ANNALS OF HUMAN BIOLOGY NOVEMBERDECEMBER 2004, VOL.

31,

NO.

6, 647659

A cross-sectional examination of growth indicators from Nicaraguan adolescent girls: a comparison of anthropometric data from their Guatemalan counterparts
L. R. Pawloski y, J. B. Moore y, L. Lumbi z and C. P. Rodriguez y
yCollege of Nursing and Health Science, George Mason University, 4400 University Dr., MSN 3C4, Fairfax, VA 22030, USA zUniversidad Politecnica de Nicaragua, Escuela de Enfemeria, Managua, Nicaragua Received 7 April 2004; in revised form 23 August 2004; accepted 26 August 2004

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Summary. Background: Few studies have examined growth data from adolescent girls in Latin America and almost none have been conducted in Nicaragua. Thus this study examines growth data from Nicaraguan adolescent girls. Aim: This study describes cross-sectional growth data from a sample of Nicaraguan girls. These data are compared with data from MexicanUS and Guatemalan girls. It is hypothesized that (a) MexicanUS and Guatemalan wealthy ladina girls will show better indicators of nutritional status when compared with the Nicaraguan girls, and (b) the Nicaraguan girls will show similar anthropometric indicators when compared with poor Guatemalan girls. Subjects and Methods: Anthropometric and age at menarche data were collected from a sample of 154 adolescent girls ages 1017 years living in Managua, Nicaragua. Results: The ndings revealed that these girls are signicantly shorter and lighter than US, MexicanUS and wealthy Guatemalan adolescent girls. These girls are also signicantly taller and heavier than their poor Guatemalan counterparts. Conclusion: This study reveals that the Nicaraguan girls are undernourished when compared with other Latin American girls living in an improved overall environment. The data also reveal that the Nicaraguan girls have better indicators of nutritional status when compared with a cohort of poor Guatemalan girls.

1.

Introduction Nutrition in developing countries is typically poor around the world, in terms of quantity of food and variety of food. While genetics and disease contribute signicantly to the growth of individuals, diet has been shown to play a substantive role (Pelletier 1994). Bogin et al. (1992) have shown that poor environment plays a great role in the dierences in height and weight between poor Mayan children compared to wealthy ladino Guatemalan children. Specically, Mayan children are signicantly shorter and lighter than their wealthy ladino counterparts due to higher rates of undernutrition and disease (Bogin et al. 1992). Nutritional needs vary throughout the lifespan and are more intense during infancy and adolescence. The nutrient needs during adolescence are the second greatest throughout the human lifespan. In developing countries, growth and development among adolescent girls is often delayed due to a variety of environmental decits. (In this study adolescence refers to physical growth and development as opposed to reecting certain behavioural and psychological changes often used outside of the literature of human growth and development. While many of these statements t both genders, this study has been focused on female adolescents and its assertions will be limited to that gender.) Adolescent girls have high nutrient needs due to the adolescent growth spurt, and pregnancy during
Annals of Human Biology ISSN 03014460 print/ISSN 14645033 online # 200? Taylor & Francis Ltd http://www.tandf.co.uk/journals DOI: 10.1080/03014460400010561

