INVISIBLE CRISIS: PILOT ASSESSMENT REVEALS OVERLAPPING MALNUTRITION IN INDIGENOUS PRESCHOOLERS OF RURAL PERU

Abstract

Introduction: This pilot case study addresses a knowledge gap in the comprehensive nutritional assessment of children in remote indigenous communities of Peru – communities where existing nutritional surveillance programs seldom reach and where evidence on the coexistence of multiple forms of malnutrition remains scarce. Objectives: The objective of this study is to assess the nutritional status (including anemia and anthropometry), feeding practices, and food sourcing among children (n=12) aged 3-6 years attending a pre-kindergarten program in the high-altitude Maras district of Cusco, Peru. Methods: Our protocol included altitude-adjusted hemoglobin assessment, anthropometric measurements (weight and height), 24-hour dietary recalls, direct observation of food preparation, and food source mapping. Traditional surveillance programs rarely reach geographically isolated indigenous communities, and even less frequently apply multidimensional assessments capable of capturing the coexistence of undernutrition and overnutrition – both of which were documented in this study. Results: Findings reveal multiple coexisting forms of malnutrition: 58% of the participants presented anemia, one third showed stunting, and another third were overweight. Notably, 25% presented with simultaneous anemia and stunting, and 14% with concurrent anemia and excess weight, prevalence rates higher than the national average. Although caloric intake was adequate (122.6% of requirements), the dietary pattern showed qualitative deficiencies, characterized by low iron bioavailability and limited consumption of animal-source foods. Conclusions: This study documents the coexistence of stunting, anemia, and excess weight among preschool children in a remote indigenous community of the high-altitude Maras district, while demonstrating the necessity of multidimensional nutritional assessments in remote indigenous communities.