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Affecting Rich and Poor: Malnutrition in Latin America and How Nuclear-Related Techniques Can Help

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Malnutrition among children is of growing concern in Latin America. Above, school children in Ecuador stand in line to get food and drinks. (Photo: E. Cody/IAEA)

An article published this month in the Food and Nutrition Bulletin concludes that commonly used methods to assess exclusive breastfeeding in Guatemala can lead to an overestimation of the amount of milk children receive. Nutritionists have studied children’s milk intake using isotopic techniques with the support of the IAEA, and found that mothers’ reports alone —which public health decision makers commonly rely on— were not precise.

This is just one example for the use of nuclear-related techniques to improve nutrition. With the help of the IAEA, experts in Latin America have been tackling malnutrition for more than ten years. Using these techniques, they can measure things like a baby’s milk intake, a child’s body fat or an old person’s bone health. Based on the data they gather and publish, institutions across the region are intervening to change lifestyle patterns and tackle malnutrition in all its forms.

Of growing concern in the region is the double burden of malnutrition: when undernutrition and obesity happen at the same time. Changing diets and lifestyles are leading to more obesity and overweight, which coexist with iron deficiencies and undernutrition.

“These problems are coming together in the same countries, and even in the same households,” said Manuel Ramirez, Coordinator of the Research Centre for Prevention of Chronic Diseases at the Institute of Nutrition of Central America and Panama (INCAP), adding that malnutrition is a problem that affects both rich and poor in all regions of the world.

The following summarizes nutritionists’ ongoing work to tackle this problem in Latin America.

Babies

A baby suffering from malnutrition during its first years has a higher risk of contracting diabetes or cancer later in life. The World Health Organization recommends exclusive breastfeeding for six months followed by the introduction of other foods and continued breastfeeding for up to two years.

Stable isotopes, which have no radioactivity, can be used to measure whether a baby is breastfed exclusively and how much milk it consumes. Health workers give mothers deuterated water — a safe but slightly different form of water — and collect saliva samples from the mother and her baby. From the amount of deuterium in the saliva, they can determine how much breastmilk or water from other sources the baby consumed, finding out whether babies are exclusively breastfed or not. The information nutritionists gather from this analysis provides valuable data for policymakers.

In Argentina, for example, scientists from the universities of La Plata and Buenos Aires collected evidence using stable isotopes with the support of the IAEA and presented it to the Ministry of Health, which is now considering the use of this method to complement their national breastfeeding survey.

Growing up

When Gabriela Salazar, Associate Professor at the Institute of Nutrition of the University of Chile, started collaborating with the IAEA in 1997, obesity among pre-school children in a day-care centre used for a pilot project amounted to 10.8%. “Obesity can lead to higher blood pressure, higher glucose levels and chronic diseases,” she said.

In 1999, Salazar and her group of scientists started measuring the risk factors in anaemic and overweight children using equipment and methods developed with IAEA experts. Their research showed that children were not getting enough exercise and were eating too much. These results motivated the Ministries of Health and Sports and the National Sports Council to incorporate structured physical activity into the day care centre’s curriculum. By 2003, they managed to reduce the amount of calories in school meals and increase children’s daily physical activity.

“Children’s obesity was reduced steadily,” Salazar said. “From 2000 to 2009 we saw that we had reduced obesity from 10.8 to 8.6%, and we’re talking about an institution which has 120 000 children.” The results led to an eventual roll-out to more education centres. Today, the model covers three quarters of Chile’s day care centres.

It was through an IAEA fellowship that scientists in Uruguay learnt about Chile’s experience. In 2013, they studied school children from 3 to 6 years of age in Uruguay and, based on the data gathered, developed an education model to promote healthy habits with an emphasis on physical activity and proper nutrition. This involved children, parents, teachers, nutrition specialists, doctors and psychologists, who helped design, implement and evaluate the model.

The model was implemented in four education centres in Montevideo, which affected 24.3% of the children enrolled in kindergartens in this area. During the five months the implementation of the model lasted, obesity prevalence in the children analysed declined from 13.7 to 10%. The government is planning to introduce the model in more education centres and to incorporate it in Uruguay’s Plan Ceibal, an Uruguayan government initiative to introduce information and communication technologies in schools across the country.

Growing old

The elderly are especially at risk of suffering from malnutrition, which can lead to loss of skeletal muscle mass (sarcopenia) or of bone mineral mass (osteoporosis). These conditions result in frailty, increased risk of broken bones and less independence.

Reduced food intake and a lack of variety in food are part of the problem. The IAEA supports scientists in applying stable isotopes and other nuclear-related techniques to measure changes in body composition and energy expenditure, helping them study things like bone and muscle health and changes in physical activity.

An IAEA project ongoing in 13 countries is helping improve the quality of life of older people through the early diagnosis of sarcopenia, the loss of skeletal muscle mass and strength.

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