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BACKGROUND: The rapid rise in obesity rates among school children in Latin America and the Caribbean (LAC) could have a direct impact on the region's physical and mental health, disability, and mortality. This review presents the available interventions likely to reduce, mitigate and/or prevent obesity among school children in LAC by modifying the food and built environments within and around schools. METHODS: Two independent reviewers searched five databases: MEDLINE, Web of Science, Cochrane Library, Scopus and Latin American and Caribbean Health Sciences Literature for peer-reviewed literature published from 1 January 2000 to September 2021; searching and screening prospective studies published in English, Spanish and Portuguese. This was followed by data extraction and quality assessment using the Cochrane risk-of-bias tool (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), adopting also the PRISMA 2020 guidelines. Due to the heterogeneity of the intervention's characteristics and obesity-related measurements across studies, a narrative synthesis was conducted. RESULTS: A total of 1342 research papers were screened, and 9 studies were included; 4 in Mexico, and 1 each in Argentina, Brazil, Chile, Colombia, and Ecuador. Four studies reported strategies for modifying food provision; four other targeted the built environment, (modifying school premises and providing materials for physical activity); a final study included both food and built environment intervention components. Overall, two studies reported that the intervention was significantly associated with a lower increase over time in BMI/obesity in the intervention against the control group. The remaining studies were non-significant. CONCLUSIONS: Data suggest that school environmental interventions, complementing nutritional and physical education can contribute to reduce incremental childhood obesity trends. However, evidence of the extent to which food and built environment components factor into obesogenic environments, within and around school grounds is inconclusive. Insufficient data hindered any urban/rural comparisons. Further school environmental intervention studies to inform policies for preventing/reducing childhood obesity in LAC are needed.
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Obesidad Infantil , Niño , Humanos , América Latina/epidemiología , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Obesidad Infantil/psicología , Estudios Prospectivos , Región del Caribe/epidemiología , Estudiantes , PolíticasRESUMEN
BACKGROUND: Zinc-biofortified potatoes have considerable potential to reduce zinc deficiency because of their low levels of phytate, an inhibitor of zinc absorption, and their high consumption, especially in the Andean region of Peru. OBJECTIVES: The purpose of this study was to measure fractional and total zinc absorption from a test meal of biofortified compared with regular potatoes. METHODS: We undertook a single-blinded randomized crossover study (using 67Zn and 70Zn stable isotopes) in which 37 women consumed 500-g biofortified or regular potatoes twice a day. Urine samples were collected to determine fractional and total zinc absorption. RESULTS: The zinc content of the biofortified potato and regular potato was 0.48 (standard deviation [SD]: 0.02) and 0.32 (SD: 0.03) mg/100 g fresh weight, respectively. Mean fractional zinc absorption (FZA) from the biofortified potatoes was lower than from the regular potatoes, 20.8% (SD: 5.4%) and 25.5% (SD: 7.0%), respectively (P < 0.01). However, total zinc absorbed was significantly higher (0.49; SD: 0.13 and 0.40; SD: 0.11 mg/500 g, P < 0.01, respectively). CONCLUSIONS: The results of this study demonstrate that biofortified potatoes provide more absorbable zinc than regular potatoes. Zinc-biofortified potatoes could contribute toward reducing zinc deficiency in populations where potatoes are a staple food. This trial was registered at clinicaltrials.gov as NCT05154500.
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Desnutrición , Solanum tuberosum , Humanos , Femenino , Zinc , Perú , Estudios Cruzados , Alimentos Fortificados , IsótoposRESUMEN
BACKGROUND: Yellow-fleshed potatoes biofortified with iron have been developed through conventional breeding, but the bioavailability of iron is unknown. OBJECTIVES: Our objective was to measure iron absorption from an iron-biofortified yellow-fleshed potato clone in comparison with a nonbiofortified yellow-fleshed potato variety. METHODS: We conducted a single-blinded, randomized, crossover, multiple-meal intervention study. Women (n = 28; mean ± SD plasma ferritin 21.3 ± 3.3 µg/L) consumed 10 meals (460 g) of both potatoes, each meal extrinsically labeled with either 58Fe sulfate (biofortified) or 57Fe sulfate (nonfortified), on consecutive days. Iron absorption was estimated from iron isotopic composition in erythrocytes 14 d after administration of the final meal. RESULTS: Mean ± SD iron, phytic acid, and ascorbic acid concentrations in iron-biofortified and the nonfortified potato meals (mg/per 100 mg) were 0.63 ± 0.01 and 0.31 ± 0.01, 39.34 ± 3.04 and 3.10 ± 1.72, and 7.65 ± 0.34 and 3.74 ± 0.39, respectively (P < 0.01), whereas chlorogenic acid concentrations were 15.14 ± 1.72 and 22.52 ± 3.98, respectively (P < 0.05). Geometric mean (95% CI) fractional iron absorption from the iron-biofortified clone and the nonbiofortified variety were 12.1% (10.3%-14.2%) and 16.6% (14.0%-19.6%), respectively (P < 0.001). Total iron absorption from the iron-biofortified clone and the nonbiofortified variety were 0.35 mg (0.30-0.41 mg) and 0.24 mg (0.20-0.28 mg) per 460 g meal, respectively (P < 0.001). CONCLUSIONS: TIA from iron-biofortified potato meals was 45.8% higher than that from nonbiofortified potato meals, suggesting that iron biofortification of potatoes through conventional breeding is a promising approach to improve iron intake in iron-deficient women. The study was registered at www. CLINICALTRIALS: gov as Identifier number NCT05154500.
