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.

Contribution of Proteins to the Latin American Diet: Results of the ELANS Study.

Dietary protein intake is vital to life. Here we sought to characterize dietary sources of protein in eight Latin American countries. Survey data were collected for Estudio Latinoamericano de Nutrición y Salud (ELANS); participants were from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (n = 9218, 15-65 years old). The primary aim of this analysis was to quantify per-person daily protein consumption by country and sociodemographic factors. Secondary aims: to quantify proportional intake of proteins by source, amount and processing, and to determine the adequacy of protein/essential amino acid intake. Younger groups (adolescents 15-19 years, adults 20-33 years) had the highest intake of proteins; middle-aged adults (34-49 years) had a lower intake, and older adults (50-65 years) had a strikingly lower intake. Protein consumption was higher in men than women. Animal proteins comprised nearly 70% of total daily protein intake in Argentina and Venezuela, contrasting with <60% in Peru, Chile, and Costa Rica. Brazil and Venezuela showed the highest protein intake within the highest education level. The higher the socioeconomic level, the higher the protein intake, except for Argentina, Chile, and Peru. Proportional intake of animal- and plant-based protein generally reflected the food availability by country. This study presents a pre-pandemic regional baseline and offers a perspective for future studies of changes related to government policies, climate, and dietary practices.

Principales alimentos con azúcares añadidos y su variación geográfica y sociodemográfica: estudio latinoamericano de nutrición y salud (ELANS) / Main foods with added sugars and their geographic and sociodemographic variation: Latin American study of nutrition and health (ELANS)

Diversos estudios epidemiológicos y de intervención apuntan a una asociación fuerte y consistente entre la ingesta excesiva de azúcares y el riesgo de desarrollar caries dentales y enfermedades crónicas no transmisibles. El objetivo fue describir los 10 principales alimentos que contribuyen a la ingesta de azúcares añadidos en muestras representativas de poblaciones urbanas de ocho países latinoamericanos, y considerar diferencias por país, sexo, nivel socioeconómico (NSE) y grupo de edad. Se realizó una encuesta transversal multinacional en hogares de Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela (N=9218; 15­65 años). La contribución porcentual a la ingesta total del nutriente sirvió para identificar los alimentos aportadores. Los datos se estratificaron por país, sexo, NSE y grupo de edad y se compararon los gramos por día. Excepto en Perú y en el grupo de 50 a 65 años, los refrescos figuraron como el principal contribuyente a la ingesta de azúcares añadidos. Las bebidas caseras y las industrializadas también destacaron. Argentina fue el país con mayor ingesta de azúcares añadidos aportados por bebidas industrializadas, y Chile el país con menor frecuencia de bebidas como fuentes. Entre los 10 contribuyentes, la ingesta de azúcares añadidos fue mayor en el sexo masculino, excepto para sacarosa y pasteles dulces. Mayores ingestas de azúcares provenientes del jugo de fruta natural y sacarosa fueron observadas en el NSE más bajo. Las mayores y menores ingestas en los grupos de edad cambian de acuerdo con la fuente alimentaria. En conclusión, las bebidas azucaradas fueron los principales contribuyentes a la ingesta de azúcares añadidos, y la ingesta varió según la ubicación geográfica y los factores sociodemográficos(AU)

This study aimed to describe the top 10 foods that contribute to added sugars intake in representative samples of urban populations in eight Latin American countries, and consider differences by country, sex, socioeconomic level (SEL), and age group. A household-based, multinational, cross-sectional survey was conducted in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (N=9218; 15­65 years). Contributors to added sugars were identified and listed based on the percentage of contribution to total intake of this nutrient. Data were stratified by country, sex, SEL, and age group, and the grams per day compared. Except in Peru and in the 50 to 65 years age group, soft drinks were the leading contributor to added sugar intake. Homemade beverages together industrialized beverages have been a prominent position on ranking. In general, the highest intake of added sugars by industrialized beverages was from Argentina, and the lowest frequency of beverages as sources of added sugars was observed in Chile. Among the top 10 contributors, male sex had highest added sugar intake, except for sucrose and sweet cakes. Higher intakes of sugars from natural fruit juice and sucrose were observed in the lower SEL. The highest and lowest intakes in the age groups change according to the food source. In conclusion, sugar-sweetened beverages were main contributors to added sugar intake, and the intake vary with geographical location and sociodemographic factors(AU)

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results.

