Protein nutrition of expectant mothers in American Samoa and its effect on the health of the infant
by Kathleen Graney Baron
A thesis submitted to the Graduate Faculty in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE in Home Economics
Montana State University
© Copyright by Kathleen Graney Baron (1971)
Abstract:
The purpose of the study was to investigate the status of protein nutrition of expectant mothers in
American Samoa and the possible effect of this status on the health of the infant. The mother's diet
before and during pregnancy is most important to her adjustment during pregnancy and the infant's
growth and development. The sample included sixty mothers that delivered and the new born babies at
the LBJ Tropical Medical Center, Pago Pago, American Samoa. Multiple regression and correlation
were the statistical methods employed in the research. It appears two of the criteria, weight of the baby
at birth and chest circumference, might be predicted from the measured predictor variables but that
more research is needed to make its use practical. It is possible for both mother and infant to obtain an
adequate diet. In p r e s e n t i n g t h i s t h e s i s in p a r t i a l fu lf illm e n t o f th e r e q u i r e ­
m e n ts for a n a d v a n c e d d e g r e e a t M o n ta n a S ta te U n i v e r s i t y , I a g re e
t h a t th e L ib rary s h a l l m ak e i t fr e e ly a v a i l a b l e for i n s p e c t i o n . I f u r th e r
a g r e e t h a t p e r m is s i o n for e x t e n s i v e c o p y in g o f t h i s t h e s i s for s c h o l a r l y
p u r p o s e s m ay b e g r a n te d by my m a jo r p r o f e s s o r , o r , in h is a b s e n c e ,
b y th e D ir e c to r o f L i b r a r i e s . It i s u n d e r s to o d th a t a n y c o p y in g or p u b ­
l i c a t i o n o f t h i s t h e s i s for f i n a n c i a l g a in s h a l l n o t be a llo w e d w ith o u t
my w r i t t e n p e r m i s s i o n .
PROTEIN NUTRITION OF EXPECTANT MOTHERS IN AMERICAN SAMOA
■AND ITS EFFECT ON THE HEALTH OF THE INFANT
by
KATHLEEN GRANEY BARON
A t h e s i s s u b m itte d to th e G ra d u a te F a c u lty in p a r t i a l
fu lf illm e n t o f th e r e q u ir e m e n ts for th e d e g re e
of
MASTER OF SCIENCE
in
Home E c o n o m ic s
A pproved:
Oh.
H e a d ,^ M a jo r D e p a rtm e n t '
a
C h a irm a n , E x a m in in g ^ommfttfeJe
Grad a re D e a n
r
MONTANA STATE UNIVERSITY
B o z e m a n , M o n ta n a
M a r c h , 1971
iii
ACKNOWLEDGMENT
I t i s w ith s i n c e r e a p p r e c i a t i o n a n d a c k n o w le d g m e n t of th e p a rt
e a c h c o n tr ib u te d to th e c o m p le tio n o f my g r a d u a te s t u d i e s t h a t I e x ­
p r e s s h e a r t f e l t th a n k s to th e fo llo w in g :
D r. M a r jo rie K e is e r w ho m ad e th e t r a i n e e s h i p a v a i l a b l e to m e .
D r. A ndrea P a g e n k o p f w ho g r a c i o u s l y o ff e re d h e r h e l p , e n c o u r ­
a g e m e n t a n d tim e u n lim it e d .
D r. E ric . S tro h m e y e r w ho a s s i s t e d me w ith th e s t a t i s t i c s .
D r. Boyd W . C o o k w ho m ad e i t p o s s i b l e for me to do th e r e s e a r c h
in A m e ric an S a m o a .
M y p a r e n t s w ho h a d f a ith in me a n d p ro v id e d m u c h n e e d e d m oral
s u p p o r t.
B ill, my h u s b a n d , w h o s e u n d e r s ta n d in g a n d p a t i e n c e h a v e g iv e n
u s b o th c o u r a g e a n d p ro v id e d me w ith th e c o n f id e n c e n e e d e d to c o n ­
tin u e my e d u c a t i o n .
>
iv
TABLE OF CONTENTS
CHAPTER
I.
PAGE
IN T R O D U C T IO N ..........................................................................................
I
Im p o rta n c e o f P ro te in N u t r i t i o n .............................................
I
P r o te in S o u r c e s
...............................................................................
I
............................................................................
3
H y p o t h e s e s .........................................................................................
3
P u r p o s e o f S tu d y
II.
..........................................................................
4
F u n c tio n s o f P ro te in in H um an N u t r i t i o n ..............................
4
N u tr it io n o f E x p e c ta n t M o th e r s a n d I n f a n t s .........................
5
REVIEW OF LITERATURE
S ta tu s o f M o t h e r .............................................. ...
6
S ta tu s o f In f a n t
.................................................................. ■„
8
K w ash io rk o r a n d M a r a s m u s ................................. ...
10
M e n t a l D e v e l o p m e n t .............................................. ...
11
M e th o d s o f D e te rm in in g P ro tein
D e f i c i e n c y o f I n f a n t s ........................................
11
A n t h r o p o m e t r i c a l .................................... ...
11
C l i n i c a l ................................. ... ........................- .
13
P r o te in N u tr itio n o f Sam o an M o th e r s a n d I n f a n ts
. . . .
13
T y p ic a l D ie t a n d E a tin g P a t t e r n ....................................
13
F a c to r s I n f lu e n c in g P r o te in In ta k e
..............................
14
C u ltu r a l I n f l u e n c e s .....................................................
14
V alue S y s te m ...................................................................
15
W e s t e r n i z a t i o n ...............................................................
16
N u tr it io n a l S ta tu s o f I n f a n ts in S a m o a .......................
18-
V
CHAPTER
III.
IV.
PAGE
PROCEDURE...................................................................................................
20
S a m p l e ....................................
20
S u rv e y I n s t r u m e n t ............................................................................
20
P ro c e d u re o n C o lle c ti o n o f D a t a ..............................................
21
M o t h e r .................................................................................. ... .
21
I n f a n t ............. ... ................................................................
21
T re a tm e n t o f D a t a ...........................................................................
22
RESULTS AND DISCUSSION .............................. ...................................
24
C h a r a c t e r i s t i c s o f S a m p l e .................■........................................
24
I n f a n t s ........................................................ ............................. .
24
M o t h e r s ............. ............................................. ..........................26
N u t r i t i o n a l S t a t u s .............................................................. .
26
R e g r e s s io n A n a l y s e s ............. .......................................................
29
R e la tio n s h ip o f M o th e r to B a b y ......................................... ... .
30
Birth W e ig h t
........................................... '................................
33
Birth L e n g t h ..............................................................................
34
H e a d C irc u m fe re n c e a t B i r t h ...........................................
34
C h e s t C irc u m fe re n c e a t B i r t h ........................................... '35
A v e rag e W e ig h t G a in Per D a y D uring
E arly I n f a n c y .................................................................
35
B a b y 's H e m o g l o b i n ........................................„•...................
35
C o r r e la tio n A n a ly s e s o f C h a r a c t e r i s t i c s o f
M o th e r to B a b y ........................................................................
36
vi
CHAPTER
PAGE
V. ' SUMMARY, C O N C L U SIO N S, RECOMMENDATIONS
................
39
S u m m a r y ....................... ... . ...............................................................
39
C o n c l u s i o n .................... ................................................................. .
41
R e c o m m e n d a tio n s
.................................................. ................... ... .
42
This S t u d y ...................................................................................
42
F u tu re S t u d i e s ..............................................
43
LITERATURE C I T E D ....................
APPENDIX
44
.
50
v ii
LIST OF TABLES
TABLE
PAGE
1.
C h a r a c t e r i s t i c s o f I n f a n t s ...........................................................................25
2.
F o o d s E a te n b y th e M o t h e r ..................................................................
27
3.
C r ite r io n V a r ia b le s w ith V alue o f
a n d F .....................................
31
4.
C o r r e la tio n o f V a ria b le s w ith V alue
o f R ........................................
37
ABSTRACT
The p u r p o s e o f th e s tu d y w a s to i n v e s t i g a t e th e s t a t u s o f p r o te in
n u tr i tio n of e x p e c t a n t m o th e rs in A m erican Sam oa a n d th e p o s s i b l e
e f f e c t o f t h i s s t a t u s on th e h e a l t h o f th e in f a n t . The m o th e r 's d i e t b e ­
fore a n d d u rin g p r e g n a n c y i s m o s t im p o r ta n t to h e r a d j u s t m e n t d u rin g
p r e g n a n c y a n d th e i n f a n t 's gro w th a n d d e v e lo p m e n t. The s a m p le i n ­
c lu d e d s i x t y m o th e rs t h a t d e liv e r e d a n d th e n e w b orn b a b i e s a t th e LBJ
T ro p ic a l M e d i c a l C e n t e r , Pago P a g o , A m erican S a m o a . M u ltip le r e ­
g r e s s i o n a n d c o r r e l a t i o n w e re th e s t a t i s t i c a l m e th o d s e m p lo y e d in th e
r e s e a r c h . It a p p e a r s tw o o f th e c r i t e r i a , w e ig h t o f th e b a b y a t b irth
a n d c h e s t c ir c u m f e r e n c e , m ig h t be p r e d i c t e d from th e m e a s u r e d p r e ­
d i c t o r v a r i a b l e s b u t t h a t more r e s e a r c h i s n e e d e d to m ake i t s u s e
p r a c t i c a l . It i s p o s s i b l e for b o th m o th e r a n d in f a n t to o b ta in an a d e ­
q u a te d i e t .
CHAPTER
I
IN T R O D U C T IO N
Im p o rta n c e o f P ro te in N u tritio n
The p ro b lem o f t o t a l food i n t a k e i s o f g r e a t im p o r ta n c e in its
r e l a t i o n s h i p to g o o d h e a l t h b u t t h a t o f food q u a lity is e v e n more im ­
p o r t a n t . All o f th e s p e c i f i c c o m p o n e n ts o f th e v a r io u s t i s s u e s o f th e
b o d y m u s t be p r o v id e d .
P ro te in i s o f m a jo r im p o r ta n c e s i n c e i t c o m ­
p o s e s th e g r e a t e s t p ro p o rtio n o f th e b o d y t i s s u e , e x c e p t for w a t e r , a n d
i s a n i n d i s p e n s a b l e c o n s t i t u e n t of e v e r y liv in g c e l l ( I ) . For th e p u r ­
p o s e o f t h i s s t u d y , i t s h a l l be th e o n ly o n e d i s c u s s e d .
It i s e s t i m a t e d t h a t a p p r o x im a te ly t w o - t h i r d s o f th e w o r ld 's p o p u ­
l a t i o n i s s u f f e r in g from so m e d e g r e e o f m a ln u tritio n (2 ). At th e h e a r t o f
th e m a ln u tr it io n p ro b le m i s th e s e r i o u s l a c k of p r o t e i n . P ro te in d e f i ­
c i e n c y in y o u n g c h ild r e n i s th e m a jo r n u tr i tio n a l p ro b le m o f th e w o r l d .
In so m e p o p u la tio n g r o u p s , th e p r o te in d e f i c i e n c y i s fu r th e r a c c e n t u ­
a t e d b y a l a c k o f c a l o r i e s a n d , t h u s , p a r t o f th e p r o te in i s u s e d for
energy.
P ro te in S o u r c e s
The m a in s o u r c e o f p r o te in in th e U n ite d S t a t e s i s food from a n i ­
m al o rig in (3 ). F oods from a n im a l p r o t e i n s are c o m p le te p r o t e i n s , t h a t
i s , th e y c o n ta i n a l l th e e s s e n t i a l am in o a c i d s .
Many, c o u n tr ie s h a v e
/
.
/■
/
2
e x tre m e li m i t a t i o n s o n th e q u a n t i t y a n d q u a l i t y of h ig h p ro te in f o o d s .
D e v e lo p in g c o u n t r i e s u s e p l a n t s a s t h e i r c h i e f s o u r c e o f p r o te in (4 ).
P la n t p r o t e i n , u n l e s s u s e d in c o m b in a tio n w ith o th e r p l a n t s , is n o t a
c o m p le te p r o te in b e c a u s e no o n e p l a n t c o n ta i n s a l l th e e s s e n t i a l a m in o
a c i d s in p ro p e r p r o p o r tio n .
P r o d u c tio n o f fo o d s h ig h in a n im a l p r o te in i s g r e a t l y lim ite d in
d e v e lo p i n g c o u n t r i e s ; t r a n s p o r t a t i o n , s t o r a g e f a c i l i t i e s a re i n a d e q u a t e ,
p u r c h a s i n g p o w e r i s lo w a n d p r e j u d i c e a g a i n s t c e r t a i n fo o d s a l l a d d to
th e p ro b le m (5 ).
M a n y s u g g e s t i o n s h a v e b e e n m a d e a s to a s o l u t i o n to th e p ro te in
m a ln u tr it io n p r o b l e m . The P ro te in A d v is o ry Group from th e FAO, W H O ,
a n d UNICEF s u g g e s t t h a t th e h i g h e s t p r io r ity be g iv e n to d e v e lo p m e n t
o f l o c a l a g r i c u l t u r a l r e s o u r c e s (6 ). All p r o te in s o u r c e s m u s t be u t i ­
l i z e d . W h ile t h e s e m e a s u r e s r e p r e s e n t a n im p o rta n t c o n tr ib u tio n to w a rd
p r e v e n tio n o f p r o te in m a ln u t r i t i o n , d e v e lo p m e n ts in o th e r fie ld s ' a re p o ­
t e n t i a l l y u s e f u l in im p ro v in g p r o te in n u t r i t i o n . O ne o f th e m ajo r n e w
d e v e lo p m e n ts i s th e u p g ra d in g o f th e n u tr i tiv e v a l u e o f c e r e a l p r o te in s
b y g e n e t i c a l l y c h a n g in g th e a m in o a c i d p a t t e r n . F o r tif ic a tio n o f c e r e a l s
w ith s y n t h e t i c am in o a c i d s i s a n o t h e r p o s s i b i l i t y .
O n e a n s w e r to th e p ro b le m w o u ld b e a p r o t e i n - r i c h food m ix tu re
for s u p p le m e n ta r y f e e d in g w h ic h w o u ld b e a c c e p t e d by th e p e o p le o f
d e v e lo p i n g n a t i o n s . G r a in , l e g u m e s , g r o u n d n u t s , c o t t o n s e e d , s o y ­
b e a n s a n d f i s h p r o te in c o n c e n t r a t e s a re u s e d a s a s u p p le m e n ta r y
3
feed in g .
C u rre n tly s e s a m e , s u n f lo w e r , a n d c o c o n u t a re b e in g s tu d ie d
a s p o s s i b l e s o u r c e s o f p ro te in for h um an u s e (7).
P u rp o se o f Study
T h is s tu d y w a s u n d e r ta k e n to i n v e s t i g a t e th e s t a t u s o f p ro te in
n u tr i tio n o f e x p e c t a n t m o th e rs in A m erican Samoa a n d th e p o s s i b l e
e f f e c t o f t h i s s t a t u s on th e "health o f th e in f a n t . S in c e th e l a s t s tu d y
w a s c o m p le te d in 1954 a n d m any c h a n g e s h av e t a k e n p l a c e s i n c e t h e n ,
th e p h y s i c i a n s f e l t s o m e c u rre n t r e s e a r c h s h o u ld be d o n e .
H y p o th e s e s
1.
Is th e b a b y 's b irth w e ig h t p r e d i c t a b l e from s e l e c t e d p h y s i c a l m e a ­
s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r?
2.
