fetal stunting, fetal wasting and maternal nutritional...
TRANSCRIPT
- -
i: . .
FETAL STUNTING, FETAL WASTING AND MATERNAL N U T R I T I O N A L STATUS
ANDRÉ E R I E N D
-* , <.. .. .
- 2 - '
SUMMARY
._' ! . i : '
To assess the n u t r t i o n a l s ta tus o f neh lorn i n fan ts by a methoc
roughly independent o f a p rec i se knw ledge o f gestat ional age, t h i s
. .. . . . .
. .-
paper suggests the use o f t\vo ind ices based on body measurements which
may r e f l e c t m a l n u t r i t i o n . On analogy w i t h o lde r ch i ld ren , the index
determining whether a newborn i n f a n t has a small body s ize compared t o
i t s head circumference was cal l e d the "s tun t ing index" whereas the one
measuring the r e l a t i v e weight f o r body length was c a l l e d the "wast ing
index", These ind ices were used t o determine the r e l a t i o n between
the n u t r i t i o n a l s ta tus o f the newborn i n fan ts and t h e i r mothers i n an
underpr iv i leged popu la t ion i n Dakar which has a r e l a t i v e l y low mean
b i r t h weight o f between 3000 and. 32009, w i t h seasonal va r ia t i ons .
a sample o f 131 subjec&,- the morphology o f the newborn in fan ts was
found t o be l a r g e l y independent o f maternal mid upper arm circumference
In - -
suggesting t h a t the main l i m i t i n g fac to r o f f e t a l growth was no t
insu f f i c iency of maternal n u t r i t i o n a l reserves. To exp la in t h i s
observat ion and the w e l l documented r a p i d g r w t h of breast fed babies
i n Dakar, both facts d i f f i c u l t t o understand i f one assumes tha; f e t a l
m a l n u t r i t i o n a t the end o f pregnancy i s the consequence o f a poor
maternal n u t r i t i o n a l s ta tus , an alterna; ve i n t e r p r e t a t i o n i s suggested :
imperfect adaptat ion o f the cardio-vascu a r system t o the up r igh t
posture a t the end o f pregnancy could be the main l i m i t i n g f a c t o r o f
f e t a l growth i n populat ions who do n o t have a gross ly d e f i c i e n t food
in take.
may be a consequence o f the i n t e n s i v e phys ica l a c t i v i t y o f the mothers
w i t h reduced o p p o r t u n i t i e s f o r r e s t a t the end o f pregnancy. C l i n i c a l
imp l ica t rons a re discussed b r i e f l y : i t i s suggested t h a t i n m r e
Therefore, the s l i g h t f e t a l m a l n u t r i t i o n observed i n Dakar,
depr ived areas, where energy de f i c iency of maternal d i e t does l i m i t
. .
fetal growth, reduct ion of maternal a c t i v i t y should b e a s s o c i a t e d w i t h
energy suppiementation to o b t a i n opt¡ mal growth o f t h e fetus, .
Key words : pregnancy, fetus, growth, n u t r i t ion, p o s t u r e .
. . . .) . .
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, , ._ .'.. . . . . . _ ~ . . .._... . . I ... . . 1 ...__. .... . . ._ . . . , __.. , . . I _.i , ,-- -.--,-. ... . - . II_̂ -".
- 4 -
I n the human spccies, the f e t a l ..growth curve has a very character-
A f t e r being almost l i n e a r from the 28th t o the 38th week i s t i c shape.
o f i n t r a u t e r i n e l i f e , there i s a progressive' reduct ion i q the growth;: .
r a t e which is more marked and occurs e a r l i e r i n the underpr iv i leged
s o c i a l classes (Gruenr.lald, 1966). I t seems u n l i k e l y tha t t h i s dec l i ne
i n f e t a l growth r a t e is of genet ic o r i g i n . Shor t l y a f t e r b i r t h , away
from the maternal environment, newborn i n f a n t s regain a growth r a t e
s i m i l a r t o the beginning of the t h i r d t r imes te r o f i n t r a u t e r i n e l i f e ,
Moreover, there i s no i r r e g u l a r i t y i n the growth curves o f prematurely
born babies near the¡ r theo re t i ca l term (Campbel 1 , 1976).
