Relationship between pica activity, iron deficiency anemia, and the nutritional status of Utah children

198 Pages·2012·2.98 MB·English

by  Jacobs, Timothy Andrew;

THE RELATIONSHIP BETWEEN PICA ACTIVITY, IRON
DEFICIENCY ANEMIA, AND THE NUTRITIONAL
STATUS OF UTAH CHILDREN
by
Timothy Andrew Jacobs
A thesis submitted to the faculty of the
University of Utah in partial fulfillment of the requirements
for the degree of
Master of Science
College of Nursing
University of Utah
June 1976
(£)
Copyright Timothy Andrew Jacobs 1976
All Rights Reserved
UNIVERSITY OF UTAH GRADUATE SCHOOL
SUPERVISORY COMMITTEE APPROVAL
ofa thessiusb mittbeyd
TimothAnyd rewJ acobs
this thesis
I haver ead andh avef oundi tt ob eo fs atisfacqtuoarlyi ftoyr a m.1.ster's
ChainnanS,u pervisCoormym ittee
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degree.
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I hav"r eadt hitsh es:iIsn hda vef Olilill1d 0 beo fs atis[;\qr.ulaolriyft oyr a master's
degree.
DaviJd . Limburg
Member,S upervisCoormym ittee
UNI\"ERSlTOFY UT.\IIC R,\\)U.\TSEC HOOL
FINAL READING APPROVAL
To thGer aduate Cooufnt chieUl n i\'eyr osfiU ttah:
I have retahdet hl:'soifs_ _ .I..i mohY.t..b nd��w_J.?_cs___� . __b ._.". ___ .___ ,
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Approvefdo rt heM ajoDrep artment
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A CKNOWLEDGMENrS
I would like to express my sincere appreciation and thanks to the many
people who contributed to, and assi~ted in, the completion of this study. I
am particularly grateful to the members of my committee for their infinite
patience and understanding in light of frequent but unavoidable delays in the
finalization of the study. I am indebted to Barbara M. Prater, R.D., M.S.,
for her cheerfulness, exuberance, and faith that all would be accomplished;
to Marie Holley, R. N., Ph. D., for her everlasting endurance and quiet con
fidence; and, to David J. Limburg, M. D., for his resourcefulness and stead
fast friendship. I thank you all.
In addition, I would like to thank the following professionals, collea ...
gues, and individuals for their assistance, and for the utilization of their
facilities in whi~h to conduct the research. I extend appreciation to Reed M.
Gardner, Ph.D., Associate Professor, Biophysics Department, University
of Utah, for so generously allowing the use of the computer facilities at the
Latter -day Saints Hospital, Salt Lake City, with which to analyze the nutri ..
tional data; Jill Carlston, R. D., Therapeutic Dietitian, Latter-day Saints
Hospital, who provided valuable technical assistance, much after ... hours
time, and continuous enthusiasm; and, Leigh Wilkerson, Dan Fuller, and
John Brown, Computer Operators, for their knowledge and patience with
non -computer operators.
I am also grateful to the Medical Director and staff members of the
Utah Group Health Plan clinic, Murray, Utah for the use of the pediatric
clinic, and for their cooperation and interest during the course of the data
collection. Mr. Floyd Norton, VA Vocational Rehabilitation Specialist, is
also to be thanked for his support and friendship during the past two years.
I would like to give special thanks to my wife Carolyn Martin Jacobs,
R .D., for her constant encouragement, technical expertise, and patience
throughout the study; to Emily L. Jones, M. D., for all her kindnesses; and
to Andrew, for his diversion. Also to be commended is Mrs. Gay Burkholz,
who expertly typed the manuscript.
Finally, I express my gratitude to the children and mothers who cheer
fully participated in the study, and without whose cooperation and interest
this work would not have been possible. This study is dedicated to all
children everywhere who live in poverty.
v
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS. iv
LIST OF TABLES . viU
ABSTRACT' • xii
Chapter
I. INTRODUCTION AND REVIEW OF THE LITERATURE 1
Introduction. • • • • • • 1
Statement of the Problem. 3
.
Definitions of Terms. • • 4
~
Review of the Literature. • • • • • . 7
Rationale for the Study. • • • • • • • 18
Significance of the Study to Child Nursing. • •• •• 21
Hypo~heses to Be Tested. • • • • • • • •••. 30
.
. . . . . . .
II. METHODOLOGY •••••• , 32
. . . . . .
Sample and Setting. • • • • " 32
Methods of Measurement. • . 37
Data Collecting Procedures. • 53
• • • qo
III. RESULTS AND DISCUSSION. • • 64