Poor health and diet quality are associated with living within a low socioeconomic status (SES). This study aimed to investigate the impact of SES on diet quality and body mass index in Latin America. Data from the "Latin American Health and Nutrition Study (ELANS)", a multi-country, population-based study of 9218 participants, were used. Dietary intake was collected through two 24 h recalls from participants of Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Diet quality was assessed using the dietary quality score (DQS), the dietary diversity score (DDS) and the nutrients adequacy ratio (NAR). Chi-squared and multivariate-variance analyses were used to estimate possible associations. We found that participants from the low SES consumed less fruits, vegetables, whole grains, fiber and fish and seafood and more legumes than those in the high SES. Also, the diet quality level, assessed by DQS, DDS and NAR mean, increased with SES. Women in the low SES also showed a larger prevalence of abdominal obesity and excess weight than those in the middle and high SES. Health policies and behavioral-change strategies should be addressed to reduce the impact of socioeconomic factors on diet quality and body weight, with gender as an additional level of vulnerability.

Intake of Vitamin E and C in Women of Reproductive Age: Results from the Latin American Study of Nutrition and Health (ELANS).

Vitamin E was identified as a lipophilic compound essential to maintain rat pregnancy. Low vitamin E intake during early pregnancy associates with congenital malformations and embryonic loss in animals and with miscarriage and intrauterine growth restriction in humans. Vitamin E protects cell membranes from lipoperoxidation and exerts non-antioxidant activities. Its function can be restored by vitamin C; thus, intake and circulating levels of both micronutrients are frequently analyzed together. Although substantial vitamin E inadequacy was reported worldwide, its consumption in Latin America (LatAm) is mostly unknown. Using data from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud, ELANS), we evaluated vitamin E and C intake in women of reproductive age (WRA) from eight LatAm countries and identified their main food sources. Two non-consecutive 24-h dietary recalls in 3704 women aged from 15 to 49 years and living in urban locations showed low average intake of vitamin E (7.9 mg/day vs. estimated average requirement (EAR) of 12 mg/day) and adequate overall vitamin C consumption (95.5 mg/day vs. EAR of 60 mg/day). The mean regional inadequacy was 89.6% for vitamin E and 36.3% for vitamin C. The primary food sources of vitamin E were fats and oils, as well as vegetables. Vitamin C intake was explained mainly by the consumption of fruit juices, fruits, and vegetables. Combined deficient intake of both vitamins was observed in 33.7% of LatAm women. Although the implications of low antioxidant vitamins' consumption in WRA are still unclear, the combined deficient intake of both vitamins observed in one-third of ELANS participants underscores the need for further research on this topic.

Food Sources of Shortfall Nutrients among Latin Americans: Results from the Latin American Study of Health and Nutrition (ELANS).

Increased consumption of energy-dense, nutrient-poor foods can lead to inadequate intakes of shortfall nutrients, including vitamin A, D, C, and E, dietary folate, calcium, iron, magnesium, potassium, and fiber. The objective was to examine the prevalence of inadequate intake of shortfall nutrients and identify food sources of shortfall nutrients in eight Latin American countries. Data from ELANS, a multi-country, population-based study of 9218 adolescents and adults were used. Dietary intake was collected through two 24 h Recalls from participants living in urban areas of Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela. Foods and beverages were classified using the adapted version of the NHANES "What We Eat in America" system. Nutrients inadequacy was estimated using the Institute of Medicine recommendations and descriptive statistics were calculated. Prevalence of inadequacy was above 50% for most of the nutrients, which the exception of vitamin C with a prevalence of inadequacy of 39%. Milk, cheese, seafoods, breads, and fruit juices/drinks were among the top 5 sources for each of the 10 shortfall nutrients examined. Many food categories were top contributors to more than one dietary component examined. Understanding the nutrient intake and food sources can help inform dietary guidance and intervention approaches.

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS).

OBJECTIVE: To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans. DESIGN: Data from the Latin American Study of Nutrition and Health (ELANS). SETTING: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. PARTICIPANTS: Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount. RESULTS: Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %). CONCLUSION: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study.