Gruenwald (1966) has suggested t h a t t h i s growth f a l t e r i n g may be
of n u t r i t i o n a l o r i g i n . According t o h i s observat ions, newborn babies
whose weight i s lower than i t would have been had t h e i r growth r%-
mained constant, have anatomical c h a r a c t e r i s t i c s reminescent o f m a l - - -
n u t r i t i o n i n o l d e r ch i ldren. Therefore, i t i s f requent ly concluded
frm h i s work and s i m i l a r s tud ies by Naeye (1965) t h a t a low b i r t h
weight f o r ges ta t i ona l age i s synonymous w i t h i n t r a u t e r i n e malnu t r i t i o n .
_. - - B i r t h weight by i t s e l f however must be considered a bad i n d i c a t o r
of the n u t r i t i o n a l status o f a newborn, F i r s t o f a l l , i t i s very
much in f luenced by the gestat ional age which i n p r a c t i c e i s f requen t l y
i n doubt.
wouid r e s u l t from the i n t e r a c t i o n o f two fac to rs which can vary
independently and which should n o t have the same s ign i f i cance : f i r s t
growth r a t e o f the fe tus and second the ex ten t and t im ing
Moreover, according t o Gruenwald - (1966) the b i r t h weight
the i n i t i a
of the dec
be re la ted
¡ne i n the growth curve.
t o i n t r a u t e r i n e n u t r i t i o n . Consequently, i f a newborn
Only t h i s second fac to r would
has a lcw b i r t h weight, one should speak o f ma l tau t r i t ion on ly i f there
is reason t o b e l i e v e tha t the low weight r e s u l t s from a pronounced
gmwth f a l t e r i n g . .
.. ._ I
- 5 ;
.- - I
- W i t h t h i s i n mind, i n t h e w o r k on n u t r i t i o n a l r e l a t i o n s between t h e
m o t h e r a n d the nev!born i n Dakar , we- t o o k i n t o c o n s i d e r a t i o n n o t t h e
b i r t h ' w e i g h C by i t s e l f , b u t d i f f e r e n t c o m b i n a t i o n s of i t w i t h h e a d c i r -
c u m f e r e n c c and body l e n g t h . T h i s r e p r e s e n t s an a t t e m p t t o a s s e s s t h e
n u t r i t i o n a r s t a t u s o f t h e newborn i n f a n t n o t by t h e a b s o l u t e v a l u e of
i t s a n t h r a p m t r i c p a r a m e t e r s b u t by c a l c u l a t e d i n d i c e s d e s c r i b i n g i t s
morpholog2. - .
We s p e c u l a t e d o n t h e a n a l o g y w i t h o l d e r c h i l d r e n ( J e 1 1 i f f e ,
1366) t h a t a o w b o r n i n f a n t w i t h a r e l a t i v e l y l a v w e i g h t and body l e n g t h
f o r h e a d - c \ r c u m f e r c n c e was l i k e l y t o h s v e h a d i n t r a u t e r i n e m a l n u t r i t i o n
r e g a r d l e s s of t h e a b s o l u t e v a l u e of t h e s e v a r i a , b l e s . C o n v e r s e l y , a
s m a l l b u t s o q r e c t l y p r o p o r t i o n e d n e w b o m i n f a n t . would b e c l a s s i f i e d as
n o r m a l l y m t d r ï s h e d and c o n s i d e r e d as h a v i n g a l o w i n i t i a l g rowth ra te
o r as haV¡qg a g e s t a t i o n a l a g e s l i g h t l y b e l o w t h e a v e r a g e of t h e g r o u p .
METHODS
T h e U;i?k was d o n e i n a m a t e r n i t y c e n t r e i n Dakar s e r v i n g womn of
a low s o c : o . e c o n o m i c leve- l . P r e v i o u s n u t r i t i o n a l s u r v e y s o f t h i s
p o p u l a t i o n r e p o r t e d a mean e n e r g y i n t a k e of s l i g h t l y o v e r 2000 k c a l . /
d a y (Cano=., a n d Chevassus-Agnes , 1 9 7 8 ) . A s a m p l e o f newborn i n f a n t s
was taker; i n J u n e 1 9 7 8 a t t h e e n d of t h e 2ry s e a s o n , a time of t h e y e a r
when tke S r t h w e i g h t i s s1 i g h t l y a b o v e a v e r a g e - ( D u p i n , Masse and
Correa, Z~S]. B a b i e s b o r n b e t w e e n 7 a.". a n d 1 p.m. on t h e d a y s of
t h e s t u % were s y s t e m a t i c a l l y e x a m i n e d . T h o s e w i t h a g e s t a t i o n a l a g e
e v a l u a t e & !& n e u r o l o g i c a l e x a m i n a t i o n ( S a i n t - A n n e D a r g a s s i e , 1974) as
b e i n g OYGL- 38 weeks a n d whose m o r h e r s h a d n o t had p r e - e ~ l a m p s i a as
d e f i n e d by the s imul t a n e o u s o c c u r r e n c e of h y p e r i e n s í o n , oedema and .. ' I . . .
