.9% and decreased to 4.12% (P<0.01). Children that were anemic (hemoglobin, Hb, < 11.0 g/dL) at study initiation had Hb increase from 10.44 to 12.36 g/dL (P<0.01). The incidence of acute diarrhea decreased from 11.2% to 6.8% (P<.001), and acute respiratory infections decreased from 11.2% to 6.8% (P<0.001) in the general nursery population. Data from this nursery population suggest that improvements in iron status plateau within one year while improvements in linear growth continue. It is concluded that providing a micronutrient‐fortified atole results in sustained improvements in linear growth and decreased morbidity in this population. This study was supported by the Mathile Institute for the Advancement of Human Nutrition and Fundación Castillo Córdova.