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adolescence can lead to greater nutrient demands. Poor nutrition during adolescence can lead to a delayed growth spurt, delayed peak height velocity, and delayed puberty, including age at menarche. Further, cultural values often create limitations to adolescent girls nutritional needs. For example, many adolescent girls are undervalued and are not allowed to go to school. In other instances, girls are given less food and have many domestic responsibilities. The nutritional situation of adolescent girls in developing countries is now considered an emerging issue and a neglected dimension by the World Health Organization (WHO 2003). Research concerning the nutritional situation of adolescent girls has been documented to some extent in many regions throughout the world including Sub-Saharan Africa (Cameron et al. 1994, Gillett-Netting 1995, Pawloski 2002, 2003) but the literature from South and Central America is quite limited. Much of the work concerning adolescent girls in Central America has been done in Guatemala including major contributions by Johnston et al. (1984), Bogin et al. (1990, 1992), and Martorell and Scrimshaw (1995). Relatively little nutrition research concerning adolescent girls has been done in Nicaragua. Such studies have been sparse even while Nicaragua has been identied by World Bank standards as the poorest country in Central America and one of the poorest in the Western hemisphere (World Bank 2003). 2. Adolescent growth and development and nutritional status In order to grow properly, adolescent girls need approximately 14 kilocalories (kcal) per centimetre per day at ages 1114 years and 13.5 kcal per centimetre per day from 15 to 18 years (Mitchell 2003). The adolescent growth spurt in healthy well-nourished girls begins on average between the ages of 1012 years. Growth reaches its peak height velocity (PHV) at around age 12 in healthy reference populations (Tanner 1990). Growth then slows until nal height is achieved in late adolescence. Tanner (1990) has reported that about 20% of nal girls height is achieved during the adolescent growth spurt. Purpose and hypotheses The purpose of this paper is to explore the nutritional status of a group of Nicaraguan adolescent girls and compare their anthropometric data to the US HHANES (Hispanic Health and Nutrition Examination Survey 1985) and from data from Guatemala described by Bogin et al. (1990, 1992). There are no major publications concerning the growth patterns of adolescents in Nicaragua. While Martorell and Scrimshaw (1995) and Bogin et al. (1990, 1992) have extensively gathered growth data from many subsets of children in Guatemala, there are very few other similar studies conducted elsewhere in Central America. Thus these ndings will not only provide more information concerning the nutritional status of Nicaraguan adolescent girls in comparison to their Guatemalan counterparts, it will provide additional information concerning the degree of malnutrition in comparison to a population with a similar genetic background living in an improved environment. Because the sample of Nicaraguan adolescents live in an urban poor barrio and attend public school, it is hypothesized that the Nicaragua girls will reveal similar growth indicators as the poor urban Guatemalan adolescent girls who attend public school. This paper will explore the following hypotheses: 3.

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(1) The Nicaraguan adolescent girls will show poorer indicators of nutritional status when compared with high socio-economic status urban Guatemalan adolescent girls. (2) The Nicaraguan adolescent girls will show similar indicators of nutritional status when compared with low socio-economic status urban Guatemalan adolescent girls. (3) Nicaraguan adolescent girls will show poorer indicators of nutritional status when compared with MexicanUS reference data. 4. Participants and methods 4.1. Study site 4.1.1. Nicaragua. World Bank (2003) data reveal that while Nicaragua has the lowest per capita income in Central America at less than $745 US, Guatemala and Honduras reveal higher percentages of children underweight, with Nicaragua at 12%, Guatemala at 24%, and Honduras at 17%. Further, the under-ve mortality rate for Nicaragua is 43 per 1000, the highest rate just behind Guatemala at 58 per 1000 (World Bank 2003). In Nicaragua, malnutrition is rampant among children under 5 years of age. Nicaragua has been plagued by hurricanes, poverty, political instability, wars and foreign debt, all which have contributed to the bleak health statistics such as high infant mortality rates and high rates of stunting and wasting among children less than 5 years (MINSA 1999). In 1997, a United Nations study reported that the average Nicaraguan adult consumes 1808 calories per day and only 18% eat as many as three meals a day (UNICEF 1997). 4.1.2. Barrio in Managua. The study was conducted in the Axom Villa Liberdad barrio in Managua, the capital of Nicaragua. This particular barrio was established approximately 12 years ago such that many of its inhabitants are displaced people who arrived in Managua from rural communities because of political instability, economic crisis and natural disasters. Electricity is available in the barrio to those who can aord it. As of 2002, some homes have running water while others use public facilities. In this community, there is neither telephone service nor paved roads. A more advanced community nursing centre is available for the residents of this barrio; however, it is not open on a daily basis. For daily healthcare needs, a medical clinic is located about one and a half kilometres away. There are several mini markets or pulperias available to purchase foods, but the majority of these markets do not sell fresh fruits, vegetables or meats. 4.2. Design and participants The study began as a longitudinal examination of adolescent growth in Nicaragua; however, this paper will only report the cross-sectional growth data collected from girls recruited in 2001, 2002 and 2003. This study encompasses a total of 154 girls ages 1017 years. The number of girls in each age class is found in table 2. Girls included in the study were only those living in the above-mentioned barrio. 4.3. Procedure The methodology used in this study was approved by the Human Subjects Review Committee at George Mason University. The data were collected at a community

