Unbalanced Macronutrient Intakes, Multiple Micronutrient Inadequacies, and Diarrhea Underscore Low-Height-for-Age in Indigenous Panamanian Preschool Children

Background: In remote indigenous Panamanian subsistence farming communities, poor diet, diarrhea, and Ascaris may have seasonally distinct contributions to high rates of stunting in preschool children. Objectives: This study explored the relative contributions of food, nutrient intakes, and infections (diarrhea and intestinal nematodes) to height-for-age z-scores (HAZ) during a dry and rainy season in Panama’s Comarca Ngäbe-Buglé. Methods: This prospective community-based study collected sociodemographic and health data from 328, 12‒59-mo-old children in both the dry and rainy seasons. Diets were assessed in nonbreastfeeding children using a food frequency questionnaire and a 24-h recall during both seasons. Bivariate comparisons between stunted and nonstunted children and between the dry and rainy seasons were conducted. Stepwise linear regression models identified associations of sociodemographic status, infections, food groups, and estimated nutrient intakes with HAZ. Results: The diet characterized as low fat, high sugar was deficient in micronutrients. Food and nutrient intakes were lower in the rainy than the dry season (P < 0.05), and stunted children had fewer servings of dairy than nonstunted children (P < 0.05). The incidence of diarrhea was higher in the rainy season (P < 0.05). Determinants of HAZ differed between dry and rainy seasons. In dry season models (P < 0.0001), HAZ was positively associated with income and fat intake and negatively associated with total sugar intake. In contrast, rainy season models (P < 0.0001) revealed that servings of grains/cereals and fat were positively associated with HAZ, and fruit and total sugar intake and diarrhea were negatively associated with HAZ. Conclusions: The multifactorial nature of linear growth faltering in these preschool children differed by season. The negative impact of diarrhea emerged only in the rainy season, but the negative impact of sugar intake and the positive impact of fat intake emerged in both seasons.