Is th e b a b y 's b irth le n g th p r e d i c t a b l e from s e l e c t e d p h y s i c a l m e a ­
s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r?
3.
Is th e b a b y 's h e a d c irc u m f e r e n c e p r e d i c t a b l e from s e l e c t e d p h y s i ­
c a l m e a s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r?
4.
Is th e b a b y 's c h e s t c irc u m f e r e n c e p r e d i c t a b l e from s e l e c t e d
p h y s i c a l m e a s u r e m e n ts a n d d i e t a r y h a b its of th e m o th e r?
5.
Is th e a v e r a g e w e ig h t g a in p e r d a y o f th e b a b y p r e d i c t a b l e from
s e l e c t e d p h y s i c a l m e a s u r e m e n ts a n d d i e ta r y h a b i t s o f th e m o th e r?
6.
Is th e b a b y 's h e m o g lo b in p r e d i c t a b l e from s e l e c t e d p h y s i c a l m e a ­
s u r e m e n ts a n d d i e t a r y h a b its o f th e m o th e r?
7.
Is th e e x p e c t a n t m o th e r 's d i e t a d e q u a t e in p r o t e i n ?
CHAPTER
R E V IE W
OF
II
L IT E R A T U R E
F u n c tio n s o f P ro te in i n Human N u tritio n
P r o te in i s e s s e n t i a l in th e g ro w th a n d r e p l a c e m e n t o f t i s s u e .
W h en g ro w th o c c u r s , th e p ro te in r e q u ir e m e n t i s n e c e s s a r i l y l a r g e ,
t h u s , in th e c a s e o f th e f e t u s , i n f a n t , c h i l d , a n d n u r s in g m o th e r , th e
i n c r e a s e o f t i s s u e a n d th e s e c r e t i o n o f m ilk m a k e s g r e a t d e m a n d s (8 ).
All liv in g c e l l s u n d e rg o c o n s t a n t c h a n g e s th ro u g h o u t t h e i r lif e s p a n a n d
a re c o n s t a n t l y in n e e d o f r e n e w a l ,
M e ta b o lis m o f p r o te in i n c l u d e s th e e x i s t e n c e o f p r o te in p o o ls in
th e l i v e r a n d o t h e r b o d y t i s s u e .
T his p e rm its ra p id a n d c o n tin u o u s
in t e r c h a n g e o f n itr o g e n o u s c o m p o u n d s b e tw e e n c e l l s a n d th e s u r r o u n d ­
in g f lu i d . T h e s e p o o ls in s u r e a b a l a n c e b e tw e e n th e n itr o g e n o u s p r o ­
d u c t s o f s y n t h e s i s a n d b re a k d o w n (9).
W h e n more p r o te in i s e a t e n t h a n i s n e e d e d fo r r e p a i r p r o c e s s e s ,
th e e x c e s s m ay f u n c tio n a s a s o u r c e o f e n e r g y or be s t o r e d in th e body.
T his s t o r e d p r o te in i s u s e d d u rin g tim e s o f f a s t i n g a n d w h e n th e in ta k e
o f f a t a n d c a r b o h y d r a te is lo w . W h e n p r o te in i s u s e d to m e e t energyr e q u ir e m e n ts , th e q u a n t i t y a v a i l a b l e for g ro w th a n d r e p a i r i s r e ­
d u c e d (10).
P ro te in i s im p o r ta n t a s a r e g u l a t o r o f o s m o tic p r e s s u r e and of
w a t e r b a l a n c e w ith in th e b o d y . It a i d s in m a in ta in in g o n e of th e b o d y 's
5
im portant- c o n s t a n t s , th e h y d ro g e n io n c o n c e n t r a t i o n , v e r y c l o s e to t h a t
o f w a t e r . P r o te in s a re a m p h o te ric s u b s t a n c e s w h ic h c o m b in e w ith a c i d
o r b a s e a n d s e r v e a s b u ff e rs w h e n a n e x c e s s o f e i t h e r a n a c i d or b a s e
co m p o u n d i s p r e s e n t (1 1 ).
M a n y b o d y h o rm o n e s are p r o te in in n a t u r e . The t r o p i c horm one
from th e p i t u i t a r y g l a n d , t h y r o x i n , a d r e n a l i n e , i n s u l i n , a n d th e d i g e s t ­
iv e e n z y m e s , to n a m e a f e w , a re a ll n itr o g e n o u s in n a tu r e (12).
O th e r d i e t a r y f a c t o r s a re i n v o lv e d in p r o te in m e t a b o l i s m . M in e r ­
a l s a n d v ita m in s a re a n im p o r ta n t p a r t o f p r o te in s y n t h e s i s .
S in c e th e
a v e r a g e d a y 's d i e t m ay n o t a lw a y s be f a v o r a b le for o p tim a l u t i l i z a t i o n ,
th e a d v a n t a g e o f a fif ty p e r c e n t s a f e t y f a c to r o v e r th e m in im a l n e e d is
e v i d e n t (10).
N u tr it io n o f E x p e c ta n t M o th e r s a n d In f a n ts
P r e g n a n c y a n d c h i ld b ir th lin k th e p r e s e n t g e n e r a t i o n to future
o n e s . F a c to r s t h a t a f f e c t r e p r o d u c tio n a f f e c t th e fa m ily a s w e ll a s th e
m o th e r. E v e ry m o th e r h a s th e rig h t to b o th a h ig h q u a l i t y and a h ig h
s t a n d a r d o f h e a l t h c a r e . This i n c l u d e s a food in ta k e t h a t w ill p re p a re
h e r for a n d c a r ry h e r th ro u g h p r e g n a n c y , c h i l d b i r t h , a n d p e rm it th e i n ­
f a n t to f lo u r is h (13).
R e la tio n s h ip o f th e n e w b o rn in f a n t to th e m o th e r i s v e ry im p o rt­
a n t.
The in f a n t h a s d e p e n d e d c o m p le te ly upon th e m o th e r du rin g th e
p r e n a t a l p e r i o d , n in e m o n th s .
M a n y t h e o r i e s o ffe r a n e x p l a n a tio n for
6
th e w e l l - b e i n g o f a n in f a n t from a p o o rly n o u r is h e d m o th e r . O ne th e o ry
i s th a t th e m o th e r i s e n d o w e d w ith a s p e c i a l a b i l i t y to p ro d u c e a
h e a lth y offspring r e g a r d l e s s o f h e r h e a l t h o r n u tr i tio n a l s t a t u s . A nother
i s a p r e g n a n t w o m an w i l l , from i n s t i n c t , a c t to m e e t th e h e a l t h o f h e r ­
s e lf and her in fa n t.
M a n y s t u d i e s h a v e sh o w n t h e s e t h e o r i e s to be
f a l s e (14).
S ta tu s o f M o th e r
The n u tr i t i o n a l s t a t u s p rio r to b e c o m in g p r e g n a n t i s m o s t im p o r t­
a n t . The b o d y s h o u ld be fu n c tio n in g p r o p e rly in o rd e r for i t to m ak e th e
n e c e s s a r y a d j u s t m e n t s to th e a d d e d b u rd e n o f th e d e v e lo p i n g f e t u s .
E x p e rim e n ts i n d i c a t e t h a t m a te r n a l n u tr itio n i s im p o r ta n t to b o th
m o th e r a n d c h i l d . K now ledge a b o u t n u tr i tio n a n d i t s in v o lv e m e n t in th e
c a u s e a n d p r e v e n tio n o f d i s e a s e is e x p a n d in g r a p i d l y . The n u m ber o f
s t i l l b i r t h s a n d in f a n t d e a t h s h a v e i n c r e a s e d in th e U n ite d S t a t e s , w h ic h
m ay or m ay n o t b e r e l a t e d to n u tr i tio n (14).
W e l l - n o u r i s h e d m o th e rs e n jo y b e t t e r h e a l t h , fe w e r c o m p lic a ti o n s ,
a n d a r e b e t t e r r i s k s d u rin g p r e g n a n c y . I n c id e n c e o f m i s c a r r i a g e s ,
s t i l l b i r t h s , a b o r t i o n s , a n d p re m a tu re b ir t h s i n c r e a s e s in wom en c o n ­
s u m in g a n i n a d e q u a t e d i e t (15). The n u tr itio n o f th e m o th e r d u rin g th e
p r e n a t a l p e rio d i n f l u e n c e s to a c o n s i d e r a b l e d e g re e th e e n tir e c o u r s e o f
p r e g n a n c y a n d d i r e c t l y a f f e c t s th e h e a l t h o f th e c h ild d u rin g th e f i r s t
7
s i x m o n th s o f lif e (16). M ore in f a n t i l l n e s s e s a n d i n c r e a s e d d e a th s
o c c u r up to t h a t t i m e .
M a n y c h a n g e s t a k e p l a c e in th e w o m a n 's b o d y d u rin g r e p r o d u c ­
t i o n . G ro w th a n d d e v e lo p m e n t o f th e t i s s u e s w h ic h a re c o n c e rn e d w ith
m a te r n a l a n d in f a n t w e l l - b e i n g t a k e p l a c e . A c r i t i c a l p e rio d is th e f i r s t
tw o w e e k s a f t e r c o n c e p tio n u n til th e e ig h th w e e k d u rin g w h ic h tim e
m a jo r o r g a n o g e n e s i s o c c u r s (17).
W e ig h t g a in r e f l e c t s th e o v e r a l l p h y s i o l o g i c c o n s e q u e n c e s o f
p r e g n a n c y . W e ig h t g a in v a r i e s g r e a t l y w ith th e i n d i v i d u a l . Young
w o m e n , g iv e n th e s a m e d i e t , te n d to g a in more t h a n o ld e r w om en (18).
In th e U n ite d S t a t e s th e t o t a l a v e r a g e w e ig h t g a in i s 24 p o u n d s . In th e
d e v e lo p i n g n a t i o n s s u c h a s In d ia a n d A frica th e a v e r a g e w e ig h t g a in i s
12 to 14 p o u n d s (19).
The n u t r i e n t r e q u ir e m e n ts fo r p r e g n a n c y a re i n c r e a s e d a b o v e t h a t
for th e n o n p r e g n a n t w o m a n . The c a o l o r i c i n c r e a s e i s a b o u t 200 c a l o r i e s
p e r d a y . I t is im p o r ta n t t h a t a p o rtio n o f t h e s e c a l o r i e s be ta k e n in th e
form o f p r o t e i n . P ro te in i s n e c e s s a r y fo r th e gro w th a n d d e v e lo p m e n t o f
t h e f e tu s a n d th e c h a n g e s t h a t t a k e p l a c e in th e m o th e r 's b o d y . The
p r o te in r e q u ir e m e n t i n c r e a s e s from 55 g ram s to 65 g ra m s p e r d a y (2 0 ).
S u p e r s t i t i o n , g o s s i p , f a d s , a n d ta b o o s s u rro u n d p r e g n a n c y .
T h e s e s o m e tim e s e n c o u r a g e th e c o n s u m p tio n of a p o o r d i e t . A m o th er
o n a p o o r d i e t h a s a lo w t o t a l w e ig h t g a i n . O th e r c o m p lic a ti o n s s u c h
a s t o x e m i a , p o o r a p p e t i t e , d i s t u r b a n c e s in d i g e s t i o n , n a u s e a , and
8
v o m itin g d u rin g th e n in e - m o n th p e rio d o c c u r a s w e l l . At c h i l d b i r t h ,
c o m p lic a ti o n s te n d to be more f r e q u e n t a n d th e i n c i d e n c e o f m i s ­
c a r r i a g e , a b o rtio n a n d s t i l l b i r t h i s h ig h e r in th e m a ln o u r is h e d m o th e r
( 2 1 ,2 2 ,2 3 ) .
D u rin g l a c t a t i o n th e m o th e r r e q u i r e s a d d itio n a l a m o u n ts o f n u t r i ­
e n t s to r e p l a c e t h o s e l o s t in m i l k a n d in th e e n e r g y u s e d for i t s p ro ­
d u c t i o n . The p r o te in re q u ir e m e n t is i n c r e a s e d by 20 g ra m s p e r d a y
a b o v e th e re c o m m e n d e d am o u n t for th e a v e r a g e w o m a n , from 55 g ram s
to 75 g ram s p e r d a y . In s e v e r e l y m a ln o u r is h e d m o t h e r s , l a c t a t i o n m ay
c o n tin u e for a c o n s i d e r a b l e p e rio d w ith o n ly s l i g h t d e t e r i o r a t i o n o f th e
q u a l i t y a n d q u a n tity o f m ilk (19).
S ta tu s o f In f a n t
There i s a c l o s e a s s o c i a t i o n b e tw e e n th e n u t r i t i o n a l s t a t u s o f th e
m o th e r d u rin g p r e g n a n c y a n d l a c t a t i o n w ith th e h e a l t h d u rin g th e f i r s t
y e a r s o f th e c h i l d 's l i f e . The f i r s t m o n th a f t e r b irth a d j u s t m e n t s in
h o m e o s t a s i s a re b e in g m ad e r a p i d l y a n d a t d if f e r e n t r a t e s in a ll in f a n ts .
T h e s e a d j u s t m e n t s a re e s p e c i a l l y c o n c e r n e d w ith d i g e s t i o n , e x c r e tio n
a n d s e c r e t i o n o f h o r m o n e s . N u tr it io n a l s t a t u s i s a f f e c t e d by t h e s e
th in g s b e c a u s e i f t h e s e a d j u s t m e n t s a re n o t m ade c o r r e c t l y body f u n c ­
t i o n s a re h a m p e re d (2 4 ).
The g ro w th r a t e d u rin g in f a n c y i s ra p id n e c e s s i t a t i n g h ig h e n e r g y
in ta k e s.
The fu ll term in f a n t h a s th e a b i l i t y to d i g e s t a n d a b s o r b a
9
m o d e ra te am o u n t o f f a t s , s im p le c a r b o h y d r a t e s , v i t a m i n s , a n d m in e r ­
a l s . H is r e n a l s y s te m f u n c tio n s w e ll b u t h e n e e d s m ore w a te r r e l a t i v e
to h is s i z e t h a n d o e s a n a d u lt (2 5 ).
P ro te in i s im p o r ta n t in th e i n f a n t 's d i e t . The i n f a n t h a s som e
n u t r i t i o n a l s t o r e s from g e s t a t i o n , e s p e c i a l l y i r o n , s o o t h e r m in e ra l a n d
v ita m in s u p p le m e n ts a re r e q u ir e d . Some m in e ra ls a n d v ita m in s a re u s e d
r a p id ly a n d n o t s to r e d in th e b o d y , t h u s a d a ily s u p p le m e n t is
n e e d e d (2 6).
B r e a s tf e e d in g i s c o n s i d e r e d th e b e s t s o u rc e o f food for th e i n ­
f a n t (2 7 ). In a d d itio n to i t s n u tr i tio n a l v a l u e , th e re s e e m s to be a
p s y c h o s o c i a l d e v e lo p m e n t b e tw e e n m o th e r and c h ild r e l a t e d to b r e a s t ­
f e e d i n g . In th e U n ite d S t a t e s o n ly a s m a ll n u m b er o f m o th e rs b r e a s t ­
f e e d . The h ig h ly e d u c a t e d a n d th e lo w e c o n o m i c , p o o rly e d u c a t e d a re
th e g ro u p s t h a t b r e a s t f e e d . A s o c i a l s tig m a s e e m s to p r e v a i l am ong th e
m id d le c l a s s . •
In th e d e v e lo p i n g n a t i o n s , th e m a jo rity of i n f a n t s a re b r e a s t f e d .
