# Introduction utrition plays a key role in health and development of an individual. Good nutrition protects the infants, the children and the mother, strengthens the immune system and reduces the risk of non communicable diseases related to foods. It also enhances the productivity of the population and can help to get out gradually from the vicious circle of poverty and hunger (UNICEF, 2011). The nutritional needs of an individual require the consumption of balanced diet. However, not everyone has access to optimal feeding. Inappropriate food habits linked to poor nutrients intakes are unable to cover nutrients needs of the body, leading to malnutrition (Baneko, 2008). Malnutrition is then a result of less or excess of one or more nutrients (FAO, 2003). In all its forms it has serious health consequences and now, there is a double burden of malnutrition especially in developing countries. According to FAO (2006), more than 3.5 billion people are suffering in the world, for malnutrition and hunger. Each year, almost 9 million deaths of children fewer than 5 years, estimated from 33 to 56% are attributable to malnutrition (UNICEF, 2011). Malnutrition if not control at the youngest age will lead to chronic diseases at adulthood. Schoolchildren are also one of groups severely affected by malnutrition, after infants and young children. Long term poor eating habits affect lifestyle and cause related chronic diseases including obesity, diabetes, cardiovascular diseases and some cancers (Kobayassi et al., 2010). In recent years, obesity has become prevalent not only among adults but also in children in Japan (Kouda et al., 2004). Those who are obese in childhood tend to remain obese as adults (Freedman et al., 2005;Guo et al., 2000;Fried et al., 2005;Whilhok et al., 2005). When children are overweight, they are more likely to develop metabolic syndrome later in life (Vanhaha et al., 1998). Furthermore, the longer individuals rae overweight, the greater their risk of cardiovascular diseases (Baker et al., 2005). Various factors contribute to obesity, including physical inactivity, an irregular and unbalanced diet, and over-eating (Sugiura et al., 2007). Dietary habits are formed during childhood (Mikkala et al., 2005). To prevent adult obesity, it is desirable that individuals acquire appropriate dietary habits in childhood. Habitual dietary intake among children should be assessed to evaluate childhood dietary problems, enabling the correction of any bad dietary habits malnutrition consequences comprising essentially, the impairment of cognitive, and learning capacities resulting in the quickly and early drop out from school (Alaimo et al., 2001;Sanokho, 2005, Victoria et al., 2008). In Cameroon, despite the quantity and diversity of food resources, populations are not exempt to nutritionals problems (PAM, 2007). According to statistics from the Department of Public Health, the prevalence of stunting among children under five rose from 23% in 1991 to 32% in 2004. Malnutrition is implicated in more than 50% of infant mortality. Deficiencies in vitamin A and iron affect respectively 38% and 58% of children under 5 years (EDSCIII, 2004). Beyond the age of 5 years there is very little information on child malnutrition in Cameroon. Available data concerns preschool children nutritional status and feeding (Kana Sop et al., 2008, Kana Sop et al., 2011), ( D D D D ) K very little work was carried on school age children (Ponka et al., 2006). This work was thus initiated to assess the nutritional status of the population of children in Makèpè Missokè in order to contribute to the optimization of food and nutrition security in this locality. # II. # Materials and Methods # a) Study Area The study took place in Douala. Douala is the most popular city of Cameroon (with 14.4% of the Cameroonian's population, which is 2,510,283 inhabitants) (CRTV news, 2010)). Makèpè Missokè is one of the poorest sub-quarter or locality of Douala according to AFEF (2011). # b) Subjects Recruitment All the children (6-14 years of age, n = 255) were registered at the Bilingual Confidence Primary School of Makèpè Missokè and enrolled in anthropometrics measurements. Ninety nine of them were randomly selected for serum albumin determination. A sub-sample of 25 children (8 females and 17 males), Representing about 10% of the sample size, were involved in 3 day Weighed food records. The study was approved by the Cameroon National Ethics committee. The study aim and methods were explained orally, and written informations were provided to