title: A prospective assessment of food and nutrient intake in a population of Malawian children at risk for kwashiorkor.
abstract: OBJECTIVE
  To determine what foods, nutrients, and dietary patterns are associated with development of kwashiorkor in populations of vulnerable 1- to 3-year-old Malawian children.
  
  
  METHODS
  This was a prospective observational study conducted in 8 rural villages. Upon enrollment, demographic, anthropometric, and dietary intake data were collected. Children were studied every 2 weeks for 10 weeks to determine whether they developed kwashiorkor. Dietary intake was assessed on enrollment using a food frequency questionnaire, which included all possible foods in the child's diet. Food frequency data were used to estimate energy, protein, vitamins C and A, niacin, thiamin, zinc, and iron intake using food composition and serving size data. Dietary diversity was assessed with a 7-point score. Regression modeling was used to determine whether the consumption of any food or nutrient was associated with the development of kwashiorkor.
  
  
  RESULTS
  A total of 43 (2.6%) of the 1651 healthy children ages 1 to 3 years enrolled developed kwashiorkor. Children who developed kwashiorkor were younger and had more nutritional wasting than those who did not. Thirty children (70%) who developed kwashiorkor were breast-fed. In the combined regression model no foods or nutrients were found to be associated with the development of kwashiorkor. There were no differences in the dietary diversity between children who developed kwashiorkor and those who did not.
  
  
  CONCLUSIONS
  No association between the development of kwashiorkor and the consumption of any food or nutrient was found.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Lin
authors.forename: Sarah
authors.initials: S
authors.lastname: Boslaugh
authors.forename: Heather M
authors.initials: HM
authors.lastname: Ciliberto
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.forename: André
authors.initials: A
authors.lastname: Briend
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D015930:Diet Records; D004435:Eating; D005260:Female; D005502:Food; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000209:etiology*; D008295:Malawi; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D012424:Rural Population