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Hierro , Solanum tuberosum , Humanos , Femenino , Isótopos de Hierro , Perú , Alimentos Fortificados , Sulfatos , Disponibilidad BiológicaRESUMEN
OBJECTIVES: Consumption of sugar sweetened beverages (SSB) is associated with childhood obesity and other negative health conditions. Feeding SSB to infants and young children (IYC) under 2 years may displace consumption of breastmilk and nutrient rich foods critical for optimal growth and development. The World Health Organization (WHO) recommends avoiding added sugar (e.g. SSB) for IYC under 2 years. We sought to describe the variety of homemade and commercial SSB as well as breastmilk and beverages without added sugar fed to IYC aged 4-23 months living in a low-income, populous peri-urban area of Lima, Peru. METHODS: A cross-sectional survey was conducted with 181 households with IYC aged 4-23 months. A list of common local homemade and commercial beverages was used to investigate what caregivers had fed to the child in the past 24 h. RESULTS: A total of 93.9% of caregivers reported feeding at least one beverage to their child other than breastmilk in the past 24 h. This included a variety of homemade SSB (73.5%), commercial SSB (18.2%) and homemade beverages without added sugar (70.2%). A high percentage (83.4%) of children were also breastfed. CONCLUSIONS FOR PRACTICE: Our findings suggest that interventions to address feeding homemade SSB to IYC within households are needed to support WHO recommendations and complement current commercial SSB policy regulations in Peru.
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Obesidad Infantil , Bebidas Azucaradas , Femenino , Niño , Humanos , Lactante , Preescolar , Lactancia Materna , Cuidadores , Perú , Estudios Transversales , Bebidas , Azúcares , CarbohidratosRESUMEN
OBJECTIVES: Peruvians are experiencing rapid dietary and lifestyle changes, resulting in a phenomenon known as the "dual burden of disease." A common manifestation of the dual burden in individuals is the co-occurrence of overweight and anemia. Despite recent initiatives introduced to address these concerns, rates continue to be public health concerns. This study investigates the relationship between immune activation and lack of response to iron supplementation after 1 month of treatment and explores variation in body fat stores as a potential moderator between immune function and response to treatment. METHODS: Data come from children, aged 2-5 years (n = 50) from a peri-urban community in Lima, Peru. Multivariate logistic regression models were used to explore the associations between response to treatment (Hb > =11.0 g/dl) after 1 month of treatment), markers of immune activation (C-reactive protein [CRP] and reported morbidity symptoms), and measures of body fat (waist-to-height ratio, triceps skinfold thickness, and body mass index [BMI]). RESULTS: We found that high CRP is associated with a lack of response to iron supplementation after 1 month of treatment and that BMI z-score may moderate this association. Generally, larger body size is associated with response to iron supplementation whether or not the children in this sample have high immune activation. However, the probability of anemic children responding to iron supplementation treatment differed across adiposity measures. CONCLUSIONS: Our finding suggesting that adiposity and CRP influence response to iron supplementation, furthers our understanding of the relationship between inflammation and anemia treatment in children and has both theoretical and public health implications.