A u th o ritie s f e e l t h i s i s f o r tu n a te b e c a u s e fe w e r n u tr i tio n a l d e f i c i e n c i e s
a re s e e n d u rin g th e tim e th e in f a n t i s b r e a s t f e d .
M a n y i n f a n t s are
- b r e a s t f e d u n til tw o y e a r s o f a g e o r u n til a n o th e r c h ild i s b o r n , w h i c h ­
e v e r c o m e s f i r s t . The w e a n in g p e r io d i s th e tim e w h e n p r o t e i n , c a l o r i c ,
a n d o th e r n u tr i t i o n a l d e f i c i e n c e s d e v e lo p a n d c a u s e s e v e r e p ro b le m s
(2 8 ).
10
W h e n a c h a n g e in th e b e h a v io r o f th e o ra l m u s c u l a tu r e o c c u r s ,
u s u a l l y a ro u n d th r e e m o n t h s , s o l i d food s h o u ld b e in t r o d u c e d . The b i t ­
in g a n d c h e w in g r e f l e x b e g in s b e tw e e n s e v e n a n d n in e m o n th s . At t h i s
t i m e , fo o d s t h a t r e q u ire c h e w in g s h o u ld be in tr o d u c e d (2 9 ).
K w ash io rk o r a n d M a r a s m u s
F ran k p r o te in d e f i c i e n c y is k now n a s k w a s h io r k o r w h e re in c a l ­
o r ie s m ay be s u f f i c i e n t b u t p r o te in i s l a c k i n g . The s y n d ro m e of
k w a s h io r k o r c o m p r is e s r e t a r d a t i o n o f gro w th a n d d e v e lo p m e n t, e d e m a ,
m u s c u l a r w a s t i n g , d e p ig m e n ta ti o n o f th e h a ir a n d s k i n , s c a l y c h a n g e s
in s k i n t e x t u r e , h y p o - a lb u m in e m ia , r e v e r s i b l e f a t t y i n f i l t r a t i o n o f th e
l i v e r , r e d u c t i o n o f e n z y m e a c t i v i t y o f th e d u o d e n a l j u i c e , d i a r r h e a , a n d
m o d e ra te a n e m ia (3 0 ).
K w ash io rk o r d e v e lo p s a f t e r s i x m o n th s a n d co m m o n ly b e tw e e n o n e
to fo u r y e a r s o f age. The b r e a s tm i lk p r o d u c tio n i s u s u a l l y d e c li n in g a n d
i s i n s u f f i c i e n t for th e g ro w in g c h i l d 's p r o te in n e e d s . I t is m o s t com m on
in p l a c e s where starch y fo o d s a re th e m a in s t a p l e , i n a d e q u a t e l y s u p p l e ­
m e n te d b y p r o t e i n - r i c h fo o d s o f a n im a l o r v e g e t a b l e o rig in (31).
In m a r a s m u s , b o th c a l o r i e s a n d p r o te in a re d e f i c i e n t (3 2 ). M a r ­
a s m u s c a n d e v e lo p in th e f i r s t fe w m o n th s o f lif e a n d w ill r e s u l t i f th e
m o t h e r 's m ilk s u p p ly i s i n s u f f i c i e n t a n d l i t t l e o r no o th e r food is g i v e n .
A lth o u g h l e s s d r a m a t i c , i t i s o fte n more s e r io u s c l i n i c a l l y w ith l e s s
f a t t y c h a n g e b u t g r o s s d e p l e t i o n o f l i v e r s u b s t a n c e (3 3 ).
11
M e n ta l D e v e lo p m e n t
The r e l a t i o n s h i p o f p ro te in in ta k e a n d m e n ta l d e v e lo p m e n t i s
u n d e r m u ch i n v e s t i g a t i o n ( 3 4 ,3 5 ,3 6 ,3 7 ) . It a p p e a r s t h a t i n f a n ts s u f f e r ­
in g from m a ln u tr itio n h a v e d e c r e a s e d m e n ta l a b i l i t y . At l e a s t a p o rtio n
o f th e m e n ta l a p a t h y c a n be u p g ra d e d w ith a n u tr i tio u s d i e t and is r e ­
v e r s i b l e (3 8 ). D u rin g th e f i r s t tw o y e a r s o f l i f e , th e b r a in i s i n c r e a s ­
in g in s i z e , th u s i t i s r e a s o n a b l e t h a t a n a d e q u a te p r b te in in ta k e i s
n e c e s s a r y for g ro w th a n d d e v e lo p m e n t.
P r e n a ta l n u tr i tio n i s i m p o r t a n t , t o o , a s th e b ra in i s d e v e lo p in g
w ith th e r e s t o f th e f e t u s . The p e a k g ro w th o f th e b r a in o c c u r s v e ry
c l o s e to tim e o f b ir th (3 9 ).
M e th o d s o f D e te rm in in g P ro te in D e f i c i e n c y o f In f a n ts
A n th ro p o m e tric a l
A n th ro p o m e try , h u m an m e a s u r e m e n t , i s u s e d in d e te r m in in g n u t r i ­
t i o n a l s t a t u s . It p r o v id e s th e o p e r a t i o n a l m e a s u r e m e n t o f lo n g term
n u t r i t i o n a l s t a t u s , g iv in g tw o lim itin g a s s u m p t i o n s , f i r s t for c h i l d r e n ,
s e c o n d a d u l t s (4 0 ). For i n d i v i d u a l s w ho a re s t i l l g ro w in g , th e a s s u m p ­
tio n i s t h a t la r g e r o n e s a re b e t t e r n o u r i s h e d . For t h o s e w ho h ave
a l r e a d y f i n i s h e d t h e i r f a t - f r e e g r o w t h , t h e a s s u m p tio n i s th a t th e d e , g re e o f f a t n e s s m e te rs th e c u m u la tiv e c a l o r i c s u r p l u s .
W e ig h t i s the a n th ro p o m e tric m e a s u r e m e n t m o s t u s e d . In d e v e l o p ­
in g c o u n t r i e s , th e p r e v a l e n c e o f p r o t e i n - c a l o r i e d e f i c i e n c y a p p e a r s to
12
b e b e s t i n d i c a t e d b y u n d e r w e i g h t e d n e s s (41). W e ig h t i n d i c a t e s g r o s s
b o d y s i z e a n d a ro u g h a p p ro x im a tio n o f b o d y v o lu m e (4 2 ).
L e n g th for a g e i s a v a l u a b l e m e a s u r e m e n t. The le n g t h o f th e i n ­
f a n t i s a f f e c t e d d i r e c t l y b y th e b o d y s t a t u r e o f th e p a r e n t s . L en g th
m e a s u r e m e n ts a re c o n c e r n e d w ith t o t a l b o d y le n g th (4 3 ).
H e a d a n d c h e s t c ir c u m f e r e n c e i n d i c a t e b o d y b u ild a n d d e v e l o p ­
m e n ta l s t a t u s .
The e x t e n t o f d e v e lo p m e n t i s d e te r m in e d b y s o f t t i s s u e ,
f a t , a n d m u s c l e (4 4 ). This a p p e a r s to b e th e m o s t d i r e c t w a y o f m e a ­
s u rin g fram e s i z e o b j e c t i v e l y , r e lia b ly , a n d w ith o u t a n e x c e s s o f i n t e r ­
fe rin g s o f t t i s s u e .
The m o s t o f te n u s e d s ta n d a r d for c o m p a r is o n o f w e i g h t , l e n g t h ,
h e a d a n d c h e s t c ir c u m f e r e n c e i s t h a t o f th e C h i l d r e n 's M e d ic a l C e n t e r
in B o s to n . The p e r c e n t i l e p o s i t i o n o f a n y m e a s u r e m e n t a t a g iv e n a g e
c a n be d e te r m in e d from t h i s a n th ro p o m e tric c h a r t (4 5 ).
M a n y s k in f o ld m e a s u r e m e n ts a re d o n e to d e te r m in e n u tr itio n a l
s t a t u s o n o ld e r c h ild r e n a n d a d u l t s . T h e s e , h o w e v e r , a re n o t u s e d on
n e w b o rn i n f a n t s (4 6 ).
G ro w th s p e c i a l i s t s o b s e r v e t h a t th e b e s t m e a s u r e o f s h o r t- te r m
n u tr i tio n a l s t a t u s i s n o t h o w big th e c h ild i s b u t how f a s t he is g ro w ­
i n g . I t i s b e t t e r to c o m p a re m e a s u r e m e n ts w ith p r e v io u s m e a s u r e m e n ts
o f th e s a m e in f a n t o v e r a p e rio d o f tim e th a n to c o m p a re w ith a c r o s s s e c t i o n a r n o r m e s t a b l i s h e d a t a g iv e n a g e (40).
13
C lin ic a l
The b e s t c l i n i c a l m e th o d o f d e te r m in in g p r o te in s t a t u s is a b lo o d
t e s t u s e d to d e te r m in e th e c o n c e n t r a t i o n o f t o t a l seru m a lb u m in .
Con­
c e n t r a t i o n o f a lb u m in l e s s th a n 3.5 g ra m s p e r 100 m i l l i l i t e r s u g g e s t s
p o o r p r o te in s t a t u s (4 7 ).
P ro te in N u tr it io n o f S am o an M o th e r s a n d In f a n ts
T y p ic a l D ie t a n d E a tin g P a tte rn
Food p l a y s a n im p o r ta n t ro le in Sam o an c u s to m s a n d t r a d i t i o n s ,
It i s a t r i b u te o f r e s p e c t , p a y m e n t , h o s p i t a l i t y , a n d f e s t i v i t y . W h ile
c u s to m s a re m u ch s t r o n g e r in th e r u r a l a r e a s , th e y a re s t i l l p r a c t i c e d to
so m e e x t e n t in a l l a r e a s .
The S am o an e a t i n g p a t t e r n fa v o rs a v e ry lig h t b r e a k f a s t of w h a t ­
e v e r food i s a v a i l a b l e , o r n o th in g a t a l l , fo r th e m o rn in g m e a l . The
l a r g e s t m e a l c o m e s a t m id d a y w h e n i t i s to o ho t to w o r k . Large
a m o u n ts o f s t a r c h y fo o d s a r e c o n s u m e d . The c h ie f s a n d a d u l t s e a t
f i r s t , t h e n th e c h ild r e n a re f e d . There i s u s u a l l y s u f f i c i e n t s t a p l e
f o o d s , fr u its a n d c o c o n u t to s a t i s f y a l l , b u t p r o te in fo o d s are l e s s
a b u n d a n t . The i n f a n t s a n d c h ild r e n m ay n o t r e c e i v e a s h a r e o f t h e s e
p r o t e i n fo o d s w h e n t h e q u a n t i t y i s s m a l l . A s h o rt p e r io d o f r e s t i n g a n d
s o c i a l i z i n g fo llo w s th e n o o n m e a l b e fo re w ork i s r e s u m e d . The l a s t
m e a l o f th e d a y i s e a t e n a t d u s k . The food i s lim it e d in v a r i e t y a n d i s
14
p r e p a r e d in th e umu o r u n d e rg ro u n d o v e n . T a ro , f i s h , c h i c k e n , b r e a d ­
f r u i t , g re e n b a n a n a , s w e e t p o t a t o , ta r o l e a v e s a n d c o c o n u t a re th e
u s u a l f o o d s . Taro i s a t r a d i t i o n a l food o f S a m o a . It i s s im ila r to a
p o ta to b u t c o n t a i n s more s t a r c h .
Taro i s p re p a r e d in m a n y w a y s a n d i s
u s e d a t a l m o s t e v e r y m e a l . B re ad fru it i s s im ila r to a n a c o r n s q u a s h in
t a s t e a n d t e x t u r e . I t g ro w s on a tr e e a n d is p r e p a r e d b y b o ilin g or
b a k i n g . Pig m ay be a d d e d to t h i s fo r c e r e m o n i e s . F ru its a re e a t e n a s
s n a c k s , rig h t from th e t r e e s , b u t r a r e l y s e r v e d a t m e a ltim e (48).
F a c to r s I n f lu e n c in g P ro te in In ta k e
C u ltu r a l I n f lu e n c e s
B a b ie s a re u s u a l l y born in th e h o s p i t a l . M o s t a r e b r e a s t f e d on
d e m a n d . The m o th e r 's m ilk i s t e s t e d by p a s s i n g a s p o o n fu l o f milk
o v e r a f la m e . If th e m ilk c u r d l e s , i t i s u n fit for th e c h i l d . In th is
c a s e , th e r e i s no g o o d s u b s t i t u t e a v a i l a b l e in m an y f a m ilie s and o fte n
th e c h ild g e t s o n ly w a t e r . At th e a g e o f 10 to 14 m o n th s a b r e a s tf e d
c h ild i s w e a n e d a n d g iv e n s o lid f o o d s . P a p a y a s o u p , g re e n c o c o n u t
s o u p , m a s t i c a t e d t a r o , b a n a n a , b r e a d f r u i t , r i c e , o r o a tm e a l a re i n t r o ­
d u c e d a t a b o u t fiv e m o n th s o f a g e .
T h ere a re som e fo o d s w h ic h a re ta b o o du rin g p r e g n a n c y . It is
th o u g h t t h a t o c to p u s c a u s e s r a s h a n d s h e l l fis h c a u s e s i n t e s t i n a l
d ifficu lties.
E x p e c ta n t m o th e rs m u s t n e v e r e a t a l o n e . P a r e n ta l m i s b e ­
h a v io r i s b e l i e v e d to b e th e c a u s e o f a b n o r m a litie s in th e new b o rn
15
i n f a n t . If a n e x p e c t a n t m o th e r s n e a k s a b ite o f p i g , w h en a l o n e ,
s u p e r s t i t i o n s a y s h e r in f a n t w ill r e s e m b le a pig (51).
I n v e s t i g a t o r s in th e U n ite d S t a t e s fin d s u p e r s t i t i o n s a b o u t food
a re fo u n d am ong p r e g n a n t w om en t h e r e . S u p e r s titio n s s e e m to be
a s s o c i a t e d w ith p r o te in a n d p r o te in r i c h f o o d s . P o rk , c h e e s e , f i s h ,
e g g s , a n d m ilk s e e m to be th e m a in fo o d s c o n n e c te d w ith t a b o o s . In
m an y c a s e s , t h e s e fo o d s a n d o th e r s w e re d i s l i k e d a s w e ll a s b e in g
c o n n e c t e d w ith s u p e r s t i t i o n s . Poor n u tr itio n is d u e to ig n o r a n c e and
d i s l i k e s b u t s u p e r s t i t i o n s played a s i g n i f i c a n t ro le a n d s h o u ld n o t be
o v e r lo o k e d w h e n d e a l i n g w ith p e o p le (5 2 ).
V alue S y ste m
. The Sam o an i s a g r o u p - o r i e n t e d p e r s o n .
He s t r i v e s for a c h i e v e ­
m e n t for h is g r o u p . I n d iv id u a l t h in k in g i s n o t d e v e lo p e d or e n c o u r ­
a g e d . A S am o an i s s u c h a n a m ia b le a n d a c c o m m o d a tin g in d iv id u a l t h a t
he w ill o fte n g iv e in r e p ly th e a n s w e r h e kn o w s o n e w o u ld lik e to hear.
The m a t a i , o r c h i e f , d o e s a l l th e p la n n in g a n d d e c i s i o n m a k in g for h is
p e o p l e . The S am o an i s a fo llo w e r .
.
The S am o an in h is n a tu r a l s u rro u n d in g s is a n i n d u s t r i o u s m a n .