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nursing centre. Girls were recruited with the assistance of brigadistas, or local health care leaders. Girls and their mothers were informed about the study by a Nicaraguan research assistant familiar with the barrio and its inhabitants. They were informed that there were no foreseeable risks and they were informed they could drop out of the study at any time. Data collected for this study included anthropometric data and age at menarche. Anthropometric data were collected using Lohman et al.s (1988) methodologies. Height was measured with a portable eld anthropometer (GPM, Seritex Inc.). Weight measurements were done using a portable electronic scale. For height and weight measurements, girls were asked to remove their shoes and socks. All measurements were taken by one investigator in a clinical setting. To determine, delay in pubertal development, mean age of menarche was determined using both retrospective and status-quo methods. Girls were interviewed by a brigadista, concerning whether or not they have begun to menstruate and the year they began to menstruate. Anthropometric data were compared with (a) MexicanUS reference percentiles from the US HHANES (1985), (b) 2000 body mass index (BMI)-for-age growth charts from the Centres for Disease Control (CDC), and (c) Guatemalan data. The reference populations are intended to provide comparisons and are not intended to represent a standard of growth for all populations (Eveleth and Tanner 1990). The HHANES data were collected from 1982 to 1984. These target populations for these data included MexicanUS, Puerto Rican, and Cuban US girls. The MexicanUS data are the only HHANES data referred to in this study. The MexicanUS data were collected from individuals living in ve south-western states in the USA (HHANES 1985). BMI-for-age data were compared with (a) the US HHANES data and (b) the 2000 BMI-for-age growth charts. The CDC growth charts data include a large sample of healthy well-nourished US children (CDC 2000). The Nicaraguan girls data are also compared Guatemalan girls data described by Bogin et al. (1990, 1992). These data come from the Longitudinal Study of Child and Adolescent Development done by the Universidad del Valle de Guatemala. These two datasets are from urban Guatemalan populations and were dened by Bogin et al. (1990, 1992) as (a) wealthy girls attending private school and (b) poor girls who attend public school. For simplicity, they will be respectively dened as (a) high socio-economic status (SES) Guatemalan girls and (b) low SES Guatemalan girls. 4.4. Reliability The researcher determined intra-observer reliability of anthropometric measurements. Reliability was determined by examining technical error of measurement (TEM) (Malina et al. 1973) and coecient of relative variation (CRV) (Jamison and Ward 1993). Data to conduct these calculations were determined by measuring and re-measuring a small sample of girls (n 19). The smaller the TEM, the greater the reliability between the measurements. CRV provides the magnitude of error relative to the size of measurement and is reported as a percentage (Jamison and Ward 1993). The reliability data fell within acceptable ranges when compared with other research (Lohman et al. 1988). The reliability results for height and weight are reported in table 1.

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Growth data from Nicaraguan adolescent girls

Table 1. Reliability results. Measurement Height (cm) Weight (kg) TEM 0.378 0.058 CRV 0.674 0.125 Reference TEM 0.494 1.17

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Reference CRV 0.302 2.11

TEM, technical error of measurement; CRV, coecient of relative variation.

5. Results 5.1. Comparison to MexicanUS data When compared with the mean height and weight data from MexicanUS girls from the HHANES (1985), the Nicaraguan girls are signicantly shorter and lighter than the HHANES reference population. These data are presented in gure 1 (height) and gure 2 (weight) by age and in tables 2 and 3. The data in these graphs are compared with mean MexicanUS girls heights and weights. Figures 1 and 2 show a pattern in which height-for-age and weight-for-age remain well below the HHANES reference population at all ages. The height-for-age data (gure 1) show a pattern in which girls appear to reach their peak height velocity at about age 12, however, because only cross-sectional data are examined, this cannot be conrmed. Further, for height, because the graph levels o after age 13, it appears that these girls do not appear to exhibit any indicators of catch-up growth, or increased growth following a period of growth restriction. For weight-for-age (gure 2), the pattern of growth appears to remain again well below the reference HHANES girls. However, the growth curve appears to increase from ages 10 to 17 years, and may eventually catch-up the HHANES reference data after age 17. However, again this cannot be conrmed because these are cross-sectional data. Further, there also is a decline between 15 and 16 years. Yet because of the small sample sizes from ages 15 to 17 years, this growth curve may only present uctuations of nal weight due to the small sample sizes in each age class. Figures 1 and 2 suggest that compared to the MexicanUS reference population, the Nicaraguan girls are growing slower for both height and weight between the ages of 10 and 17 years. Further, these charts show that girls are closer to the reference mean for weight-for-age and farther from the reference mean for height-for-age. t-tests reveal that the Nicaraguan girls are signicantly shorter ( p<0.05) than the HHANES mean reference girls at each age. t-tests reveal the Nicaraguan girls are signicantly lighter than the HHANES mean reference girls ages 10, 12, 14 and 16 years ( p<0.05). For all t-tests described, the assumption of homogeneity of the variance was examined and met. 5.2. Comparison with Guatemalan data The Guatemalan data are presented in gure 1 (height) and gure 2 (weight) by age and in tables 2 and 3. Comparisons with the Guatemala data reveal that the Nicaraguan girls are shorter than the high SES girls from Guatemala, yet they are taller than the low SES girls from Guatemala (see gure 1). The high SES Guatemalan girls reveal a growth curve that is more similar to the mean HHANES data. t-tests were done to examine statistical dierences for height and weight between two groups: (a) the high SES Guatemalan girls and the Nicaraguan girls and (b) the low SES Guatemalan girls and the Nicaraguan girls. Comparisons of height with

