Indicators of nutritional risk.

Essentially all children in this Indian region are breast-fed and do well for aboutn 4 months afteer which 2 types of findings appear: aveerage growth increments drop significantly below Harvard standards and a high rate of morbidity is evident at 4 months of age. Seasonal patterns of prevalence suggest that diarrhea may be associated with the timing of greatest nutritional stress. Undoubtedly the heavy infection load affects the adequacy of breast-feeding to maintain growth. The cultural tabboo against feeding sick children including breast-feeding and the direct nutritional drain caused by infections are important factors. Synergism can probably also be initiated by specific dietray deficits the most obvious in Narangwal children being anemia. Another causal factor of synergism is the shift in breast-feeding from demand-feeding to opportunity feeding. International standards for dietray intake have been based mainly on clinical studies in well-nourished populations in developed countries; this is one of the few studies of developing countries children. The results of the dietary survey suggest strongly that the aveerage consumption of calories was insufficient for all children under 1 year of age. For Ramadasias however this deficiency continued up to the age of 36 months. Therre is also clear-cut evidence of iron-deficiency especially in children under 1 year old. The standard of the Food and Agriculture Organization of the UN (FAO) for iron-intake is probably inappropriate for children in the Punjab environment. No clinic evidence of vitamin A deficiency was found so FAO standards are supported. Evidence of protein lack was suggested by findings such as hair color changes. Protein intakes judged adequate by US or European standards may be inadequate in developing countries. Intakes were found to vary significantly between castes and sexes. The concordance between the different methods of judging nutritional status used at Narangwal suggests that the delivery methods of this project were appropriate in emphasizing single growth surveillance and efforts to provide intensive nutrition supplementation for children with faltering growth. Even more intensive efforts are still needed however.