all parents/guardians (i.e., the person whose prepared the child's were enrolled). Then, the parents/guardians provided their written informed consent. # c) Weight Measurements Using Salter scale (1 -120 Kg Cap, AMSUA at 0, 01 Kg), subjects were made to stand on the platform without touching anything. Shoes were removed. Readings were taken to the nearest 0.2Kg. Weighing was done when the stomach was virtually empty. # d) Height Measurements The children were made to stand without shoes on the platform of the vertical toise. The head erect comfortably was held in the same vertical plane as the external auditory meatus. The head piece was then lowered gently, crushing the hair and making contact with the top of the head. Readings were taken to the nearest 0.5 cm. # e) Biochemical Analyses Blood samples were collected only on children whose parents gave their consent and signed the inform consent form. Thus, blood samples of 99 children were taken on an empty stomach in the morning between 8 and 10 h. Approximately 2 ml of venous blood were collected from each child. The blood collected was introduced in dry tubes and sent to the biochemistry laboratory at the University of Douala. Centrifugation of the blood was performed using a Sigma 2-6 E centrifuge type at the speed of 3600 x g for 20 min. This technique serum (supernatant) was extracted using a micropipette "eppendorf" (1000 mL) and introduced into cryotubes (1.2 mL). The serum obtained was then used to determine the albumin content. f) Food Intakes Three days weighed food records were conducted during a week. Foods intakes of children was quantified by using household weighing measuring tools, such as standard measuring cups and spoons, ruler for Measuring dimensions. We help children parents and guardians to fill the form detailing each menu according to breakfast, lunch, dinner, or snack in each investigation day. We determined the child's daily intake of food items by weighing their meal before an after each meal. We then calculated the nutrient intake for each child using the nutrients composition of dishes consumed in Douala of Kana Sop et al., 2008 and other item present in Nutrisurvey software. We defined food as not only a single food item (e.g., banana) but also as a mixed dish (e.g., banana stew). We calculated the composition of nutrients in the food per 100 g. For even the coating data sheets, we had the help of investigators trained for the occasion. # g) Anthropometric Analyses Data from anthropometric measurements were analyzed using WHO (2007) standard references. Nutritional state indicators used were Body Mass Indices (BMI) for age, weight for age, height for age Zscores. By the use of the indicator's above Z-score results, percentages of stunted, wasted, overweight and normal children were calculated. The overall prevalence rates of malnutrition were obtained by setting the threshold of normality to -2 z-scores below the baseline average for indicators P/A and T/A and 2 z-scores above the average reference indicator for BMI/A. Serum albumin concentrations of the children were compared according to their nutritional status. Food composition tables published by Kana Sop et al. (2008) and Nutrisurvey 2007 software were used to calculate and estimate the energy and micronutrients intakes of dishes consumed by any of the enrolled subjects. The results then were compared with the requirement or daily recommended values. We used two methods to develop the list of food types. First, we used the method reported by Block et al., 1998 and modified by Kobayashi el al (2010) and ranked all of the reported food types according to the contribution analysis. We were especially interested in the total energy, protein and calcium, magnesium, phosphor, zinc, copper and iron. The percentages were calculated by dividing the nutrient contents of each food type by the total nutrient amounts. All of the food types that contributed at least 0.15% to the total energy and nutrients were combined. In addition, we excluded food types eaten by fewer than 15 subjects. # III. # Statistical Analyses Mean and standard deviation of the height and weight measurements and serum albumin concentration were determined using Graph pad prism version 5. Significance was considered with p? 0.05. # IV. # Results and Discussions In this study, male sex was the most represented with 136 boys against 119 girls. Sixty seven percent (67%) of children live in families with at least five individuals. In addition, nearly 78.6% of mothers of investigated children had