The important elements as indicated for the stunted growth life cycle in children are mentioned below;
1. Vitamin –A
Vitamin A is an essential vitamin required in small amounts by human beings for the normal functioning of the visual system, maintenance of cell function for growth, epithelial cellular integrity, immune function and reproduction. Dietary requirements for vitamin A are normally provided as a mixture of retinol, which is present in animal source foods, and carotenoids, which are derived from fruits and vegetables. Carotenoids are converted into retinol by tissues such as the intestinal mucosa and the liver.
Risk element and Vitamin A Deficiency
Less consumption of the foods rich in Vitamin A or its precursor carotene is major risk elements. In different countries like India and Pakistan, about 454 µg Retinal is taken as vitamin A and 38% of this consists of precursor carotenoids from vegetable source but recommended daily allowance (RDA) for vitamin A is 600 µg/day. Vitamin A is fat soluble and transported in the body along with fat. Low fat diet affects the predisposing elements. Women and children are more susceptible to vitamin A deficiency as it is required during childhood, adolescent, pregnancy and lactation. This group needs supplementation of vitamin A. Vitamin A deficiency leads to defect visual function, night blindness and xerophthalmia. Smoking, taking tea, taking fruits and salads with meals rather than empty stomach.
Anticipation and Control
- Vitamin A deficiency is not related to income but it is due to unawareness of the general public to its common sources. Liver, egg yolk, yellow fruits and green leafy vegetables are the rich sources of vitamin A.
2. Vitamin D
Vitamin D has several important functions. The most vital are, regulating the absorption of calcium and phosphorous and facilitating normal immune system function. Getting a sufficient amount of vitamin D is important for normal growth and development of bones and teeth, as well as improved resistance against certain diseases. In Pakistan, most of the population is vitamin D deficient as people prefer chicken meat over beef which contain sufficient amounts of vitamin D. Also, vegetable oils with no vitamin D added, have preference over butter. At industrial level, fortification of vegetable oils with vitamin A, D, E and K is not properly monitored. RDA for vitamin D is 5 µg/day.
Risk element and Vitamin D Deficiency
Vitamin D deficiency is associated with bone abnormalities (osteomalacia) and fragile bones (osteoporosis). Lower levels of vitamin D are also coupled with less resistance against flu and prevalence of depression. Pollution, use of sunscreens, spending more time indoors, living in big cities where buildings block sunlight and darker skin are the contributory elements of vitamin D deficiency. General tiredness aches & pains and a general sense of not feeling well are the symptoms of vitamin D deficiency. Severe deficiency causes difficulty in climbing stairs or getting up from the floor and sometimes stress fractures in hip and pelvis area.
Anticipation and Control
- Fish, egg yolk, cereals, milk and shrimps are wealthy source of vitamin D.
- General awareness to spend some time outdoor.
- Vitamin D supplementation programs should be planned for school going children and women.
3. Iron
Most of the iron in the human body is present in the erythrocytes as hemoglobin, where its main function is to carry oxygen from the lungs to the tissues. Iron is also an important component of various enzyme systems, such as the cytochromes, which are involved in oxidative metabolism. It is stored in the liver as ferritin and as haemosiderin. RDA for iron is 15 mg/day.
Iron deficiency and anemia
The terms, “iron deficiency” and “iron-deficiency anemia” are often used synonymously although they are not the same conditions. About 40% of the world’s population (i.e. more than 2 billion individuals) is thought to suffer from anemia, i.e. low blood hemoglobin. The mean prevalence amount specific population groups are estimated to be: pregnant women, infants and children aged 1-2 years, 50%, preschool-aged children, 25%, school children 40%, adolescents, 30-55% and non-pregnant women, 35%.
