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Current knowledge on the role of intergenerational effects on linear growth is reviewed on the basis of a literature search and recent findings from an ongoing study in Guatemala. Fourteen studies were identified, most of which examined the intergenerational relationships in birth weight. Overall, for every 100 g increase in maternal birth weight, her child's birth weight increased by 10-20 g. The study samples were primarily from developed countries, and birth weight data were extracted from hospital records and/or birth registries. Among the few studies that examined associations between the adult heights of parents and their offspring, correlation coefficients of 0.42-0.5 were reported. None of the studies examined intergenerational relationships in birth length or linear growth patterns during early childhood, preadolescence and/or adolescence. Prospectively collected data from long-term studies being carried out in rural Guatemala provide the first evidence of intergenerational relationships in birth size in a developing country setting. Data were available for 215 mother-child pairs. Maternal birth size was a significant predictor (P < 0.05) of child's birth size after adjusting for gestational age and sex of the child and other potential confounders. Child's birth weight increased by 29 g/100 g increase in maternal birth weight which is nearly twice that reported in developed countries. Similarly, child's birth length increased by 0.2 cm for every 1 cm increase in mother's birth length. The effect of maternal birth weight remained significant even after adjusting for maternal adult size. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent growth retardation.

To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). Childhood stunting (height-for-age z score) was associated with a lower body mass index and percent body fat in men, while no associations were found in women. In both sexes, however, severely stunted children had significantly greater adult abdominal fatness (waist:hip ratio), once overall fatness and confounders were controlled. The adult waist:hip ratio (x100) was increased by 0.65 (95% confidence interval 0.10 to 1.20) in men and 0.29 (95% confidence interval -0.03 to 0.61) in women for each height-for-age z score less at age three. Migration to urban centers was significantly associated with an even greater waist:hip ratio in severely stunted females (p = 0.03). In a subsample of 137 women, short and thin newborns had significantly greater adult abdominal fatness compared with long and thin or short and fat newborns or children who became stunted postnatally. The adult waist:hip ratio (x100) was increased by 1.58 (95% confidence interval 0.35 to 2.81) for each kilogram less birth weight. The authors conclude that, in countries where maternal and child malnutrition exists alongside rapid economic development and urban migration, abdominal obesity and related chronic diseases are likely to increase.

Programs providing cash transfers to poor families, conditioned upon uptake of preventive health services, are common in Latin America. Because of the consistent association between undernutrition and poverty, and the role of health services in providing growth promotion, these programs are supposed to improve children's growth. The impact of such a program was assessed in 4 municipalities in northeast Brazil by comparing 1387 children under 7 y of age from program beneficiary households with 502 matched nonbeneficiaries who were selected to receive the program but who subsequently were excluded as a result of quasi-random administrative errors. Anthropometric status was assessed 6 mo after benefits began to be distributed, and beneficiary children were 0.13 Z-scores lighter (weight-for-age) than excluded children, after adjusting for confounders (P = 0.024). The children's growth trajectories were reconstructed by copying up to 10 recorded weights from their Ministry of Health growth monitoring cards and by relating each weight to the child's age, gender, and duration of receipt of the program benefit in a random effects regression model. Totals of 472 beneficiary and 158 excluded children under 3 y of age were included in this analysis. Each additional month of exposure to the program was associated with a rate of weight gain 31 g lower than that observed in excluded children of the same age (P < 0.001). This failure to respond positively to the program may have been due to a perception that benefits would be discontinued if the child started to grow well. Nutrition programs should guard against giving the impression that poor growth will be rewarded.

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The potential impact of wheat flour fortification with iron and folic acid was assessed using data about food purchases from the nationally representative 2000 Guatemalan Living Standards Measurement Survey. Of 7265 households, 35% were indigenous and 57% rural; 11% were extremely poor, 35% were poor, and 54% were nonpoor. The percentage of households that purchased wheat flour, sweet bread, French rolls, and sliced bread in the previous 15 d was 10, 88, 59, and 11%, respectively. The median amount of fortified wheat flour equivalents in purchased foods was 50 g/d per adult equivalent; fortified wheat flour equivalents were 7, 25, and 110 g/d for the poverty groups, 16 g/d in indigenous households and 24 g/d in rural households. Wheat flour fortification contributed 2.3 mg/d of iron and 90 microg/d of folic acid per adult equivalent. Assuming 5% bioavailability, wheat flour fortification provided 2% of the recommended dietary allowance (RDA) and 6% of estimated average requirement (EAR) iron levels for women of reproductive age; values were 1, 3, and 12% of EAR levels for the poverty groups, respectively. Wheat flour fortification met 26% of folic acid RDA and 33% of EAR levels for women; values were 5, 16, and 71% of EAR levels for the poverty groups, respectively. In conclusion, the impact of fortification is likely to be substantial for folate status in nonpoor and urban women but limited in the case of iron status among all social groups. The poorest, rural, indigenous populations who suffer the highest burden of nutritional deficiencies likely benefit least from wheat flour fortification.

The large within- and between-sample variability in breast milk lipid content greatly complicates the collection of representative samples in field studies. The main purpose of this study was to validate the ability of individual daytime samples to predict the 24-h lipid concentration of breast milk. We also studied maternal, child, and other factors (time of day and interval between feeds) associated with the within- and between-mother variability in milk lipid content. Fifty-two primiparous urban Guatemalan women between 1 and 4 mo postpartum were studied. Milk samples were collected during six 2-h intervals from 0600 to 1800, and throughout the night when the child breast-fed. On average, the 24-h pooled milk samples contained 4.2 +/- 0.92% (mean +/- SD) lipids and the best concordance with this value was obtained with samples collected between 0600 and 0800 (concordance correlation coefficient = 0.60, P < 0.05). None of the regression equations to predict the 24-h lipid content of breast milk based on daytime samples reached a sufficiently high predictive power to be recommended for the estimation of individual child intake. Time of day and time elapsed since the last feeding were significant determinants of diurnal variations in milk lipid content, whereas between-mother variability was explained by maternal weight (P = 0.05) and body mass index (P < 0.05). For the collection of milk samples in surveys and pre-post studies, we recommend standardization of time of day and interval between feeds.