Dietary diversity, an important component of diet quality, is associated with an increased probability of adequate micronutrient intake. Women of childbearing age (WCA) are particularly vulnerable to micronutrient inadequacy. The Minimum Dietary Diversity for Women (MDD-W) has been used widely as a proxy measurement of micronutrient adequacy. This study aimed to assess the association between MDD-W and nutrients adequacy among WCA of eight Latin American countries. Nutrient intakes from 3704 WCA were analyzed with two 24-hour dietary recalls. Dietary diversity was calculated based on ten food groups with a cut-off point of intake ≥5 groups. The mean dietary diversity score was 4.72 points, and 57.7% of WCA achieved MDD-W. Vitamin D and E showed a mean Nutrient Adequacy Ratio (NAR) of 0.03 and 0.38, respectively. WCA with a diverse diet (MDD-W > 5) reported a significantly higher intake of most micronutrients and healthy food groups with less consumption of red and processed meats and sugar-sweetened beverages. MDD-W was significantly associated with the mean adequacy ratio (MAR) of 18 micronutrients evaluated. Nevertheless, even those women with a diverse diet fell short of meeting the Estimated Average Requirements (EAR) for vitamins D and E. MDD-W is an appropriate tool to evaluate micronutrients adequacy in WCA from Latin America, showing that women who achieved the MDD-W reported higher adequacy ratios for most micronutrients and an overall healthier diet.

Latin American consumption of major food groups: Results from the ELANS study.

BACKGROUND: The Latin American (LA) region is still facing an ongoing epidemiological transition and shows a complex public health scenario regarding non-communicable diseases (NCDs). A healthy diet and consumption of specific food groups may decrease the risk of NCDs, however there is a lack of dietary intake data in LA countries. OBJECTIVE: Provide updated data on the dietary intake of key science-based selected food groups related to NCDs risk in LA countries. DESIGN: ELANS (Latin American Study of Nutrition and Health) is a multicenter cross-sectional study assessing food consumption from an urban sample between15 to 65 years old from 8 LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Two 24-HR were obtained from 9,218 individuals. The daily intake of 10 food groups related to NCDs risk (fruits; vegetables; legumes/beans; nuts and seeds; whole grains products; fish and seafood; yogurt; red meat; processed meats; sugar-sweetened beverages (ready-to-drink and homemade)) were assessed and compared to global recommendations. RESULTS: Only 7.2% of the overall sample reached WHO's recommendation for fruits and vegetables consumption (400 grams per day). Regarding the dietary patterns related to a reduced risk of NCDs, among the overall sample legumes and fruits were the food groups with closer intake to the recommendation, although much lower than expected (13.1% and 11.5%, respectively). Less than 3.5% of the sample met the optimal consumption level of vegetables, nuts, whole grains, fish and yogurt. Largest country-dependent differences in average daily consumption were found for legumes, nuts, fish, and yogurt. Mean consumption of SSB showed large differences between countries. CONCLUSION: Diet intake quality is deficient for nutrient-dense food groups, suggesting a higher risk for NCDs in the urban LA region in upcoming decades. These data provide relevant and up-to-date information to take urgent public health actions to improve consumption of critically foods in order to prevent NCDs.

Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS).

This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15-65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish.

Developing a cooperative multicenter study in Latin America: Lessons learned from the Latin American Study of Nutrition and Health Project

[ABSTRACT]. This report examines the challenges of conducting a multicenter, cross-sectional study of countries with diverse cultures, and shares the lessons learned. The Latin American Study of Nutrition and Health (ELANS) was used as a feasibility study involving the most populous cities of eight countries in Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela) in 2014–2015, about 40% of the population of the Americas. The target sample included 9 000 individuals, 15–65 years of age, and was stratified by geographic location (only urban areas), gender, age, and socioeconomic status. Six principal challenges were identified: team structuring and site selections; developing a single protocol; obtaining ethic approvals; completing simultaneous fieldwork; ensuring data quality; and extracting data and maintaining consistency across databases. Lessons learned show that harmonization, pilot study, uniformity of procedures, high data quality control, and communication and collaboration across sites are imperative. Barriers included organizational complexity, recruitment of collaborators and research staff, institutional cooperation, development of infrastructure, and identification of resources. Consensus on uniform measures and outcomes and data collection methodology, as well as a plan for data management and analysis, communication, publication, and dissemination of study results should be in place prior to beginning fieldwork. While challenging, such studies offer great potential for building a scientific base for studies on nutrition, physical activity, and other health topics, while facilitating comparisons among countries.

