C. Hollenbeck

Prevalence of malnutrition in human immunodeficiency virus/acquired immunodeficiency syndrome orphans in the Nyanza province of Kenya: a comparison of conventional indexes with a composite index of anthropometric failure.

The prevalence of undernutrition in children is commonly reported using a conventional index, which identifies three conventional categories: stunting, underweight, and wasting. Recently, a composite index of anthropometric failure was developed to categorize undernutrition into seven mutually exclusive categories, including single failures (stunting, underweight, or wasting) and multiple failures (stunting and underweight, stunting and wasting, underweight and wasting, and stunting and underweight and wasting). This cross-sectional study used baseline data gathered during a feeding program targeting orphans and vulnerable children impacted by human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS) in Kenya to compare the conventional index with the composite index of anthropometric failure. Children younger than 5 years of age who participated in the feeding trial were included in the analysis (n=170). The conventional index found that the prevalence of undernutrition included 31.2% stunted, 14.1% underweight, and 5.9% wasted children, whereas the composite index of anthropometric failure estimated a more severe overall prevalence rate (38.2%); thus, the conventional index did not uncover the complexity of malnutrition experienced. Of the 53 children classified as stunted by the conventional index, the composite index of anthropometric failure identified 36 (67.9%) as stunted and 17 (32.1%) as stunted and underweight. Thus, the composite index of anthropometric failure was able to distinguish children with multiple anthropometric failures. In total, multiple anthropometric failures were found in 22 of the 65 children with anthropometric failure. These data suggest that the complexity and prevalence of undernutrition may be underestimated using the conventional index because it does not identify children experiencing multiple anthropometric failures. The ability of the composite index of anthropometric failure to identify children with multiple anthropometric failures may have profound implications for prioritizing, designing, and targeting nutritional interventions.

The Importance of Being Choline

Adiscussion of the importance of choline first appeared in the 7th edition of the Recommended Dietary Allowances in 1968 (1); however, it was not until 1998 that an adequate intake was established for choline (2). At that time there was only a single study in normal men cited that provided evidence of a deleterious effect of a choline-deficient diet in humans (3); data on women, infants, children, and older individuals were not available. Since that publication, additional evidence has accumulated about potential deleterious effects of choline deficiencies in men and premenopausal and postmenopausal women (4-6). Scant data exist regarding choline needs of women during pregnancy and lactation or for infants and children, life stages when choline requirements might be expected to be increased. The review by Caudill (7) in this issue of the Journal adds to the discussion and argues the importance of choline during pregnancy and lactation for fetal and infant development and health.