Human milk immune factors, maternal nutritional status, and infant sex: The INSPIRE study.

OBJECTIVES: Breastfeeding is an energetically costly and intense form of human parental investment, providing sole-source nutrition in early infancy and bioactive components, including immune factors. Given the energetic cost of lactation, milk factors may be subject to tradeoffs, and variation in concentrations have been explored utilizing the Trivers-Willard hypothesis. As human milk immune factors are critical to developing immune system and protect infants against pathogens, we tested whether concentrations of milk immune factors (IgA, IgM, IgG, EGF, TGFß2, and IL-10) vary in response to infant sex and maternal condition (proxied by maternal diet diversity [DD] and body mass index [BMI]) as posited in the Trivers-Willard hypothesis and consider the application of the hypothesis to milk composition. METHODS: We analyzed concentrations of immune factors in 358 milk samples collected from women residing in 10 international sites using linear mixed-effects models to test for an interaction between maternal condition, including population as a random effect and infant age and maternal age as fixed effects. RESULTS: IgG concentrations were significantly lower in milk produced by women consuming diets with low diversity with male infants than those with female infants. No other significant associations were identified. CONCLUSIONS: IgG concentrations were related to infant sex and maternal diet diversity, providing minimal support for the hypothesis. Given the lack of associations across other select immune factors, results suggest that the Trivers-Willard hypothesis may not be broadly applied to human milk immune factors as a measure of maternal investment, which are likely buffered against perturbations in maternal condition.

Are the different cut-off points for sitting time associated with excess weight in adults? A population based study in Latin America.

BACKGROUND: Excess weight is increasing worldwide, and in Latin America more than half of the population is excess weight. One of the reasons for this increase has been excessive sitting time. Still, it remains to be seen whether there is an excessive amount of that time in Latin American adults. This study aimed to associate different sitting time cut-off points with the excess weight. METHODS: Data from the Latin American Study of Nutrition and Health (ELANS), a cross-sectional population-based survey conducted in eight Latin American countries, were used. The excess weight indicators used were body mass index, and waist and neck circumferences. Sitting time was obtained using questionnaires and categorized at different cut-off points. Differences between sitting time categories (< 4 or ≥ 4; < 6 or ≥ 6; and < 8 or ≥ 8 hours/day) and excess weight were obtained by Student's t test for independent samples and the association between sitting time categories and different indicators of excess weight were obtained by logistic regression. RESULTS: The median of the sitting time was 420 min/day (IQR: 240-600). There were no significant differences between body mass index (kg/m2) and waist circumference (cm) with categories of sitting time. The mean values of neck circumference (cm) were significantly higher in ≥4, ≥6 and ≥ 8 hours/day than < 4, < 6, and < 8 hours/day of sitting time in the pooled sample. Some distinct differences by country were observed. There were significant differences among excess weight by body mass index (63.2% versus 60.8) with < 8 vs ≥8 hours/day of sitting time. The proportion of excess weight by neck circumference was higher in participants who reported ≥4, ≥6, and ≥ 8 hours/day compared to < 4, < 6, and < 8 hours/day of sitting time. Considering ≥8 hours/day of sitting time, higher odds of excess weight were found evaluated by body mass index (OR: 1.10; 95% CI: 1.01, 1.20) and neck circumference (OR: 1.13; CI 95%: 1.03, 1.24) overall. CONCLUSIONS: Sitting time above 8 hours/day was associated with higher odds of excess weight, even though there were no differences in waist circumference between sitting time categories. TRIAL REGISTRATION: Clinical Trials NCT02226627. (27/08/2014).

Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS).