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165 160 155 150 145 140 135 130 125 120

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Height in centimetres

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10

11

12

13 Age

14

15

16

17

Nicaraguan girls

Mexican-US girls (HHANES)

Low SES Guatemalan public school girls

High SES Guatemalan girls

Figure 1. Height-for-age of Latin American adolescent girls.

60

55

50 Weight in kilogrammes

45

40

35

30

25

20 10 11 12 13 Age 14 15 16 17

Nicaraguan girls

Mexican US girls (HHANES)

Guatemalan public school girls

High SES Guatemalan girls

Figure 2. Weight-for-age of Latin American adolescent girls.

the high SES Guatemalan girls reveal the high SES Guatemalan girls are statistically signicantly taller than the Nicaraguan girls at all ages except 11 years ( p<0.05). Comparisons with the low SES Guatemalan girls reveal that the Nicaraguan girls are statistically signicantly taller than the low SES Guatemalan girls at ages 1014 years, but not for girls ages 15 and 16. No Guatemalan data are available to make comparisons at age 17. t-test comparisons of weight with the high SES Guatemalan girls reveal that the high SES Guatemalan girls are statistically signicant heavier than the Nicaraguan girls only at ages 10, 14 and 16 years ( p<0.05), and comparisons of weight with the low SES Guatemalan girls reveal that the Nicaraguan girls are statistically signicantly heavier than the low SES Guatemalan girls at all ages except at 16 years ( p<0.05).

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Table 2. Height data (in cm) for Nicaraguan girls, HHANES data and Guatemalan girls by age. Nicaraguan girls HHANES girls n 94 115 103 89 75 85 99 75 SD 6.7 8.2 5.5 5.5 5.4 5.5 7.4 5.7 Low SES Guatemalan girls Mean height (cm) 130.5 137.2 141.7 146.1 146.6 148.4 144.7 n SD High SES Guatemalan girls Mean height (cm) 139.2 145.0 152.2 156.3 159.5 159.4 159.9 160.9 n 360 175 386 355 138 276 121 248 SD 6.8 7.5 6.9 5.8 5.4 9.0 6.0 6.0

Age Mean height Mean height (years) (cm) n SD (cm) 10 11 12 13 14 15 16 17 136.5 141.8 145.6 151.0 151.7 153.1 153.2 152.2 31 23 19 14 22 10 17 7 7.8 8.4 8.7 5.4 5.7 5.1 6.0 2.9 142.0 147.3 152.9 156.0 156.5 160.4 158.0 158.7

175 7.4 133 6.9 135 7.3 45 7.2 19 5.3 5 2.7 3 14.1

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Bold denotes statistical signicance ( p<0.05) for comparisons with Nicaraguan girls.

Table 3.

Weight data (in cm) for Nicaraguan girls, HHANES data and Guatemalan girls by age. Nicaraguan girls HHANES girls n 94 115 103 89 75 85 99 75 SD 6.7 8.2 5.5 5.5 5.4 5.5 7.4 5.7 Low SES Guatemalan girls Mean weight (kg) 29.9 34.6 38.3 41.7 43.0 44.1 45.4 n 175 133 135 45 19 5 3 SD 5.8 7.1 7.6 8.1 5.2 3.5 9.0 High SES Guatemalan girls Mean weight (kg) 34.6 38.5 44.7 48.6 53.8 53.9 55.3 56.0 n 360 175 384 354 138 274 121 248 SD 7.0 8.3 8.5 8.2 8.4 8.0 8.5 8.2

Age Mean weight Mean weight (years) (kg) n SD (kg) 10 11 12 13 14 15 16 17 32.8 38.1 42.8 48.7 47.8 53.5 47.8 50.4 31 23 19 14 22 10 17 7 4.8 8.9 9.5 6.5 9.0 6.7 5.5 7.3 38.3 41.5 48.2 52.4 54.3 57.1 57.4 56.3

Bold denotes statistical signicance ( p<0.05) for comparisons with Nicaraguan girls.

