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Nutritional Status of a Group of Bolivians Living in the State of Cochabamba

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Nutritional Status of a Group of Bolivians Living in the State of Cochabamba INFORMATION TO USERS This reproduction was made from a copy of a document sent to us for microfilming. While the most advanced technology has been used to photograph and reproduce this document, the quality of the reproduction is heavily dependent upon the quality of the material submitted. The following explanation of techniques is provided to help clarify markings or notations which may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting through an image and duplicating adjacent pages to assure complete continuity. 2. When an image on the film is obliterated with a round black mark, it is an indication of either blurred copy because of movement during exposure, duplicate copy, or copyrighted materials that should not have been filmed. For blurred pages, a good image of the page can be found in the adjacent frame. If copyrighted materials were deleted, a target note will appear listing the pages in the adjacent frame. 3. When a map, drawing or chart, etc., is part of the material being photographed, a definite method of "sectioning" the material has been followed. It is customary to begin filming at the upper left hand corner of a large sheet and to continue from left to right in equal sections with small overlaps. If necessary, sectioning is continued again—beginning below the first row and continuing on until complete. 4. For illustrations that cannot be satisfactorily reproduced by xerographic means, photographic prints can be purchased at additional cost and inserted into your xerographic copy. These prints are available upon request from the Dissertations Customer Services Department. 5. Some pages in any document may have indistinct print. In all cases the best available copy has been filmed. University Microfilms International 300 N. Zeeb Road Ann Arbor, Ml 48106 8306199 Zahran, Effat Abdel-Kader NUTRITIONAL STATUS OF A GROUP OF BOLIVIANS LIVING IN THE STATE OF COCHABAMBA The University of North Carolina at Greensboro PH.D. 1982 University Microfilms International 300 N. Zeeb Road, Ann Arbor, MI 48106 PLEASE NOTE: In all cases this material has been filmed in the best possible way from the available copy. Problems encountered with this document have been identified here with a check mark V . 1. Glossy photographs or pages 2. Colored illustrations, paper or print 3. Photographs with dark background 4. Illustrations are poor copy 5. Pages with black marks, not original copy 6. Print shows through as there is text on both sides of page 7. Indistinct, broken or small print on several pages 8. Print exceeds margin requirements 9. Tightly bound copy with print lost in spine 10. Computer printout pages with indistinct print 11. Page(s) lacking when material received, and not available from school or author. 12. Page(s) seem to be missing in numbering only as text follows. 13. Two pages numbered . Text follows. 14. Curling and wrinkled pages 15. Other University Microfilms International NUTRITIONAL STATUS OF A GROUP OF BOLIVIANS LIVING IN THE STATE OF COCHABAMBA by Effat Abdel-Kader Zahran A Dissertation submitted to the Faculty of the Graduate School at the University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 1982 A 1 1 _ APPROVAL FAGE This dissertation has been approvea by the following committee of the Faculty of the Graduate School at the University of North Carolina at Greensboro. Dissertation Co-advisor ' /'It 73 Cl'U- , i • J/ /I;.. Committae Members yfljJjjJ > o(- SCJU/xj w~-- h/~-< rr /uz~ Date of Acceptance by Committee PI) /f&i— Date of Final Orcil Examination i i ZAHRAN, EFFAT ABDEL-KADER. Nutritional Status of a Group of Bolivians Living in the State of Cochabamba. (1982) Directed by: Dr. Aden C. Magee & Mrs. Mary A. Dickey. Pp. 168 The nutritional status of 710 Bolivians was evaluated in connection with a project sponsored by the United States Agency for International Development for the promotion of soybean utilization. Rural and urban families residing in the state of Cochabamba were included in the study. Criteria used to evaluate nutritional status included demographic factors, anthropometric data, energy and nutrient intakes, and hemoglobin and hematocrit determinations. The adequacy of the diets with regard to eight nutrients and energy was evaluated using the Food and Agricultural Organization Recommended Dietary Intakes, and the amino acid content of proteins ingested by the Bolivian sample was compared to the FAO reference pattern. Anthropometric data on weight and height/age and arm measurements/age were compared to the 50th percentiles of the National Center for Health Statistics (NCHS) and the Frisancho standards, respectively. The Gomez and Waterlow classifications were used to determine the degree of protein-energy malnutrition