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Adiposidad/fisiología , Anemia Ferropénica , Hierro , Anemia Ferropénica/complicaciones , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/epidemiología , Proteína C-Reactiva/análisis , Preescolar , Costo de Enfermedad , Suplementos Dietéticos , Femenino , Humanos , Inflamación/sangre , Inflamación/complicaciones , Inflamación/epidemiología , Hierro/administración & dosificación , Hierro/sangre , Hierro/uso terapéutico , Masculino , Obesidad Infantil/complicaciones , Obesidad Infantil/epidemiología , PerúRESUMEN
BACKGROUND: Sweetpotato and potato are fast-maturing staple crops and widely consumed in low- and middle-income countries. Conventional breeding to biofortify these crops with iron could improve iron intakes. To our knowledge, iron absorption from sweetpotato and potato has not been assessed. OBJECTIVE: The aim was to assess iron absorption from regular and iron-biofortified orange-fleshed sweetpotato in Malawi and yellow-fleshed potato and iron-biofortified purple-fleshed potato in Peru. METHODS: We conducted 2 randomized, multiple-meal studies in generally healthy, iron-depleted women of reproductive age. Malawian women (n = 24) received 400 g regular or biofortified sweetpotato test meals and Peruvian women (n = 35) received 500 g regular or biofortified potato test meals. Women consumed the meals at breakfast for 2 wk and were then crossed over to the other variety. We labeled the test meals with 57Fe or 58Fe and measured cumulative erythrocyte incorporation of the labels 14 d after completion of each test-meal sequence to calculate iron absorption. Iron absorption was compared by paired-sample t tests. RESULTS: The regular and biofortified orange-fleshed sweetpotato test meals contained 0.55 and 0.97 mg Fe/100 g. Geometric mean (95% CI) fractional iron absorption (FIA) was 5.82% (3.79%, 8.95%) and 6.02% (4.51%, 8.05%), respectively (P = 0.81), resulting in 1.9-fold higher total iron absorption (TIA) from biofortified sweetpotato (P < 0.001). The regular and biofortified potato test meals contained 0.33 and 0.69 mg Fe/100 g. FIA was 28.4% (23.5%, 34.2%) from the regular yellow-fleshed and 13.3% (10.6%, 16.6%) from the biofortified purple-fleshed potato meals, respectively (P < 0.001), resulting in no significant difference in TIA (P = 0.88). CONCLUSIONS: FIA from regular yellow-fleshed potato was remarkably high, at 28%. Iron absorbed from both potato test meals covered 33% of the daily absorbed iron requirement for women of reproductive age, while the biofortified orange-fleshed sweetpotato test meal covered 18% of this requirement. High polyphenol concentrations were likely the major inhibitors of iron absorption. These trials were registered at www.clinicaltrials.gov as NCT03840031 (Malawi) and NCT04216030 (Peru).
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Biofortificación , Ipomoea batatas/metabolismo , Hierro/administración & dosificación , Solanum tuberosum/metabolismo , Adulto , Transporte Biológico , Dieta , Femenino , Análisis de los Alimentos , Alimentos Fortificados , Humanos , Ipomoea batatas/química , Hierro/química , Hierro/metabolismo , Malaui , Perú , Solanum tuberosum/química , Adulto JovenRESUMEN
OBJECTIVES: To develop an exposure and risk assessment model to estimate listeriosis infection risks for Peruvian women. METHODS: A simulation model was developed utilising Listeria monocytogenes concentrations on kitchen and latrine surfaces in Peruvian homes, hand trace data from Peruvian women and behavioural data from literature. Scenarios involving varying proportions of uncontaminated, or 'clean', surfaces and non-porous surfaces were simulated. Infection risks were estimated for 4, 6 and 8 h of behaviours and interactions with surfaces. RESULTS: Although infection risks were estimated across scenarios for various time points (e.g. 4, 6, 8 h), overall mean estimated infection risks for all scenarios were ≥ 0.31. Infection risks increased as the proportions of clean surfaces decreased. Hand-to-general surface contacts accounted for the most cumulative change in L. monocytogenes concentration on hands. CONCLUSIONS: In addition to gaining insights on how human behaviours affect exposure and infection risk, this model addressed uncertainties regarding the influence of household surface contamination levels. Understanding the influence of surface contamination in preventing pathogen transmission in households could help to develop intervention strategies to reduce L. monocytogenes infection and associated health risks.
