PEDIATRICS Vol. 16 No. 3 September 1955, pp. 378-397
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REVIEW ARTICLE

NUTRITIONAL PROBLEMS OF CHILDREN IN CENTRAL AMERICA AND PANAMA

Nevin S. Scrimshaw 1, Moisés Behar 1, Carlos Pérez 1, and Fernando Viteri 1

1 The Institute of Nutrition of Central America and Panama (INCAP) Guatemala City, C. A., a cooperative Institute for the study of human nutrition.

The principal nutritional problems of school children in Central America and Panama are those of a lack of sufficient protein of good quality, vitamin A, and riboflavin. Where tortillas prepared from lime-treated corn are not used, calcium deficiency is also evident. In many areas the high incidence of endemic goiter reflects an absolute or relative deficiency of iodine. Because supplementary feeding of nursing infants, and particularly the feeding of the child after weaning, are poorly carried out in the area, malnutrition is almost universal among children of these ages in low income and rural groups.

This is reflected in the tendency for growth and bone maturation, which parallels that for U. S. children during the first months after birth, to be severely retarded during the period from 1 to 4 years. During these ages either the cumulative effect of the poor diet or the poor diet plus some additional stress, results in the child developing Infantile Pluricarencial Syndrome (I.P.S.). Infectious diarrhea is a frequent precipitating cause. The I.P.S. of Central America, characterized by edema, skin and hair changes, retardation in growth and development, apathy, diarrhea and anorexia, is not essentially different from kwashiorkor.

The basically poor nutritional state of many pre-school children is defined and given the name incipient I.P.S. or prekwashiorkor. Nutritional surveys reveal physical signs compatible with a deficiency of vitamin A and sometimes also of riboflavin. In general deficiencies of niacin, ascorbic acid, vitamin D and thiamine are not recognized. Anemias are frequent and usually of a macrocytic type. In hookworm infested areas an appreciable amount of microcytic anemia may also be observed.

Investigations in progress by the Institute of Nutrition of Central America and Panama (INCAP) in the area include: continued nutritional and dietary surveys; studies of the effect of vitamin B12 and antibiotics on growth; studies of the physiopathology of I.P.S., and the development of vegetable mixtures and other dietary means of improving child feeding practices at low cost.