p r o t e i n u r t a w e r e i n c l u d e d i n t h e s u r v e y . T h e t o t a l was 131 b a b i e s ,
, . . ,.-., .. :... .. .. .
d"
. I
- 6 -
. ~, -.. . ., I . . i.. , . .__. ~ . . . ' . . . -_ .. . i .. " . . - . . _ _ . ' . . _ . 2.. . _ . :
Il
- c &
1 the
c i r-
I
l eng th
.i t i o n 1
i a
.d as
J roup.
I I
. .
?n o f
3
31 ./
fants
2 year
s o f
1 age
1 as
S
d
es.,
1
of wolo f , Peulhe, Toucouleur o r Sere o i i g in . The 'average p a r i t y I
of the mothers was 3,s (s.d. = 2 , l ) ; there were 22 primiparae.
' , . .- The accuracy o f the masQrements ;.ras t l o g f o r U i r t h weight, f 1mm
f o r [lead circumference and ? 0,s cm f o r body length, Subjects w i t h
cephalhaematoma were excluded,
ference o f every m t h e r was a l s o masured (accuracy = k ~ m n ) .
The he igh t and mid upper a r m circÜm-
RESULTS
t h e i r mothers are shown i n Table 1 and 2. There i s
t i o n between the infan; meas&ements-as shown i n Tab
The mean values o f the measurements o f the newborn in fants and
a s t rong co r re la -
e 3, whi ch means
t h a t these var iab les each g ive very s i m i l a r informat on. To ob ta in
- independent ind ices descr ib ing morphological cha rac te r i s t i cs o f every
subject and p rov id ing a maximum of i n fo rmat ion , we made a p r i n c i p a l
component analysis.
anthropometr ic data by a r o t a t i o n o f t he a x i s i n three independent
I n o ther words, we transformed the standardized
-
ind ices Z1 ,:Z2, Z3-which are s u f f i c i e n t t o charac ter ize a newborn
i n fan t .
i
The formula f o r the t rans format ion o f the standardized data can
be deduced from t h e coordinates of the e igenvectors o f the c o r r e l a t i o n
matr ix . We obta ined :
Z1 = 0 , 6 1 Weight + O,59 Body Length f 0,53 Head Circumference
22 = -0,25 Weight -0,49 Body Length + 0,84 Head Ci
Z3 = -0,76 Weight + 0,63 Body Length + 0,16 H-ead C
These ind ices exp la in respec t ive ly 76%, 17% and 7% of
cumference
iance, T h e i r mean value f o r the whole sample is zero.
rcumfe ren ce
the g lobal var-
.- e
t - To i l l u s t r a t e t h e s e formulae,we w i l l use them to c a l c u l a t e the in-
d ices of a newborn i r . f a r , t ~ J ! \ O S ~ b i r t h f ; . e igh t i s 3226 q, body l e n g t h is
43.4 cm a n d head c i r c u n f e r c n c e is 3 3 , & ai. These d a t a r e p r e s e n t t h e
a v e r a g e v a l u e s of newborn i n f a n t s i n Denver ( C o l o r a d o , U.S.A.) a t 40 --
weeks o f g e s t a t i o n a l a g e a c c o r d i n 0 to :he pro::th c h a r t o f Lubchenco
(1963; 1966) . T r a n s l a t e d i n t o s i l s n d s r d l zed da:a, t h e s e p a r a m e t e r s
Head ci r c c n f c r c n c c = - 1 , I I -
21 = -0,67~0,04 - o,52xo,33 - 0.53~1 , I I = -o,81 . _ -
likewise :
22 = -0,77,z3 = - 0 3 .