OBJECTIFS: Développer un modèle d'exposition et d'évaluation des risques pour estimer les risques d'infection par la listériose chez les femmes péruviennes. MÉTHODES: Un modèle de simulation a été développé en utilisant des concentrations de Listeria monocytogenes sur la surface des cuisines et des latrines dans des foyers péruviens, des données de traces de mains de femmes péruviennes et des données comportementales de la littérature. Des scénarios impliquant différentes proportions de surfaces non contaminées ou «propres¼ et de surfaces non poreuses ont été simulés. Les risques d'infection ont été estimés pour 4, 6 et 8 heures de comportements et d'interactions avec les surfaces. RÉSULTATS: Bien que les risques d'infection aient été estimés pour tous les scénarios à différents moments (par ex. à 4, 6 ou 8 heures), les risques d'infection globaux moyens estimés pour tous les scénarios étaient ≥ 0,31. Les risques d'infection augmentaient à mesure que les proportions de surfaces propres diminuaient. Les contacts entre la main et les surfaces générales contribuent pour le plus de changement cumulatif de la concentration de L. monocytogenes sur les mains. CONCLUSIONS: En plus de comprendre comment les comportements humains affectent l'exposition et le risque d'infection, ce modèle a traité des incertitudes quant à l'influence des niveaux de contamination des surfaces ménagers. Comprendre l'influence de la contamination de surface dans la prévention de la transmission d'agents pathogènes dans les ménages pourrait aider à développer des stratégies d'intervention pour réduire l'infection à L. monocytogenes et les risques associés pour la santé.
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Higiene , Listeria monocytogenes/aislamiento & purificación , Listeriosis/epidemiología , Recuento de Colonia Microbiana/métodos , Recuento de Colonia Microbiana/estadística & datos numéricos , Femenino , Humanos , Perú/epidemiología , Medición de RiesgoRESUMEN
OBJECTIVES: This article explores the optimal iron hypothesis through secondary data analysis of the association between hemoglobin levels and morbidity among children living in Canto Grande, a peri-urban community located on the outskirts of Lima, Peru. METHODS: Risk ratios were used to test whether lower iron status, assessed using the HemoCue B-Hemoglobin System, was associated with an increased relative risk of morbidity symptoms compared to iron replete status, controlling for infant age, sex, weight for height z-score, maternal education, and repeated measures in 515 infants aged 6-12 months. RESULTS: Infants with fewer current respiratory and diarrheal morbidity symptoms had a lower risk of low iron deficiency compared to participants who were iron replete (P < .10). Infants with fewer current respiratory infection symptoms had a statistically significant (P < .05) reduction in risk of moderate iron deficiency compared to infants who were iron replete. CONCLUSION: In this study, morbidity status was not predictive of iron deficient status over a six-month interval period, but nonreplete iron status was shown to be associated with current morbidity symptoms. These results support investigating iron status as an allostatic system that responds to infection adaptively, rather than expecting an optimal preinfection value.
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Diarrea/epidemiología , Deficiencias de Hierro , Estado Nutricional , Enfermedades Respiratorias/epidemiología , Factores de Edad , Diarrea/inducido químicamente , Femenino , Humanos , Lactante , Masculino , Oportunidad Relativa , Perú/epidemiología , Prevalencia , Enfermedades Respiratorias/inducido químicamente , Factores SexualesRESUMEN
BACKGROUND: Seasons affect many social, economic, and biological outcomes, particularly in low-resource settings, and some studies suggest that birth season affects child growth. AIM: To study a predictor of stunting that has received limited attention: birth season. SUBJECTS AND METHODS: This study uses cross-sectional data collected during 2008 in a low-resource society of horticulturists-foragers in the Bolivian Amazon, Tsimane'. It estimates the associations between birth months and height-for-age Z-scores (HAZ) for 562 girls and 546 boys separately, from birth until age 11 years or pre-puberty, which in this society occurs â¼13-14 years. RESULTS: Children born during the rainy season (February-May) were shorter, while children born during the end of the dry season and the start of the rainy season (August-November) were taller, both compared with their age-sex peers born during the rest of the year. The correlations of birth season with HAZ were stronger for boys than for girls. Controlling for birth season, there is some evidence of eventual partial catch-up growth, with the HAZ of girls or boys worsening until â¼ age 4-5 years, but improving thereafter. By age 6 years, many girls and boys had ceased to be stunted, irrespective of birth season. CONCLUSION: The results suggest that redressing stunting will require attention to conditions in utero, infancy and late childhood.