PURPOSE: Understanding whole-grain intake and its associated factors is essential to tackle the double burden of malnutrition faced by Latin American countries. This study aimed to characterize total and whole grain intake in Latin American countries and to investigate foods contributing to these intake in the region. METHODS: Data were obtained from the multicenter cross-sectional survey Latin American Study of Nutrition and Health (ELANS), including 9128 participants residing in urban areas of eight Latin American countries. Data collection was performed via two household visits using a standardized questionnaire and two 24 h dietary recalls. Usual dietary intake of total grain foods and foods containing whole grains was estimated. The association between the intake of grain food groups and sociodemographic variables was investigated using multiple linear regression models with random intercepts. RESULTS: Mean intake of total grain foods and foods containing whole grains was 318.6 g/d and 14.7 g/d, respectively. Total grain foods were less consumed by participants at older ages (-9.8 g/d), and females (-9.9 g/d), and more consumed by those in the lowest socioeconomic category (24.8 g/d). Foods containing whole grains were more consumed by participants at older ages (3.3 g/d), and females (4.0 g/d), while those in the lowest socioeconomic category consumed 2.9 g/d less. Major contributors to energy provided from foods containing whole grains were oatmeal, masa harina, whole-wheat bread, corn chips, and wheat crackers. CONCLUSION: The intake of grain foods represented a substantial part of the Latin American population's diet, but the intake of foods containing whole grains was extremely low in all assessed countries.

Relationship between socio-demographic correlates and human development index with physical activity and sedentary time in a cross-sectional multicenter study.

BACKGROUND: Socio-demographic correlates and human development index (HDI) are associated with self-reported physical activity, but only a few studies have focused on device-measured physical activity and sedentary time in Latin America. We examined the relationship between socio-demographic correlates and HDI with physical activity and sedentary time in a cross-sectional study. METHODS: We based our analyses on 2522 (53.1% women; 18-65 years [mean age 38.3 years]) adults drawn from the eight Latin America countries. Physical activity (light, moderate, vigorous, and moderate-to-vigorous intensity and steps) and sedentary time were assessed using Actigraph GT3X + accelerometers. Sex, age, and race/ethnicity were self-reported. The HDI country information was obtained from the United Nations Development Program. RESULTS: For the age, ethnicity, vigorous physical activity and steps/day, there were significant differences between high and very high HDI countries. Women and younger age presented lower sedentary time than men and older. In moderate-to-vigorous physical activity, we found lower duration in women (-13.4 min/week), younger age (-0.1 min/week), and white/caucasian (-2.7 min/week) than men, older ages and mixed ethnicity. Women (-1266.5 steps/week) and very high HDI (-847.3 steps/week) presented lower steps than men and high HDI. Black (2853.9 steps/week), other (1785.4 steps/week), and white/caucasian ethnicity (660.6 steps/week) showed higher steps than mixed ethnicity. CONCLUSIONS: Different socio-demographic correlates are associated with physical activity intensity; however, HDI is associated with vigorous physical activity and steps in the Latin American region, which can in turn guide policies to promote physical activity in the region. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Walking and cycling, as active transportation, and obesity factors in adolescents from eight countries.

BACKGROUND: Evidence has shown that active transportation decreases obesity rates, but considering walking or cycling as separate modes could provide additional information on the health benefits in adolescents. This study aimed to examine the associations between walking and cycling as form active transportation and obesity indicators in Latin American adolescents. METHODS: Population-based study with 671 adolescents (mean age: 15.9 [standard deviation: 0.8] years) from eight countries participating in the Latin American Study of Nutrition and Health/Estudio Latino Americano Nutrition y Salud (ELANS). Walking and cycling for active transportation were measured using the International Physical Activity Questionnaire long version. Body mass index, waist circumference, neck circumference, and relative fat mass were used as obesity indicators. Associations were estimated using logistic regression models for the pooled data adjusted for country, sex, age, socio-economic levels, race/ethnicity, leisure-time physical activity and energy intake. RESULTS: Mean time spent walking and cycling was 22.6 (SD: 33.1) and 5.1 (SD: 24.1) min/day, respectively. The median values were 12.8 (IQR: 4.2; 25.7) and 0 (IQR: 0; 6.2) for walking and cycling. Participants reporting ≥ 10 min/week of walking or cycling for active transportation were 84.2% and 15.5%, respectively. Costa Rica (94.3% and 28.6%) showed the highest prevalence for walking and cycling, respectively, while Venezuela (68.3% and 2.4%) showed the lowest prevalence. There was no significant association between walking for active transportation and any obesity indicator. In the overall sample, cycling for ≥ 10 min/week was significantly associated with a lower likelihood of overweight/obesity based on BMI (OR: 0.86; 95%CI: 0.88; 0.94) and waist circumference (OR: 0.90; 95%CI: 0.83; 0.97) adjusted for country, sex, age, socio-economic level, race/ethnicity, leisure-time physical activity and energy intake compared to cycling for < 10 min/week. There were no significant associations between cycling for active transportation and neck circumference as well as relative fat mass. CONCLUSIONS: Cycling for active transportation was negatively associated with obesity indicators, especially body mass index and waist circumference. Programs for promoting cycling for active transportation could be a feasible strategy to tackle the high obesity rates in adolescents in Latin America. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Key genetic variants associated with variation of milk oligosaccharides from diverse human populations.

Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P < 4.23-9 to P < 4.5-70) gene with seven HMO and provide evidence of balancing selection for FUT2. Although polymorphisms in FUT3 were also associated with variation in lacto-N-fucopentaose II and difucosyllacto-N-tetrose, we found little evidence of selection on FUT3. To our knowledge, this is the first report of the use of genome-wide association analyses on HMO.

Sociodemographic inequities and active transportation in adults from Latin America: an eight-country observational study.

BACKGROUND: Active transportation is a crucial sort of physical activity for developing sustainable environments and provides essential health benefits. This is particularly important in Latin American countries because they present the highest burden of non-communicable diseases relative to other worldwide regions. This study aimed to examine the patterns of active transportation and its association with sociodemographic inequities in Latin American countries. METHODS: This cross-sectional study was conducted in eight countries. Participants (n = 8547, 18-65 years) self-reported their active transportation (walking, cycling, and total) using the International Physical Activity Questionnaire. Sex, age, ethnicity, socioeconomic level, education level, public and private transport use, and transport mode were used as sociodemographic inequities. RESULTS: Participants spent a total of 19.9, 3.1, and 23.3 min/day with walking, cycling, and total active transportation, respectively. Mixed and other ethnicity (Asian, Indigenous, Gypsy, and other), high socioeconomic level as well as middle and high education level presented higher walking than Caucasian, low socioeconomic and education level. Private transport mode and use of ≥ 6 days/week of private transport showed lower walking than public transport mode and ≤ 2 days/week of private transport. Use of ≥ 3 days/week of public transport use presented higher walking than ≤ 2 days/week of public transport. Men had higher cycling for active transportation than women. Use of ≥ 3 days/week of public transport use presented higher cycling than ≤ 2 days/week of public transport. ≥6 days/week showed lower cycling than ≤ 2 days/week of private transport use. Men (b: 5.57: 95 %CI: 3.89;7.26), black (3.77: 0.23;7.31), mixed (3.20: 1.39;5.00) and other ethnicity (7.30: 2.55;12.04), had higher total active transportation than women and Caucasian. Private transport mode (-7.03: -11.65;-2.41) and ≥ 6 days/week of private transport use (-4.80: -6.91;-0.31) showed lower total active transportation than public transport mode and ≤ 2 days/week of private transport use. Use of 3-5 (5.10: 1.35;8.85) and ≥ 6 days/week (8.90: 3.07;14.73) of public transport use presented higher total active transportation than ≤ 2 days/week of public transport use. Differences among countries were observed. CONCLUSIONS: Sociodemographic inequities are associated differently with active transportation across Latin American countries. Interventions and policies that target the promotion of active policies transportation essential to consider sociodemographic inequities. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Household composition and the infant fecal microbiome: The INSPIRE study.