H is d a y s t a r t s b e fo re d a w n , a s he l i k e s to te n d to h is c h o r e s b efo re
t h e s u n 's h e a t b e c o m e s to o i n t e n s e . W om en do l i g h t e r t a s k s o f c l e a n ­
i n g , c o o k in g , a n d c u l t i v a t i n g a ro u n d th e v i l l a g e .
C h ild r e n a re a s ­
s i g n e d th e d u t i e s o f c le a n i n g v i l l a g e g r o u n d s , g a th e r in g fir e w o o d , a n d
16
c a r in g for i n f a n t s . In f a n ts a re n e v e r l e f t a l o n e . O ld e r s i b l i n g s h a v e
th e r e s p o n s i b i l i t y o f fu ll c a r e w h ile th e m o th e r i s a w a y from h o m e .
If c o o k in g i s d o n e in th e o v e n , i t i s u s u a l l y d o n e by th e u n title d
m en.
C o o k in g o v e r c h a r c o a l i s d o n e b y th e w o m en . M o s t t r a d i t i o n a l
i n f a n t d i s h e s a re p r e p a r e d by b o ilin g (53).
The ru lin g c l a s s , or a l i i , is a t th e to p w ith th e m a ta i d ir e c tin g
th e p e o p l e . The m a ta i i s e l e c t e d b y th e a i g a , or fa m ily g ro u p , for h is
m e m o ry , c u n n in g , p h y s i q u e , i n t e l l i g e n c e , a n d a b i l i t y to t a l k . As th e
m a ta i a s s u m e s h is p o s i t i o n , h e t a k e s th e nam e b e lo n g in g to t h a t p o s i ­
tio n .
He m a k e s a l l d e c i s i o n s for h is a i g a r e la tin g to f o o d , tr a v e l a n d
t r o u b l e . If a fa m ily m em ber w a n ts s o m e t h in g , a fu ll v e r b a l e x p l a n a ­
tio n a n d j u s t i f i c a t i o n m u s t be g i v e n . The fin a l d e c i s i o n is m ade by th e
m a ta i w ho i s s u p p o r te d b y h is p e o p le a s in th e fe u d a l s y s t e m s o f
E urope.
A m erican v a l u e s of o w n e r s h i p , p u r c h a s i n g , p o s s e s s i o n , f i n a n c ­
i n g , o r o b lig a tio n m e an n o th in g to th e S a m o a n . N e e d s w h ic h a n i n d i ­
v i d u a l i s u n a b le to fill a lo n e a re s a t i s f i e d by a s k in g th e a s s i s t a n c e o f
r e l a t i v e s . T h e s e r e q u e s t s , o r " f a 'a l a v a l a v a , " a re r a r e l y d e n ie d (5 4 ).
W este rn iz atio n
A m erican Sam oa i s a group o f s e v e n i s l a n d s l o c a t e d in th e South
C e n t r a l P a c i f i c O c e a n b e tw e e n IS0 SO1 a n d 14°32; S o u th L a titu d e and
1 6 8 °0 8 ' a n d 172°50' W e s t L o n g itu d e .
The te rrito ry c o v e r s an a r e a o f
17
76 s q u a r e . m i l e s w ith a p o p u la tio n o f a p p r o x im a te ly 26,000 P o ly n e ­
s i a n s , I t i s th e h a lf w a y mark b e tw e e n H a w a ii a n d N e w Z e a l a n d . The
I s l a n d s a re o f v o l c a n i c o r ig i n , s u rro u n d e d by c o ra l r e e f s . They are
h e a v i l y f o r e s t e d , b u t th e s o i l i s th in a n d ro c k y s o c u l t i v a t i o n i s lim ­
i t e d to c o a s t a l a r e a s a n d a d j a c e n t s l o p e s . The c lim a te is m ild w ith
a n a v e r a g e te m p e r a tu r e o f 78.4 d e g r e e s (5 5 ).
By t r e a t y in 1 8 7 8 , th e U n ite d S t a t e s c o n firm e d th e rig h t to b u ild
a n a v a l s t a t i o n a t P ag o P a g o , S a m o a . The U n ite d S t a t e s w a s e s p e ­
c i a l l y i n t e r e s t e d in Pago Pago b e c a u s e o f i t s fin e h a r b o r . In 1 8 9 9 , th e
U n ite d S t a t e s o b t a i n e d w h a t i s n o w k n ow n a s A m erican Sam oa (49).
In 1 9 5 1 , S am oa w a s m ade a n u n in c o r p o r a te d te r r it o r y a n d tu rn e d
o v e r to th e D e p a rtm e n t o f th e I n te r io r . The P r e s id e n t o f th e U n ite d
S t a t e s a p p o in ts a g o v e rn o r for th e I s l a n d s w ith th e c o n s e n t o f th e
S am o an L e g i s l a t u r e c o n s i s t i n g o f a C o u n c il o f C h ie f s a n d a H o u se o f
R e p r e s e n t a t i v e s e l e c t e d by th e p e o p le (5 0 ).
W e s t e r n i n f l u e n c e c a n be s e e n in w h a t th e S am o an b u y s in a d d i ­
tio n to n a t i v e f o o d s . T in n ed c o rn b e e f , a- so u p m ad e from i t know n a s
"pea soupo", canned fis h , ric e , flo u r, bread, b is c u its , co ffee, su g ar,
c a n d y , a n d c a r b o n a te d b e v e r a g e s a re p u r c h a s e d in la r g e q u a n t i t i e s .
F o o d s s u c h a s c h e e s e , b u t t e r , c a n n e d s o u p , a n d s p a g h e t t i ite m s a re
o c c a s i o n a l l y p u r c h a s e d . M ilk is b o u g h t in s m a ll q u a n t i t i e s . M o s t o f
t h e s e food, ite m s a re im p o rte d a n d a re v e r y e x p e n s i v e .
18
M e a t is a s c a r c e c o m m o d ity on th e I s l a n d .
M o s t m e a t i s im ­
p o rte d from N e w Z e a la n d (5 6 ). P o u ltry a n d p ig a re u s e d for f e s t i v a l s
F is h i s u s e d o f te n a s th e S am o an i s a g o o d f is h e r m a n .
M ilk , e g g s ,
a n d c h e e s e a re n o t t r a d i t i o n a l fo o d s b u t a re im p o rte d from th e U n ite d
S t a t e s a n d N e w Z e a la n d .
There i s a n a b u n d a n t s u p p ly o f food in S a m o a . W e s t e r n i z a t i o n
h a s i n f l u e n c e d th e food h a b i t s o f th e S am o an a n d w ill c o n tin u e to do
s o in th e fu tu re .
N u tr it io n a l S ta tu s o f I n f a n ts in S am oa
S h e ila M a lc o lm , d i e t i t i a n a n d n u t r i t i o n i s t , c o n d u c te d a s tu d y on
d i e t a n d n u tr itio n in S am oa in 1 9 5 4 , u n d e r th e s p o n s o r s h i p o f th e
S o u th P a c i f i c C o m m is s io n (5 7 ). The aim o f t h i s r e s e a r c h w a s to i n ­
v e s t i g a t e th e d i e t a n d n u tr i tio n o f S am o an c h ild re n d u rin g th e f i r s t tw o
and o n e -h a lf y e ars of th e ir life .
G row th a n d d e v e l o p m e n t , fe e d in g
h a b i t s , fo o d s a v a i l a b l e , food c u s t o m s , a n d food p r e p a r a t i o n w e re
re p o rte d .
The d a t a s h o w e d t h a t th e g ro w th a n d d e v e lo p m e n t o f c h ild re n
frpm b ir t h to th e a g e o f tw o y e a r s i s , o n th e w h o l e , s a t i s f a c t o r y . Up
to th e a g e o f n in e m o n t h s , th e c o n d itio n o f th e h e a l t h y Sam oan c h ild
c o m p a r e s f a v o r a b ly w ith t h a t o f th e E u ro p e a n c h i l d .
D u rin g th e w e a n ­
in g p e r i o d , th e c h i l d ' s c o n d itio n s e e m s to d e p e n d l a r g e l y on th e
n a tu r e o f th e c a r e g iv e n by th e m o t h e r .
19
Food s u p p le m e n ts a re u s u a l l y in tr o d u c e d in to th e c h i l d 's d ie t
a t a c o n v e n i e n t t i m e . A lthough S a m o a n s h a v e a n u m b e r o f good food
r e c i p e s for th e p r e p a r a t i o n o f c h ild r e n ' s f o o d s , th e food i s s e ld o m in
a s u i t a b l e fo r m .
A lth o u g h a c e r t a i n n u m b er o f c h ild r e n s u f f e r from e v i d e n t m a ln u ­
t r i t i o n , i t a p p e a r s p o s s i b l e to o b ta in a n a d e q u a te d i e t for c h ild r e n in
A m erican S a m o a . A d e q u a te fo o d s a re a v a i l a b l e or c a n b e e a s i l y o b ­
t a i n e d b u t t h e i r u s e i s n o t a lw a y s s a t i s f a c t o r y .
From th e d a ta of th e
s t u d y , i t w a s c o n c lu d e d t h a t m ore e d u c a t i o n is n e e d e d a n d im p o rta n c e
s h o u ld b e p l a c e d on d i e t a n d n u tr i tio n .
CHAPTER
III
PROCEDURE
S am p le
The s a m p le w a s to be a ll S am o an m o th e rs w ho d e l i v e r e d a n d
t h e i r n e w b orn i n f a n t s a t th e LBJ T ro p ic a l M e d ic a l C e n t e r , Pago P a g o ,
A m e ric an S a m o a , b e t w e e n J u ly 2 7 a n d S e p te m b e r 7, 19 70.
S u rv e y In s tru m e n t
A q u e s t i o n n a i r e (A ppendix A) w a s d e v e lo p e d w ith th e a s s i s t a n c e
of a n u tritio n is t, a s ta t is tic ia n , and a p h y s ic ia n .
It w a s u s e d to
s t r u c t u r e a n i n t e r v i e w w ith e a c h m o th e r. In fo rm a tio n to b e o b ta in e d
w o u ld th u s be c o n s i s t e n t b e c a u s e m ore th a n o n e p e r s o n w ould be d o ­
in g th e i n t e r v i e w . I t w a s d e s i g n e d to d e te rm in e a p p ro x im a te food
i n t a k e , e a t i n g p a t t e r n s , fe e d in g h a b i t s , food c u s t o m s , a n d food p r e ­
p a r a t i o n . Food in t a k e w a s d e te r m in e d b y d o in g a m o d if ie d food r e c a l l
o n th e m o t h e r . The m o th e r w a s a s k e d th e num ber o f m e a l s s h e u s u a l l y
a t e p e r d a y to e s t a b l i s h a n e a t i n g p a t t e r n . Food h a b i t s a n d c u s to m s
w e re g e n e r a l l y d e te r m in e d b y a s k i n g food l i k e s a n d d i s l i k e s in g e n e r a l
c o n v e rsa tio n .
M e th o d s o f p r e p a r a t io n w e re e s t a b l i s h e d b y a s k in g
e a c h m o th e r h o w food w a s u s u a l l y s e r v e d . The h o s p i t a l c h a r ts w e re
u s e d to g a t h e r in fo rm a tio n t h a t w a s im p o r ta n t to th e s t u d y b u t w ould
n o t be a v a i l a b l e th ro u g h th e i n t e r v i e w w ith th e m o th e r.
21
P ro c e d u re on C o l l e c t i o n o f D a ta
It w a s n e c e s s a r y to u s e a n i n t e r p r e t e r in th e i n t e r v i e w b e c a u s e
m a n y S a m o a n s do n o t s p e a k o r u n d e r s ta n d E n g l is h . S e v e r a l w om en
w e re a v a i l a b l e a s i n t e r p r e t e r s : a P u b lic H e a lth N u r s e , a s t u d e n t
n u r s e , a n d a S am o an w om an in h e r f o r t i e s w ho h a d a fa m ily a n d w a s
r e s p e c t e d in th e c o m m u n ity . The m o s t s u c c e s s f u l i n t e r v i e w e r p ro v e d
to b e t h e Sam oan w o m a n . E a c h i n t e r p r e t e r w a s i n s t r u c t e d a s to th e
p u r p o s e o f th e s tu d y a n d h o w to u s e th e q u e s t i o n n a i r e for i n t e r v i e w s .
M o th e r
The m o th e rs w e re v i s i t e d th e s e c o n d d a y a f t e r d e l i v e r y , u s u a l l y
d u rin g th e m o r n i n g . C h a r ts w e re r e a d b e fo re th e i n t e r v i e w in o rd e r to
k n o w so m e o f th e b a c k g r o u n d o f th e m o th e r. W e i g h t , h e i g h t , h e m o ­
g l o b i n , a n d s k e t c h y fa m ily in fo rm a tio n a l s o w a s r e c o r d e d from th e
c h a r t s . M o th e r s w e re a s k e d a b o u t t h e i r d i e t , n u r s in g th e b a b y , a n d
t h e d i e t th e y in te n d e d to fe e d th e b a b y .
W h e n th e b a b y w a s b ro u g h t b a c k to th e c l i n i c from tw o to four
w e e k s a f t e r d i s m i s s a l from th e h o s p i t a l , th e m o th e r w a s a g a i n c o n ­
su lte d about her d ie t.
In f a n t
The i n f a n t s w e re s e e n w ith in 24 h o u rs a f t e r d e l i v e r y . R eco rd s
w e re m a d e o f p h y s i c a l f e a t u r e s .
22
W e ig h t — w a s w e ig h e d on an in f a n t s c a l e w ith o u t c lo t h i n g .
L e n g th — w a s m e a s u r e d w ith in f a n t ly in g on a firm s u r f a c e p a r a l l e l to
th e r u l e . C a r e w a s t a k e n s o th e k n e e s w e re s t r a i g h t a n d th e
head w as up.
H e a d C ir c u m f e r e n c e — w a s m e a s u r e d w ith in f a n t ly in g on h is b a c k .
The t a p e w a s p l a c e d o v e r th e lo w e r f o r e h e a d a n d a ro u n d the
b a c k o v e r th e m o s t p ro m in e n t p a r t o f th e b a c k o f th e h e a d .
C h e s t C ir c u m f e r e n c e — w a s t a k e n a t th e n ip p le lin e w h e re th e c h e s t
w as la rg e st.
M axim um c ir c u m f e r e n c e w a s o b ta in e d w ith t h e s e tw o m e a s u r e m e n ts
(4 0 ).
The b a b y w a s r e tu r n e d to th e W e ll C h ild C lin ic from tw o to four
w e e k s a f t e r b e in g r e l e a s e d from th e h o s p i t a l .
w as recorded a g a in .
The w e ig h t of th e in f a n t
The b a b y 's d i e t a n d e a ti n g h a b i t s w e re d i s ­
c u s s e d . A b lo o d s a m p le w a s t a k e n from th e b a b y by a h e e l p ric k for
d e te r m in a tio n o f h e m o g lo b in by th e W ong M e th o d a n d h e m a t o c r i t by
th e c e n tr if u g e m e th o d in th e h o s p i t a l la b o r a to r y (5 8 ). H e m o g lo b in w a s
d e te r m in e d b e c a u s e p h y s i c i a n s u s e t h i s t e s t to d e te r m in e i f th e b a b y
is h e a lth y .
T re a tm e n t o f D a ta
The s t a t i s t i c a l t e c h n i q u e s u s e d to a n a ly z e th e d a t a w ere
m u ltip le r e g r e s s i o n a n d c o r r e l a t i o n .
M u ltip le r e g r e s s i o n i s u s e d to
23
e x a m in e th e r e l a t i o n s h i p b e tw e e n a d e p e n d e n t v a r i a b l e , th e c r i t e r i o n ,
a n d two or m ore i n d e p e n d e n t v a r i a b l e s t h e p r e d i c t o r s .