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Estatura , Desarrollo Infantil , Trastornos del Crecimiento/epidemiología , Indígenas Sudamericanos/estadística & datos numéricos , Bolivia/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Trastornos del Crecimiento/etiología , Humanos , Lactante , Recién Nacido , Masculino , Parto , Pubertad , Estaciones del AñoRESUMEN
OBJECTIVE: To investigate changes in dietary diversity and dietary composition among adolescents in four developing countries. DESIGN: We analysed dietary diversity and consumption of seven food groups and foods with added sugars as reported by adolescents from two cohorts growing up 8 years apart, when they were aged about 12 years. SETTING: Ethiopia, India (Andhra Pradesh), Peru and Vietnam in 2006 and 2013. SUBJECTS: Adolescents (n 3659) from the older cohort (OC) born in 1995/96 and adolescents (n 7422) from the younger cohort (YC) born in 2001/02 (N 11 081). RESULTS: Controlling for other factors, dietary diversity increased in Peru (OC=4·89, YC=5·34, P<0·001) and Ethiopia (OC=3·52, YC=3·94, P=0·001). Dietary diversity was stable in India (OC=4·28, YC=4·29, P=0·982) and Vietnam (OC=4·71, YC=4·73, P=0·814); however, changes in dietary composition were observed. YC adolescents were more likely to consume eggs (India: +32 %, P=0·038; Vietnam: +50 %, P<0·001) and milk and dairy (India: +12 %, P=0·029; Vietnam: +46 %, P<0·001). Other notable shifts included meat consumption in Peru (+72 %, P<0·001) and consumption of fruit and vegetables in Ethiopia (+36 %, P<0·001). Compared with OC, the prevalence of added sugar consumption was greater among the YC in Ethiopia (+35 %, P=0·001) and Vietnam (+44 % P<0·001). Between 2006 and 2013, disparities in dietary diversity associated with household wealth and place of residence declined, although this varied by country. No marked gender disparities in dietary diversity were evident. CONCLUSIONS: We found significant changes over time in dietary diversity among adolescents in four countries consistent with the hypothesis of the nutrition transition.
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Dieta , Evaluación Nutricional , Adolescente , Niño , Estudios de Cohortes , Estudios Transversales , Países en Desarrollo , Etiopía , Femenino , Frutas , Humanos , India , Masculino , Carne , Perú , Factores Socioeconómicos , Verduras , VietnamRESUMEN
BACKGROUND: This study's purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <-2 SD) and thinness (BMI-Z <-2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. RESULTS: In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. CONCLUSIONS: Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness.
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Trastornos del Crecimiento/etiología , Saneamiento/estadística & datos numéricos , Abastecimiento de Agua/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Etiopía/epidemiología , Composición Familiar , Femenino , Trastornos del Crecimiento/epidemiología , Humanos , India/epidemiología , Lactante , Masculino , Oportunidad Relativa , Perú/epidemiología , Riesgo , Delgadez/epidemiología , Delgadez/etiología , Vietnam/epidemiologíaRESUMEN
Fruits and vegetables are essential for healthy life. We examined the fruits and vegetables consumption by 240 caregivers and their children aged 1-17 years in peri-urban Lima, and the ways that they were incorporated into local cuisine. A randomized cross-sectional household survey collected information on the weight of all foods eaten the previous day (24 h) including fruits and vegetables, their preparation and serving sizes. Fruit and vegetable consumption was low and very variable: fruit intake was mean 185.2 ± 171.5 g day-1 , median 138 g day-1 for caregivers and 203.6 ± 190.6 g day-1 and 159 g day-1 for children, vegetable intake was mean 116.9 ± 94.0 g day-1 median 92 g day-1 for caregivers, mean 89.3 ± 84.7 g day-1 median 60 g day-1 for children. Only 23.8% of children and 26.2% of caregivers met the recommended ≥400 g of fruit or vegetable/day. Vegetables were mainly eaten either as ingredients of the main course recipe, eaten by about 80% of caregivers and children, or as salads eaten by 47% of caregivers and 42% of children. Fruits were most commonly eaten as whole fresh fruits eaten by 68% of caregivers and 75% of children. In multivariate analysis of the extent to which different presentations contributed to daily fruit and vegetable consumption, main courses contributed most to determining vegetable intake for caregivers, and for children, main course and salads had similar contributions. For fruit intake, the amount eaten as whole fruit determined total fruit and total fruit plus vegetable intake for both caregivers and children. Local cuisine should be considered in interventions to promote fruit and vegetable consumption. © 2016 John Wiley & Sons Ltd.
