Farm-Level Agricultural Biodiversity in the Peruvian Andes Is Associated with Greater Odds of Women Achieving a Minimally Diverse and Micronutrient Adequate Diet.

Background: The extent to and mechanisms by which agricultural biodiversity may influence diet diversity and quality among women are not well understood. Objectives: We aimed to 1) determine the association of farm-level agricultural biodiversity with diet diversity and quality among women of reproductive age in Peru and 2) determine the extent to which farm market orientation mediates or moderates this association. Methods: We surveyed 600 households with the use of stratified random sampling across 3 study landscapes in the Peruvian Andes with diverse agroecological and market conditions. Diet diversity and quality among women were assessed by using quantitative 24-h dietary recalls with repeat recalls among 100 randomly selected women. We calculated a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, probability of adequacy (PA) of 9 micronutrients by using a measurement-error model approach, and mean PA (MPA; mean of PAs for all nutrients). Agricultural biodiversity was defined as a count of crop species cultivated by the household during the 2016-2017 agricultural season. Results: In regression analyses adjusting for sociodemographic and agricultural characteristics, farm-level agricultural biodiversity was associated with a higher DDS (incidence rate ratio from Poisson regression: 1.03; P < 0.05) and MPA (ordinary least-squares ß-coefficient: 0.65; P < 0.1) and higher odds of achieving a minimally diverse diet (MDD-W: OR from logistic regression: 1.17; 95% CI: 1.11, 1.23) and a diet that met a minimum threshold for micronutrient adequacy (MPA >60%: OR: 1.21; 95% CI: 1.10, 1.35). Farm market orientation did not consistently moderate these associations, and in path analyses we observed no consistent evidence of mediation of these associations by farm market orientation. Conclusions: Farm-level agricultural biodiversity was associated with moderately more diverse and more micronutrient-adequate diets among Peruvian women. This association was consistent across farms with varying levels of market orientation, although agricultural biodiversity likely contributed to diets principally through subsistence consumption.

Fruits and vegetables are incorporated into home cuisine in different ways that are relevant to promoting increased consumption.

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.

Early rapid weight gain and subsequent overweight and obesity in middle childhood in Peru.

BACKGROUND: Rapid postnatal weight gain is associated with risk of overweight and obesity, but it's unclear whether this holds in populations exposed to concurrent obesogenic risk factors and for children who have been extensively breastfed. This study investigates whether an increase in weight for age from birth to 1 year (infancy) and from 1 to 5 years (early childhood) predicts overweight and obesity, and waist circumference at 8 years, using data from a longitudinal cohort study in Peru. METHODS: Generalized estimating equations (GEE) models were constructed for overweight and obesity, obesity alone and waist circumference at 8 years versus rapid weight gain in infancy, and early childhood including adjusted models to account for confounders. RESULTS: Rapid weight gain in both periods was associated with double the risk of overweight and obesity, obesity alone at 8 years and increased waist circumference even after controlling for maternal BMI and education level, sex of child, height-for-age at 8 years, consumption of "fast food" and number of days of active exercise. The association was significant, with some differences, for children in both rural and urban environments. CONCLUSIONS: Rapid weight gain in infancy and in early childhood in Peru is associated with overweight and obesity at age 8 years even when considering other determinants of childhood obesity.

Randomized controlled trial of the effect of daily supplementation with zinc or multiple micronutrients on the morbidity, growth, and micronutrient status of young Peruvian children.