[RESUMEN]. En este informe se examinan los retos de llevar a cabo un estudio transversal multicéntrico en países con culturas diversas y se transmiten las enseñanzas extraídas. Se usó el Estudio Latinoamericano de Nutrición y Salud (ELANS) como un estudio de factibilidad realizado en el período 2014–2015, que incluyó las ciudades más populosas de ocho países de América Latina (Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela) y abarcó a cerca de 40% de la población de la Región de las Américas. La muestra establecida incluyó a 9 000 personas de 15 a 65 años de edad, y fue estratificada según la ubicación geográfica (solo zonas urbanas) y por sexo, edad y situación socioeconómica. Se encontraron seis retos principales: estructurar los equipos y seleccionar los sitios; preparar un protocolo único; obtener las aprobaciones éticas; terminar simultáneamente el trabajo sobre el terreno; velar por la calidad de los datos y extraer datos y mantener la uniformidad en todas las bases de datos. Las enseñanzas extraídas muestran que la armonización, los estudios piloto, la uniformidad de los procedimientos, el riguroso control de la calidad de los datos y la comunicación y colaboración entre todos los sitios son imperativos. Los obstáculos incluyeron la complejidad de la organización, el reclutamiento de colaboradores y personal de investigación, la cooperación institucional, el desarrollo de infraestructura y la definición de los recursos. Antes de comenzar el trabajo sobre el terreno, se debe llegar a un consenso acerca de mediciones y resultados uniformes y la metodología de recopilación de datos, así como un plan para la gestión y el análisis de los datos y la comunicación, publicación y difusión de los resultados del estudio. A pesar de que estos estudios constituyen un desafío, hacen posible establecer una base científica para los estudios sobre la nutrición, la actividad física y otros temas de salud, al facilitar las comparaciones entre los países de América Latina.

[RESUMO]. Neste relato se examinam os desafios de realizar um estudo transversal multicêntrico em países com culturas diversas e os ensinamentos tirados. O Estudo Latino-americano de Nutrição e Saúde (ELANS) serviu de estudo de viabilidade, englobando as cidades mais populosas de oito países da América Latina (Argentina, Brasil, Chile, Colômbia, Costa Rica, Equador, Peru e Venezuela) em 2014–2015, representando cerca de 40% da população das Américas. A amostra pretendida compreendeu 9.000 indivíduos com 15 a 65 anos de idade e foi estratificada por localização geográfica (exclusivamente áreas urbanas), sexo, idade e nível socioeconômico. Os seis principais desafios identificados foram: estruturar as equipes e selecionar as sedes, elaborar um único protocolo, obter as aprovações dos comitês de ética, realizar trabalho de campo simultâneo, assegurar a qualidade dos dados e extrair os dados e manter a consistência em todas as bases de dados. Os ensinamentos tirados demonstram serem imprescindíveis harmonização, estudo-piloto, uniformidade dos procedimentos, ótimo controle da qualidade dos dados e comunicação e colaboração entre as sedes. Entre as barreiras estão a complexidade organizacional, recrutamento de colaboradores e pessoal de pesquisa, cooperação institucional, desenvolvimento de infraestrutura e identificação dos recursos. Antes do início do trabalho de campo, deve-se chegar a um consenso sobre medidas e resultados uniformes e metodologia de coleta de dados assim como um plano para o gerenciamento e análise dos dados, comunicação, publicação e disseminação dos resultados dos estudos. Apesar da sua complexidade, tais estudos têm um grande potencial de fundar uma base científica para estudos de nutrição, atividade física e outros tópicos relacionados à saúde, ao mesmo tempo que facilitam comparações entre os países da América Latina.

Developing a cooperative multicenter study in Latin America: Lessons learned from the Latin American Study of Nutrition and Health Project.

This report examines the challenges of conducting a multicenter, cross-sectional study of countries with diverse cultures, and shares the lessons learned. The Latin American Study of Nutrition and Health (ELANS) was used as a feasibility study involving the most populous cities of eight countries in Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela) in 2014-2015, about 40% of the population of the Americas. The target sample included 9 000 individuals, 15-65 years of age, and was stratified by geographic location (only urban areas), gender, age, and socioeconomic status. Six principal challenges were identified: team structuring and site selections; developing a single protocol; obtaining ethic approvals; completing simultaneous fieldwork; ensuring data quality; and extracting data and maintaining consistency across databases. Lessons learned show that harmonization, pilot study, uniformity of procedures, high data quality control, and communication and collaboration across sites are imperative. Barriers included organizational complexity, recruitment of collaborators and research staff, institutional cooperation, development of infrastructure, and identification of resources. Consensus on uniform measures and outcomes and data collection methodology, as well as a plan for data management and analysis, communication, publication, and dissemination of study results should be in place prior to beginning fieldwork. While challenging, such studies offer great potential for building a scientific base for studies on nutrition, physical activity, and other health topics, while facilitating comparisons among countries.