C o rre la tio n is
c o n c e r n e d w ith d e s c r i b i n g th e d e g re e o f r e l a t i o n b e tw e e n v a r i a b l e s .
CHAPTER
IV
RESULTS AND DISCUSSION
’C h a r a c t e r i s t i c s o f Sam ple
In f a n ts
T h ere w e re 28 f e m a l e s a n d 32 m a le s born to s i x t y m o th e rs a t th e
h o s p i t a l d u rin g th e s i x - w e e k p e r io d .
The w e ig h t for i n f a n t s ra n g e d
from 92.00 o u n c e s to 166.00 o u n c e s for th e f e m a le s a n d from 80.00
o u n c e s to 175.00 o u n c e s fo r th e m a l e s .
The m e an w e ig h t for th e group
w a s 122.97 o u n c e s . The a v e r a g e w e ig h t g a in p e r d a y w a s 1.08 o u n c e s .
L e n g th for f e m a le s r a n g e d from 19.00 to 22.00 i n c h e s a n d from 18.00 to
22.00 i n c h e s for th e m a le s w ith a c o m b in e d m e an o f 19.84 i n c h e s .
H e a d c ir c u m f e r e n c e r a n g e d from 12.00 to 16.00 i n c h e s fo r m a le s a n d f e ­
m a le s.
The m e an w a s 14.16 i n c h e s .
C h e s t c ir c u m f e r e n c e ra n g e d from
12.00 to 17.00 i n c h e s a n d th e m e an w a s 14.00 i n c h e s (T ab le I ) .
The h e a v i e s t b a b y w a s a l s o th e l o n g e s t w ith th e l a r g e s t h e a d
a n d c h e s t c i r c u m f e r e n c e . The s a m e w a s tru e of th e l i g h t e s t ; i t w a s
th e s h o r t e s t w ith th e s m a l l e s t h e a d a n d c h e s t c i r c u m f e r e n c e . The
h e a v i e s t m o th e rs h a d th e h e a v i e s t b a b i e s b u t th e r e v e r s e w a s n o t t r u e .
O u t o f s i x t y b a b i e s , 36 (60%) w e re b r e a s t f e d .
T h is w a s i n t e r ­
e s t i n g a s i t w a s s u s p e c t e d t h a t b r e a s t f e e d i n g w a s d e c r e a s i n g in
S am oa ( 59) .
25
TABLE I
CHARACTERISTICS OF INFANTS
C h arac te ristic
W e ig h t
L e n g th
H e a d C irc u m fe re n c e
M easu rem en ts
N o . o f B ab ies in
W h ic h O b s e rv e d
l e s s th a n 6 p o u n d s
5
6 -8 pounds
30
8-10 p o u n d s
23
m ore th a n 10 p o u n d s
2
l e s s t h a n 19 i n c h e s
4
19-20 i n c h e s
19
20-21 i n c h e s
24
m ore th a n 21 i n c h e s
13
l e s s t h a n 14 i n c h e s
16
14-15 i n c h e s
36
8
m ore t h a n 15 i n c h e s
C h e s t C ir c u m f e r e n c e
H e m o g lo b in
l e s s th a n 14 i n c h e s
,
19
14-15 i n c h e s
30
m ore th a n 15 i n c h e s
11
l e s s t h a n 12
11
12-16
15
16-18
33
m ore th a n 18
I
26
No o th e r s t a t i s t i c s a re a v a i l a b l e for S am oan n e w b o rn s s o no
c o m p a r is o n s w e re m a d e .
M o th e r s
M o th e r s r a n g e d in a g e from 17.00 to 42.00 y e a r s o f a g e w ith th e
m e a n a g e 2 6.58 y e a r s . The w e ig h t o f th e m o th e rs r a n g e d from 118.00 to
247.00 p o u n d s w ith a m e an o f 170.55 p o u n d s .. H e m o g lo b in ra n g e d from
9 to 14. O n ly 11 (18%) o f th e m o th e rs w o rk e d .
N u tr it io n a l S ta tu s
All e x p e c t a n t m o th e rs a re r o u t i n e l y g iv e n a v ita m in m in e ra l s u p ­
p le m e n t a t th e tim e o f t h e i r f i r s t c l i n i c v i s i t . O f th e s i x t y m o th e rs
i n t e r v i e w e d , 2 7 (45%) s a i d th e y d id n o t t a k e th e v ita m in s e v e n th o u g h
t h e y h a d b e e n p r e s c r i b e d b y th e d o c t o r . All m o th e rs f e l t th e y h ad a
g o o d a p p e t i t e a n d t h a t t h e i r d i e t w a s a d e q u a t e . T w e n t y - s i x (43%) d id
n o t e a t th r e e m e a l s p e r d a y . The m e a l m o s t fr e q u e n tly m i s s e d w a s
b r e a k f a s t . F o r ty - n in e (82%) d id n o t d rin k m ilk (T ab le 2 ) . The m o t h e r s .
a l l a t e a t l e a s t th r e e s e r v i n g s p e r d a y o f a v e g e t a b l e , fr u it or j u ic e
a n d a t l e a s t fo u r s e r v i n g s o f b re a d o r c e r e a l . All m o th e rs a te th e ir
n a t i v e fo o d s o f ta r o a n d b r e a d f r u it d a i l y . All m o th e rs a t e m e a t , f i s h ,
c h i c k e n , o r e g g s a t l e a s t tw ic e a w e e k . There w e re o n ly fiv e (8%)
m o th e rs w ho d id n o t d rin k s o d a . The m e a n in ta k e o f o u n c e s of s o d a
p e r d a y w a s 9.6. This i s l i k e l y a r e s u l t o f W e s t e r n i z a t i o n . The fo o d s
d i s l i k e d m o s t f r e q u e n tly w e re c h e e s e , m ilk , a n d e g g s .
■
27
TABLE 2
FOODS EATEN BY THE MOTHER
F oods
M ilk
F ru its a n d j u i c e
Yes
No
11
49
18
0
100
. 60
'
% Y es
V e g e ta b le s
60
0
100
C e r e a l s , Bread
60
0
100
M e a t , C h i c k e n , F is h
60
0
100
S o d a Pop
55
5
92
28
There w e re 2 5 (42%) m o th e rs t h a t did n o t h a v e a n a d e q u a te p r o ­
t e i n i n t a k e . A d e q u a c y o f th e m o th e r s ' d i e t w a s d e te r m in e d by h er
in t a k e from e a c h o f th e b a s i c fo u r food g r o u p s . This w a s b e c a u s e th e
m o th e r d id n o t d rin k m ilk a n d o n ly h a d tw o s m a ll s e r v i n g s of m e a t ,
f i s h , or c h i c k e n a w e e k . In t h i s group o f 2 5 m o t h e r s , 6 w e re w o r k i n g ,
13 n u r s e d t h e i r b a b i e s , a n d 13 d id n o t t a k e th e v i t a m i n s . T here w e re
o n ly fo u r b a b i e s from t h i s group o f m o th e rs t h a t c o u ld b e c o n s id e r e d
n o t h e a l t h y . O ne b a b y w a s a d m itte d to th e h o s p i t a l w ith d ia g n o s i s a s
fa ilu r e to t h r i v e . After m an y t e s t s s e p s i s , b lo o d p o i s o n i n g , w a s d i a g ­
n o s e d . A nother b a b y d id n o t g a in w e ig h t from tim e o f b ir th u n til th e
tw o w e e k c h e c k u p . T h r e e - b a b ie s h a d a h e m o g lo b in o f 9 a n d w e re g iv e n
a n iro n i n j e c t i o n .
H e m o g lo b in w a s n o t r o u ti n e ly d o n e o n th e n e w b o r n s . For t h i s
s t u d y , h e m o g lo b in w a s d o n e on a l l n e w b o rn s p a r t i c i p a t i n g in th e s tu d y
a t th e i n s i s t e n c e of th e i n v e s t i g a t o r .
S in c e th re e lo w h e m o g lo b in s
w e re d e t e c t e d , t h e p e d i a t r i c i a n d e c i d e d t h a t h e m o g lo b in s s h o u ld be
ro u tin e o n a l l f o llo w - u p e x a m i n a tio n s for n e w b o r n s . The b lo o d w a s o b ­
ta in e d by a h eel p ric k .
In fo rm a tio n a b o u t th e fa m ily a n d n u m ber o f p r e g n a n c i e s w a s
s k e t c h y a n d h ard to o b t a i n . The w e ig h t g a in d u rin g p r e g n a n c y is a c u l ­
tu r a l t h i n g . The S am o an b e l i e v e s t h a t th e more th e m o th e r g a i n s , th e
h e a l t h i e r a n d h e a v i e r th e b a b y w ill b e . The o b s t e t r i c i a n g a v e up try in g
to f ig h t c u l t u r e .
29
R egression Analyses
M u ltip le r e g r e s s i o n w a s th e t e c h n i q u e e m p lo y e d in th e a n a l y s i s
of th e se d a ta .
M u ltip le r e g r e s s i o n w a s u s e d to e x a m in e th e r e l a t i o n ­
s h ip b e t w e e n th e d e p e n d e n t v a r i a b l e , th e c r i t e r i o n , a n d tw o o r more
i n d e p e n d e n t v a r i a b l e s , th e p r e d ic to r s .
For e x a m p le : L e t u s a s s u m e w e a re i n t e r e s t e d in p r e d ic tin g th e
w e i g h t o f a n u n b o rn b a b y from th e k n o w le d g e o f th e m o th e r 's a g e ,
m o t h e r 's w e i g h t , n u m b e r o f p r e g n a n c i e s , a n d d i e t . In t h i s c a s e , th e
b a b y 's w e ig h t i s th e c r i t e r i o n a n d th e m o th e r 's a g e , w e i g h t , n u m b er o f
p r e g n a n c i e s , a n d d i e t a re th e p r e d i c t o r s .
The m e a s u r e s o f th e c r ite r io n
a n d th e p r e d i c t o r s m u s t be m ade o n th e i n d i v i d u a l s in th e s a m p l e .
The r e g r e s s i o n e q u a ti o n w ill t a k e th e form of
y' = b 1x 1 + ........................................................... 4 ................ + b4x4 + k
w h e re y ' = th e c r i t e r i o n .
b j - b 4 = A p p ro p ria te w e i g h t s a s s i g n e d to e a c h of th e p r e d i c t o r s . T h e s e
w e i g h t s r e m a in c o n s t a n t for e a c h in d i v i d u a l in t h e l e a s t s q u a r e s s o l u ­
tio n o f th e p r e d i c t i o n e q u a t i o n .
X^-X4 = The p r e d i c t o r v a r i a b l e s . T h e s e w ill v a ry for e a c h i n d iv id u a l,
k = a co n sta n t.
H ow a c c u r a t e l y th e r e g r e s s i o n e q u a ti o n w ill p r e d i c t th e c r ite r io n
d e p e n d s u p o n th e m u ltip le c o r r e l a t i o n b e tw e e n th e p r e d i c t o r s and th e
2
c r i t e r i o n . A c o m p u te d i n d e x , R , w ith a maximum ra n g e from 0 to I is
30
u s e d to d e te r m in e th e e f f e c t i v e n e s s o f th e m o d e l. The s q u a r e ro o t o f
2
R or R i s th e m u ltip le c o r r e la tio n c o e f f i c i e n t .
2
An R o f I i n d i c a t e s t h a t w e c a n p r e d i c t a c r ite r io n p e r f e c t l y .
2
An R o f 0 i n d i c a t e s t h a t th e re i s no r e l a t i o n s h i p b e tw e e n th e p r e d ic to r
v a r i a b l e s a n d th e c r i t e r i o n .
I t i s u n lik e ly t h a t w e w o u ld e v e r h a v e a r e g r e s s i o n e q u a tio n
2
w h o s e R w a s 0. C h a n c e f l u c t u a t i o n s w o u ld a llo w for so m e r e l a t i o n ­
s h ip a lth o u g h v e r y s m a l l . W e a re u s u a l l y i n t e r e s t e d in d e te rm in in g
2
w h e th e r th e R i s s i g n i f i c a n t l y b e t t e r th a n c h a n c e (d if f e r e n t from zero).
There i s a v a i l a b l e a n F t e s t for s u c h a c o m p a r is o n (6 0 ). W h e n th e
v a l u e o f F is o b t a i n e d , i t i s c o m p a re d in th e t r a d i t i o n a l m a n n e r to a
c r i t i c a l v a l u e in a n F t a b l e .
R e l a tio n s h ip o f M o th e r to Baby
In t h i s m o d e l th e r e a re 21 v a r i a b l e s .
The f i r s t s i x v a r i a b l e s are
th e c r i t e r i a a n d th e re m a in in g 15 a re th e p r e d i c t o r s . E a c h c rite rio n w a s
t e s t e d w ith in th e 15 p r e d ic to r s a n d a v a lu e o f R a n d F w a s o b ta in e d .
The c r i t i c a l v a lu e o f F i s 2.52 a t th e o n e p e r c e n t (.01) l e v e l o f s i g n i f i ­
c a n c e w ith th e d e g r e e s o f freedom for th e l e s s e r m e a n s q u a r e a s 44
a n d th e d e g r e e o f freed o m for th e g r e a t e r m e an s q u a r e a s 14. The c r i 2
t e r i a a n d th e v a l u e o f R a n d F a re l i s t e d in T ab le 3.
The c o d in g for th e 21 v a r i a b l e s w a s a s fo llo w s:
I.
B a b y 's b ir th w e ig h t in o u n c e s .
31
TABLE I
CRITERION VARIABLES WITH VALUE OF R2 a n d F
C r ite r io n V a r ia b le s
R2
F
Birth W e ig h t -
0.4946
2.87*
Birth L e n g th
0.2911
1.20
H e a d C irc u m fe re n c e
0.4238
2.16
C h e s t C irc u m fe re n c e
0.5065
3.01*
A v e rag e W e ig h t G a in p e r D a y
0.2848
1.17
B a b y 's H e m o g lo b in
0.3068
1.30
* S ig n ifican t
C r i t i c a l v a l u e o f F, d f = 44 a n d 14, a = .01, o n e t a i l t e s t i s 2.52 .
The s a m e f i f t e e n p r e d i c t o r v a r i a b l e s w e re u s e d w ith e a c h c r i t e r O
io n v a r i a b l e in d e te r m in in g R a n d F.
32
2 . , B a b y 's b irth le n g t h in i n c h e s .
3 . B a b y 's h e a d c ir c u m f e r e n c e in i n c h e s .
4 . B a b y 's c h e s t c irc u m f e r e n c e in i n c h e s .
5'. A v e rag e w e ig h t g a in p e r d a y in o u n c e s , b irth to fo llo w u p .
6. B a b y 's h e m o g l o b i n .•
7. M o t h e r 's a g e in y e a r s .
8 . M o t h e r 's w e ig h t in p o u n d s .
9 . N u m b er o f p r e g n a n c i e s o f t h e m o th e r.
1 0 . M o t h e r 's a g e a t tim e o f f i r s t p r e g n a n c y .
1 1 . M o t h e r 's h e m o g lo b in .
1 2 . N u r s in g th e b a b y : X es - 1, N o - 0 .
1 3 . W o rk in g m other: Y e s - 0 , N o - 1 .
1 4 . B r e a k f a s t e a t e n b y m other: Y e s - I , N o - 0 .
1 5 . O u n c e s o f s o d a c o n s u m e d b y m o th e r p e r d a y .