primary level of education against only 21.4% for secondary school level and beyond (table 1). Table 2 shows mean weights and heights of the children ranged from 19.2 ± 3.1 to 36.5 ± 8.0 kg and 108.7 ± 5.3 to 143.6 ± 7.8 cm respectively. Evolution of height and weight of these children shows that there growth faltering in many cases (table 2). Prevalences of various nutritional disorders encountered in the study population were 18.0 % for stunting, 5.1 % for underweight and 1.6 % for overweight (table 3). These prevalences were much lower than those of children under 5 years in Cameroon according to the ESDCIII (2004). These results showed a decrease of nutritional disorders with age in Cameroon. No significant difference (p> 0.05) between age of children suffering from stunting (9.5 ± 1.8 years), low weight (10.2 ± 2.4 years) and overweight (9.0 ± 1.4 years) were observed. From the children suffering from nutritionals disorders, height and weight were lower than that of normal children. On the number of children with wasting and overweight, girls were most affected with respectively 53.84 and 75% of cases (Table 4). The content of serum albumin of children who are underweight was the lowest (31.2 ± 2.9 g / l) and below standard (35-55 g/l) recommended by the assay method (table 4). Serum albumin levels of all children except of those suffering of wasting were in the normal range (table 4). Boys took between 89.5% and 100.6% of their daily energy requirement and girls between 100.9% and 114.1%. Mean daily protein intake of the Children was above 50% for all the children. However their daily calcium, magnesium, potassium, zinc, and iron intakes were below the daily requirement values. Copper intakes of 10-12 years children were above requirement for all the two sexes. The food type intake frequencies were classified into many levels linking consumption mode. For example, we used seven (i.e., everyday, 5-6 times per week, 3-4 times per week, 1-2 times per week, 2-3 times per month, 1 time per month, or never); eight ("2-3 times per day" was added to seven categories); nine ("4-5 times per day" was added to eight categories) and eleven ("8-10 times per day", "6-7 times per day" were added to nine categories) according to general intake frequency of each food type. The estimation of portion size was classified into six categories referring to the photographs in full-scale size; that is, one-third, one-half, the same amount, 1.5 times, twice, and other. It was observed that children diet was very monotonous. Stunting and falter growth observed may be due to poor knowledge on optimal feeding. Intakes of nutrients estimated by weighed foods dairy record (WDR) showed very insufficient coverage of daily needs apart for energy. We used weighed foods dairy record (WDR) for easy estimation of nutrients intakes. WDR is quantified either by weighing or determining volumes using a household measuring tool, such as standard measuring cups and spoons, and a ruler for measuring dimensions. Usually, general WDR performers weigh the raw ingredients (Buzzard, 1998), but we were interested by the weight of eaten portions of the meals. We used a digital cooking scale as an index of the size of the dish. Energy, protein, was calculated directly. To obtain the necessary open-ended data from children, we conducted our WDR personally. Even if energy needs were meeting globally, the recipes were imbalanced in tem of macronutrients contribution to energy intakes. The fact that in this study, male group was the most represented with 136 boys against 119 girls may be linked to ignorance. Girls are always in high number than boys in our society. However, girls drop out from school earlier to help household activities. In poor families, when funds lack, parent preferred to send boys at school (ESDCIII, 2004). Sixty seven percent (67%) of children live in families with at least five individuals and this condition was linked to poor growth. The number of children and the family size was inversely correlated malnutrition indicators. According to Emel et al., (2005) household size has a very big influence on young children nutritional state. There is therefore competition on the household's financial resources which could affect the nutritional status of children living in poorest families were also most malnourished. According to Madginzira et al., (1995), the educational level of mothers is very important especially when living conditions are difficult. Poverty and malnutrition form a vicious cycle. Poverty prevents individuals to