Height and weight gains in a nutrition rehabilitation day-care service

Abstract

Objective: To evaluate nutritional recovery patterns in 106 undernourished children assisted by the Center of Nutritional Recovery and Education (CREN, in Portuguese) between January 1995 and December 1999. Design: CREN assists undernourished children aged 0 to 72 months living in the southern regions of Sao Paulo, in an outpatient setting. Nutritional status was assessed by Z-scores of weight-for-age, height-for-age and weight-for-height. Nutritional recovery evaluation considered Z-score gains in weight-for-age and height-for-age, grouping into four categories (Z-score increment of 0?50 between groups). Children with birth weight less than 2500 g were classified as low birth weight (LBW), while those born at term and with LBW were classified as small for gestational age. Setting: CREN (Center of Nutritional Recovery and Education in Portuguese), Sao Paulo, Brazil. Subjects: One hundred and six children from CREN. Results: Among the 106 evaluated children, ninety-eight (92?5 %) recovered their weight or height and seventy-two (67?9 %) recovered both. Nearly half of studied children presented a nutritional recovery (increase in Z-score) of more than 0?50 in height-for-age (46?2 %) and about 40 % in weight-for-age (38?7 %). Multivariate analysis showed that treatment duration and initial weight-for-age contributed to weight-for-age Z-score increment, explaining 25 % of the variation; and treatment duration, initial height-for-age and weight-for-age Z-score increment contributed to height-for-age Z-score increment, explaining 62 % of the variation. Conclusions: Our findings show that nutritional recovery among children who attended CREN was influenced primarily by the degree of nutritional deficit at admission. It has also been shown that biological variables are more important than socio-economic status in determining the rate of nutritional recovery.

Evaluation of a Residential Nutrition Rehabilitation Center in Rural Bolivia: Short-Term Effectiveness and Follow-Up Results

“…WHZ and HAZ at entrance were negatively associated with change in z-score, suggesting that those who entered with lower z-scores showed greater changes in z-score from entrance to exit. This finding corroborates the modeling results of the nutrition study in Brazil [6]. This is encouraging, as it indicates that those who enter with the poorest nutritional status are benefiting the most as a result of the program.…”

“…A significant change in weight-for-height and weight-for-age and a minimal change in height-for-age have been reported in several other studies of nutrition rehabilitation programs [5, 11]. Our finding that nutritional status at entrance is a strong predictor of changes in z-score during the program is supported by a study of a daycare rehabilitation center in Brazil [6]. …”

“…Although this could help explain why children at follow-up had improved their average nutritional status only up to community norms, it is also plausible that the root determinants of high rates of undernutrition in a community may ultimately determine the nutritional status of rehabilitated children. Length of stay was positively associated with nutritional improvements in two studies of nutrition rehabilitation programs in Brazil [5, 6] as well as a study of NRCs in Ghana [11]. One hypothesis for the lack of association observed in our study is that there was a threshold after which more time spent at CRIN does not result in added benefits.…”

“…Two linear regression models, one for change in HAZ and one for change in WHZ, were used to elucidate the factors associated with improvements in z-score between entrance and exit from the program while controlling for age and sex (table 3). The covariates included in the model were selected based on associations that have been described in the literature [6, 10] as well as significant associations found in bivariate analyses (table 2). Although diarrhea was not a statistically significant predictor for change in WHZ, it was left in the model to remain consistent with model 1 and because it was significant in bivariate analysis.…”

“…Overall, the centers' effectiveness was found to be low, with inadequate rates of weight gain in children and a mean duration of rehabilitation of 8.7 months, exceeding the 4-month recommendation from WHO. Evaluation of two NRCs in an urban area of Brazil showed that although improvement in weight-for-age and weight-for height was substantial, no significant change occurred in the degree of stunting experienced by children over the course of the program [5, 6]. …”