1 6 . A d e q u a te p r o te in in m o t h e r 's d ie t: Y e s - I , N o - 0 .
1 7 . A d e q u a te m ilk i n t a k e in m o t h e r 's d ie t: Y e s - I , N o - 0 .
1 8 . A d e q u a te m e a t in ta k e in m o t h e r 's d ie t: Y e s - I , N o - 0 .
1 9 . A d e q u a te v e g e t a b l e a n d fr u it in ta k e in m o t h e r 's d iet:
Y es - 1 , No - 0 . •
2 0 . A d e q u a te b re a d a n d c e r e a l in t a k e in m o th e r 's d ie t: Yes - I ,
N o -0 .
2 1 . " S e x o f b aby: M a le - 0 , F e m a le - 1.
33
The a d e q u a c y o f th e m o th e r 's d i e t w a s d e te r m in e d by h e r in t a k e
from e a c h o f th e b a s i c fo u r food g r o u p s . This in fo r m a tio n is c o n ta i n e d
in th e p r e d i c t o r v a r i a b l e s 16 th ro u g h 2 0 .
The p r o te in i n t a k e w a s th e n
d e c i d e d from th e c o m b in e d i n ta k e o f m ilk a n d m e a t .
Birth W e ig h t
In th e f i r s t m o d e l , b ir t h w e ig h t w a s t e s t e d u s in g p r e d ic to r s 7
th ro u g h 21 in th e m u ltip le r e g r e s s i o n e q u a t i o n . The v a l u e o f R w a s
0.4946; t h e v a l u e o f F 2.87 (T ab le 3 ). The s t a n d a r d F t a b l e s h o w s th e
v a lu e o f F to b e s i g n i f i c a n t . It m a y b e p o s s i b l e th e r e f o r e to p r e d i c t a n
u n b o rn b a b y 's w e i g h t from th e g iv e n p r e d i c t o r s . T his in fo rm a tio n
c o u ld b e v a l u a b l e in c o u n s e l i n g a m o th e r on d ie t a n d h e r a llo w e d
w e ig h t g a in for th e n in e m o n th s . If th e b a b y w a s p r e d i c t e d to be e s ­
p e c i a l l y h e a v y , th e d o c to r c o u ld d e c i d e i f th e m o t h e r 's b o d y w a s s u c h
t h a t s h e c o u ld d e l i v e r a h e a v y b a b y o r w o u ld s p e c i a l p r e c a u t i o n s n e e d
to b e t a k e n .
For e x a m p l e , w o u ld th e o p e n in g in th e c e r v i x a r e a be
la r g e e n o u g h to a c c o m m o d a te th e p a s s a g e o f th e b a b y o r w o u ld i t be
n e c e s s a r y to do a C a e s a r i a n S e c t i o n ?
If th e b a b y w a s p r e d i c t e d to be
e s p e c i a l l y l i g h t , i t m ig h t b e t h a t so m e s p e c i a l m e a s u r e s s h o u ld be
t a k e n to s a f e g u a r d i t s lif e at b i r t h . Before th is c o u ld b e p u t in to p r a c ­
t i c a l u s e , i t w o u ld b e n e c e s s a r y to t e s t th e r e l a t i o n s h i p b e tw e e n th e
c r ite r io n v a r i a b l e a n d th e p r e d i c t o r v a r i a b l e s more th o r o u g h ly . If th e
m e a s u r e m e n t p r o c e d u r e c o u ld be r e f i n e d , it is p o s s i b l e t h a t a h ig h e r
34
d e g r e e o f r e l a t i o n s h i p c o u ld be e s t a b l i s h e d b e tw e e n th e c r i t e r i a and
p re d ic to rs.
Birth L e n g th
Birth le n g th w a s t e s t e d u s in g p r e d ic to r s 7 th ro u g h 21 in th e
2
e q u a t i o n . R w a s 0.2911 a n d th e v a lu e o f F w a s 1.20 (T ab le 3). The
v a l u e o f F w a s n o t s i g n i f i c a n t w h e n c o m p a re d to th e F t a b l e .
T hus,
t h e s e p r e d i c t o r s c a n n o t s u c c e s s f u l l y be u s e d to p r e d i c t th e b a b y 's
l e n g t h . O ne r e a s o n w h ic h c o u ld a c c o u n t for t h i s r e s u l t w a s th a t a ll
th e p r e d i c t o r s w e re t a k e n from th e m o th e r, no n e from th e f a th e r .
L e n g th a n d th e t e n d e n c y to b e t a l l o r s h o r t i s an in h e r ite d fa c to r w h ic h
i s i n f l u e n c e d by b o th m o th e r a n d f a t h e r .
H e a d C irc u m fe re n c e a t Birth
In t h i s r e g r e s s i o n e q u a t i o n , h e a d c ir c u m f e r e n c e w a s p r e d ic te d
2
u s i n g v a r i a b l e s 7 th ro u g h 21. The v a l u e o f R w a s 0.42 38 w ith th e
v a lu e o f F 2.16 (T ab le 3 ). The v a lu e o f F w a s n o t s i g n i f i c a n t w h en
c o m p a re d to th e F t a b l e .
This c a n b e a c c o u n te d for b y th e f a c t th a t th e
f o n t a n e l s w o u ld be a t a d if f e r e n t s t a g e o f d e v e lo p m e n t in e a c h c h ild .
N u tritio n o r i n h e r i t a n c e do n o t p la y a n im p o rta n t ro le in th e h e a d c i r ­
c u m fe re n c e (5 9 ). T h u s , th e p r e d ic to r s c a n n o t be u s e d to p r e d ic t th e
h e a d c ir c u m f e r e n c e of th e in f a n t.
35
C h e s t C irc u m fe re n c e a t Birth
C r ite r io n fo u r , c h e s t c i r c u m f e r e n c e , w a s s e t up w ith v a r i a b l e s 7
2
th ro u g h 21 a s th e p r e d i c t o r s . The R w a s 0.5065 a n d th e F w a s 3.01
(T ab le 3 ). The v a lu e o f F w a s s i g n i f i c a n t .
C h e s t c ir c u m f e r e n c e w o u ld
be a f f e c t e d b y th e m o th e r 's w e i g h t , d i e t , e a ti n g p a t t e r n s , s e x o f th e
b a b y , a n d to a c e r t a i n e x t e n t i n h e r i t a n c e o f b o d y b u ild from p a r e n t s .
C h e s t c ir c u m f e r e n c e is a m e a s u r e o f th e f l e s h y p a r t o f th e c h e s t a n d
th u s i s a f f e c t e d b y n u t r i t i o n . I t c a n b e s a i d t h a t c h e s t c irc u m fe re n c e
p r o b a b ly c a n be p r e d i c t e d from th e g iv e n p r e d ic to r v a r i a b l e s .
A v e rag e W e ig h t G a in P er D a y D u rin g E arly I n f a n c y
A v e rag e w e ig h t g a i n p e r d a y w a s t e s t e d by u s in g th e p r e d ic to r
2
v a r i a b l e s 7 th ro u g h 21. The v a l u e o f R w a s 0.2 848 a n d th e v a lu e o f F
w a s 1.17 (T ab le 3 ). T h ere w a s no r e l a t i o n s h i p b e tw e e n th e 15 p r e ­
d i c t o r s a n d th e a v e r a g e w e ig h t g a in p e r d a y o f th e i n f a n t . The a v e r a g e
w e ig h t g a in of th e i n f a n t w a s d e p e n d e n t u p o n th e d i e t o f th e in fa n t
a f t e r b ir t h r a t h e r th a n the' v a r i a b l e s m e a s u r e d on th e m o th e r.
B a b y 's H e m o g lo b in
In t h i s r e g r e s s i o n e q u a t i o n , th e b a b y 's h e m o g lo b in w a s t e s t e d
2
u s i n g v a r i a b l e s 7 th ro u g h 21 a s p r e d i c t o r s . The v a l u e o f R w a s 0.3068
a n d th e v a l u e o f F w a s 1.30 (T ab le 3 ). W h en F w a s c o m p a re d w ith th e
t a b l e , i t "was n o t s i g n i f i c a n t . . The m o th e r 's d i e t p rio r to a n d du rin g
p r e g n a n c y p l a y s a n im p o r ta n t p a r t in p ro v id in g a n iro n s u p p ly for th e
36
b a b y . The m o th e r 's iro n s t o r e s t h a t h a v e b e e n b u ilt up o v e r th e y e a r s
p l a y a n im p o r ta n t p a r t in th e am o u n t o f iro n th e b a b y r e c e i v e s b e fo re
b ir t h . There i s no w a y o f a c c u r a t e l y m e a s u rin g t h e s e s t o r e s (61). I t i s ■
a l s o p o s s i b l e th e b a b y d o e s n o t a b s o r b a l l th e iro n a v a i l a b l e from th e
m o th e r. The b a b y 's h e m o g lo b in c a n n o t be p r e d i c t e d from t h e s e
v a ria b le s.
In tw o o f th e m o d e ls a s i g n i f i c a n t r e l a t i o n s h i p w a s found b e ­
tw e e n th e c r ite r io n a n d p r e d i c t o r s . There w a s a r e l a t i o n s h i p b e tw e e n
th e b a b y 's b irth w e ig h t a n d c h e s t c irc u m fe re n c e a n d th e 15 p r e d ic to r
v a ria b le s.
T h e s e v a r i a b l e s d e p e n d m ore on th e p r e d i c t o r s th a t w e re
t a k e n from th e m o th e r th a n do th e o th e r four c r ite r io n v a r i a b l e s . T h e s e
fo u r re m a in in g c r ite r io n v a r i a b l e s w e re m ore d e p e n d e n t on o u t s i d e f a c ­
to r s t h a t h a v e l i t t l e to do w ith th e m o th e r or f a c to r s t h a t c o u ld n o t
a c c u r a t e l y or e a s i l y b e m e a s u r e d .
C o r r e la tio n A n a ly s e s o f C h a r a c t e r i s t i c s o f M o th e r to Baby
The m o s t w id e ly u s e d m e a s u r e o f c o r r e la tio n i s th e P e a rs o n P ro ­
d u c t M o m en t C o r r e la tio n C o e f f i c i e n t (6 2 ). C o r r e la tio n i s c o n c e rn e d
w ith d e s c r i b i n g th e d e g r e e o f r e l a t i o n s h i p b e tw e e n v a r i a b l e s .
The P e a r s o n P ro d u c t M o m en t C o r r e la tio n w a s c o m p u te d b e tw e e n
c ertain v a ria b le s .
T h e s e v a r i a b l e s w e re u s e d b e c a u s e th e y w e re of
s p e c i a l i n t e r e s t to th e p h y s i c i a n s on th e I s l a n d a n d to th e r e s e a r c h e r .
T h e s e c o r r e l a t i o n s a re r e p o r te d in T a b le 4 . The r e l a t i o n s h i p b e tw e e n
37
TABLE 2
CORRELATION OF VARIABLES WITH VALUE OF r
V a ria b le I
V a ria b le 2
rI /2
W e ig h t o f b a b y
M o t h e r 's a g e
.06488
W e ig h t o f b a b y
M o t h e r 's w e ig h t
.39744*
W e ig h t o f b a b y
L e n g th o f b a b y
.49592*
H e a d c ir c u m f e r e n c e
C h e s t c ir c u m f e r e n c e
.74808*
W e ig h t o f b a b y
B re a s tfe d
.23229*
L e n g th o f b a b y
B re a s tfe d
H e a d c ir c u m f e r e n c e
B re a s tfe d
.32478*
C h e s t c ir c u m f e r e n c e
B re a s tfe d
.22221
W e ig h t o f b a b y
N u m b er o f p r e g n a n c ie s
.18894
W e ig h t o f b a b y
Age o f 1 s t p re g n a n c y
- .1 6 4 4 3 .
W e ig h t o f b a b y
M o t h e r 's h e m o g lo b in
- .0 1 2 6 8
L e n g th o f b a b y
M o t h e r 's h em o g lo b in
-.0 1 8 8 9
H e a d c irc u m f e r e n c e
M o t h e r 's h e m o g lo b in
.09526
C h e s t c irc u m f e r e n c e
M o t h e r 's h e m o g lo b in
.00326
B a b y 's h e m o g lo b in
M o t h e r 's h e m o g lo b in
-.0 0 9 2 9
W e ig h t o f b a b y
M o t h e r 's b r e a k f a s t
.15236
W e ig h t o f b a b y
M o th e r w o rk in g
.26657*
L e n g th o f b a b y
M o th e r w o rk in g
.12367
H e a d c ir c u m f e r e n c e
M o th e r w o rk in g
.21321
C h e s t c irc u m f e r e n c e
M o th e r w o rk in g
.49195*
- .0 8 3 9 7
* S ig n i f ic a n t
C r i t i c a l v a lu e o f r , df.= 5 8 , a - .1 0 , tw o t a i l t e s t i s + .231.
38
th e w e i g h t o f th e b a b y a n d th e m o t h e r 's w e ig h t w a s s i g n i f i c a n t .
This
i s u n d e r s t a n d a b l e b e c a u s e a s th e f e tu s i s d e v e lo p i n g th e m o th e r is
g a in in g w e i g h t a n d th e f e tu s i s g a i n i n g . L ength o f t h e b a b y a n d w e ig h t
o f th e b a b y w e re s i g n i f i c a n t . As th e f e tu s s i z e i n c r e a s e s b o th le n g th
a n d w e i g h t w ill i n c r e a s e . There i s a r e l a t i o n s h i p b e tw e e n h e a d a n d
c h e s t c i r c u m f e r e n c e . T h e s e tw o m e a s u r e m e n ts a re im p o r ta n t a n t h r o p o m e tr ic a l m e a s u r e s a n d i n d i c a t e d e g r e e o f d e v e lo p m e n t. W e ig h t o f
th e b a b y a n d h e a d c ir c u m f e r e n c e a re r e l a t e d to th e b a b y b e in g b r e a s t ­
f e d . T h ere i s a r e l a t i o n s h i p b e tw e e n th e b a b y 's w e ig h t a n d c h e s t
c ir c u m f e r e n c e a n d th e w o rk in g m o th e r.
CHAPTER
V
SUMMARY, CO NC LU SIO N S, RECOMMENDATIONS
Summary
I t i s e s t i m a t e d t h a t tw o - t h i r d s o f th e w o r ld 's p o p u la tio n i s s u f ­
fe rin g from som e d e g r e e o f m a ln u tr it io n , At th e h e a r t o f t h i s p ro b lem i s
th e s e r i o u s l a c k o f p r o t e i n .
There a re tw o s o u r c e s o f p r o t e i n , a n im a l
a n d v e g e t a b l e . Animal p r o te in i s a c o m p le te p r o te in t h a t c o n ta i n s a ll
th e e s s e n t i a l a m in o a c i d s . No o n e v e g e t a b l e p r o te in c o n t a i n s a ll th e
e s s e n t i a l a m in o a c i d s i n th e p r o p e r p r o p o r tio n s . The p u r p o s e o f t h i s
s tu d y w a s to i n v e s t i g a t e th e s t a t u s o f p r o te in n u tr i tio n o f e x p e c t a n t
m o th e rs in A m erican S am oa a n d th e p o s s i b l e e f f e c t o f t h i s s t a t u s on th e
h e a l t h of th e i n f a n t .
The m o t h e r 's d i e t b e fo re a n d d u rin g p r e g n a n c y i s m o s t im p o rta n t
to h e r a d j u s t m e n t d u rin g p r e g n a n c y a n d th e i n f a n t 's g ro w th and d e v e l o p ­
m e n t. P r o te in i s e s s e n t i a l to th e g ro w th a n d r e p l a c e m e n t o f t i s s u e .
