Dr. Nelly Zavaleta
Instituto de Investigacion Nutricional
Lima Peru

General information

According to the last National Demographic and Health Survey (ENDES 1996), Peru has 24 millions of inhabitants, of whom seventy percent live in urban areas, especially in the coast. The population growth rate is 1.8% per year. It is estimated that forty nine percent of the Peruvian population live in poverty. Peru has a great diversity of climate, geographical regions, agriculture, food availability, feeding patterns, health status and access to health services. In general the poorest people live in the rural areas of the highlands and jungle.

Health and Nutrition

There are several studies that have shown the close relationship between health and nutrition. People with good health and nutrition are more productive, have better school performance, physical capacity, wellbeing and are more likely to achieve their best potential and get better living standards.

The most vulnerable groups to get sick and die are children and pregnant women. Current infant mortality rate is 43 per 1000 live new borns. Mortality in children under five is 59 per 1000 children, and maternal mortality is 265 per 10000 births. Although these rates have diminished in the last decades, they are stilll among the highest in Latin America. The main causes of infant mortality are related to diarreal diseases and respiratory infections. Complications during the neonatal period are also important causes of infant morbidity and mortality.

Nutritional problems

The groups, most like to present nutritional deficiencies are infants and small children. During the first year of life nutritional deficiencies are related to lack of exclusive breast feeding in the first 6 months of life and to inapropiate weaning diets in the second half of the first year. Infants usually consume diets that have a low energy content, these diets are also low in other nutrients such as animal protein, fat, vitamins and minerals. Because of their inadequate feeding patterns, infants cannot meet their higher nutritional requirements due to their rapid growth velocity.

Infants and small children have also the highest rates of infections. Sick children have higher nutritional demands, tend to eat less and may have increased nutritional losses and these diseases make worse the nutritional status of children. In the other hand the immune response is impaired in malnourished children and they are more vulnerable to get sick by infectious diseases which in turn impair nutritional status and so the vicious cycle of malnutrition and infection is established.

During preschool and school period nutritional requirements are not as high as during infancy, but they are still high and some important percentage of this population cannot meet these recommendations and are likely at risk of presenting nutritional deficiencies.

The current situation in infancy in Peru is relatively high rates of infant morbidity, and mortality, high rates of stunting, nutritional anemias and other micronutrient deficiencies such as vitamin A, and iron.

During pregnancy, an adequate nutritional status is also very important for the health of the mother and the fetus. For instance weight gain during pregnancy can influence birth weight, and duration of gestation.

At present, the main nutritional problems in Peru are:

1. Stunting, this reflects a chronic nutritional problem which is usually associated with a history of repeated infections in the presence of an inadequate diet;

2. Nutritional anemia, especially iron deficiency anemia,

3. Iodine and vitamin A deficiency in some areas of the country.

Is Zinc deficiency a problem in Peru?

In the last years more information has been collected to suggest that we do have a problem of zinc deficiency in Peru.

Data on consumption: There is little information about zinc consumption in Peru. Some studies done in adolescent school girls and in pregnant women in Lima have found that they consume approximately 50% of their zinc requirements. Foods rich in zinc of high availability are meat, sea food, fish and other animal products. These foods are usually consumed in small amounts due to their high cost.

Serum zinc: Although the limitations of this indicator to measure the zinc status of individuals are well documented, it is accepted as a useful indicator to measure zinc deficiency in populations. Values below 60 ug/ml are considered indicative of deficiency. Some studies done at the Instituto de Investigacion Nutricional (IIN) in Lima, have shown low zinc values in an important percentage of pregnant women and infants in Lima and in preschool children in Tarma.

An indirect indicator of zinc deficiency is the high percentage of stunting in children. In the last National and Health Survey (ENDES 1996) 25% of Peruvian children were found to have low height for age. Another indirect indicator is the high incidence of diarreal diseases and respiratory infections in Children. A combined analysis of controlled trials in various countries world wide including Peru (IIN) has shown that zinc supplementation can reduce the incidence and severity of diarreal and respiratory diseases.

It is very important to get more information to document the zinc status of the Peruvian population. Considering the beneficial effects and the important role of zinc, interventions to combat zinc deficiency can be incorporated within the framework of other nutrition and health programs. The benefit of such interventions in improving maternal and infant health needs to be investigated.

August 9, 1998