5.3. Comparison to US BMI-for-age data The Nicaraguan girls are compared with the US BMI-for-age data to high and low SES Guatemalan girls data, HHANES mean data, and US reference data in gure 3. Concerning comparisons with the Guatemalan data, t-tests reveal only signicant dierences to be between comparisons with the Nicaraguan girls and the low SES Guatemalan girls at ages 13 and 15 years ( p<0.05). No statistically signicant dierences are seen at any ages between the Nicaraguan girls and the high SES Guatemalan girls. Looking at gure 3, it is apparent that the Nicaraguan BMI-for-age growth curve does not come close to the cut-o point for overweight determined by the CDC, or the 85th percentile (Must et al. 1991). However, this graph does show the Nicaraguan girls growth curve falling closer to the HHANES mean curve than the other curves. Thus for BMI-for-age, the growth indicators for the Nicaraguan girls appear to fare better than the Guatemalan girls. Using the retrospective method, mean age at menarche was reported to be 12.03 1.07. Further, using the status-quo method, the median age of menarche was found to be 12.2. No data were available to report for the mean age of menarche of the Guatemalan girls.

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25

23

BMI

21

19

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15 10 11 12 13 Age 14 15 16 17

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Nicaraguan girls High SES Guatemalan girls

Mexican USgirls (HHANES) 85th BMI-for-age percentilefor US data

Low SES Guatemalan girls

Figure 3. BMI-for-age for Latin American adolescent girls.

Discussion These data suggest that Nicaraguan adolescent girls are shorter and lighter than their MexicanUS counterparts and thus reveal indicators of malnutrition. The growth curves also suggest that these girls do not exhibit any evidence of catch-up growth for height-for-age, however, for weight-for-age, it appears that there may be some catch-up growth. The growth curves also reveal that the Nicaraguan girls are further from the reference curve for height when compared with weight. This might suggest that these girls are more severely stunted than they are underweight. Many authors have suggested a dierent genetic potential of height among many Latin American populations (Eveleth and Tanner 1990), such that they are shorter and heavier than their US counterparts. Eveleth and Tanner (1990) reviewed a great deal of literature concerning heights of children throughout the world and concluded that the heights of children from Latin America were lower than those from Asia and Europe. Martorell et al. (1987) have also suggested that Amerindian and mestizo children from Latin America are shorter and stockier than those of European ancestry. Further Martorell and Scrimshaw (1995) noted that when compared to US populations, Guatemalan adolescents do not appear to show any evidence of catch-up growth, however, catch-up growth is evident when comparisons are made with their MexicanUS counterparts from the HHANES data. Data were also compared with data from Guatemala so that a reference population from a more similar environment can be compared. The comparison with the Guatemalan girls of high SES reveal that the Nicaraguan girls are shorter and lighter than their female high SES Guatemalan counterparts. The high SES Guatemalan girls are girls who are described as Ladinas, also known as mestizos, or being of mixed Amerindian and Spanish descent (Bogin et al. 1990, 1992). Bogin et al.s more recent (2002) study comparing Mayan Guatemalans and Mayans growing up in the USA supports environmental factors such as poor nutrition having a great impact on the growth and development of Latin American children. They found that Mayan children growing up in the USA are signicantly taller (11.54 cm) than Mayan children living in Guatemala, suggesting that environmental inuences, such

6.