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Dieta , Frutas , Verduras , Adolescente , Niño , Preescolar , Estudios Transversales , Composición Familiar , Femenino , Humanos , Lactante , Masculino , Recuerdo Mental , Encuestas Nutricionales , Perú , Ingesta Diaria Recomendada , Encuestas y CuestionariosRESUMEN
Formative research is critical for developing effective nutrition-specific interventions to improve infant and young child (IYC) feeding practices and promote healthy growth. Health workers interact with caregivers during health facility visits, yet there is limited research about how to optimize delivery of such interventions during these visits. The extensive reach of IYC health services globally calls for research to address this gap. In Trujillo, Peru, formative research was conducted to explore complementary feeding practices with caregivers as well as health worker routines and interactions with caregivers related to feeding and healthy growth; results informed the development and delivery of an educational intervention. Multiple qualitative methods were used to collect data on a purposive sample of health workers and caregivers from three health facilities and communities: household trials followed. Complementary feeding messages with doable behaviours were developed, and three were selected as key to promote based on their nutritional impact and cultural acceptability. In the health facilities, medical consultation, well-child visits and nutrition consultation all dealt with aspects of IYC nutrition/growth during their interactions with caregivers but were independent and inconsistent in approach. A nutrition education strategy was developed based on consistency, quality and coverage in the IYC health services. We conclude that formative research undertaken in the community and IYC health services was critical to developing a successful and culturally relevant intervention to promote optimal complementary feeding practices and healthy growth during interactions between health workers and caregivers at routine health facility visits. © 2016 John Wiley & Sons Ltd.
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Agentes Comunitarios de Salud , Educación en Salud , Promoción de la Salud , Fenómenos Fisiológicos Nutricionales del Lactante , Servicios de Salud Materno-Infantil/organización & administración , Anemia Ferropénica/prevención & control , Cuidadores/educación , Desarrollo Infantil , Preescolar , Consejo , Composición Familiar , Estudios de Factibilidad , Trastornos del Crecimiento/prevención & control , Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Desnutrición/prevención & control , Micronutrientes/administración & dosificación , Madres/educación , Perú , Proyectos PilotoRESUMEN
BACKGROUND: Effects of early-life stunting on adiposity development later in childhood are not well understood, specifically with respect to age in the onset of overweight and obesity. OBJECTIVES: We analyzed associations of infant stunting with prevalence of, incidence of, and reversion from high body mass index-for-age z score (BMIZ) later in life. We then estimated whether associations of infant stunting with BMIZ varied by sex, indigenous status, and rural or urban residence. METHODS: Data were collected from 1942 Peruvian children in the Young Lives cohort study at ages 1, 5, 8, and 12 y. Multivariable generalized linear models estimated associations of stunting (height-for-age z score <-2) at age 1 y with risk of BMIZ > 1 and BMIZ > 2 prevalence, incidence (moving above a BMIZ threshold between ages), and reversion (moving below a BMIZ threshold between ages) at later ages. RESULTS: After adjustment for covariates, stunting at age 1 y was associated with a lower prevalence of BMIZ > 1 at age 8 y (RR: 0.81; 95% CI: 0.66, 1.00; P = 0.049) and 12 y (RR: 0.75; 95% CI: 0.61, 0.91; P = 0.004), as well as a lower prevalence of BMIZ > 2 at age 8 y. Stunting was not associated with incident risk of BMIZ > 1 or BMIZ > 2. Stunting was positively associated at age 5 y with risk of reversion from BMIZ > 1 (RR: 1.22; 95% CI: 1.05, 1.42; P = 0.008) and BMIZ > 2. We found evidence that the association of stunting with prevalent and incident BMIZ > 1 was stronger for urban children at ages 5 and 8 y, and for nonindigenous children at age 8 y. CONCLUSIONS: Stunting predicted a lower risk of prevalent BMIZ > 1 and BMIZ > 2, even after controlling for potential confounders. This finding may be driven in part by a higher risk of reversion from BMIZ > 1 by age 5 y. Our results contribute to an understanding of how nutritional stunting in infancy is associated with BMIZ later in life.
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Índice de Masa Corporal , Desarrollo Infantil , Trastornos del Crecimiento , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Humanos , LactanteRESUMEN
BACKGROUND: Peruvian adolescents are at high nutritional risk, facing issues such as overweight and obesity, anemia, and pregnancy during a period of development. Research seeking to understand contextual factors that influence eating habits to inform the development of public health interventions is lacking in this population. This study aimed to understand socio-cultural influences on eating among adolescents in periurban Lima, Peru using qualitative methods. METHODS: Semi-structured interviews and pile sort activities were conducted with 14 adolescents 15-17 years. The interview was designed to elicit information on influences on eating habits at four levels: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal). The pile sort activity required adolescents to place cards with food images into groups and then to describe the characteristics of the foods placed in each group. Content analysis was used to identify predominant themes of influencing factors in interviews. Multidimensional scaling and hierarchical clustering analysis was completed with pile sort data. RESULTS: Individual influences on behavior included lack of financial resources to purchase food and concerns about body image. Nutrition-related knowledge also played a role; participants noted the importance of foods such as beans for anemia prevention. At the social environmental level, parents promoted healthy eating by providing advice on food selection and home-cooked meals. The physical environment also influenced intake, with foods available in schools being predominantly low-nutrient energy-dense. Macrosystem influences were evident, as adolescents used the Internet for nutrition information, which they viewed as credible. CONCLUSIONS: To address nutrition-related issues such as obesity and iron-deficiency anemia in Peruvian adolescents, further research is warranted to elucidate the roles of certain factors shaping behavior, particularly that of family, cited numerous times as having a positive influence. Addressing nutrition-related issues such as obesity and iron-deficiency anemia in this population requires consideration of the effect of social and environmental factors in the context of adolescent lifestyles on behavior. Nutrition education messages for adolescents should consider the cultural perceptions and importance of particular foods, taking into account the diverse factors that influence eating behaviors.
