One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between anaemia and maternal, child and household variables, and biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C-reactive protein, and α1acid glycoprotein) were explored. Rates of anaemia were 56% among infants/toddlers and 12.1% among preschoolers. In children with anaemia, rates of iron deficiency (low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L) and zinc deficiency (serum zinc <65 μg/dl) were 81.1% and 53.7%, respectively.Folate deficiency (either plasma folate <3 ng/ml or erythrocyte folate <100 ng/ml) was 3.3%. Vitamin B12 deficiency (plasma vitamin B12 <148 pmol/L) was 7.5%. For infants and toddlers (<24 months), the odds ratio of anaemia was lower when higher number of adults lived in the household (OR = 0.69; 95% CI [0.53, 0.90]), and higher when children were zinc deficient (OR = 3.40; 95% CI [1.54, 7.47]). For preschoolers (36-60 months), the odds ratio of anaemia was lower for every additional month of age (OR = 0.90; 95% CI [0.81, 1.00]). Findings suggest that micronutrient deficiencies coexist in Guatemalan rural children, and zinc deficiency is associated with anaemia in children <24 months, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. Further research examining how household composition, feeding practices, and accessibility to micronutrient supplements and to animal source foods is needed to incorporate strategies to improve the nutritional status of Guatemalan children.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Chispuditos® is a corn/soy atole fortified with 21 vitamins and minerals designed to reduce micronutrient deficiency of Central American children. A portion of atole (18.75g) was provided for 5 days/week to 6‐72 month‐old children. Seven hundred and forty seven children completed 1 year of the nutritional intervention. Hemoglobin, anthropometry and incidence of respiratory tract infections and diarrhea were analyzed at baseline, six months and one year. Repeated measures ANOVA indicated an increase in hemoglobin from baseline=11.76±1.17g/dL to endline=12.39±1.05 g/dL, p<0.001. HAZ scores increased from ‐1.25±1.02 to ‐1.07±0.96, p<0.001 over the time course of the intervention. Furthermore, there was a 57.1% reduction in respiratory tract infections, p<0.001 after 12 months. No changes in the incidence of diarrhea from baseline to one year were observed. Overall, children in this study had an improvement in HAZ scores, hemoglobin concentrations and respiratory tract infections after 12 months of intervention, while previous studies in comparable settings took approximately 24 months for HAZ scores to improve.Funded 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.

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®

This study assessed growth, morbidity and nutritional biomarkers in toddlers and children receiving multiple micronutrients via a fortified corn/soy atole. Children 6–72 mo of age, n=1003, from six municipal nurseries in Guatemala City, GT were enrolled in a prospective, longitudinal study. Five d/wk for 10 mo children received Chispuditos®, a corn/soy atole beverage mix (18.8 g blended in 227 ml heated liquid), under the supervision of nursery staff. Chispuditos was fortified with 21 vitamins/minerals and provided 12 mg iron and 9 mg zinc per serving. Anthropometric data and morbidity were monitored every 2 mo and fasting venous blood samples obtained at baseline and end line. Growth rates increased (P<0.05) across all age groups (58% for children 6–23 mo, 87% 24–35 mo, 69% 36–59 mo, 80% 60–72 mo) when compared to similar aged children in the same nurseries the prior yr. After 10 mo the incidence of acute diarrhea and acute respiratory infections were lowered (61% and 71% decrease, respectively, p<0.05). End line hemoglobin, iron, transferrin, folic acid and vitamin B12 increased (P<.0.05) vs baseline. Zinc, ferritin and C‐reactive protein did not change. We conclude that Chispuditos is a culturally acceptable mechanism to provide multiple micronutrients and improve health and nutritional status in malnourished Guatemalan children. Supported by the Mathile Institute for the Advancement of Human Nutrition®.