access good nutrients sources. For example, meat, fishes and animal foods sources are very rich in bioavailable minerals, but it is very inaccessible to poor population. They are forced to consume mainly vegetal foods that contain many antinutritional substances that inhibit micronutrients bioavailability and sometimes micronutrients digestibility. Illiteracy is another underlying factor of poor feeding. Individuals in these cases are limited in knowledge and cannot master optimal feeding. It is well known that those stunted children would have poor school result as they may be usually ill. Malnourished children tend to start school later, progress less rapidly, have lower attainments, and perform less well on cognitive achievement tests, even into adulthood. These indirect effects of malnutrition on productivity are substantially more than the direct effects of height on schooling and hiring. Malnourished children may receive less education than their well-nourished peers for a number of reasons. Caregivers may invest less in their education or schools may use physical size as a rough indicator of school readiness, and thus bar children of short stature from entering school at the appropriate age. Malnourished children are also sick more often and so absent more often, and learn less well when they are in school. Studies showed that delayed entry to school leads to lower expected lifetime earnings because of fewer years in the workforce (Behrman et al., 2004). In addition to its impact on adult productivity through less schooling, severe malnutrition also affects learning capacity or cognitive development directly, with consequent impact on schooling productivity and labor productivity. Birth weight and breast-feeding both correlate with cognitive development; malnourished children perform poorly on cognitive tests, have poorer psychomotor development and fine motor skills, have lower activity levels, interact less frequently with their environments and fail to acquire skills at normal rates (Grantham- McGregor et al., 1999). Stunting prevalences were still high in these group affecting mostly boys. Similar results were found by Wamani et al. (2007) in Congo, in children less than 5 years. In fact, malnutrition that start during preschool age is usually not corrected among affected children that are exposed to the same food habits. However, the stunting rate is lower than those found in preschool infant (ESDC, 2004). As indicated earlier, growth deficits in the first 2 to 3 years of life are only partially regained during childhood and adolescence, particularly when children remain in poor environments. Stature at age 3 is strongly correlated with attained body size in adulthood in several countries (Martorell et al., 1994;Simondon et al., 1998). Actions need to be taken because affected children may have poor scores in school and are more exposed to diseases. The synergy between malnutrition and infectious diseases is well established (Schrimshaw et al., 1968). In a widely quoted study, Pelletier et al. (1995) estimated that 56% of child deaths can be attributed to the potentiating effect of malnutrition (including low birth weight), with most of those deaths linked to mild or moderate malnutrition, rather than severe malnutrition. Although severely malnourished children are more likely to die, they are far fewer in number. Children with mild, moderate or severe malnutrition would be, respectively, 2.5, 4.6 and 8.4 times more likely to die than children whose weights are within the normal range for their ages. Not only a significant proportion of child can deaths from common infectious diseases be attributed to malnutrition (measles, 44.8 %; malaria, 7.3 %; diarrhea, 60.7 %; and pneumonia, 52.3 %) but malnutrition also increases the likelihood of having an attack of malaria, diarrhea or pneumonia (but not measles) (Caulfield et al., 2004). There is also increasing evidence that fetal malnutrition predisposes to the metabolic syndrome later in life (Barker, 1998). This result suggests that boys recover less of their growth retardation with age. The contents of serum albumin of children who were underweight were low (31.2 ± 2.9 g / l) and below standard (35-55 g / l) (table 4). Serum albumin levels of Coverage of energy by boys ranging between 89.5% and 100.6% of their daily energy requirement where lower than those of girls, ranging between 100.9% and 114.1%. This may be explained by the fact that girls eat more frequently than boys. No matter the age group considered, girls energy intake