Asunto(s)
Imagen Corporal , Dieta , Ambiente , Conducta Alimentaria , Preferencias Alimentarias , Conocimientos, Actitudes y Práctica en Salud , Estado Nutricional , Adolescente , Conducta del Adolescente , Anemia Ferropénica/etiología , Ingestión de Alimentos , Femenino , Humanos , Internet , Masculino , Obesidad/etiología , Padres , Perú , Investigación Cualitativa , Características de la Residencia , Instituciones Académicas , Medio Social , Población UrbanaRESUMEN
BACKGROUND: Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status. OBJECTIVES: We assessed concurrent and subsequent associations between food insecurity and height-for-age z scores (HAZs) and body mass index-for-age z scores (BMI-Zs); evaluated associations with transitory and chronic food insecurity; and tested whether dietary diversity mediates associations between food insecurity and nutritional status. METHODS: We used data from the Young Lives younger cohort composed of children in Ethiopia (n = 1757), India (n = 1825), Peru (n = 1844), and Vietnam (n = 1828) recruited in 2002 (round 1) at â¼1 y old, with subsequent data collection at 5 y in 2006 (round 2) and 8 y in 2009 (round 3). RESULTS: Children from food-insecure households had significantly lower HAZs in all countries at 5 y (Ethiopia, -0.33; India, -0.53; Peru, -0.31; and Vietnam, -0.68 HAZ; all P < 0.001), although results were attenuated after controlling for potential confounders (Ethiopia, -0.21; India, -0.32; Peru, -0.14; and Vietnam, -0.27 HAZ; P < 0.01). Age 5 y food insecurity predicted the age 8 y HAZ, but did not add predictive power beyond HAZ at age 5 y in Ethiopia, India, or Peru. Age 5 y food insecurity predicted the age 8 y BMI-Z even after controlling for the 5 y BMI-Z, although associations were not significant after the inclusion of additional confounding variables (Ethiopia, P = 0.12; India, P = 0.29; Peru, P = 0.16; and Vietnam, P = 0.51). Chronically food-insecure households had significantly lower HAZs than households that were consistently food-secure, although BMI-Zs did not differ by chronic food-insecurity status. Dietary diversity mediated 18.8-30.5% of the association between food security and anthropometry in Vietnam, but mediated to a lesser degree (8.4-19.3%) in other countries. CONCLUSIONS: In 4 countries, food insecurity at 5 y of age was associated with both HAZ and BMI-Z at age 8 y, although the association was attenuated after adjusting for other household factors and anthropometry at age 5 y, and remained significant only for the HAZ in Vietnam.
Asunto(s)
Antropometría , Desarrollo Infantil , Composición Familiar , Abastecimiento de Alimentos/normas , Niño , Preescolar , Estudios Transversales , Etiopía , Femenino , Humanos , India , Estudios Longitudinales , Masculino , Perú , VietnamRESUMEN
OBJECTIVE: To determine the prevalence of and factors associated with childhood overweight and obesity among a cohort of children 7-8 years of age in Peru. METHODS: This was a cross-sectional secondary analysis of data from the Young Lives longitudinal study of childhood poverty. The sample was a cohort of 1 737 children 7-8 years of age in 2009. Prevalence of overweight and obesity was assessed using body mass index-forage Z-scores. Logistic regression was used to determine associations with a number of individual, household, and community factors. RESULTS: Prevalences of overweight and obesity were 19.2% and 8.6%, respectively. A prevalence of 32.0% and 23.5% overweight and obesity was found among males and females, respectively. High socioeconomic status, living in Lima, having a mother who was overweight or obese, being male, and being an only child or having only one sibling were associated with being overweight and obese at this age. CONCLUSIONS: This study shows a high prevalence of childhood and maternal overweight and obesity in Peru. In contrast to findings in many high-income countries, the findings in Peru indicate that children from wealthier households were more likely to be overweight or obese than those from poorer households. In addition, there is something particularly obesogenic about the Lima environment that merits further investigation, and several key issues to consider when targeting future interventions and research.