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as diet, may have as signicant if not more of an inuence on total height than genetic inuences (Bogin et al. 2002). The comparisons of these Nicaraguan data with reference data also suggest that the Nicaraguan girls suer from poor growth and development due to environmental inuences. When compared with a population that is of a more similar SES, however, the Nicaraguan girls appear to be nutritionally better o. The Guatemalan girls of low SES live in similar economic and environmental conditions as the Nicaraguan girls. Both groups attend free public girls schools and live in poor squatter communities. The Guatemalan girls of low SES were dened to be of low SES status by Bogin et al. (1990, 1992) due to their poor environment and living conditions. Because the Nicaraguan girls and the poor Guatemalan girls live in urban poor barrios and attend public schools, it was hypothesized that the Nicaraguan girls would reveal similar ndings compared with the poor Guatemalan girls, however, the Nicaraguan girls appear to be taller and heavier than the poor SES Guatemalan girls. Only future analyses that better examine dierences between these populations and between other communities in Nicaragua will help explain this discrepancy. Regarding pubertal indicators, it appears that these girls do not reveal evidence of delayed menarche. The mean age of menarche of healthy well-nourished American girls ranges from 11 to 12.8 years (Tanner 1990). These data are surprising since many data from adolescent girls living in developing countries reveal delayed indicators of pubertal development. Malina et al. (1977) have reported mean age of menarche in low SES girls from Mexico to be between 12.6 and 12.8, which is slightly higher to the mean and median ages found in this study. Obesity, often in combination with low micronutrient intake, is a growing nutritional concern in some developing countries, and has grown to be of particular interest in urban areas of Latin America (Pena and Bacallao 2000). Martorell et al. (1998) have reported that throughout Latin America the highest prevalence of overweight and obesity in women ages 1549 was found to be in Peru, Colombia, Guatemala and Bolivia. Further they reported that among MexicanUS children, 24% were classied as being overweight (Martorell et al. 1998). Because of the rise of obesity noted throughout Latin America, BMI-for-age has been described among these adolescent girls. One national study conducted by the Ministry of Health in Nicaragua among women 1549 years revealed that these women are short for their age, yet they are overweight. Obesity and overweight among women in Nicaragua is most likely due to the higher consumption of energyrich foods such as rice and beans which are fried in oil and tortillas and the low consumption of nutrient-dense foods. However, the anthropometric indicators do not reveal strong evidence of obesity among these girls. The BMI-for-age curve for the Nicaraguan girls falls well below the US 85th percentile, which has been established as the cut-o curve to detect overweight girls. Looking at frequency data for these girls, it was determined that 1% were classied as obese and 17% were classied as overweight. In the US, 14% of adolescents ages 1018 years are considered to be obese. Thus, there are few girls classied as being obese in this sample. However, because many of the girls were classied as being overweight, these ndings support data among women from other countries in Latin America as well as the nationwide study done in Nicaragua among women. The evidence of overweight and obesity in this community is likely due to low activity levels of the girls and high-energy snacks. Ethnographic data collected by the author revealed that girls partake in very few daily energy-expending activities. At most, girls reported participating in sports twice

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a week in school. These ndings are a stark contrast to data of adolescent girls ne ce (1992) and Pawloski (1999) in Senegal and Mali, where described by Be high-energy demands contribute signicantly to poor growth and development. BMI-for-age however, might not necessarily be appropriate in suggesting that so many of these girls are doing ne. The BMI values may actually be misleading due to the body proportions of these girls. The comparisons with the MexicanUS data show that the girls are shorter when compared with the reference data than they are lighter in weight, so that these girls are more stunted than they are underweight. The BMI formula is kg m2 and thus might not accurately reect risk of underweight individuals who are shorter and stockier. Further, de Onis and Habicht (1997) have reported that little is known regarding specic BMI values in adolescence and their relationships with concurrent or future risk (de Onis and Habicht 1996, p. 8) and that the BMI-for-age curves do not necessarily provide a desirable pattern that should be used as a healthy goal for adolescents internationally (de Onis and Habicht 1997, p. 8). Overall, these girls exhibit growth indicators suggesting that these girls suer more from undernutrition than overnutrition. Undernutrition among adolescent girls is caused by a variety of factors. The staple diet in Nicaragua consists of rice, beans and tortillas. Very little meat and milk are consumed because they are not aordable. Ethnographic evidence revealed that the consumption of fresh fruits and vegetables is quite low, thus these girls are not only at risk of macronutrient deciencies, but micronutrient deciencies as well. Many girls reported that they preferred sugary fruit juices, fresco (a drink made with oranges, limes, tamarinds, or pineapple and sugar), or Coca Cola rather than purchasing an orange (of equal price) or other fruit. Fruits and vegetables are not consumed often because they are considered expensive and only available at the larger community market, which is not often frequented by girls because of the fear of being robbed and unavailability to transportation. Poverty may be one factor which signicantly contributes to undernutrition among girls in the community. The Universidad Politecnica de Nicaragua has reported that approximately 80% of the people living in this specic barrio are unemployed and many are lacking basic necessities such as potable water, sanitation, trash removal, bus service, and police services. The cost of foods in Nicaragua is extraordinary. FAO (2001) reported that a basket of the basic food products costs the equivalent of $175 dollars, which suggests that the average Nicaraguan can only aord 44% of that basket. 7. Conclusions This study is one of the rst to report the nutritional status of Nicaraguan adolescent girls and the ndings suggest that these girls are at a greater risk of being undernourished than overnourished. These data reveal that Nicaraguan adolescent girls have delayed growth when compared with MexicanUS and high SES Guatemalan reference girls. The girls do not reveal indicators of delayed pubertal development. These data suggest girls suer from mild to moderate malnutrition and show little evidence of obesity although there is evidence of the girls being overweight. Comparisons with data from low SES Guatemalan girls show that the Nicaraguan girls are taller and heavier, which does not support the hypothesis that the Nicaraguan girls would reveal similar indicators of nutritional status when compared with low SES Guatemalan girls. Finally, ethnographic data suggest that the poor growth of these girls is due to environmental