T h e s e t h r e e va l r tes ãre ouzside t h e i n t e r v a l o f v a r i a t i o n o f t h e a v e r a g e
of t h e s e i n d i c e s i n our s a n ~ l e (p F 0 , O l ) . T h i s p i n t w i l l b e d i s c u s s e d
1 a t e r .
li
1
After c a l c u l a t i n g i n d i c e s 2 1 , 22 and 23 f o r e v e r y newborn i n f a n t ,
we examZned t h e i r r e l a t i o n to r a t e r n a 1 h e i g h t and mid upper arm circux-
ference. The c o r r e l a t i o n c o e f f i c i e n t s . a r e g i v e n i n Ï a b l e 4 . Br ie f
Z1 i s s i g n i f i c a n t l y and p o s i t i v e l y c o r r e l a t e d w i t h - m a t e r n a i h e i g h t
(D < 0,05), 22 is G e 9 sionificanriy n e g a t i v e l y c o r r e l a t e d w i t h t h e
same p a r a m z t e r (p < O . O J ) , Z3 is v e r y s i g n i f i c a n t l y n e g a t i v e l y corr-
e l a t e d w i z h m a r e r n a l arm c i r c u n f e r e n c e (p < 0,Ol).
/
f . :..
6
I , :.
40
CO
rs
we r a g e
ji s c u s s e
n f a n t ,
ci rcum-
r i e f l y ,
h t
t h e
o r r -
i i
. .
- a - .
. - - 1
DISCUSS I ON
1. Interpretation ‘of t h ; indices
Index Z 1 is p o s i t i v e l y c o r r e l a t e d y¡ t h t h e t h r e e a n t h r o p o m e t r i c
p a r a m e t e r s of t h e newborn i n f a n t s .
b o t h to t h e g e s t a t i o n a l a g e and to t h e - g r m t h p o t c n t i a l of e v e r y sub-
j e c t , t h i s i n d e x may b e c o n s i d e r e d as r e s u l t i n g from b o t h v a r i a b l e s ,
As e a c h o n e i s c l o s e l y r e l a t e d
t n d i c e s 22 and 23 a r e a m e a s u r e o f t h e e x t e n t to which t h e n e w b o r n
morphology r e s e m b l e s t h a t of o l d e r c h i l d r e n who h a v e had some d e g r e e
of m a l n u t r i t i o n . 22 i s h i g h . f o r b a b i e s w i t h a low b i r t h w e i g h t and
a s m a l l body l e n g t h fo r t h e i r h e a d c i r c u m f e r e n c e , Z3 i s h i g h f o r
t h o s e who h a v e a low w e i g h t fo r b o d y l e n g t h ,
ch’ i ldren , ( J e l l i f f e , 1966) \ . rewi 1 1 d e s i g n a t e 22 t h e “ s t u n t i n g index”
and Z3 t h e “ w a s t i n g index“ .
On a n a l o g y w i t h o l d e r . .- - -
Because of t h e way t h e y a r e c a l c u l a t e d , 22 and Z3 v a r y i n d e p e n d -
So, i f o n e follows t h e i n t e r p r e t a t i o n of Z l s u g g e s t e d , e n t l y of 21.
t h e a s s e s s m e n t o f n u t r i t i o n a l s t a t u s of t h e newborn i n f a n t s o b t a i n e d
by e v a l u a t i o n of t h e s e i n d i c e s i s n o t i n f l u e n c e d by t h e i n a c c u r a c y o f
g e s t a t i o n a i a g e o r by t h e v a r i a t i o n s o f g r a v t h p o t e n t i a l .
e x t e n t , 22 and Z3 may b e c o n s i d e r e d a s ; ” p r e c i s e a g e i n d e p e n d e n t
To some
i n d i c e s ” of n u t r i t i o n a l s t a t u s .
2. Validity of the mathematka2 mode2
T h e m a t h e m a t i c a l model w e u s e d to assess t h e n u t r i t i o n a l s t a t u s
o f t h e newborn i n f a n t s assumes t h a t t h e r e l a t i o n be tween t h e dimen-
s i o n s of t h e h e a d a n d t h e body i s m a i n l y i n f l u e n c e d by n u t r i t i o n a l
factors. T h i s i s n o t t o t a l l y t r u e . F i r s t , some i n d i v i d u a l v a r i a -
t i o n s of t h e morphology may b e of g e n e t i c o r i g i n and t h i s can b i a s
the resu l ts . Moreover, the volume of the head o f a newborn i n fan t i s
p r o p o r t i o n a l l y g rea ter when the ges ta t i ona l age i s l o w (Vaughan and
MacKay, 1975).
a r e l a t i v e l y homogenous sample o f newborn i n f a n t s f o r gestat ional age
To avoid d i s t o r t i o n from t h i s second factor,we se lec ted
by t e s t i n g t h e i r m a t u r i t y neuro log ica l l y .