En este informe se examinan los retos de llevar a cabo un estudio transversal multicéntrico en países con culturas diversas y se transmiten las enseñanzas extraídas. Se usó el Estudio Latinoamericano de Nutrición y Salud (ELANS) como un estudio de factibilidad realizado en el período 2014­2015, que incluyó las ciudades más populosas de ocho países de América Latina (Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela) y abarcó a cerca de 40% de la población de la Región de las Américas. La muestra establecida incluyó a 9 000 personas de 15 a 65 años de edad, y fue estratificada según la ubicación geográfica (solo zonas urbanas) y por sexo, edad y situación socioeconómica.Se encontraron seis retos principales: estructurar los equipos y seleccionar los sitios; preparar un protocolo único; obtener las aprobaciones éticas; terminar simultáneamente el trabajo sobre el terreno; velar por la calidad de los datos y extraer datos y mantener la uniformidad en todas las bases de datos. Las enseñanzas extraídas muestran que la armonización, los estudios piloto, la uniformidad de los procedimientos, el riguroso control de la calidad de los datos y la comunicación y colaboración entre todos los sitios son imperativos. Los obstáculos incluyeron la complejidad de la organización, el reclutamiento de colaboradores y personal de investigación, la cooperación institucional, el desarrollo de infraestructura y la definición de los recursos. Antes de comenzar el trabajo sobre el terreno, se debe llegar a un consenso acerca de mediciones y resultados uniformes y la metodología de recopilación de datos, así como un plan para la gestión y el análisis de los datos y la comunicación, publicación y difusión de los resultados del estudio. A pesar de que estos estudios constituyen un desafío, hacen posible establecer una base científica para los estudios sobre la nutrición, la actividad física y otros temas de salud, al facilitar las comparaciones entre los países de América Latina.

Neste relato se examinam os desafios de realizar um estudo transversal multicêntrico em países com culturas diversas e os ensinamentos tirados. O Estudo Latino-americano de Nutrição e Saúde (ELANS) serviu de estudo de viabilidade, englobando as cidades mais populosas de oito países da América Latina (Argentina, Brasil, Chile, Colômbia, Costa Rica, Equador, Peru e Venezuela) em 2014­2015, representando cerca de 40% da população das Américas. A amostra pretendida compreendeu 9.000 indivíduos com 15 a 65 anos de idade e foi estratificada por localização geográfica (exclusivamente áreas urbanas), sexo, idade e nível socioeconômico.Os seis principais desafios identificados foram: estruturar as equipes e selecionar as sedes, elaborar um único protocolo, obter as aprovações dos comitês de ética, realizar trabalho de campo simultâneo, assegurar a qualidade dos dados e extrair os dados e manter a consistência em todas as bases de dados. Os ensinamentos tirados demonstram serem imprescindíveis harmonização, estudo-piloto, uniformidade dos procedimentos, ótimo controle da qualidade dos dados e comunicação e colaboração entre as sedes. Entre as barreiras estão a complexidade organizacional, recrutamento de colaboradores e pessoal de pesquisa, cooperação institucional, desenvolvimento de infraestrutura e identificação dos recursos. Antes do início do trabalho de campo, deve-se chegar a um consenso sobre medidas e resultados uniformes e metodologia de coleta de dados assim como um plano para o gerenciamento e análise dos dados, comunicação, publicação e disseminação dos resultados dos estudos. Apesar da sua complexidade, tais estudos têm um grande potencial de fundar uma base científica para estudos de nutrição, atividade física e outros tópicos relacionados à saúde, ao mesmo tempo que facilitam comparações entre os países da América Latina.

Developing a cooperative multicenter study in Latin America: Lessons learned from the Latin American Study of Nutrition and Health Project / Elaboração de estudo cooperativo multicêntrico na América Latina: ensinamentos do Projeto do Estudo Latino-americano de Nutrição e Saúde / Elaboración de un estudio colaborativo multicéntrico en América Latina: enseñanzas extraídas del Estudio Latinoamericano de Nutrición y Salud