was above WHO (1985) and FAO (1990) standard. This observation could be due to the high number of snack found in their diaries. Most of their proteins intakes were from plant foods but there are some good nutritionally combinations they make in the area that can help in improving the quality of their protein intake. For example, plant foods like beans were being prepared with animal foods like dried fish. Vegetables and cereals were usually blended together in their meals and this combination gives protein of very high quality. Calcium, magnesium, potassium, zinc and iron intakes were low in the diet of these children. The problem with micronutrients like calcium, iron, zinc, magnesium and copper from plant sources is poor bioavailability because of phytates and fibres contains of plants ( Kana Sop et al., 2008Kana Sop et al., 2012). Another explanation of the low intake of minerals was poor consumption of vegetables and fruits, poor consumption of animal foods and practices in preparations process in the area (these include, reheating of vegetables in meals several times before consumption, fruits and vegetables of exposure to some degree of sun-drying before eating). This study highlights types and causes of nutritional problems in the area of Makèpè Missokè. Stunting, wasting and overweight were the physical forms of malnutrition identified in that area. Besides macronutrients, there were poor intakes of micronutrients due to inappropriate feeding linked to poor knowledge of available foods and poverty. The solution therefore remains the intensification of nutrition education, dietary diversification and fortification, optimal processing, post harvest improvement in storage and handling techniques. ![those affected by wasting were in the normal range. However, the children suffering from nutritionals disorders have their heights and weights lower than those of normal children. This decrease was also reported byDiouf et al., 2000; Simpore et al., 2009 in children suffering from severe malnutrition, and Yapi et al., (2010) among children under 5 years suffering from moderate or minor malnutrition.](image-2.png "") 1ParametersEffectiveFrequency (%)SexMale13653.3Female11946.7Age (years)6-1016363.910-14 years923.1Size of household< 5 persons8433? 5 persons16867Mothers instruction level252Primary19878.6Secondary and beyong5421.4M= Male; F= female, SD= Standard Deviation 20132YearVolume XIII Issue II Version ID D D D ) K(Age (years)SexNumberMean weight (± SD) (Kg)Mean height (± SD) (cm)BMI (± SD) (Kg/m²)6M1119.2 ± 3.1110.2 ± 6.315.7 ± 1.9F918.3 ± 2.6108.7 ± 5.315.2 ± 2.67M1422.5 ± 3.0118.4± 5.516.5 ± 1.2F1821.3 ± 3.5116.5 ± 5.315.3 ± 1.88M2025.4 ± 4.5121.7 ±10.616.8 ± 2.7F2125.8 ± 3.2123.9 ± 4.516.9 ± 1.39M3926.6 ± 3.2126.3 ± 6.917.0 ± 1.9F3127.4 ± 5.2128.6 ± 7.216.2 ± 2.2 3IndicatorsNormal <-2 SD, >+2SDWasting ?-2SDStunting ?-2SDUnderweight ?-2SDoverweight ? + 2SDTotalWeight for age94.5 (241)51 (13)-0.4 (1)100 (255)Height for age81.6 (208)-18 (46)0.4 (1)100 (255)BMI for age96.47 (246)--1.96 (5)1.6 (4)100 (255)The numbers in brackets represent the number of subjects. SD= Standard Deviation 4Parameters 5daily needsMacronutrients and micronutrients intake levels were estimated from KanaSop et al. (2008) © 2013 Global Journals Inc. (US) ## Acknowledgements The authors thank responsible of Bilingual Confidence School, parents and children who participated to the study. * Development food insufficiency and American school-aged children's cognitive, academic, and psychosocial KAlaimo CMOlson EAFrongillo Pediatrics 108 2001 * Children bodymass index and the risk of coronary heart disease in adulthood JBaker LOlsen TSorensen N Engl J Med 357 2007 * Potentiel énergétique de trois plats consommés dans quelques restaurants classe moyenne de Douala: Water fufu et sauce éru, Plantain mur et sauce ndolè, Patate et morelle sautée YBaneko 2008 Mémoire de Maitrise en Biochimie, Université de Douala * Mothers, Babies and Health in Later Life DBarker London: Churchill Livingstone 1998 2nd ed. * Global Crisis, Global Solutions. Cambridge JRBehrman HAlderman JHoddinott Bull WHO Lomborg B 73 4 1995 Hunger and malnutrition * A data-based approach to diet questionnaire design and testing GBlock AMHartman CMDresser MDCarroll JGannon LGardner Am J Epidemiol 124 1986 * 24-hour dietary recall and food record methods MBuzzard Nutritional epidemiology 1998 Oxford University Press * Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles LECaulfield MDe Onis MBlossner Am J Clin Nutr 80 2004 * CRTV News of 15/04/2010. Statistics