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factors such as poverty and poor diet, however only further analyses can better determine their impacts on girls growth. Acknowledgments We would like to acknowledge the College of Nursing and Health Science at George Mason University, for this study would not be possible without their support. Further funding for this study was made possible by the Provosts Oce at George Mason University. We would like to thank the Escuela de Enfermeria at Universidad Politecnica de Nicaragua, and particularly Carmen Benvenides and Lidya Zamora for their continuous support and assistance. We are also grateful to Johana Cruz for her assistance with recruiting and locating participants. We want to thank Dr Barry Bogin for generous assistance in obtaining the Guatemalan dataset. The Guatemalan dataset is part of the Longitudinal Study of Child and Adolescent Development, Universidad del Valle de Guatemala, which was created and directed by Dr Robert MacVean. Finally we would like to thank Dr Carlos Sluzki, Dr Heibatollah Baghi, Kalpana Ramiah, Karen Whitt and Diana Louder for their assistance with the manuscript. References
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Martorell , R., and Scrimshaw , N. S., 1995, The eects of improved nutrition in early childhood: The Institute of Nutrition of Central America and Panama (INCAP) Follow-up Study. Journal of Nutrition, Suppl. 125, 1060S1067S. Martorell , R., Mendoza, F. S., Castillo, R. O., Pawson , I. G., and Budge , C. C., 1987, Short and plump physique of MexicanAmerican children. American Journal of Physical Anthropology, 73, 475487. Martorell , R., Khan, L. K., Hughes, M. L., and Grummer-Strawn , L. M., 1998, Obesity in Latin American women and children. Journal of Nutrition, 128, 14641473. Mitchell , M. K., 2003, Nutrition Across the Lifespan, 2nd edn (Philadelphia, PA: Elsevier Science). MINSA (Ministerio de Salud), 1999, Encuesta Nicaraguense de Demograa y Salud (ENDENSA) 1998, Demographic and Health Surveys. Instituto Nacional de Estadisticas y Censos (INEC), Managua, Nicaragua. Must , A., Dallal , G. E., and Dietz, W. H., 1991, Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. American Journal of Clinical Nutrition, 53, 839846. Pawloski, L. R., 1999, The growth, development, and nutritional status of adolescent girls from the Segou Region of Mali (West Africa): a biocultural approach to the analysis of health. PhD Dissertation, Department of Anthropology, Indiana University, Bloomington, IN (University Microlms, Ann Arbor, MI). Pawloski, L. R., 2002, The growth and development of adolescent girls from the Segou Region of Mali (West Africa). American Journal of Physical Anthropology, 117, 364372. Pawloski, L. R., 2003, Longitudinal growth data of Malian adolescent girls. American Journal of Human Biology, 15, 178186. Pelletier, D., 1994, The potential eects of malnutrition on child mortality: epidemiological evidence and policy implications. Nutrition Reviews, 52, 409415. Pena M., and Bacallao, J., eds, 2000, Obesity and Poverty: A New Public Health Challenge (Washington DC: Pan American Health Organization, WHO). Tanner , J. M., 1990, Foetus into Man, Physical Growth from Conception to Maturity (Cambridge, MA: Harvard University Press). UNICEF (United Nations Childrens Fund ), 1997, The State of the Worlds Children, Nicaragua 1997 (New York: UNICEF). World Bank , 2003, 2003 World Development Indicators (Washington, DC: World Bank). WHO, 2003, Adolescent nutrition: a neglected dimension. World Health Organization Health Topics. http://www.who.int/nut/ado.ht. Address for correspondence: Lisa R. Pawloski, College of Nursing and Health Science, George Mason University, 4400 University Dr., MSN 3C4, Fairfax, VA 22030, USA. email: lpawlosk@gmu.edu. Zusammenfassung. Hintergrund: Wenige Untersuchungen haben sich mit Wachstumsdaten jugendlicher Ma dchen in Lateinamerika bescha ftigt, und es sind bisher fast keine in Nicaragua durchgefu hrt worden. Aus diesem Grunde untersucht diese Studie Wachstumsdaten von nicaraguanischen Ma dchen. Ziel: Diese Studie beschreibt Querschnittswachstumsdaten einer Stichprobe nicaraguanischer Ma dchen. Diese Daten werden mit Daten US-mexikanischer und guatemaltekischer Ma dchen verglichen. Es besteht die Hypothese, dass (a) US-mexikanische und guatemaltekischer Ladina-Ma dchen aus wohlhabenden Schichten Hinweise auf einen besseren Erna hrungszustand aufweisen als nicaraguanische Ma dchen, und dass (b) die nicaraguanischen Ma dchen a hnliche anthropometrische Charakteristika zeigen im Vergleich mit armen guatemaltekischen Ma dchen. Ergebnisse: Die Ergebnisse zeigten, dass diese Ma dchen signikant kleiner und leichter sind als Ma dchen aus den USA, US-mexikanische Ma dchen und guatemaltekische Ma dchen aus wohlhabenden Schichten. Diese Ma dchen sind auch signikant gro er und schwerer als ihre armen guatemaltekischen Gegenspieler. Zusammenfassung: Die Studie zeigt, dass die nicaraguanischen Ma dchen untererna hrt im Vergleich mit anderen lateinamerikanischen Ma dchen aus besserer Schicht. Die Daten zeigen auch, dass nicaraguanische Ma dchen Hinweise auf einen besseren Erna hrungszustand aufweisen im Vergleich mit einer Stichprobe armer guatemaltekischer Ma dchen. sume . Arrie`re-plan: Peu de tudes ont examine les donne es de croissance des adolescentes dAme rique Re te eectue e au Nicaragua. Par conse quent, cette e tude examine les latine et virtuellement aucune na e es de croissance des adolescentes nicaraguayennes. donne crire la croissance transversale dun e chantillon de lles du Nicaragua. Ces donne es sont comparBut: De es a ` celles de mexicaines vivant aux USA et a ` celles de guate malte ` ques. On forme lhypothe ` se que (a) les e ricaines et guate malte ` ques aise es auront de meilleurs indicateurs nutritionnels adolescentes mexico-ame que les nicaraguayennes et (b), que les lles nicaraguayennes auront de meilleurs indicateurs anthropome triques que des adolescentes pauvres du Guatemala. es anthropome triques et la ` res re ` gles ont e te obtenus pour un Sujets et methodes: Des donne ge aux premie chantillon de 154 adolescentes de 10 a ` 17 ans de la ville de Managua. e

