The Nutritional Status of Nicaraguan Adolescent Girls by jib24063

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									  The Nutritional Status of
Nicaraguan Adolescent Girls

          Lisa Pawloski, PhD
       George Mason University
 College of Nursing and Health Science
              Fairfax, VA
Why Adolescent Girls?
Nicaragua
Research Team
Universidad Politecnica de
        Nicaragua
Anexo Villa Liberdad Barrio
                Methods
 Anthropometry
 Clinical Signs of Nutrient Deficiencies
 Age at Menarche
 Interviews on Diet and Lifestyle
 Ethnographic Data
Anthropometry
RESULTS
                                           Height-for-Age Z-scores
                            0
Height-for-Age Z-scores




                          -0.2
                          -0.4
                          -0.6
                          -0.8
                           -1
                          -1.2
                          -1.4
                          -1.6
                          -1.8
                           -2
                                 10   11      12     13         14   15   16   17

                                                          Age
                                           Weight-for-Age Z-scores
                            0
Weight-for-Age Z-scores




                          -0.2

                          -0.4

                          -0.6

                          -0.8

                           -1

                          -1.2

                          -1.4
                                 10   11      12     13         14   15   16   17

                                                          Age
                   Results
Variable        Mean          Standard
                              Deviation
HAZ             -1.24         .97

WAZ             -.54          .84

Percentage of   29.0 %        5.58
Body Fat
BMI             20.08         3.08

Age at Menarche 12.34 years   1.03
                                               BMI for Age of Nicaraguan Girls

             34
             32
             30
             28
             26
             24
             22
BMI values




             20
             18
             16
             14
             12
             10
              8
              6
              4
              2
              0
                  10              11           12                13           14          15              16             17

                                                                      Age


                       Nicaraguan Girls' BMI    5th Percentile        50th Percentile   85th Percentile        95th Percentile
          Risk for Obesity
 Underweight = 2%
 Overweight = 17%
 Obese          = 1%
 In U.S. 14% of adolescents ages 10 to 18
  years are obese.
                                                       Triceps Skinfolds of Nicaraguan Girls


                         30


                         25
Skinfold Values (m m )




                         20


                         15


                         10


                         5


                         0
                              10       11             12                 13             14            15           16               17
                                                                              Age


                                   Nicaraguan Girls    10th Percentile        25th Percentile   50th Percentile   75th Percentile
     Implications for Nutrition
      Intervention Programs
 Not only are girls undernourished, but many are at
  risk of being overweight and obese, and deficient
  in many micronutrients.
 Understanding how girls can (and can be
  encouraged) to increase their consumption of
  micronutrients and consuming energy rich foods
  in moderation is critical to improving their
  nutritional status.
 Girls can be encouraged to increase the
  consumption of available fruits and vegetables and
  reduce coffee consumption during meals.
January 2002 and January 2003
   Additional Data Collection
    – Anthropometric data. (to examine growth rates and to
      examine longitudinal data).
    – Interviews on diet, energy expenditure, wealth,
      demographic information.
    – Hemocue analysis to determine anemia.
   Initiated Nutrition Education Program
    – 5 nutrition education classes (anemia, being a healthy
      mother, beverages, vitamins, underweight and
      overweight)
    – To evaluate, girls are given pre-tests and post-tests.
                     Sample

   100 adolescent girls in 2002
   113 adolescent girls in 2003
   Ages 10 – 18 (9 - 22)
   Homogeneous group
   Live in a barrio in Managua
   Low SES
   Latino
             Measurement

   Anthropometric measurements

   Interviews

   Measurement of hemoglobin levels

   Pretests and posttests
    Nutrition Education Program


 Consisted of four, one hour teaching
  sessions on nutrition.
 These sessions were taught in January,
  April, July, and October 2002.
 Included content on various topics in
  nutrition.
Nutrition Education Program
Pretests and Posttests
                   Procedure

   Invited by member of the community to
    participate
   Came to Nursing Center to be measured and
    interviewed
   Completed measurement process in about 30
    minutes
   Received small gifts for participation
   Took pretest, attended nutrition class, took posttest
     Findings