Though t h i s method o f assessment of n u t r i t i o n a l s ta tus i s f a r from
per fec t , i t should be more accurate than the usual one o f comparing
the b i r t h weight o f a newborn i n f a n t wi th the average fo r i t s ges ta t iona l
age which i s based on the double assumption t h a t a l l the subjects have
the same i n i t i a l growth ra te and tha t t h e i r ges ta t i ona l age is known
p rec i se l y . These hypotheses can never be v e r i f i e d i n pract ice.
Whatever method i s used, i t seems ind ispensable t o r e l y on a model
based on the simultaneous ana lys is o f severa l anthropomet-ric - - var iab les.
Mathematical ly, i t is impossible t o e x t r a c t from the va r ia t i ons o f the
b i r t h weight alone the r e l a t i v e importance o f i n t r a u t e r i n e n u t r i t i o n
and o the r fac to rs t o determine s i z e a t b i r th. It i s necessary t o
consider a t l e a s t one other v a r i a b l e submi t ted t o the same in f luences -. - -
bu t reac t i ng d i f f e r e n t l y .
3 . Comparison of the Dakar newborn infmrts w i t h t h e Denver s t a n d a d
Previous lywe ca l cu la ted the i n d i ces-of the mean values o f t he
anthropometr ic parameters o f 4 0 week Denver newborn in fan ts . As the
mean b i r t h weight o f our sample is .32419 which i s s l i g h t l y above the
Denver standard, one might assume tha t the n u t r i t i o n a l s ta tus o f Dakar
newborn i n fan ts i s very s i m i l a r t o the Denver one.
o f n u t r i t i o n a l ind ices con t rad i c t s t h i s f i r s t impression.
The c a l c u l a t i o n
> 1
The "s tun t ing '1 and "wasting" i nd i ces 22 and Z 3 which are supposed
t o be c h a r a c t e r i s t i c o f i n t r a - u t e r i n e ma lnu t r i t i o n obtained by the
...
I ' .
t is" 4 I i d
3 : lec ted II
< !
age I
i !
l 1
4 r from j
ag
t a t i on a l
have I
I
i
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own
,/
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iables. 1 2f the
i t i o n 1
I
1 t o
ences
gdards ~
:he
Is the
3 the
f Dakar
t i o n
uppos ed
the '
. .
. .-
- l o -
I '
transformation of the Denver data are c l e a r l y below ze'ro which i s by
d e f i n i t i o n the mean value o f o u r sample. T h i s suggests tha t the fac to rs
1 i m i t i n g the fe
occur sooner i n
The f i r s t
a.1 'grJordth a t fhe ,cn¿'of i n t r a u t e r i n e 1 ¡,fe. are greater o r
Dakar than i n Denver.
ndex 21 i s a l so h igher i n Dakar, T h i s can be exp la ined
i n two d i f f e r e n t ways : one might argue t h a t the growth p o t e n t i a l i s
h igher inoursample o r t h a t the mean ges ta t i ona l age of the newborn in-
fants examined i s s l i g h t l y more than 4 0 weeks. These two p o s s i b i l -
i t i e s a r e not mutual ly exc lus ive. Unfor tunate ly , the data g ive no
i nd i ca t i on o f the cor rec t i n t e rp r e t a t ion.
Maybe e t h n i c fac to rs i n f l uence the growth p o t e n t i a l dur ing f e t a l
l i f e .
heavier than wh i te ones up t o 28 or 30 weeks .of ges ta t iona l age a l though
It was repor ted from New York t h a t b lack newborn i n fan ts were
- -
t h e i r subsequent b i r t h weight was s l i g h t l y lower (Erhardt e t aZ, 1964).
The p o s s i b i l i t y o f a mean g e s t a t i o n a l age of s l i g h t l y more than 40
weeks i n my sample o f i n fan ts must a l s o be considered. Geber and
Dean (
degree
be exp
1974).
957) repor ted tha t the A f r i can newborn i n f a n t has an advanced
o f neuro log ica l maturat ion by European standards. This migh t
I n
tha t c l ¡mat
durat ion of
the Rhesus
ained by a prolonged pe r iod o f ges ta t i on (Saint Anne Dargassie,
Monkey, R i o p e l l e and Hale (1975) have shown
c and nu t r t i o n a l f a c t o r s have sane in f luence on the
pregnancy. - These two p o s s i b i l i t i e s o f a d i f f e r e n t groclcth p o t e n t i a l i n o u r
populat ion or of a d i f f e r e n t g e s t a t i o n length suggest t h a t !he assess-
ment o f n u t r i t i o n a l
alone may be b iased
urgent need t o deve
knowledge o f ges ta t
status o f a newborn i n f a n t by i t s b i r t h weight
by unexpected fac to rs .
op improved ind ices , independent o f p r e c i s e
This under l ines the
onal age for i n v e s t i g a t i o n . of f e t a l n u t r i t i o n .in
develop i ng count r ¡es.