on population in 2010 Cameroon * La malnutrition protéino-calorique chez les enfants de moins de 5 ans en zone rurale sénégalaise (Khombole) SDiouf ADiallo BCamara Med Afr N 47 5 2000 * Institut national de la statistique Edsciii 12/05/2012 Site web 2004 * Prévalence of anémia and risk factors among school children in Istanbul GEmel YInci CTiraje Guneycan ASemra AhmetASima GSerdar C J. Trop pediatr 51 2005 * Ciblage et amélioration de la nutrition Fao 2003 107 Rome, Italie Moyen d'évaluer le statut nutritionnel * The state of food insecurity in the World. Eradicating world hunger taking stock ten years after the World Food Summit Rome Fao 2006 Italia * Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood AField NCook MGillman Obes Res 13 2005 * The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study DFreedman LKhan MSerdula WDietz RSrinivasan GBerenson Pediatrics 115 2005 * Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life. Low birthweight, breastfeeding and protein-energy malnutrition SGrantham-Mcgregor LFernald KSethuraman Food Nutr Bull 20 1999 * Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposity: the Fels Longitudinal Study SSGuo CHuang LMMaynard EDemerath BTowne WCChumlea RMSiervogel Int J Obes Relat Metab Disord 24 2000 * Mineral content in some Cameroonian household foods eaten in Douala KanaSop MMGouado ITeugwa MMiro SFotso MTetanye E African Journal of Biotechnology 7 17 2008 * Young children feeding and zinc levels of complementary foods in western cameroon AJFFAND KanaSop MMKikafunda JKMeli FCGouado IZollo PhaOberleas D ETetanye 2011 4 * Tetanye Ekoe. Trace elements in foods of children from Cameroon: A focus on zinc and phytates content KanaSop MMGouado IMananga MDjeukeu WA AmvamZollo PHOberleas D J Trace Elem Med Biol 26 2012. 2012 * Development of a food frequency questionnaire to estimate habitual dietary intake in Japanese children TKobayashi STanaka TToji HShinohara MKamimura NOkamoto SImai MFukui IDate Nutrition Journal 9 2010 * Trends in levels of cholesterol in Japanese children from 1993 through KKouda HNakamura RTokunaga HTakeuchi J Epidemiol 14 2004. 2001 * Malnutrition in children under five in Zimbabwe: effect of socioeconomic factors and disease NMadzingira Soc. Biol 42 3-4 1995 * Reversibility of stunting: epidemiological findings in children from developing countries RMartorell KLKhan DGSchroeder Eur J Clin Nutr 52 S1 1994 * Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study VMikkilä LRäsänen OTRaitakari PPietinen JViikari Br J Nutr 93 2005 * Analyse globale de la sécurité alimentaire et de la vulnérabilité Pam 2007 République au Cameroun, P.9 * The effects of malnutrition on child mortality in developing countries DLPelletier EAFrongilloJr DGSchroeder JPHabicht World Health Organization 1968 * Composition of dishes consumed in Cameroon RPonka EFokou MFotso FMbiapo-Tchouanguep RLeke JSouopgui MAchu-Bih International Journal of Food Science and Technology 41 2006 * Enquête nutritionnelle dans les quatre groupes scolaires de la commune urbaine de ke-macina MYSanokho 2005 99 Pharmacie et d'Odontostomatologie), Université de Bamako Fac médecine Thèse de doctorat en médecine * Interaction of Nutrition and Infection NSSchrimshaw CETaylor JEGordon Monogr Ser 57 2004 Cambridge University Press * Preschool stunting, age at menarche and adolescent height: a longitudinal study in rural Senegal KSimondon FSimondon ASimon Eur J Clin Nutr 52 1998 * Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola JSimpore FKabore FZongo Nutr J 5 2009 * Risk of life-style related diseases in young children RSugiura MSakamoto MMurata Jpn J Nutri Diete 65 2007 * La malnutrition responsable de la moitié des décès. www.unicef.fr/la-malnutritionresponsable-de-la-moitie-des-deces-d'enfants Unicef 2011. 05/03/2011 * Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study MVanhala PVanhala EKumpusalo PHalonen JTakala BMJ 3 1998 * Maternal and child undernutrition: consequences for adult health and human capital CGVictoria The Lancet 371 2008 * Facteurs prédictifs de la malnutrition chez les enfants âgés de moins de cinq ans à Lubumbashi (RDC) MMWamami 2007 Université de Lubumbashi École de Santé Publique * Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force EPWhitlock SBWilliams RGold PRSmith SAShipman Pediatrics 116 2005 * Effet des malnutritions mineures et modérées sur les protéines immunitaires inflammatoires et nutritionnelles chez l'enfant en cote d'ivoire. Mali médical 2010 tome XXV n°2 HYapi AYapo DYeo HAhiboh JNguessan MAttoungré DMonnet ADjaman 2010