Research Questions
What is the impact of a nutrition intervention
 program on:
 Nutritional status?
 Knowledge of nutrition?
Variable       Means for 2002   Means for 2003   T       P

Height-for-    -1.13 ± .85      -1.05 ± .78      1.69    .10
age Z-scores   (n = 33)         (n=33)
Weight-for-    -.54 ± .89       -.52 ± .93       .35     .73
age Z-scores   (n=33)           (n=33)

Height         .33 ± .88        .25 ± .90        -.39    .70
Velocity Z-    (n = 36)         (n=36)
scores
Weight         .02 ± .61        .004 ± .61       -.12    .90
Velocity Z-    (n=36)           (n=36)
scores
BMI-for-Age    50.59 ± 27.37    50.72 ± 27.37    .06     .96
Percentiles    (n=36)           (n=36)

Hemoglobin     13.13 ± 1.18     12.58 ± 1.00     -2.88   .01
Values (mg/dl) (n=38)           (n=38)
                                  HAZ of Nicaragua Adolescent Girls

                   1

                 0.5
Z-score values




                   0

                 -0.5

                  -1

                 -1.5

                  -2
                        10   11           12         13             14    15   16
                                                Age in Years
                                               HAZ 2002        HAZ 2003
                             WAZ of Nicaraguan Adolescent Girls

                 0.2
                   0
                 -0.2
Z-score values




                 -0.4
                 -0.6
                 -0.8
                  -1
                 -1.2
                 -1.4
                        10     11      12          13          14    15   16
                                               Age in years

                                            WAZ 2002      WAZ 2003
                                          BMI for Age of Nicaraguan Girls

             34
             32
             30
             28
             26
             24
             22
BMI values




             20
             18
             16
             14
             12
             10
              8
              6
              4
              2
              0
                  10            11         12          13            14          15            16               17

                                                            Age


                   5th Percentile    50th Percentile   95th Percentile    BMI for 2002 girls        BMI for 2003 girls
            Percent     Percent     N
            Frequency   Frequency
            With        Without
            Anemia      Anemia
2002 Data   11%         89%         100


2003 Data   25%         75%         112
                 Hemoglobin Value. Taken in 2002.
            20




            10
Frequency




                                                                        Std. Dev = 1.09
                                                                        Mean = 13.13
            0                                                           N = 97.00
                 9.50   10.50   11.50   12.50   13.50   14.50   15.50
                    10.00   11.00   12.00   13.00   14.00   15.00


                 Hemoglobin Value. Taken in 2002.
                 Hemoglobin value of girls taken in 2003.
            30




            20




            10
Frequency




                                                                               Std. Dev = 1.26
                                                                               Mean = 12.36
            0                                                                  N = 112.00
                 8.00   9.00   10.00   11.00   12.00   13.00   14.00   15.00
                    8.50   9.50   10.50   11.50   12.50   13.50   14.50


                 Hemoglobin value of girls taken in 2003.
                           Classes Attended
            40




            30




            20




            10
Frequency




            0
                 1.00           2.00        3.00     4.00


                        Number of Classes Attended
               Mean   SD    T       DF   P

January 2002   1.54   1.32 9.184    69   .000
Intervention
April 2002     .23    .69   3.041   80   .003
Intervention
July 2002      1.44   1.61 6.869    58   .000
Intervention
October 2002   .39    1.35 2.164    56   .035
Intervention
             Discussion


 Nutritional   status

  – Include mothers in teaching program
  – Follow up on girls with anemia
      For girls with anemia

 Inform girls and mothers in writing about
  having anemia and special class.
 Teach class on anemia to girls and mothers.
 Determine if girls smoke or are pregnant.
 Refer to health clinic for Dx and Rx of
  parasites.
 If remain anemic, give 100 iron tablets.
                  Discussion



   Knowledge of nutrition
    – Increase precision of measurement on pretests
      and posttests
              Discussion


 Further   analyses needed for variables
     Other anthropometric measures
     By age

     By growth rate

     By BMI for age

								
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