- 1 1 -'
4. Relation beta)ecn materna2 anthmpometry -- - wid indices of the i n f m t s h
The observed pos¡ t i v e c o r r e l a t i o n between 21 and maternal he igh t n
mans t h a t arger mothers tend t o have la rge babies a t b i r t h . T h i s .
i s a genera
and Le i t ch , 1971) . The r e l a t i o n s o f 22 and Z 3 w i t h maternal anthropo-
metry provides more o r i g i n a l in format ion about the in f luence o f maternal
n u t r i t i o n a l s ta tus on f e t a l growth. we t r i e d t o use these ind ices t o
determine whether, i n oursample, the i n f a n t s whose morphology was
suggest ive o f m a l n u t r i t i o n were born t o th inne r women as m i g h t be ex-
pected i f the poor n u t r i t i o n a l s ta tus of the mothers was the main
l i m i t i n g f a c t o r o f f e t a l growth.
r u l e which app l ies even between d i f f e r e n t species (Hytten
The index o f wast ing (Z3 ) was s i g n i f i c a n t l y negat ive ly c o r r e l a t e d
w i t h maternal mid upper arm circumference.
o f the women examined had i n s u f f i c i e n t n u t r i t i o n a l reserves t o
T h i s suggests t h a t s o r e
support f e t a l growth up t o the end o f pregnancy. This phenomenon
however must be considered as r e l a t i v e l y minor : Z3 expla ins on ly a
smal l p a r t o f the g loba l var iance (7%) which means t h a t i t had l i t t l e
i n f l uence on the morphology of the i n fan ts ;
(22) accounted f o r much m r e o f the morphological v a r i a t i o n i n t h e
The index o f s t u n t i n g
sample (77% of the g lobal var iance),
w i t h maternal mid upper arm circumference.
o f f e t a l dep r i va t i on assessed by the r e l a t i v e p;oportions o f the head
and the body was l a r g e l y independent of t h i s i n d i c a t o r o f maternal
n u t r i t i o n a l s ta tus .
w ide l y h e l d b e l i e f t h a t poor maternal n u t r i t i o n a l reserves are the
p r i n c i p a l , l i m i t i n g fac to r o f f e t a l growth i n developing countr ies.
The i n t e r v e n t i o n of o t h e r f a c t o r s independent o f maternal n u t r i t i o n a l
s ta tus , suggested by the resu l t s , could exp la in why breas t fed babies
However, i t was no t c o r r e l a t e d
I n o ther words, the degree
This f i n d i n g i s s u r p r i s i n g i n the l i g h t o f t he
I * . ..
,d 1%
n fa? t s
i g h t
'h is
i y t ten
rh ropo-
na t e rna 1
2s t o
* :
5
e ex-
n
e l a t e d
S O I X
) 1 1
i Y a i
on I
i t t l e
l i n g
:he
3 1 a ted
2 degree
3 head
na1
f the
the
es.
t i o n a l
ab I es
1
. .
. .
* . - - 1 2 - ; -
have very rap id growth a f t e r b i r t h i n Dakar despi te a r e l a t i v e l y low
" mean b i r th weight (Masse, 196:). ' , . .'
4 I
To expla in these facts, impossible to understand on a pu re l y
n u t r i t i o n a l bas is , we suggesc a n o n - n u t r i t i o n a l i n t e r p r e t a t i o n o f -_
var ia t ions o f
theory o f evo
observed j u s t
ion; there i s
f e t a l growth in d i f f e r e n t s o c i a l groups drawn from the
u f i o n (Briend, i n p repara t ion) . The growth f a 1 t e r i n g
before b i r t h i n man must be considered as an imper fect -
no reason - t o be l i eve tha t dep r i va t i on o f the fetus j u s t
before the s t ress o f de l i ve ry would be o f any value t o the species.
