Stunting in an Andean Community: Prevalence and Etiology PETER R. BERTI,* WILLIAM R. LEONARD, AND WILMA J. BERTI Department of Human Biology and Nutritional Sciences, University of Guelph, Guelph, Ontario, N1G 2W1 ABSTRACT The magnitude and potential causes of linear growth retar- dation in a rural agricultural community of the Ecuadorian Andes are exam- ined. Growth stunting is common in this population, as height-for-age Z- scores (HAZ) for boys and girls 1–5 years average -2.2 and -2.0, respectively. Dietary analyses suggest multiple nutrient deficiencies. The diet appears to be moderately deficient in energy, protein, calcium, and vitamin A, and more severely limiting in zinc. Additionally, analyses of the local water supply and household hygiene indicate that risk of infection is relatively high among this population. Of the 23 days for which water quality was monitored, slight Escherichia coli contamination was observed on 13 days (57%), and moderate contamination was seen once (4%). Overall, it appears that growth faltering in this population reflects the synergistic effect of mild-to-moderate malnu- trition and disease. It is unlikely that malnutrition alone is sufficient to explain the degree of stunting seen in this and other Andean populations. Rather, the stress of coping with chronic disease in the presence of malnu- trition may contribute to early childhood growth faltering and compromise potential catch up growth later in life. Am. J. Hum. Biol. 10:229–240, 1998. © 1998 Wiley-Liss, Inc. Research in the 1960s in the Andes led to the proposal that the widespread stunting in the Andes was largely a result of the hy- pobaric hypoxia of high altitude (Baker, 1969; Frisancho and Baker, 1970). While stunting has been repeatedly observed in more recent studies in the Andes (de Meer et al., 1993; Dirren et al., 1994; Freire et al., 1988; INEMSP, 1986; Leatherman et al., 1995; Leonard, 1989; Leonard et al., 1990, 1993, 1995a; Mueller et al., 1978; Stinson, 1980), the role of hypoxia is now thought to be secondary to the role of nutrition and other environmental agents, reflected in so- cioeconomic status (Greksa, 1986; Greksa et al., 1985; Haas et al., 1982; Leonard, 1989; Leonard et al., 1990, 1995a; Obert et al., 1994; Stinson 1982; contra Frisancho, 1993). In the last 20 years, a number of studies have been done on the diet of Andean com- munities via dietary survey (Anderson 1981; Ferroni 1982; Kim et al. 1991; Leo- nard et al., 1990, 1993), biochemical survey (Beard et al. 1983, 1988; Canizares et al., 1988; Dirren et al. 1994; Freire et al. 1988; Imai et al. 1991), dietary intervention (Fre- ire et al. 1988) and energy expenditure sur- vey (Kashiwazaki et al. 1995; Kim et al. 1991; Leonard et al. 1995b; Spurr and Reina 1989). Typical Andean diets are tuber-based (potato, melloco [Ullucus tuberosus], cas- sava and oca [Oxalis crenata]), but unre- fined grains are also important in some ar- eas. As with most developing countries, the relatively low intake of animal foods puts the populations at risk of various nutrient deficiencies, particularly protein, calcium, zinc, iron, and vitamin B-12. Yet none of the abovementioned Andean studies explicitly assessed the dietary adequacy of all nutri- ents required for growth. Contract grant sponsor: Natural Science and Engineering Re- search Council; Contract grant number: OGP-0116785; Contract grant sponsor: US National Science Foundation; Contract grant number SBR-9106378; Contract grant sponsors: Ontario Gradu- ate Scholarship, International Development Research Centre of Canada Young Canadian Researchers Award. *Correspondence to: Dr. Peter R. Berti, Centre for Nutrition and the Environment of Indigenous Peoples, Macdonald Cam- pus, McGill University, 21,111 Lakeshore Rd, Ste Anne de Bel- levue, Quebec, H9X 3V9. Received December 5, 1996; Accepted March 5, 1997 AMERICAN JOURNAL OF HUMAN BIOLOGY 10:229–240 (1998) © 1998 Wiley-Liss, Inc. PROD #711