OBJECTIVES: Establishment and development of the infant gastrointestinal microbiome (GIM) varies cross-culturally and is thought to be influenced by factors such as gestational age, birth mode, diet, and antibiotic exposure. However, there is little data as to how the composition of infants' households may play a role, particularly from a cross-cultural perspective. Here, we examined relationships between infant fecal microbiome (IFM) diversity/composition and infants' household size, number of siblings, and number of other household members. MATERIALS AND METHODS: We analyzed 377 fecal samples from healthy, breastfeeding infants across 11 sites in eight different countries (Ethiopia, The Gambia, Ghana, Kenya, Peru, Spain, Sweden, and the United States). Fecal microbial community structure was determined by amplifying, sequencing, and classifying (to the genus level) the V1-V3 region of the bacterial 16S rRNA gene. Surveys administered to infants' mothers identified household members and composition. RESULTS: Our results indicated that household composition (represented by the number of cohabitating siblings and other household members) did not have a measurable impact on the bacterial diversity, evenness, or richness of the IFM. However, we observed that variation in household composition categories did correspond to differential relative abundances of specific taxa, namely: Lactobacillus, Clostridium, Enterobacter, and Klebsiella. DISCUSSION: This study, to our knowledge, is the largest cross-cultural study to date examining the association between household composition and the IFM. Our results indicate that the social environment of infants (represented here by the proxy of household composition) may influence the bacterial composition of the infant GIM, although the mechanism is unknown. A higher number and diversity of cohabitants and potential caregivers may facilitate social transmission of beneficial bacteria to the infant gastrointestinal tract, by way of shared environment or through direct physical and social contact between the maternal-infant dyad and other household members. These findings contribute to the discussion concerning ways by which infants are influenced by their social environments and add further dimensionality to the ongoing exploration of social transmission of gut microbiota and the "old friends" hypothesis.

Energy intake and food sources of eight Latin American countries: results from the Latin American Study of Nutrition and Health (ELANS).

OBJECTIVE: Few previous studies in Latin America (LA) have provided data on dietary intake composition with a standardized methodology. The present study aimed to characterize energy intake (EI) and to describe the main food sources of energy in representative samples of the urban population from eight LA countries from the Latin American Study in Nutrition and Health (ELANS). DESIGN: Cross-sectional study. Usual dietary intake was assessed with two non-consecutive 24 h dietary recalls. SETTING: Urban areas from eight countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, Venezuela), September 2014 to July 2015. SUBJECTS: Adolescents and adults aged 15-65 years. Final sample comprised 9218 individuals, of whom 6648 (72·1 %) were considered plausible reporters. RESULTS: Overall, mean EI was 8196 kJ/d (1959 kcal/d), with a balanced distribution of macronutrients (54 % carbohydrate, 30 % fat, 16 % protein). Main food sources of energy were grains, pasta and bread (28 %), followed by meat and eggs (19 %), oils and fats (10 %), non-alcoholic homemade beverages (6 %) and ready-to-drink beverages (6 %). More than 25 % of EI was provided from food sources rich in sugar and fat, like sugary drinks, pastries, chips and candies. Meanwhile, only 18 % of EI was from food sources rich in fibre and micronutrients, such as whole grains, roots, fruits, vegetables, beans, fish and nuts. No critical differences were observed by gender or age. CONCLUSIONS: Public health efforts oriented to diminish consumption of refined carbohydrates, meats, oils and sugar and to increase nutrient dense-foods are a priority in the region to drive to a healthier diet.

A case-control study to examine the association between breastfeeding during late pregnancy and risk of a small-for-gestational-age birth in Lima, Peru.

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

Infant and Maternal Morbidity Symptoms as Predictors for the Interruption of Exclusive Breastfeeding in Lima, Peru: A Prospective Study.

INTRODUCTION: The global prevalence of exclusive breastfeeding for 6 months is 48%. This analysis examined the relationship between infant and maternal morbidity symptoms and the interruption of exclusive breastfeeding. METHODS: Data from a cohort study among women living in a peri-urban community in Peru were used. Data were collected during pregnancy, birth, and the first 6 months postpartum among 179 dyads... RESULTS: After the first month, interruption of exclusive breastfeeding was almost twofold (adjusted odds ration [aOR] = 1.99, 95% confidence interval [CI]: 1.14, 3.45) more likely among infants with symptoms (e.g., diarrhea, cough) than those without. Maternal morbidity symptoms (e.g., gastrointestinal, respiratory) and breast problems were positively associated with interruption of exclusive breastfeeding throughout the first 6 months (aOR = 1.77, 95% CI: 1.11, 2.82 and aOR = 3.23, 95% CI: 1.84, 5.69, respectively). DISCUSSION: Mother-infant dyads often experience illness symptoms that are not contraindications to breastfeeding. Health professionals need to reinforce that exclusive breastfeeding should continue during illness.