Very l i k e l y , t h i s - imper fect ion appeared a t the same t ime as the
acqu is i t i on o f the u p r i g h t p o s i t i o n which was associated w i t h a
r e l a t i v e d iminu t ion o f the dimensions o f the p e l v i s and o f the t runk
and the appearance o f lumSer lo rdos is .
predispose t o compression by the pregnant u terus o f the ao r ta and
These s k e l e t a l mod i f i ca t ions
for f e t a l
This
i mpe r f e c t
. . I '
i n f e r i o r vena cava. The r e s u l t i n g haemdynamic changes have un-
favourable imp l i ca t i ons for the p lacen ta l b lood f l ow and hence f o r
f e t a I n u t r i t i o n and are aggravated by the s tanding p o s i t i o n . The
negat ive c o r r e l a t i o n we observed between 22 ( s tun t i ng ) and mate rna l
he ight may be a consequence of the reduc t ion o f the space a v a i l a b l e
development.
hypothesis impl ies t h a t pregngnt women must be considered as
y adapted t o the up r igh t p o s i t i o n and t h a t t h e i r way of l i f e
a t the end o f pregnancy may in f l uence f e t a l n u t r i t i o n .
exp la in why the dec l i ne o f f e t a l growth a t the end of i n t r a u t e r i n e
l i f e tha t e x i s t s i n i ndus t ra l i zed count r ies seems p a r t i c u l a r l y
Pronounced i n o u r sample : i n Dakar, wmen o f low socio-economic l e v e l
are very a c t i v e p h y s i c a l l y and remain on t h e i r f e e t up t o t h e end of
pregnancy wi th 1 i t t l e poss ib i 1 ¡ t y of rest .
Th is cou ld
. . . . , .., . _ _ ._-;*- . -. . I... .. :-" , . . . . . - .. . ,' . . . '._ ,.., . L :. :... . , . , > _.,. i' :.. ____. ., . . . ' ..: Z'. . .: . .. . *.....,t. . , . - . .
- 1 3 - '
CONCLUS I ON
I n Dakar, the mean b i r t h w i g h t , between 3OOOg and 32009 w i t h
seasonal var ia t ions (Dupin, Masse and Correa, 7962) i s low compared t o
European standards. .. .
I t is s i m i l a r t o tha t observed i n groups o f l w
socio-economic leve l i n developed count r ies (Gruenwald, 1966). I n our
sample o f f u l l term nenborn infants,we observed t h a t thd i r morphology,
assessed by the r e l a t i v e dimensions o f the head and the body, was
reminescent o f ma lnu t r i t i on i n o l d e r c h i l d r e n , which suggested t h a t
they may have undergone s l i g h t n u t r i t i o n a l dep r i va t i on i n l a t e f e t a l
1 i fe. -
I t seems d i f f i c u l t t o exp la in these two fac ts on a pure ly nu t -
r i t i o n a l basis and t o r e l a t e them t o an i n s u f f i c i e n c y of the maternal - . - -
d i e t . F i r s t , inoursample, the morphology o f the i n f a n t s was l a r g e l y
indpendent.of the mid upper arm circumference o f t he mothers when the
reserse should have been observed i f a poor maternal n u t r i t i o n a l
s ta tus had been the main l i m i t i n g f a c t o r o f f e t a l growth. On the o t h e r
hand, i t i s we l l documented t h a t i n Dakar, breast f e d babies have r a p i d
g r w t h , a t leas t dur ing the f i r s t months o f l i f e and catch up very
qu i c k l y t o in te rna t iona l standards (Masse, 1969). An a l t e r n a t i ve
exp lanat ion must be considered andwe suggest t h a t impairment o f f e t a l
growth i n Dakar, may be the consequence o f the e f f e c t o f excessive
maternal a c t i v i t y on p lacenta l b lood f low.
-
T h i s conclusion leads us t o r a i s e some quest ions. There i s good
evidence that , i n contrast t o Dakar, energy de f ic iency o f the maternal
d i e t i s the main l i m i t i n g fac to r of f e t a l growth i n many depr ived areas
o f developing countr ies, (Lecht ig e t aZ, 1p75).'
whether supplementation of the maternal d i e t alone i s r e a l l y ab le t o
I r .. However, we ques t ion
5
hat
e t a1
u t -
e rna
arge
' I
L. 3h
.h
-ed to
f l0rJ _ .