Food p l a y s a n im p o r ta n t ro le in Sam o an c u s to m s a n d t r a d i t i o n s . T h eir
m e a l p a t t e r n i s u s u a l l y a l i g h t m orning m e a l o r n o th in g a t a l l , a h e a v y
m id d a y m e a l , a n d a s n a c k a t d u s k .
B ab ies are u s u a l l y b o rn in th e
h o s p i t a l a n d b r e a s t f e d o n d e m a n d . W e s t e r n in f l u e n c e s e e m s to be i n ­
f l u e n t i a l in th e S am o an d i e t .
A q u e s t i o n n a i r e w a s d e v e lo p e d to s tr u c tu r e a n i n t e r v i e w w ith
e a c h m o th e r. It w a s d e s i g n e d to d e te r m in e a p p ro x im a te food i n t a k e ,
40
e a t i n g p a t t e r n s , f e e d in g h a b i t s , food c u s to m s , a n d food p r e p a r a t i o n .
The s a m p le i n c l u d e d a l l Sam oan m o th e rs t h a t d e l i v e r e d a n d th e ir n e w
born i n f a n t s a t th e LBJ T ro p ic a l M e d i c a l C e n t e r , Pago P a g o , A m erican
S a m o a , b e tw e e n J u ly 27 and S e p te m b e r 7, 19 7 0 . S ix ty m o th e rs w e re
s e e n in th e s i x - w e e k p e r i o d . The m o th e rs a n d i n f a n ts w e re s e e n in th e
h o s p i t a l a n d a g a i n a t th e W e ll C h ild C lin ic from tw o to fo u r w e e k s
a f t e r b e in g r e l e a s e d from th e h o s p i t a l .
M u ltip le r e g r e s s i o n a n d c o r r e l a t i o n w e re th e s t a t i s t i c a l m e th o d s
e m p lo y e d in t h i s r e s e a r c h . M u ltip le r e g r e s s i o n w a s u s e d to e x a m in e
th e r e l a t i o n s h i p b e t w e e n s i x d e p e n d e n t v a r i a b l e s o f th e b a b y a n d 15
i n d e p e n d e n t v a r i a b l e s on th e p h y s i c a l m e a s u r e m e n ts a n d d ie ta r y h a b i t s
o f th e m o th e r.- It a p p e a r e d t h a t th e p r e d ic to r s c o u ld b e u s e d to p r e d i c t
tw o o f th e c r i t e r i a .
T h e s e c r i t e r i a w e re th e b a b y 's b irth w e ig h t and
c h e s t c i r c u m f e r e n c e . The P e a r s o n P ro d u c t M o m en t C o r r e la tio n C o e f f i­
c i e n t w a s c o n c e r n e d w ith d e s c r i b i n g th e d e g re e o f r e l a t i o n b e tw e e n
v a ria b le s.
There w a s a s i g n i f i c a n t r e l a t i o n s h i p b e tw e e n : w e ig h t o f th e
b a b y a n d th e m o t h e r 's w e ig h t; b a b y 's w e ig h t a n d b a b y 's le n g th ;
b a b y 's h e a d a n d c h e s t c irc u m fe re n c e ; b a b y 's w e ig h t a n d i f i t w a s
b r e a s t f e d ; h e a d c ir c u m f e r e n c e a n d i f th e b a b y w a s b re a s tfe d ; w e ig h t of
b a b y a n d i f th e m o th e r i s w o rk in g ; a n d c h e s t c ir c u m f e r e n c e and i f th e
m o th e r i s w o rk in g . L e s s th a n h a l f o f th e m o th e rs (42%) r e c e iv e d a n i n ­
a d e q u a t e q u a n t i t y o f p r o te in in t h e i r d i e t . All m o th e rs th o u g h t they h ad
a n a d e q u a t e d ie t; 45% d id n o t ta k e v ita m in s ; 43% d id n o t e a t th re e
41
m e a l s p e r d ay ; 82% d id n o t d rin k m ilk; 8% d id n o t d rin k s o d a ; a n d 100%
a t e a t l e a s t th r e e s e r v i n g s o f fru it a n d v e g e t a b l e s p e r d a y and four
s e r v i n g s o f b re a d or c e r e a l „
C o n clu sio n s
From d a t a c o l l e c t e d d u rin g a s i x - w e e k p e r i o d , th e fo llo w in g c a n
b e c o n c lu d e d for t h i s stu d y :
1.
The b a b y 's b irth w e ig h t i s p r e d i c t a b l e from s e l e c t e d p h y s i c a l
m e a s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r.
2.
The b a b y 's b irth le n g th i s n o t p r e d i c t a b l e from s e l e c t e d p h y s i c a l
'
3.
m e a s u r e m e n t s a n d d i e t a r y h a b i t s o f th e m o th e r.
B a b y 's h e a d c ir c u m f e r e n c e i s n o t p r e d i c t a b l e from s e l e c t e d p h y s i ­
c a l m e a s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r.
4.
B a b y 's c h e s t c ir c u m f e r e n c e i s p re d ic ta b le " fr o m s e l e c t e d p h y s i c a l
m e a s u r e m e n ts a n d d i e t a r y h a b i t s o f th e m o th e r.
5.
The a v e r a g e w e i g h t g a in p e r d a y o f th e b a b y i s n o t p r e d i c t a b l e
from s e l e c t e d p h y s i c a l m e a s u r e m e n ts a n d d i e t a r y h a b i t s of th e
m o th e r.
6.
The b a b y ' Q h e m o g lo b in is n o t p r e d i c t a b l e from s e l e c t e d p h y s i c a l
m e a s u r e m e n t s a n d d i e t a r y h a b i t s o f th e m o t h e r . ■
7.
The e x p e c t a n t 'm o t h e r 's d i e t i s a d e q u a t e in p r o te in .
■42
R e c o m m e n d a tio n s
This StudyH e a d a n d c h e s t c ir c u m f e r e n c e a n d le n g th s h o u ld b e m e a s u re d on
th e i n f a n t a t th e c l i n i c in a d d itio n to t h a t d o n e a t b ir t h s o a c o m p a r i­
s o n c o u ld b e m a d e . W e ig h t g a in d u rin g th e p r e g n a n c y w o u ld h a v e b e e n
a v a l u a b l e fig u re to o b t a i n . So t h a t m ore in fo rm a tio n c o u ld be found
a b o u t th e f a t h e r 's r o le in th e f a m ily , i t w o u ld be i n t e r e s t i n g to g e t i n ­
fo rm a tio n on th e f a t h e r , th e fa m ily a s a w h o l e , i t s in c o m e , a n d l e v e l
o f e d u c a t i o n . M u c h m ore c o u ld be l e a r n e d a b o u t th e S am o an from
t h e s e d a t a . I t w o u ld h a v e b e e n i n t e r e s t i n g to i n t e r v i e w in th e v i l l a g e s
i n s t e a d o f a t th e h o s p i t a l . L a b o ra to ry f a c i l i t i e s s h o u ld be im p ro v ed s o
t e s t s w o u ld be more v a l i d .
Anyone d o in g a n in t e r v i e w w ith a Sam o an w o u ld h a v e p ro b le m s
o b ta in in g v a l i d a n s w e r s . The Sam o an t e l l s one w h a t he th in k s one
w a n ts to h e a r s o a s to n o t h a v e a n y u n h a p p i n e s s . W h e n u s in g i n t e r ­
p r e t e r s in a s t u d y , th e i n t e r p r e t e r n e e d s i n s t r u c t i o n w ith th e s a m p le
b e fo re a c t u a l l y b e g i n n i n g . The i n t e r p r e t e r s h o u ld h a v e c o m p le te
u n d e r s t a n d i n g o f i t a n d w h a t i s h o p e d to be l e a r n e d . The r e s e a r c h e r
s h o u ld k n o w a l l h e c a n a b o u t th e p e o p l e , t h e ir c u s t o m s , a n d la n g u a g e
b e fo re i n i t i a t i o n o f s u c h a s tu d y .
43
Fu tu re S tu d ie s
For fu tu re s t u d i e s a lo n g er, tim e p e rio d a n d a la r g e r s a m p le
s h o u ld b e u s e d . M e a s u r in g d e v i c e s a n d t e c h n i q u e s s h o u ld be t e s t e d
a n d im p ro v e d w h e n p o s s i b l e .
S ta n d a rd s s h o u ld be s e t fo r m ak in g c o m ­
p a r i s o n s . Know w h a t la b o r a to r y f a c i l i t i e s a re a v a i l a b l e a n d w h a t
t e c h n i c i a n s c a n d o . It m ig h t be n e c e s s a r y to u s e a f ie ld l a b o r a t o r y .
S tu d i e s c o u ld b e c o m p le te d on o th e r s e g m e n ts of th e p o p u la tio n . E x­
c e l l e n t s t u d i e s c o u ld b e d o n e w ith p r e s c h o o l c h i l d r e n , e le m e n ta r y a n d
h ig h s c h o o l s t u d e n t s e s p e c i a l l y d u rin g th e s c h o o l y e a r When a c l a s s ­
room s i t u a t i o n w o u ld b e a v a i l a b l e .
LITERATURE CITED
1. C h a n e y , M a r g a r e t , S . N u t r i t i o n . B oston; H o u g h to n M ifflin C om ­
pany, 1960, p . 99.
2 . R o ss , M a r g a r e t , L . "The Long V iew ." J. Am. D i e t e t . A ., 5 6 (A p ril,
1970), p . 295 .
3 . The N u tr it io n F o u n d a tio n , I n c . P r e s e n t K now ledge o f N u t r i t i o n .
N e w York; The N u tr it io n F o u n d a tio n , I n c . , 19 67, p . 9 .
4 . W a t e r l a n , J. C . , a n d M e n d e s , C . B. " C o m p o s itio n o f M u s c le in
M a l n o u r i s h e d I n f a n t s . " N a t u r e , 180 (1957), p . 1 3 6 1 .
5.
H a n d , D . B. "F ood T e c h n o lo g y a n d th e W orld Food P roblem ." Food
T e c h n o l ., 20 (1966), p . 1 0 3 1 .
\
6. Food a n d A g ric u ltu re O r g a n iz a tio n o f th e U n ite d N a t i o n s . Jo in t
FAO/W HO E x p e rt C o m m itte e o n N u t r i t i o n . Rome: W o rld H e a lth
O r g a n i z a t i o n , 1 9 6 6 , p . 57.
7„ J e l l i f f e e , D e r r i c k , B. I n f a n t N u tr it io n in th e S u b tr o p ic s and
T r o p i c s . G e n e v a : W o rld H e a lth O r g a n i z a t i o n , 19 6 8 , p . 2 66.
8 . C h a n e y , M a r g a r e t , S . N u t r i t i o n , p . 100.
9 . I b i d . , p . 10 1 .
10. I b i d . , p . 1 0 3 .
11. I b i d ., p . 1 0 5 .
12. N a t i o n a l A c ad e m y o f S c i e n c e s . P r o g r e s s in M e e tin g P ro tein N e e d s
o f I n f a n ts a n d P r e s c h o o l C h ild r e n . W a s h i n g t o n , D . C . : N a tio n a l
R e s e a r c h C o u n c i l , 19 6 1 , p . 3 0 1 .
45
13. W h ite H o u s e C o n f e r e n c e o n F o o d , N u tritio n a n d H e a l t h . F in a l
R e p o r t. W a s h i n g t o n , D . C . : W h ite H o u se C o n f e r e n c e on F o o d ,
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14. S h a n k , R. E.
"A C h in k in O ur Armor." N u tritio n Today (Summer,
1970), p . 4 .
1 5 . E b b s , J . H.; T i s d e l l , F. F.; a n d S c o t t , W. A. "The I n f lu e n c e of P r e ­
n a t a l D ie t o n th e M o th e r a n d C h ild ." J. N u t r ., 22 (1941), p . 516.
1 6 . I b i d ., p . 517.
17. S h a n k , R . E . N u tr it io n T o d a y , p . 11.
18. I b i d . , p . 7.
19. Food a n d A g ric u ltu re O r g a n iz a tio n o f th e U n ite d N a t i o n s . Jo in t
FAO/W HO E x p e rt C o m m itte e on N u t r i t i o n , S e v e n th R e p o r t. Rome:
W o rld H e a lth O r g a n i z a t i o n , 19 67, p . 2 0 .
2 0 . Food a n d A g ric u ltu re O r g a n iz a tio n o f th e U n ite d N a t i o n s . R eport o f
th e J o in t FAO/WHO T e c h n ic a l M e e t i n g , M e th o d s o f P la n n in g a n d
E v a lu a tio n in A p p lied N u tritio n P r o g r a m s . Rome: W o rld H e a lth
O r g a n i z a t i o n , 19 6 5 , p . 63.
2 1 . Al A n i, J.
"A S tu d y of th e N u tr it io n a l S ta te of t h e P r e g n a n t M o th e r
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2 2 . D ie c k m a n n , J. W. " O b s e r v a t i o n s on P ro tein I n ta k e a n d th e H e a lth
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p .1 0 5 3 .
2 3 . J e a n s , C . P.; S m ith , B. M .; a n d T e a m s , 8 . G .
" I n c i d e n c e of P r e ­
m a tu r ity in R e la tio n to M a te r n a l N u tritio n ." J. Am. D i e t e t . A . , 31
( F e b . , 1955), p . 5 7 6 .
24. Chaney, M arg are t, S . N u tritio n , p .3 8 7 .
46
25.
U n ite d S t a t e s D e p a rtm e n t o f H e a l t h , E d u c a tio n , a n d W e l f a r e .
In f a n t C a r e . W a s h i n g t o n , D . C . : C h ild r e n 's B u re a u , 1 9 6 9 , p . 21.
2 6 . W i l l i a m s , R. S . N u tritio n a n d D ie t T h e r a p y . S t. L o u is: The C . V.
M o s b y Company,. 19 6 9 , p . 3 7 8 .
2 7 . B a k w in , H .
" F e e d in g Program s fo r In f a n ts ." F e d e r a tio n P r o c e e d ­
in g s , 23 (P art I , 1964), p . 67.
2 8 . J e l l i f f e e , D e r r ic k . In f a n t N u tr itio n in th e S u b tr o p ic s a n d T r o p i c s ,
p . 26.
29.
B a k w in , H . F e d e r a tio n P r o c e e d in g s , p . 66.
3 0 . W o rld H e a lth O r g a n i z a t i o n .
The H e a lth A s p e c ts o f Food and N u t r i ­
tio n for th e W e s t e r n P a c if ic R e g i o n . M a n ila : W o rld H e a lth O r g a n i­
z a tio n , 1966, p . 58.
3 1 . W i l l i a m s , R. S . N u tritio n a n d D ie t T h e r a p y , p . 3 2 3 .
3 2 . I b i d . , p . 322 .
3 3 . W o rld H e a lth O r g a n i z a t i o n .
The H e a lth A s p e c ts o f Food and N u t r i ­
tio n for th e W e s t e r n P a c if ic R e g i o n , p . 60.
3 4 . F r i s c h , R. C .
" P r e s e n t S ta tu s o f th e S u p p o s itio n t h a t M a ln u tr itio n
C a u s e s P e rm a n e n t M e n ta l R e ta r d a tio n ." Am. I . C l i n . N u t r ., 23
(1970), p . 1 89.
35. C o u rs in , D.
" R e la tio n s h ip o f N u tr itio n to C e n tr a l S y ste m D e v e l o p ­
m e n t a n d F u n c tio n ." F e d e r a tio n P r o c e e d in g s , 26 ( J a n . - F e b . , 1967),
p . 136.