Risk element for deficiency
Since only 10% of iron in the food is absorbed in normal condition therefore, the food hampers absorption. Severe diarrhea, intestinal ill-health, excessive phytic acid in food and phosphorous hinders absorption. Children of growing age, adolescent girls, lactating and pregnant women need extra iron for daily intake; therefore they are more vulnerable to iron deficiency. Chronic bleeding like hemorrhoids, peptic ulcer, hemenorrhagia and hook-worm diseases are also important causes of iron deficiency. The stored iron in the body even if it is sufficient may not be properly utilized in chronic infection or in the absence of other hematopoietic elements especially vitamin B 12. An inadequate intake of vitamin C (ascorbic acid) from fruits and vegetables, the presence of vitamin C enhances the absorption of iron from the diet.
Anticipation and Control
- For controlling iron deficiency, discover and treat the cause: give iron medicines, B complex including B12 and folic acid.
- Addition of Iron in the form of Ferrous sulphate, Ferrous fumarate and Ferrous saccharate are the most commonly recommended iron sources in different cereals, pulses, dairy products, cocoa products, soya sauces , and ketchups.
- For anticipation, correct feeding of infants and correct weaning practices.
- Intake of foods rich in iron, especially with more available iron like kidney, liver, meat fish, green leafy vegetables, grams, brown sugar and dry fruits.
- Supplementation of children and women with iron
- Avoid delayed weaning of infants.
- Control of parasitic diseases by creating better sanitation and personal hygiene.
- Creating effective nutrition awareness by seminars and workshops among masses.
Iodine
Iodine is preset in the body in minute amounts mainly in the thyroid gland and its only confirmed role is in the synthesis of thyroid hormones. Iodine deficiency is a major public health problem for populations throughout the world, particularly young children and pregnant women representing a significant threat to national social and economic development. The most devastating outcome of iodine deficiency is mental retardation. RDA for iodine is 150 µg/day.
Risk element for Iodine Deficiency
Iodine deficiency is exacerbated by a high consumption of natural goiterogens that are present in some staple foods such as cassava. The antithyroid action of goiterogens is related to the presence of thiocyanate which inhibits thyroid iodide transport and at higher doses, competes with iodine in the synthesis of thyroid hormones. Goiterogenicity is determined by the balance between the dietary supply of iodine and thiocyanate. Goiter develops when the urinary iodine (µg): thiocyanate (mg) ratio falls below 3.
Anticipation and Control:
- Sea foods are a rich source of iodine but being expensive, affordability is a major hindrance for general public.
- Common salt in the form of iodized salt (10 to 25mg/Kg) is available at a cheaper price in the market throughout the country but it is observed that masses are reluctant to use iodized salt in rural areas because they believe that reproductively will be decreased by using this salt but the reality is otherwise.
- Awareness should be created at school level that iodized salt will be helpful in gaining general exuberance in life by improving thyroid functions.
Zinc (Zn)
Zinc is an essential component of a large number of enzymes and plays a central role in cellular growth and differentiation in tissues that have rapid differentiation and turnover, including those of the immune system and those in the gastrointestinal tract. The positive impact of zinc supplementation on the growth of some children and on the prevalence of selected childhood diseases like diarrhea suggests that zinc deficiency is a significant health problem. Pregnant and lactating women are more susceptible to zinc deficiency. RDA for zinc is 15 mg/day.
Risk element for Zinc Deficiency
Foods rich in phytates reduce the bioavailability of zinc in the body. In most cases, iron and zinc deficiencies occur side by side as they are found in common sources like meat, egg, fish and dairy products. Marginal zinc deficiency is hard to detect and only severe deficiency is indicated by plasma and hair zinc levels. Several random studies showed that stunted children and children with low zinc plasma levels responded positively to zinc supplementation. These results suggest that zinc deficiency was a limiting element in their growth. This is not too say that zinc deficiency affects up to one third children in the developing countries since zinc deficiency is only one of the several possible causes of growth stunting.
Anticipation and Control
- Meat, egg, fish and dairy products are a rich source of zinc.
- Foods high in phytates like unrefined cereals and pulses should be avoided.
Bio availability of zinc could be enhanced by increasing milk and protein contents of the food