Listless? Constantly ill? Test your child’s nutrition levels

By Carol Aloysius

Nutrition plays a significant role in shaping who we are and what we become in life.

Between 1987 and 2000 Sri Lanka’s health indicators showed a remarkable improvement in child health, with underweight levels plunging by almost 25 percent during this period and stunting, a measure of long term under-nutrition declining dramatically by 75 percent to a new low from an earlier ‘high’. Then, Sri Lanka was able to boast of having the lowest prevalence of underweight in South Asia suggesting that she was likely to achieving the Millennium Development Target of 19 percent prevalence by 2015.

However in the past decade from 2000 on, there has been a slow down in the rate of malnutrition and despite continued efforts to put things right by the Government of Sri Lanka, underweight prevalence remains high relative to world standards.

How did this happen in a country where all other health indicators such as low infant and maternal morbidity and mortality rates, are far higher than almost all other countries in the region? What are the health impacts of under nutrition on school children?

The Sunday Observer spoke to some experts in the field from the Schools Health Program and School Nutrition division of the Ministry of Health who answered our questions on grounds of anonymity.

Q: Why is under nutrition in children an important health issue?

A: Education and health are inter-dependent and there’s a critical synergistic relationship between learning and health for the child. The importance of regular attendance at school cannot be overemphasised in improving learning achievements of school children. Studies have show that those who do not attend school perform poorly in their studies.

Today, unlike in the past, there is a high degree of absenteeism among school children.

Q: What are the main causes?

A: Ill health. This is one of the main reasons why children stay away from school.

Q: What kind of illnesses do they complain of more frequently?

A: Headaches, fever, bowel diseases, respiratory infections, colds and coughs are among the most common reasons for staying away from school.

Q: What are the long term health impacts?

A: If untreated, it can weaken their immune systems, and make them malnourished. Severe malnutrition if neglected could even lead to death. In addition, poor nutrition also affects physical growth and mental ability.

Q: What are the symptoms to indicate a child is undernourished?

A: Apathy, listless, inability to concentrate on his studies.

Q: What about stunting?

A: In Sri Lanka under-nutrition as indicated by stunting and wasting are significant problems among school children.

Q: Are there any other health issues related to under nutrition?

A: Anaemia, vitamin A deficiency and iodine deficiency have also been identified as nutrition deficiencies in school children.

Q: Have there been any studies to show the levels of under nutrition in Sri Lanka among school children?

A: Studies by the Medical Research Institute (MRI) show that 29 percent of school children are under nourished.

Q: What about anaemia?

A: According to a multiple micro-nutrient survey by the MRI in 2012, the prevalence of anaemia among preschoolers was 15 percent and among school children 20 percent. Anaemia is also prevalent among adolescent girls. The National Food Security Survey of 2009 revealed that the prevalence of anaemia among non pregnant women aged 15 onwards was 22.2 percent.

Q: Does that mean they are underweight?

A: No. Even plump children who look health outwardly could be under nourished because they haven’t eaten proper balanced diets. Obesity in children is an emerging problem especially in schools in the cities where there’s a lot of junk foods, available in food outlets. Children who get used to eating foods with high starch content, high sugar content and high salt content, such as pastries, rolls, hamburgers, carbonated drinks, cakes, puddings, are invariably open to early non communicable diseases such as diabetes, hypertension and heart diseases.

Q: What are the interventions to halt this trend by the Health Ministry?

A: The Government of Sri Lanka recognised the need for ensuring nutrition to some decades ago, when it developed a National Nutrition Policy in 1986.The aim of this policy, was to ensure adequate and appropriate nutrition throughout the life cycle, starting with the pregnant mother. Adequate nutrition for pregnant women was ensured with vitamin supplements etc, to enable easy delivery of their baby. The growth and development of the young child was ensured by instructing all mothers to exclusively

breastfeed their baby for at least four months. At the same time arrangements were made to ensure the nutrition development and growth of school children.

Q: What about reducing under-nutrition and obesity in adolescents?

A: Reducing these two health risk factors along with malnutrition among adolescents to enable them to be healthy productive adults, was also a component in this program.

Q: Has there been a follow up to this program in recent years?

A: Studies show that Sri Lanka showed a marked improvement in the national status of the young due to the schools feeding program. And these other inputs. But as we said earlier, there has been a slow down in the recent past.