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ge ` res que les lles Resultats: Les adolescentes nicaraguayennes sont signicativement plus petites et plus le ricaines, mexico-ame ricaines et guate malte ` ques aise es. Elles sont par contre plus grandes et plus ame malte ` ques. lourdes que les adolescentes guate tude montre que les adolescentes nicaraguayennes sont sous-nutries lorsque compare es Conclusion: Cette e ` des homologues latino-ame ricaines be ne ciant dun environnement globalement plus favorable. Les a es montrent e galement que les lles nicaraguayennes ont un meilleur statut nutritionnel que celui donne malte ` ques pauvres. dune cohorte dadolescentes guate Resumen. Antecedentes: Pocos estudios han examinado los datos de crecimiento de nin as adolescentes en rica y casi ninguno ha sido realizado en Nicaragua. As , este estudio examina datos de creciLatinoame miento de las adolescentes nicaragu enses. Objetivo: Este estudio describe datos transversales de crecimiento de una muestra de nin as nicaragu enses. xico-estadounidenses y guatemaltecas. Se planEstos datos se comparan con otros obtenidos en nin as me tesis de que (a): las nin xico-estadounidenses y las ladinas guatemaltecas sanas mostrara n tea la hipo as me mejores indicadores del estado nutricional respecto a las nin as nicaragu as nicaragu enses, y (b): las nin enses n indicadores antropome tricos similares al compararlas con las nin mostrara as guatemaltecas pobres. tricos y la edad de menarquia en una muestra de 154 Sujetos y metodos: Se recogieron datos antropome adolescentes de 1017 an os de edad, residentes en Managua, Nicaragua. s bajas y tienen menos que Resultados: Los resultados muestran que estas nin as son signicativamente ma xico-estadounidenses y las adolescentes guatemaltecas sanas. Estas nin las estadounidenses, las me as son s signicativamente ma s altas y con ma s peso que sus contempora neas guatemaltecas pobres. adema n: Este estudio muestra que las nin n desnutridas cuando las comparamos Conclusio as nicaragu enses esta con otras nin as latinoamericanas residentes en un ambiente global mejorado. Los datos revelan igualmente que las nin as nicaragu enses tienen mejores indicadores del estado nutricional cuando las comparamos con una cohorte de nin as nicaragu enses pobres.

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