found in the sample population. Hematological data were compared to the appropriate World Health Organization (WHO) standards, and partial correlations were used to examine the relationships between iron intakes and hemoglobin and hematocrit levels. Multiple regression analysis was used to determine the relationships of five demographic variables and the overall adequacy of the Bolivian diets. Only 6 percent of the sample received diets which appeared to be adequate in all nutrients and energy. Using the 67 percent level of the FAO Recommended Dietary Intake standards, 50 percent of the sampled individuals had energy intakes below this level while 17 percent of the sample had protein intakes below this value. Low thiamin, riboflavin, niacin, ascorbic acid, and vitamin A intakes were found in 33, 33, 44, 20, and 70 percent of the sample, respectively. Only 23 percent of the sample had iron intakes below the 67 percent level of the standards, but 63 percent of the sample were quite deficient in calcium intake. The most limiting amino acids in the diets of the Bolivians sampled were methionine and cystine. Based on the Gomez classification, 9.3, 15.9, and 10.3 percent of the Bolivians had 3rd, 2nd, and 1st degree malnutrition, respectively, while 22.9 percent, 0.9, and 42.1 percent were stunted and wasted, wasted, and stunted according to the Waterlow classification. Hemoglobin and hematocrit values below the WHO standards were found in 19 and 37 percent of the sample, respectively. Daily iron intakes correlated significantly with hematocrit level. Sex, age, household size, place of residence, and education had a highly significant effect on variation in the diet adequacy. ACKNOWLEDGMENT The author wishes to express-her sincere gratitude to Dr. Aden Magee, the chairman of her dissertation advisory committee for his continual help, inspiration, guidance, and patience throughout the doctoral program. I am especially indebted to Mrs. Mary Dickey for providing me with the chance to analyze the Bolivian Soybean Project data and for her helpful suggestions and support. My sincere appreciation goes to other members of my committee, Dr. Elizabeth Schiller, Dr. Mildred Johnson, and Dr. William Powers for valuable guidance and help. Gratitude is extended to Dr. Lucille Wakefield, the chairman of the Foods, Nutrition, and Food Service Management Department at UNC-G for her encouragement and concern. In addition, I am grateful to the staff of the Computer Center at the Department of Nutrition, UNC-Chapel Hill, especially Mrs. Joy Wood for her time and effort given through the initial computer analysis of the data. Sincere appreciation is also due to the staff of the Computer Center at UNC-G and particularly to Mrs. Marlene Pratto for her help, guidance, and patience throughout the computer analysis of the data. iii TABLE OF CONTENTS Page APPROVAL PAGE ii ACKNOWLEDGMENT iii LIST OF TABLES vi LIST OF APPENDIX TABLES . ix LIST OF FIGURES CHAPTER I. INTRODUCTION 1 i Objectives of the Study 4 II. REVIEW OF THE LITERATURE 5 Nutritional Assessment Studies ..... .6 The Far East 6 Africa 12 The Near East 15 Europe 20 North America 23 Latin America 27 Methodology Related Studies 40 III. DATA SOURCE AND METHODOLOGY 46 Sample Selection 47 Data Collection 48 Data Source 49 Age and Sex Composition of the Sample 51 Demographic Characteristics by Place of Residence 52 Methods of Analysis .56 Evaluation of nutrient intakes ,56 Evaluation of the quality of protein. .59 Evaluation of the anthropometric data 59 Estimation of the prevalence of anemia 61 Correlation between iron status and energy intake ... 62 Regression analysis ....... 62 iv Page CHAPTER IV. RESULTS 64 Dietary Intake 64 Protein Quality 83 Anthropometric Evaluation 87 Hemoglobin and Hematocrit Evaluation 105 The Partial Correlation Study. 108 Multiple Regression Study 110 V. DISCUSSION 112 Protein-Energy Nutriture 112 Vitamin Deficiencies 122 Mineral Deficiencies 124 Relation Between Dietary Iron and Energy and Hematological Status 129 Regression Analysis 131 Implications of the Study 135 VI. SUMMARY 136 BIBLIOGRAPHY 140 APPENDIX A. BOLIVIA: BRIEF BACKGROUND 151 APPENDIX B. SURVEY SITE 156 APPENDIX C. STANDARDS USED FOR THE EVALUATION OF THE DATA. .... .160 APPENDIX D. AVERAGE DAILY INTAKES OF AMINO ACIDS 168 v LIST OF TABLES Page TABLE 1. Distribution of Total Sample and of Subsample Used for Anthropometric and Biochemical Measurements by Selected Demographic Characteristics 50 2. Composition of the Sample by Age and Sex. .51 3. Distribution of the Sample by Place of Residence and Selected Demographic Characteristics 53 4. Composition of the Sample by Place of Residence, Age, and Sex 54 5. Percentage Distribution of the Sample by Years of Education, Age and Sex 55 6. Distribution of the Sample by Age, Household Size, and Sex .57 7. Foods Frequently Served for the Bolivians 65 8. Distribution of Daily Nutrient Intakes by Meal 66 9.
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