I n our
3 b Y ,
I
ie o t h e r 1
t Y ]
n t h e
i /e rapid
2 ry
i ve
f e t a l
i ve
i s good
a t e rna l
ed a reas
ues t i on
le to
- 14 - - - ' -
i overcom th i s t y p e o f f e t a l malnut r i t ion .
ignores the h u g e work load t h a t f a l l s on mothers i n developing count-
ries' and which,we, be l i eve , even i n urban areas s.uch as Dakar, may.
i t s e l f a f f e c t f e t a l growth.
the energy expendi ture of t h e women by reducing t h e i r more s t renuous
work?
placental blood flow, amplify the e f f e c t o f any d i e t a ry supplement
on energy balance, and improve t h e s tandard o f ch i ld care during t h e
Such an approach t o t a l l y
. .. . . : * ' '
Would i t not a l so be advisable t o reduce
This,we be l i eve , would suppress unfavourable e f f e c t s on
f i r s t months o f l i fe . T h u s reduct ion o f maternal a c t i v i t y should b e
associated w i t h energy supplementation of t h e maternal d i e t t o o b t a i n
optimal f e t a l growth i n developing count r ies . -
. _ -
ACKNOWLEDGEMENTS
This work was supported by 0.R.S.TfO.M. (Off ice d e Recherche
Sc ien t i f ique e t Technique Outre Mer) and 0.R.A.N.A. (Organisme d e
Recherche s u r 1I.Alimentation e t la Nu t r i t i on Afr icaine) i n Dakar, c c
Senegal.
(M.R.C. Dunn Nu t r i t i on U n i t , Cambridge) for h e l p and advice i n the
I w i s h a l s o to express my g r a t i t u d e t o Dr. M.G.M. Rowland
preparat ion of t h i s manuscript.
- 1 5 - -
RE FE RENCES
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Campbel l S.: Fetal growth . In: F e t a l p h y s i o l o g y a n d m e d i c i n e , e d .
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c
Canonne P., Chevassus-Agnes S. : E n q e t e d e consommsr ion a l i m e n t a i re
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- -(1962).
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v a r i a t i o n s . Am. J. O b s t e t . Gyriec. 54, 712-119 (1966).
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B 1 ackwel 1 S c i e n t i f i c P u b 1 i c a t i o n s , London ( 1 971 *
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c o r m u n i t y - WHO m n c s r a p h , Geneve.
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(1966)-
I
P e d i a t r i c s , - 56, 508-20 ( 1 3 7 5 ) .
In *
d.
any
ta¡ re
s d e
lrs des
3 0
In-
- t a l i t y
r i can
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c . :
g h t .
... . .
- 16 - -
1
Lubchenco L.O., Hansman c . , Dressle; M . , Boyd E.: In t rau ter ine growth
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! '
a t ion . Pcdfa t r ics ; - 3 2 , 793-800 (Iq63). i :
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W. B. Saunders Company, P h i ladelphi a (1975) -
i
. u
n
Table 1
5 . .
I ' t ' * .
NTHROPOMETRI C PARAIiETERS OF THE NEWBORN INFANTS
Weight (9) Body l e n g t h Head C i r c u m f e i e n c e ( c d ("1
324 1 50 35 1 me an
s.d. 392 11
. .
_-
e
Table 2
ANTHROPOMETRIC PARAMETERS OF T H E MOTHERS
Me an
Height (un)
162
A r m ci rcumference (mn)
- 26 1
- S.d. - - fi 33
Table 3 i:
C O R E L A T lot1 HATRI X OF THE Aì4fMWO$QMETRI C PARAIIETERS
OF THE NEWBORN I~EFANTS
B i r t h Body Head \le i gh t Length c i rcumference -
B i r t h we¡ g h t 1 n 9 790 0 , W
Body leng th - ..
0,790
Head circumference 0,606
1
0,579
0,513
1
I
- . . - i
.. . .: '
CORRELATION MATRIX OF INDlCES Zl, Z2 and Z3 VlTH
MATERNAL ANTHROPOMETRIC P a R A H E T E R S
z1 22 ( s t u n t i n g ) ~3 ( w a s t i n g )
He i g h t O, 176".
Arm c i rcumference O , 143 ns
- 0,2435
O,í14 ns
- 0,152 ns
ns : non s i g n i f i c a n t
2; : p less t h a n 0,OS J. ,.,. -1. : p less t h a n 0,Ol
. . _.. . ^ . ' . , . ... ., :. ..: .
- . , ' . , L I - . I.',..+. T-. . ,: . e,<: .
. . . ' .. I I . . ..i- ._ ., ,
. , . . I . .1.
... . I - .,~. . . ...,. .:::. . -, . . . . . . .