3 6 . S c r i m s h a w , N . S ., a n d B e h a n , N . " M a ln u tr itio n in U n d e rd e v e lo p e d
C o u n t r i e s ." N e w E n g lan d J o u rn a l o f M e d i c i n e , 27 (1965), p . 137.
47
3 7 . K u g le m a ss , I . N .; P o u l l , L . E .; a n d S a m u e l , L . E . " N u tr itio n a l Im­
p ro v e m e n t o f C h ild M e n t a l i t y . " A m erican Jo u rn a l o f M e d ic a l
S c i e n c e , 208 (1954), p . 631.
3 8 . Food a n d A g ric u ltu re O r g a n iz a tio n o f th e U n ite d N a t i o n s . Jo in t
FAO/W HO E x p e rt C o m m itte e on N u t r i t i o n , S e v e n th R e p o r t, p . 3 7.
3 9 . S c r im s h a w , N . S ., a n d G o r d o n , E . J . M a l n u t r i t i o n , L e a rn in g , a n d
B e h a v io r . B oston: M a s s a c h u s e t t s I n s t i t u t e of T ec h n o lo g y , 1 9 6 8 ,
p . 502, 5 0 3 .
4 0 . G a r n , M . S . "A n th ro p o m etry in C l i n i c a l A p p ra is a l o f N u tr it io n a l
S t a t u s ." Am. J. C lin . N u t r . , 11 (N o v ., 1962), p. 418.
4 1 . U n ite d S t a t e s D e p a rtm e n t o f H e a l t h , E d u c a tio n , a n d W e lf a r e . S u g ­
g e s t e d G u id e lin e s for E v a lu a tio n o f th e N u tr it io n a l S ta tu s o f P r e s c h o o l C h ild r e n . W a s h i n g t o n , D . C . : C h i l d r e n 's B u re a u , 19 67,
P . 11.
4 2 . B r o z e k , J.
"Body M e a s u r e m e n t s . "
Human B io lo g y , 28 (1956),
p . 12 2 .
4 3 . Food a n d A g ric u ltu re O r g a n iz a tio n o f th e U n ite d N a t i o n s . R eport o f
th e J o in t FAO/W HO T e c h n ic a l M e e tin g on M e th o d s o f P la n n in g a n d
E v a lu a tio n in A p p lied N u tritio n P r o g r a m s , p . 3 2 .
4 4 . G a rn , M . S . A m erican Jo u rn al o f C lin ic a l N u t r i t i o n , p , 419 .
45. M ead Johnson L a b o ra to rie s.
P e r c e n tile C h a rt for M e a s u r e m e n ts o f
of I n f a n t s , 1968.
4 6 . N a s n El D in , A ., a n d L a b i b , A. "Som e P h y s ic a l M e a s u r e m e n ts a n d
H e m a to l o g ic a l S tu d ie s in th e N e w b o rn Baby." J o u rn a l of T ro p ical
M e d ic in e H y g ie n e , 70 (19 67), p . 2 72.
48
4 7 . U n ite d S t a t e s D e p a rtm e n t o f H e a l t h , E d u c a tio n , a n d W e lf a r e .
S u g g e s te d G u id e lin e s for E v a lu a tio n of th e N u tr it io n a l S ta tu s o f
Preschool C h ild re n , p . 2 4 .
4 8 . H o n o lu lu D e p a rtm e n t o f H e a l t h .
19 66 , p . I .
"S am o an P r o je c t." H onolulu:
(M im e o g ra p h e d ).
4 9 . L e e , C a l v i n . A m erican S a m o a , R eport by th e G o v e r n o r . W a s h i n g ­
t o n , D . C . , 1927 ( W a s h in g to n , D . C . U n ite d S t a t e s G o v ern m en t
P r i n t i n g . O f f i c e , 1927), p . 3.
50. W ie n s , J . H .
P a c if ic I s l a n d B a s tio n s of th e U n ite d S t a t e s . N ew
York: D . Van N o s t r a n d C o m p a n y , I n c . , 19 62 , p . 3 5 .
5 1 . H o n o lu lu D e p a rtm e n t o f H e a l t h ,
"S am o an P r o je c t." p . 3.
5 2 . B a rth o lo m e w , J . M . ; a n d P o s t o n , E. F . " E ffe c t o f Food Taboos on
P r e n a ta l N u tr itio n ." Jo u rn a l o f N u tritio n E d u c a t i o n , 2 (Summer,
1970), p . 16.
5 3 . H o n o lu lu D e p a rtm e n t o f H e a l t h ,
"S am o an P r o je c t." p . 4.
5 4 . U n ite d S t a t e s D e p a rtm e n t o f I n te r io r . Annual R e p o r t , A m erican
S a m o a , 19 69. ( W a s h in g to n , D . C . ; G o v e rn m e n t P rin tin g O f f ic e .
1 9 6 9 ).
5 5 . H o n o lu lu D e p a rtm e n t o f H e a l t h .
5 6 . B lo o m fie ld , E l i z a b e t h .
"S am o an P r o je c t." p . 2 .
"The Pago Pago Bay A rea." S o u th P a c if ic
B u lle tin (Reprint) ( F irs t Q u arter), 19 6 8 , p . 5.
5 7 . M a lc o lm , S h i e l a . D ie t a n d N u tr itio n in A m erican S a m o a . N o u m e a ,
N e w C a le d o n ia : S o u th P a c if ic C o m m is s io n . T e c h n ic a l P a p e r N u m ­
b e r 63 , 1954 , p . 2 .
5 8 . W o n g , S . Y,
" C o lo rm e tric D e te r m in a tio n o f Iron a n d H em o g lo b in
in B lood." J . B iol. C h e m ., 77 (1928), p . 4 0 9 .
49
59.
C o o k , B. W ., C h ie f o f P e d i a t r i c s , LBJ T ro p ic a l M e d ic a l C e n t e r ,
P ag o P a g o , A m erican S a m o a . (P e r s o n a l C o n ta c t) .
60. F e r g u s o n , G. A. S t a t i s t i c a l A n a ly s is in P s y c h o lo g y a n d E d u c a t i o n .
N e w York: M c G ra w H i l l , 19 6 6 , p . 182.
61. B o g e r t, L. J . ; B rig g s , G . M . ; a n d C a llo w a y , D . H . N u tritio n a n d
'
P h y s i c a l F i t n e s s . P h ila d e lp h ia : W. B. S a u n d e rs C o . , 19 6 8 , p . 17 4 .
6 2 . F e r g u s o n , G . A,. S t a t i s t i c a l A n a ly s is in P s y c h o lo g y a n d E d u c a t i o n ,
p . 106.
APPENDIX
51
APPENDIX A ' — QUESTIONNAIRE
QUESTIONNAIRE
- INFANT
I n it ia l:
C a te g o ry :
_______________________
<
D a te
___________________________
F o llo w up: ■
_________ '
N am e
_________ M ________ F
Sex
____________________ __
Birth D a te
_____________________________
___________________•
L e n g th
W e ig h t
__ _________
.____________
_______________________
Birth O rd e r
________ ______________
G e s t a t i o n a l Age
_______________________ _
H e a d C irc u m fe re n c e
____________
________________________
C h e s t C irc u m fe re n c e
___ ________
_______________________
T o ta l Serum P ro te in
.____________
________________________Serum Albumin
____________
____________________________
____________
_______________________
____ Y es _____N o
H e m o g lo b in
H e m a to c r it
B re a s t F e d ?
G e n e r a l H e a lth
O th e r C o m m en ts:
____________
52
QUESTIONNAIRE
MOTHER
D a te
N am e
Age
W e ig h t
H e ig h t
W e ig h t g a in d u rin g p re g n a n c y
N um ber of p re g n a n c ie s:
N u m b e r o f liv e b o r n in f a n ts :
__ _____________________ liv e b o r n
________________ now liv in g
__ ____________________
______________ __ now d e a d
stillb o rn
__ __________________ m i s c a r r i a g e
________________________ a g e of d e a t h
Age a t f i r s t p r e g n a n c y
T o ta l Serum P ro te in
Serum Albumin
H e m o g lo b in
H e m a to c r it
Blood P r e s s u r e
G e n e r a l H e alth :
FAMILY
____________________
F a t h e r 's Age
Y es
L iv e s w ith fa m ily ?
________ No
53
E d u c a tio n , h i g h e s t g ra d e c o m p le te d
Rural
U rb an
Home lo c a t io n
H ow m a n y m em b ers in h o u s e h o l d ?
W ho a re th e y a n d a g e ?
F a m ily in c o m e , from w h e re ?
DIET
____• W h en i s th e f i r s t tim e d u rin g th e d a y y ou
e a t or d rin k a n y th in g ?
W h a t do you e a t ?
Y es
JMo
How m u c h ?
W a s i n t a k e u n u s u a l in a n y w a y ?
If y e s , w h y ?
_Yes
____
W h a t tim e do you go to b e d ?
JMo
Do you t a k e v ita m in o r m in e r a l s u p p l e ­
m e n ts ?
____
I f y e s z how m a n y / d a y ?
P er w e e k ?
____
M u ltiv ita m in s
__ _
A s c o rb ic a c i d
____
Iron
____
V itam in A & D
____
C a lc iu m
__ _
O ther:
Jfes
JMo
Is y o u r a p p e t i t e g o o d ?
Jfes
JMo
Is y o u r d i e t g o o d ?
Yes
JMo
Do y o u e a t th re e m e a ls a d a y ?
Yes
No
Do you e a t m orning m e a l e v e r y d a y ?
Y es
No
Do you e a t m id d a y m e a l e a c h d a y ?
Y es
No
Do y ou e a t e v e n in g m e a l e v e r y d a y ?
Yes
No
Do y ou s n a c k ?
W hen?
Yes
No
Do you d rin k m ilk ?
How o f t e n ?
Yes
No
Do y ou d rin k fru it j u i c e ?
Yes
No
Do you e a t c e r e a l ?
Yes
No
Do you e a t b r e a d ?
Yes
No
Do you e a t m e a t a n d f i s h ?
Yes
No
Do you e a t v e g e t a b l e s ?
Yes
No
Are you on a s p e c i a l d i e t ?
R ic e ?
( t a r o , b re a d fru it)
W h a t k in d ?
Yes
No
Do y ou d rin k c a r b o n a te d b e v e r a g e s ?
How o f t e n ?
G eneral d ie t?
W h a t fo o d s do you d i s l i k e ?
How do you p re p a re y o u r fo o d ?
W h a t fo o d s do you l i k e ?
W h a t a n d w h e n do you f e e d y o u r b a b y ?
55
O f w h a t w ill y o u r b a b y 's p o s t - l a c t a t i o n
d ie t c o n s is t?
S o u rc e o f v ita m in s , m i n e r a l s , c a r b o ­
h y d ra te s, p ro te in , fa t?
56
APPENDIX B — TOTALS, RANGE, MEAN
QUESTIONNAIRE
INFANT
I n itia l:
C a te g o r y
D a te
F o llo w up:
------
N am e
32
M
28 F
S ex
Birth D a te
M a le
18.00-22.00 i n c h e s
F e m a le 19,00-22.00 i n c h e s
M a le
M ean
L e n g th
19.84 in c h e s
W e ig h t
122.9 7 o u n c e s
80.00-175.00 o u n c e s
F e m a le 92.00-166.00 o u n c e s
Birth O rd er
G e s t a t i o n a l Age
12.00-16.00 i n c h e s
H e a d C irc u m fe re n c e
14.16 in c h e s
12.00-17.00 i n c h e s
C h e s t C irc u m fe re n c e
14.00 in c h e s
T o tal Serum P ro te in
---------- ------
Serum Albumin
-----------------
8—19
H e m o g lo b in
______________
3 0 —45
H e m a to c rit
______________
36
yes
24
no
B re a s t F e d ?
G e n e r a l H e a lth
O th e r C om m ents:
------
57
QUESTIONNAIRE
MOTHER
------------ -------------- ------------------------------------
--------------------
D a te
N am e
M ean
17.00—42.00 y e a r s ______________
Age
2 6.58 y e a r s ______
118.00- 247.00 p o u n d s ___________
W e ig h t
170.55 p o u n d s
-------------- -----------------------
H e ig h t
------------ -------------- ---------------- .
W e ig h t g a in d u rin g p r e g n a n c y
------------ -------------- -----------------------
Age a t f i r s t p r e g n a n c y
-------------- -----------------------
T o ta l Serum P ro te in
------------ -------------- -----------------------
Serum Albumin
9-14_____________________________
H e m o g lo b in
■
______IZZ1ZIZIO___________
H e m a to c rit
------------ -------------- -------------
Blood P r e s s u r e
------------ --------------
G e n e r a l H ealth :
11_____ Y es
49
------------No
W o rk in g
DIET
__________________________ __
W h en i s th e f ir s t tim e d u rin g th e d a y you
e a t o r d rin k a n y th in g ?
W h a t do you e a t ?
_________ Y es __________No
H ow m u ch
W a s i n t a k e u n u s u a l in a n y w a y ?
If y e s , w hy ?
58
_________________________
W h a t tim e do you go to b e d ?
33
Do y ou t a k e v ita m in or m in e ra l s u p p l e ­
Ye s
27
No
m e n ts ?
_________________________
If y e s , h o w m a n y / d a y ?
_________________________
M u ltiv ita m in s
_________________________
A s c o rb ic a c i d
_________________________
Iron
______________________ __
V itam in A & D
_________________________
C a lc iu m
_________________________
O ther:
P er w e e k ?
60
Yes
No
Is y o u r a p p e t i t e g o o d ?
60
Yes
No
Is y o u r d i e t g o o d ?
34
Yes
No
Do y ou e a t th r e e m e a ls a d a y ?
Yes
No
Do y o u e a t m orning m e a l e v e r y d a y ?
Yes
No
Do you e a t m id d a y m e a l e a c h d a y ?
Yes
No
Do y ou e a t e v e n in g m e a l e v e r y d a y ?
Yes
No
Do y o u s n a c k ?
26
W h en ?
11
Yes
49
No
Do y ou d rin k m ilk ?
H ow o f t e n ?
60
Yes
No
Do you d rin k fruit j u i c e ?
60
Yes
No
Do you e a t c e r e a l ?
60
Yes
No
Do you e a t b r e a d ?
60
Yes
No
Do you e a t m e a t a n d f i s h ?
R ic e ?
59
Do y ou e a t v e g e t a b l e s ?
( ta r o , b re a d fru it)
Are you on a s p e c i a l d i e t ?
W h a t k in d ?
Do y ou d rin k c a r b o n a te d b e v e r a g e s ?
H ow o f t e n ?
G e n e r a l D ie t?
W h a t fo o d s do you d i s l i k e :
c h e e s e , m ilk , e g g s
H ow do y ou p re p a re y o u r fo o d ?
f r y , r o a s t , b o il
W h a t fo o d s do you l i k e ?
W h a t a n d w h e n do you fe e d y o u r b a b y ?
O f w h a t w ill your b a b y 's p o s t - l a c t a t i o n
d ie t c o n sis t?
S o u rc e o f v ita m in s , m in e r a ls , c a r b o ­
h y d ra te s , p ro te in , fa t?
MONTANA STATE UNIVERSITY LIBRARIES
762
B266
cop. 2
001
1 3
B a ro n , K ath leen
P r o te i n n u t r i t i o n o f
e x p e c ta n t m o th ers in
American Samoa and i t s
e f f e c t on th e h e a l th
o f th e in f a n t
NAME
AO JT L y Y W o L i
Y
AND
AODNEEE
,
~C
-ft . S2.