Can the high prevalence of micronutrient deficiencies, stunting and overweight in children at ages 1 and 3 years in the Central Region of Limpopo province be explained by diet?

Objective. To assess whether the high prevalence of stunting and overweight accompanied by serum deficiencies of iron, folate and vitamin B12 in children at ages 1 and 3 years, can be explained by their diet. Design. A prospective cohort study. Setting. Villages in the central region of Limpopo province, which are serviced by Mankweng Hospital. Subjects. A cohort of children (N = 219) followed from birth were included in the study. Of the original cohort, 156 and 162 could be traced and assessed at ages 1 and 3 years, respectively. Dietary intake of the children was assessed using a quantitative food frequency questionnaire and at 3 years a 24-hour recall questionnaire was also administered. Results. The children in this cohort consumed an energy-dense diet of poor quality as evidenced by insufficient intakes of iron, zinc, calcium and phosphates as well as folate, riboflavin, vitamin B6, niacin and vitamin A. Overall, nearly 70% of the energy intake of the diet came from carbohydrates while the contribution from fat was less than 20%. Average protein intake was adequate but comprised mainly protein from vegetable sources which are poor sources of iron and certain essential amino acids. Furthermore, the diet was judged to be high in phytates because of the high intake of cereals and this would have contributed to making iron and zinc less available for absorption. Low fruit and vegetable intake was the cause of the low intake of folate, vitamin A and vitamin C. The prevalence of micronutrient deficiencies was confirmed by the high prevalence of children with iron and folate biochemical deficiencies. Conclusion. The children's diet was poor in several micronutrients which included iron, calcium, folate and vitamin A. Chronic energy deficiency, especially from animal sources, seems to be the factor contributing to the high levels of stunting observed.