Asunto(s)
Obesidad/epidemiología , Sobrepeso/epidemiología , Índice de Masa Corporal , Niño , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Perú/epidemiología , Prevalencia , Factores SocioeconómicosRESUMEN
Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥ 28 weeks) and the risk of having a small-for-gestational-age (SGA) newborn, using a matched case-control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non-SGA controls: 50th percentile Asunto(s)
Lactancia Materna
, Recién Nacido Pequeño para la Edad Gestacional
, Adulto
, Estudios de Casos y Controles
, Ingestión de Energía
, Femenino
, Edad Gestacional
, Humanos
, Recién Nacido de Bajo Peso
, Recién Nacido
, Modelos Logísticos
, Fenómenos Fisiologicos Nutricionales Maternos
, Evaluación Nutricional
, Perú
, Embarazo
, Tercer Trimestre del Embarazo
, Factores de Riesgo
, Factores Socioeconómicos
, Adulto Joven
RESUMEN
BACKGROUND: Infection with human papillomavirus (HPV) and diseases caused by HPV are common in boys and men. We report on the safety of a quadrivalent vaccine (active against HPV types 6, 11, 16, and 18) and on its efficacy in preventing the development of external genital lesions and anogenital HPV infection in boys and men. METHODS: We enrolled 4065 healthy boys and men 16 to 26 years of age, from 18 countries in a randomized, placebo-controlled, double-blind trial. The primary efficacy objective was to show that the quadrivalent HPV vaccine reduced the incidence of external genital lesions related to HPV-6, 11, 16, or 18. Efficacy analyses were conducted in a per-protocol population, in which subjects received all three vaccinations and were negative for relevant HPV types at enrollment, and in an intention-to-treat population, in which subjects received vaccine or placebo, regardless of baseline HPV status. RESULTS: In the intention-to-treat population, 36 external genital lesions were seen in the vaccine group as compared with 89 in the placebo group, for an observed efficacy of 60.2% (95% confidence interval [CI], 40.8 to 73.8); the efficacy was 65.5% (95% CI, 45.8 to 78.6) for lesions related to HPV-6, 11, 16, or 18. In the per-protocol population, efficacy against lesions related to HPV-6, 11, 16, or 18 was 90.4% (95% CI, 69.2 to 98.1). Efficacy with respect to persistent infection with HPV-6, 11, 16, or 18 and detection of related DNA at any time was 47.8% (95% CI, 36.0 to 57.6) and 27.1% (95% CI, 16.6 to 36.3), respectively, in the intention-to-treat population and 85.6% (97.5% CI, 73.4 to 92.9) and 44.7% (95% CI, 31.5 to 55.6) in the per-protocol population. Injection-site pain was significantly more frequent among subjects receiving quadrivalent HPV vaccine than among those receiving placebo (57% vs. 51%, P<0.001). CONCLUSIONS: Quadrivalent HPV vaccine prevents infection with HPV-6, 11, 16, and 18 and the development of related external genital lesions in males 16 to 26 years of age. (Funded by Merck and others; ClinicalTrials.gov number, NCT00090285.).
Asunto(s)
Enfermedades de los Genitales Masculinos/prevención & control , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Adolescente , Adulto , Alphapapillomavirus , Método Doble Ciego , Enfermedades de los Genitales Masculinos/epidemiología , Enfermedades de los Genitales Masculinos/virología , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18 , Humanos , Incidencia , Inyecciones/efectos adversos , Análisis de Intención de Tratar , Masculino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting. DESIGN: Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries. SETTING: We analysed length/height measurements for children at ages 1, 5 and 8 years. SUBJECTS: Children (n 7171) in Ethiopia, India, Peru and Vietnam. RESULTS: Mean height-for-age Z-score (HAZ) at age 1 year ranged from -1·51 (Ethiopia) to -1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P < 0·001) and decreased among the other cohorts (range: -0·19 (Peru) to -0·32 (India); all P < 0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P < 0·001). Prevalence of stunting (HAZ<-2·0) at 1 year ranged from 21 % (Vietnam) to 46 % (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P < 0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P ≤ 0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P < 0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11 % (Vietnam) to 22 % (India); between ages 5 to 8 years, it ranged from 3 % (Peru) to 6 % (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27 % (Vietnam) to 53 % (Ethiopia); between ages 5 and 8 years, it ranged from 30 % (India) to 47 % (Ethiopia). CONCLUSIONS: We found substantial recovery from early stunting among children in four low- and middle-income countries.