Q: Why?

A: According to the World Bank, the causes included: household food insecurity, limited access to safe water and sanitation and poor maternal childcare practices as the main causes for the high levels of under nutrition. Low birth weight and mothers poor nutritional status also had direct impacts on the child’s weight.

The government of Sri Lanka now has in place a National Food and Nutrition Policy 2006-2010 whose goal is to address the country’s problem of child under-nutrition mainly. Under this there are three broad strategies:

Direct food strategies
Direct food assistance

The integrated package of maternal and nutrition services under the Ministry of Healthcare and Nutrition (MOHN) and poverty reduction. For smaller micro-nutrient deficiencies control it conducts awareness programs for parents to change behaviour regarding food habits. In addition it has direct food and supplementary feeding programs. Triposha is given to pregnant women and school children identified as nutritionally deficient. Growth monitoring is conducted in all school health programs and children in need receive micro-nutrients like iron, calcium and vitamin c and vitamin A as well as de-worming therapy.

Q: Is it true that an apple a day keeps the doctor away?

A: No. Apples like other fruits don't provide all the nutrients for a balanced diet.

Furthermore, apples are mostly imported fruits in Sri Lanka.

However there are many local fruits that are equally or more nutritious than apples such as avocado, mango, banana, papaw, custard apple etc.

A better slogan for us would be a ‘cup of kola kende keeps the doctor away’ as kola kende (leafy porridge) contains some proteins, minerals, vitamins, and calories.

Q: Does eating spinach and carrots make you stronger than other vegetables?

A: Spinach is rich in B Carotene which is converted to vitamin A, iron, calcium and vitamin C. So are most other dark leaves such as mukunuvenna, gotukola, thampala, katurumurunga. Carrots are rich in carotene. So too are vattakka and sweet potatoe (the yellow variety).

Q: Must we eat meat to be strong?

A: Strength comes from a balanced diet and exercise. There are strong people who are vegetarians (e.g. In India) who don't eat any meat, but eat preparations of wheat, pulses, and consume milk in the form of curd.

Q: Is sugar essential for energy?

A: Energy comes from fat, carbohydrates such as starch and sugar and also proteins. Excessive sugar can cause tooth cavities in young children.

Q: Is brown bread better than white bread?

A: White bread is made of wheat flour which when refined loses much of its B vitamins, iron and some protein as well as dietary fibre. Whole wheat bread (i.e. Brown bread) preserves the nutrients. String hoppers, Roti, chapathi made of flour is also rich in nutrients.

Q: What about kurakkan (red millet)?

A: In most preparations of wheat and rice, the outer covering of the seed containing most of the vitamins and minerals, is extracted when milled. In kurakkan food preparations all these nutrients are preserved as kurakkan is not milled.

Q: Is it essential to eat ‘good foods' such as chicken, meat, fish, pork, and cheese daily to maintain a balanced diet?

A: Certainly not. It is also incorrect to say these are ‘good foods'. Not only are they expensive, there are cheaper and readily available foods of nutritious value such as dark green leaves, pulses, small fish , dried sprats, and fruits that provide a balanced meal.

Q: Why are vitamins necessary?

A: Vitamin A helps in proper function and maintenance of the following:

Night vision and colour vision

The cells that line major organs like the skin, eye, respiratory trace, gastrointestinal tract, bone, teeth. Vit. A also guards against invading organisms.

Vit. D helps absorption and transport of calcium and phosphorous.
Vit. E helps in the proper formation of red blood cells
Vit. K helps in the clotting of blood
Vit. B1 helps in the production of energy from carbohydrates and assists body maintenance and repair of cells.

[Myths and facts about nutrition]

We now give you some frequently asked questions by parents on nutritious diets for their children taken from ‘Your child, your Family ‘compiled by Prof. H.A: Aponso et al’

[Role of nutrients]

Nutrients are essential for obtaining energy requirements, growth and repair. Nutrients play an important role in shaping who and what we become in life.

[How energy is obtained?]

The body obtains its energy from three types of food substances. These are carbohydrates, fats and proteins. One gram of carbohydrates supplies four calories. Fats and oil (liquid oil) are concentrated sources of calories. one gram supplies nine calories.