Energy imbalance gap was associated with body mass index and sex in Latin American adolescents-results from the ELANS study.

Introduction: Energy imbalance gap (EIG) is defined as the average daily difference between energy intake (EI) and energy expenditure (EE). This study aimed to examine the associations between EIG and sociodemographic and anthropometric variables in the adolescent population of eight Latin America countries. Methods: A total of 680 adolescents aged 15 to 18 were included in this study. The estimation of EI was based on two non-consecutive 24-h dietary recalls. EE was predicted from Schofield equations using physical activity level obtained through the long version of the International Physical Activity Questionnaire. Sociodemographic data and anthropometric measurements were also obtained. A descriptive analysis and multilevel linear regression models were used to examine associations between variables. Results: The mean EI, EE, and EIG were 2091.3 kcal, 2067.8 kcal, and 23.5 kcal, respectively. Argentina had the highest EI and EIG, whereas Chile had the lowest EI and EIG. Males had a higher EI (2262.4 kcal) and EE (2172.2 kcal) than females (1930.1 kcal and 2084.5 kcal), respectively (p < 0.05). Overweight subjects had a lower EIG than did underweight and normal-weight subjects (p < 0.05). Subjects with low socioeconomic status (SES) had a lower EE (2047.0 kcal) than those with a high SES (2164.2 kcal) (p < 0.05). Conclusion: Sex and BMI were associated with EIG in adolescents from Latin America.

Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol.

INTRODUCTION: Nutrition during the complementary feeding period (6-23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach. METHODS AND ANALYSIS: The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6-23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6-23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.

Perceived Neighborhood Safety and Active Transportation in Adults from Eight Latin American Countries.

Neighborhood built environment is associated with domain-specific physical activity. However, few studies with representative samples have examined the association between perceived neighborhood safety indicators and domain-specific active transportation in Latin America. This study aimed to examine the associations of perceived neighborhood safety with domain-specific active transportation in adults from eight Latin American countries. Data were obtained from the Latin American Study of Nutrition and Health (n = 8547, aged 18-65). Active transportation (walking and cycling) was assessed using the long form of the International Physical Activity Questionnaire. Specifically, traffic density and speed as well as street lightening, visibility of residents regarding pedestrians and bicyclists, traffic lights and crosswalks, safety of public spaces during the day and at night, crime rate during the day and at night were used to evaluate perceived neighborhood safety. Slow traffic speeds, unsafe public spaces during the day, and crime during the day were associated with ≥10 min/week vs. <10 min/week of walking. Furthermore, drivers exceeding the speed limit and crime rate during the day were associated with reporting ≥10 min/week vs. <10 min/week of cycling. These results indicate a stronger association of the perceived neighborhood safety with walking compared to cycling.

Physical activity and daily steps cut offs points for overweight/obesity prevention among eight Latin American countries.

This study aims to establish cut-off points for the number of minutes of physical activity intensity and the number of daily steps that identify overweight/obesity in adolescents, adults, and older adults. This study examined data from 2737 participants. Physical activity intensity and the number of daily steps were assessed using GT3X+ ActiGraph model accelerometers. Body mass index, waist-to-height ratio, and waist-to-hip ratio were used as indicators of overweight/obesity. The cut-off points for moderate-to-vigorous physical activity for the prevention of overweight/obesity according to body mass index in women ranged from 15.1 to 30.2 min/day; in men, the values were from 15.4 to 33.8 min/day. The lowest cut-off point for daily steps was established in the adolescent group for women and men (7304 and 5162). The highest value in women was 11,412 (51-65 years) and 13,234 in men (18-30 years). Results from measurements different from BMI, show average cut-off points for moderate-to-vigorous physical activity and daily steps of 29.1/8348 and 43.5/10,456 according to waist-to-height ratio; and results of 29.3/11,900 and 44.3/11,056 according to the waist-to-hip ratio; in women and men respectively. A more specific recommendation of physical activity and daily steps adjusted by sex and age range is suggested to prevent overweight/obesity.

Perceived urban environment attributes and obesity indices in adults: an 8-Nation study from Latin America.