ABSTRACT This report examines the challenges of conducting a multicenter, cross-sectional study of countries with diverse cultures, and shares the lessons learned. The Latin American Study of Nutrition and Health (ELANS) was used as a feasibility study involving the most populous cities of eight countries in Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela) in 2014-2015, about 40% of the population of the Americas. The target sample included 9 000 individuals, 15-65 years of age, and was stratified by geographic location (only urban areas), gender, age, and socioeconomic status. Six principal challenges were identified: team structuring and site selections; developing a single protocol; obtaining ethic approvals; completing simultaneous fieldwork; ensuring data quality; and extracting data and maintaining consistency across databases. Lessons learned show that harmonization, pilot study, uniformity of procedures, high data quality control, and communication and collaboration across sites are imperative. Barriers included organizational complexity, recruitment of collaborators and research staff, institutional cooperation, development of infrastructure, and identification of resources. Consensus on uniform measures and outcomes and data collection methodology, as well as a plan for data management and analysis, communication, publication, and dissemination of study results should be in place prior to beginning fieldwork. While challenging, such studies offer great potential for building a scientific base for studies on nutrition, physical activity, and other health topics, while facilitating comparisons among countries.

RESUMEN En este informe se examinan los retos de llevar a cabo un estudio transversal multicéntrico en países con culturas diversas y se transmiten las enseñanzas extraídas. Se usó el Estudio Latinoamericano de Nutrición y Salud (ELANS) como un estudio de factibilidad realizado en el período 2014-2015, que incluyó las ciudades más populosas de ocho países de América Latina (Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela) y abarcó a cerca de 40% de la población de la Región de las Américas. La muestra establecida incluyó a 9 000 personas de 15 a 65 años de edad, y fue estratificada según la ubicación geográfica (solo zonas urbanas) y por sexo, edad y situación socioeconómica. Se encontraron seis retos principales: estructurar los equipos y seleccionar los sitios; preparar un protocolo único; obtener las aprobaciones éticas; terminar simultáneamente el trabajo sobre el terreno; velar por la calidad de los datos y extraer datos y mantener la uniformidad en todas las bases de datos. Las enseñanzas extraídas muestran que la armonización, los estudios piloto, la uniformidad de los procedimientos, el riguroso control de la calidad de los datos y la comunicación y colaboración entre todos los sitios son imperativos. Los obstáculos incluyeron la complejidad de la organización, el reclutamiento de colaboradores y personal de investigación, la cooperación institucional, el desarrollo de infraestructura y la definición de los recursos. Antes de comenzar el trabajo sobre el terreno, se debe llegar a un consenso acerca de mediciones y resultados uniformes y la metodología de recopilación de datos, así como un plan para la gestión y el análisis de los datos y la comunicación, publicación y difusión de los resultados del estudio. A pesar de que estos estudios constituyen un desafío, hacen posible establecer una base científica para los estudios sobre la nutrición, la actividad física y otros temas de salud, al facilitar las comparaciones entre los países de América Latina.

RESUMO Neste relato se examinam os desafios de realizar um estudo transversal multicêntrico em países com culturas diversas e os ensinamentos tirados. O Estudo Latino-americano de Nutrição e Saúde (ELANS) serviu de estudo de viabilidade, englobando as cidades mais populosas de oito países da América Latina (Argentina, Brasil, Chile, Colômbia, Costa Rica, Equador, Peru e Venezuela) em 2014-2015, representando cerca de 40% da população das Américas. A amostra pretendida compreendeu 9.000 indivíduos com 15 a 65 anos de idade e foi estratificada por localização geográfica (exclusivamente áreas urbanas), sexo, idade e nível socioeconômico. Os seis principais desafios identificados foram: estruturar as equipes e selecionar as sedes, elaborar um único protocolo, obter as aprovações dos comitês de ética, realizar trabalho de campo simultâneo, assegurar a qualidade dos dados e extrair os dados e manter a consistência em todas as bases de dados. Os ensinamentos tirados demonstram serem imprescindíveis harmonização, estudo-piloto, uniformidade dos procedimentos, ótimo controle da qualidade dos dados e comunicação e colaboração entre as sedes. Entre as barreiras estão a complexidade organizacional, recrutamento de colaboradores e pessoal de pesquisa, cooperação institucional, desenvolvimento de infraestrutura e identificação dos recursos. Antes do início do trabalho de campo, deve-se chegar a um consenso sobre medidas e resultados uniformes e metodologia de coleta de dados assim como um plano para o gerenciamento e análise dos dados, comunicação, publicação e disseminação dos resultados dos estudos. Apesar da sua complexidade, tais estudos têm um grande potencial de fundar uma base científica para estudos de nutrição, atividade física e outros tópicos relacionados à saúde, ao mesmo tempo que facilitam comparações entre os países da América Latina.