Proteins are also a source of carbohydrates. They supply the same amount of cabs and calories. One gram of protein supplies four calories. But protein other than supplying calories have a much more important role to perform in growth, maintenance and repair.

Hearing protein required to convert sound into brain signals

A specific protein found in the bridge-like structures that make up part of the auditory machinery of the inner ear is essential for hearing.

The absence of this protein or impairment of the gene that codes for this protein leads to profound deafness in mice and humans, respectively, reports a team of researchers.

“The goal of our study was to identify which isoform of protocadherin-15 forms the tip-links, the essential connections of the auditory mechanotransduction machinery within mature hair cells that are needed to convert sound into electrical signals,” remarks Christine Petit, the lead author of the study and Professor at the Institut Pasteur in Paris and at Collège de France.

Three types of protocadherin-15 are known to exist in auditory sensory cells of the inner ear but it was not clear which of these protein isoforms was essential for hearing. “

Our work pinpoints the CD2 isoform of protocadherin-15 as an essential component of the tip-link and reveals that the absence of protocadherin-15 CD2 in mouse hair cells results in profound deafness.”

Within the hair bundle, the sensory antenna of auditory sensory cells, the tip-link is a bridge-like structure that when stretched can activate the ion channel responsible for generating electrical signals from sound.

Tension in the tip-link created by sound stimulation opens this channel of unknown molecular composition thus generating electrical signals and, ultimately, the perception of sound.

The researchers engineered mice that lack only the CD2 isoform of protocadherin-15 exclusively during adulthood.

While the absence of this isoform led to profound deafness, the lack of the other protocadherin-15 isoforms in mice did not affect their hearing.

Patients who carry a mutation in the gene encoding protocadherin15 are affected by a rare devastating disorder, Usher syndrome, which is characterised by profound deafness, balance problems and gradual visual loss due to retinitis pigmentosA:

In a separate approach, the scientists also sequenced the genes of 60 patients who had profound deafness without balance and visual impairment. Three of these patients were shown to have mutations specifically affecting protocadherin-15 CD2.

“The demonstration of a requirement for protocadherin-15 CD2 for hearing not only in mice but also in humans constitutes a major step in the objective of deciphering the components of the auditory mechanotransduction machinery.

This isoform can be used as a starting point to identify the other components of the auditory machinery. By focusing our attention on the CD2 isoform of protocadherin-15, we can now consider developing gene therapy strategies for deafness caused by defects in this gene,” says EMBO Member Christine Petit.

- MNT

Anxious children have bigger ‘fear centres’ in the brain

The amygdala is a key “fear centre” in the brain. Alterations in the development of the amygdala during childhood may have an important influence on the development of anxiety problems, reports a new study.

Researchers at the Stanford University School of Medicine recruited 76 children, seven to nine years of age, a period when anxiety-related traits and symptoms can first be reliably identified.

The children's parents completed assessments designed to measure the anxiety levels of the children, and the children then underwent non-invasive magnetic resonance imaging (MRI) scans of brain structure and function.

The researchers found that children with high levels of anxiety had enlarged amygdala volume and increased connectivity with other brain regions responsible for attention, emotion perception, and regulation, compared to children with low levels of anxiety.

They also developed an equation that reliably predicted the children's anxiety level from the MRI measurements of amygdala volume and amygdala functional connectivity.

The most affected region was the basolateral portion of the amygdala, a subregion of the amygdala implicated in fear learning and the processing of emotion-related information.

“It is a bit surprising that alterations to the structure and connectivity of the amygdala were so significant in children with higher levels of anxiety, given both the young age of the children and the fact that their anxiety levels were too low to be observed clinically,” commented Dr. Shaozheng Qin, first author on this study. Dr. John Krystal, Editor of Biological Psychiatry, commented, “It is critical that we move from these interesting cross-sectional observations to longitudinal studies, so that we can separate the extent to which larger and better connected amygdalae are risk factors or consequences of increased childhood anxiety.”

“However, our study represents an important step in characterizing altered brain systems and developing predictive biomarkers in the identification for young children at risk for anxiety disorders,” Qin added.

“Understanding the influence of childhood anxiety on specific amygdala circuits, as identified in our study, will provide important new insights into the neurodevelopmental origins of anxiety in humans.”

- MNT