This study examines the associations between perceived urban environment attributes and obesity indices by country using data from an eight-nation study from Latin America. The data were collected from 8185 adults. The Neighbourhood Environment Walkability-abbreviated scale was used to assess perceived urban environment attributes. Obesity indices considered were body mass index, waist circumference, neck circumference, a body shape index and waist-to-height ratio. The perception of a more and better land use mix-diversity (ß - 0.44; 95% CI - 0.59, - 0.28), traffic safety (- 0.39; - 0.66, - 0.12), and safety from crime (- 0.36; - 0.57, - 0.15) was associated with lower body mass index across the entire sample. Land use mix-diversity (- 1.21; - 1.60, - 0.82), street connectivity (- 0.26; - 0.37, - 0.15), and traffic safety (- 0.79; - 1.47, - 0.12) were negatively associated with waist circumference. Land use mix-diversity (- 0.11; - 0.20, - 0.03), land use mix-access (- 0.23; - 0.34, 0.12), walking/cycling facilities (- 0.22; - 0.37, - 0.08), and safety from crime (- 0.27; - 0.42, - 0.12) were negatively associated with neck circumference. No associations between perceived urban environment attributes and a body shape index were found. Land use mix-diversity (- 0.01; - 0.02, - 0.01), aesthetics (- 0.02; - 0.03, - 0.01), and safety from crime (- 0.02; - 0.04, - 0.01) were associated with waist-to-height ratio. Environmental interventions involving urban environment attributes are associated with obesity indices and, therefore, may help decrease the prevalence of overweight and obesity.

A Comparison of Associations Between Self-Reported and Device-Based Sedentary Behavior and Obesity Markers in Adults: A Multi-National Cross-Sectional Study.

The purpose of this study was to examine the associations between self-reported and device-based measures of sedentary behavior (SB) with obesity markers in adults from Latin American countries. Sitting time and total time spent in different SBs were self-reported using two different questionnaires. Accelerometers were used to assess total sedentary time. Body mass index, waist, and neck circumferences were assessed. The highest self-reported sitting time was in Argentina, the highest total time spent in different SBs was in Brazil and Costa Rica, and the highest device-based sedentary time was observed in Peru. Neither self-reported sitting time, total time spent in different SBs or device-based sedentary time were associated with body mass index. Device-based sedentary time was positively associated with waist circumference and self-reported sitting time was positively associated with neck circumference. Caution is warranted when comparing the associations of self-reported and device-based assessments of SB with anthropometric variables.

Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study.

OBJECTIVE: To assess the association between the physical activity level and the built environment by accessibility, microinfrastructure and security in Latin America (LA). DESIGN: We conducted a multicentre cross-sectional study to collect physical activity and built environment data. The levels of physical activity were calculated through the International Physical Activity Questionnaire survey. Using the Neighbourhood Environment Walkability Scale-Abbreviated, characteristics of the built environment were measured through three domains: accessibility, microinfrastructure and security. To estimate the association of the built environment and physical activity, we used mixed effects logistic regression analysis. In addition, likelihood ratio test to account for clustered effect within countries and/or cities was used. SETTING: Eight countries in LA. PARTICIPANTS: Adults aged 15-65 years (n=9218) living in urban areas and consented to participate of the Latin American Study of Nutrition and Health. RESULTS: Most of the population in LA had access to a grocery store (97.2%), public transport stop (91.5%) and children's playground (81.6%). Metropolitan parks were more accessible in Ecuador (59.8%) and Colombia (59.2%) than in Venezuela (33.5%). Individuals located within 20 min of walking from sport facilities or children's playground areas were more likely to perform moderate-to-high physical activity OR 1.20 (95% CI 1.06 to 1.36) and OR 1.25 (95% CI 1.02 to 1.53), respectively. Only 14.5% of the population from the region considered that their neighbourhood had an adequate design for walking or cycling. Likewise, among adults living in LA, only 39.75% had the perception of living in a safe neighbourhood. CONCLUSIONS: This multicentre study shows that currently, LA built environment does not promote physical activity in the region. Our findings provide the rationale to push forward, at regional and national levels, policies and interventions that will help to achieve a safe, healthy and friendly built environment to encourage participation in active recreation and sports in leisure time. TRIAL REGISTRATION NUMBER: NCT02226627.