Statistical Analysis of the Data. • • 64
Findings. ~ • • • . •• • .•• • • • 65
Additional Findings. • • • • • 73
Discussion of the Findings. • • • 98
Discussion of the Additional Findings • 113
IV. SUMMARY AND RECOMMENDATIONS. 133
Summary. • • • • • • • • • • • • • 133
Nursing Implications. • . 142
0 • " • • • .
Recommendations for Further Study. • 144
Appendices Page
APPENDIX A: DATA TABLES ••• 147
. . .
APPENDIX B: SAMPLE FORMS. " 159
Introductory Letter.. • 160
'! • • _ • • • • • • • • • •
Parental Consent Form • • • • • • • • . • • • • • • 161
Food Sample Instruction Sheet. . • • • • • • • • , 162
1'1'1'
Your Child's 3-Day Diet and Nutrition History • • • • 163
Picp. History Form. • • • • . • • • • • • • • • • 168
Record of Height, Weight, Chest Circumference, Hip
Width, and Left Calf Circumference, With Hemo
globin, Hematocrit, and Mean Corpuscular Hemo
globin Concentration (MCHC), for Children 18
Months Through 6 Years of Age. • . • • 171
REFERENCES. • - . 172
'! •
VITA •••••• 179
vii
LIST OF TABLES
Table Page
1. Subjects With a P9sitive Pica History Compared With Non-
pica History According to Age Groups. • • • • • . • .• 66
2. Chi -Square Table Illustrating the Significance of the Dif
ference in the Incidence of Pica Between Utah Study Sub
jects and Three Regional Reports of Pica Practices
Among White Children. • • • • • • • • • " • • • • •• 67
3. Chi -Square Table Illustrating the Significance of th~ Dif
ference in the Incidence of Pica Between Utah Study Sub
jects and Three Regional Reports of Pica Practices
Among White Children. • • • • • • • • • • • • • • 68
4. Chi -Square Table Illustrating the Significance of the Dif
ference in the Incidence of Pica Between Utah Study Sub
jects and Three Regional Reports of Pica Practices
Among White Children. • • • • • • • • • • • • • • 69
5. Pearson Product-Moment Correlations Demonstrating the
Relationship Between Hematological Variables and Dietary
Nutrients for the Sample Children. • • • • • • • • . 70
6. I.,-tests of Five Body (Anthropometric) Measurements for
Pica and Non-pica Subjects. • • • • • • • • • • • • 72
7. Total Incidence of Pica by Age Groups According to Sex • 74
8. Mean Age at Onset of Pica and Mean Age the Activity
Ceased by Age Groups • • • • . ~ • . • • • • • 75
9. Mean Duration of Pica Activity by Age Groups • • • 76
10. Total Incidence of Pica by Age Groups According to
Ethnicity. • • • • • • • • • • • • • • • • • • 77
11. Frequency of Types of Pica Materials Ingested According
to Age Groups • • • • • • • . • • • • • • • • • , • • • 79
Table Page
12. Distribution of Subjects With Pica According to the Types of
Materials Ingested. , • • .. • • • • • • . • • • • • 80
13. Three -Day Summary Mean Caloric and Selected Nutrient
Intakes by Age Groups. • • .. • • .. • • • • • • . • 81
14. Means, Standard Deviations, and Minimum and Maximum
Values of Dietary Iron for Pica and Non -pica Subjects • 83
15. Means, Standard Deviations, and Minimum and Maximum
Values of Dietary Iron for the Subjects According to
Sex Grouping. • 84
It .. • .. • • • • • • • • • • • • •
16. Percentage of Subjects With Pica Activity Meeting or Ex
ceeding 1974 RDA for Dietary Iron and Subjects Below
the RDA for Dietary Iron With Notations of Vitamin or
Mineral Supplementation. • ~ • . • • • • • • • • • 85
17. Percentage of Non-pica Subjects Meeting or Exceeding 1974
RDA for Dietary Iron and Subjects Below the RDA for
Dietary Iron With Notations of Vitamin or Mineral Supple-
mentation. . • • • • • 86
Co • • • • • • • • • • • • • ••
18. Pica Subjects Deficient in SpecifiC Nutrients • • • 87
19. Non ... pica Subjects Deficient in Specific Nutrients • • 87
20. Specific Nutrient Deficiencies and Non -food Substances
Ingested by Pica Subjects According to Age Groups. • 89
21. Table of Blood Values: Hemoglobin, Microhematocrit, and
MCHC, for Children One and One-half Through Six Years
of Age. ~ ~ 90
Cit Ii Ii Ii • • • 10 • • • • • • • • • • • •
22. Means, Standard Deviations, and Minimum and Maximum
Values of Hemoglobin, Hematocrit, and MCHC for All
Subjects by Specific Category.. • • • . • • • • • • • 91
23. Distribution of Hematological Findings for Pica Group. . 92
24. Hematological Findings for Pica Group According to Per-
centage of Subjects .. • .. • .. • . • • • • • • • .. . • 93
25. Distribution of Hematological Findings for Non -pica Group.. 93
ix