BACKGROUND: Zinc supplements reduce childhood morbidity in populations in whom zinc deficiency is common. In such populations, deficiencies in other micronutrients may also occur. OBJECTIVE: The objective was to determine whether the administration of other micronutrients with zinc modifies the effect of zinc supplementation on children's morbidity and physical growth. DESIGN: Two hundred forty-six children aged 6-35 mo with persistent diarrhea were randomly assigned to 1 of 3 groups to receive a daily supplement of 10 mg Zn alone (Zn; n = 81), zinc plus vitamins and other minerals at 1-2 times recommended daily intakes (Zn+VM; n = 82), or placebo (n = 83) for approximately 6 mo after the diarrhea episode ended. Morbidity information was collected on weekdays. Weight, length, and other anthropometric indicators were measured monthly, and plasma zinc and other indicators of micronutrient status were measured at baseline and 6 mo. RESULTS: Supplement consumption was high ( approximately 90%) in all groups, although slightly more vomiting was reported in the Zn+VM group (P < 0.0001, analysis of variance). The change in plasma zinc from baseline to 6 mo was greater in the 2 zinc groups (6.1, 27.3, and 16.2 micro g/dL in the placebo, Zn, and Zn+VM groups, respectively; P < 0.0001, analysis of variance). The Zn group had fewer episodes of diarrhea, dysentery, and respiratory illness and a lower prevalence of fever and cough than did the Zn+VM group and a lower prevalence of cough than did the placebo group (P = 0.05). No significant effects of supplementation on growth were observed. CONCLUSION: Morbidity was greater after supplementation with zinc plus multivitamins and minerals than it was after supplementation with zinc alone.

An overlap of breastfeeding during late pregnancy is associated with subsequent changes in colostrum composition and morbidity rates among Peruvian infants and their mothers.

An overlap of breast-feeding and late pregnancy is associated with decreased intake of human milk and reduced infant growth. We evaluated the association of an overlap with macronutrient and immunological components of milk, infant urinary IgA, and infant and maternal morbidity. On d 2 and 1 mo postpartum, staff measured 24-h intake of breast milk and collected samples from 133 Peruvian women; 68 had breast-fed during the last trimester of pregnancy (BFP) and 65 had not breast-fed during pregnancy (NBFP). Data on maternal and infant anthropometry and health were collected for 1 mo. On d 2, lactose and lysozyme concentrations were higher, total lysozyme intake was higher and concentration and total intake of lactoferrin were lower in the BFP than the NBFP group (P < 0.05). The total 1-mo IgA intake was lower among BFP than NBFP infants (P = 0.01). Urinary IgA concentration was correlated with breast milk IgA concentration (r = 0.29; P = 0.01) but not with breast-feeding during pregnancy. An overlap was not associated with diarrhea but BFP infants were 5 times as likely to have a cough for at least 7 d than NBFP infants (P < 0.05). Reported mastitis was rare and occurred only in the NBFP group (P = 0.05). An overlap of breast-feeding and late pregnancy was associated with changes in milk composition, an increased frequency in symptoms of infant respiratory illness but decreased reported mastitis. Further in-depth studies are warranted to determine the cumulative effects associated with a breast-feeding/pregnancy overlap on infant and maternal outcomes.

Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy.

OBJECTIVE: Despite cultural pressure to wean when a new pregnancy occurs, some women choose to continue breastfeeding. We determined the effect of an overlap of lactation and late pregnancy on breastfeeding and growth in early infancy. METHODS: We studied 133 Peruvian pregnant women who were > or =18 years of age, had a child <4 years old, and who then had a vaginal birth with a healthy, normal weight infant. Of the 133 women, 68 breastfed during the last trimester of pregnancy (BFP), and 65 had not breastfed during pregnancy (NBFP). On day 2 and at 1-month postpartum, 24-hour intake of breast milk and other liquids was measured. Twice weekly home surveillance documented infant morbidity and dietary intakes. Anthropometry was taken at birth and at 1 month. Maternal anthropometric, health, and socioeconomic status data were collected pre- and postpartum. RESULTS: Pregnant BFP mothers breastfed 5.3 +/- 4.3 times/day. BFP and NBFP infants did not differ in breastfeeding behavior or in colostrum intake on day 2. BFP infants breastfed longer per feed and per 24 hours (35.2 minutes/24 hours) than did NBFP infants; however, 1-month intakes per feed tended to be lower among the BFP infants. After controlling for confounders, BFP infants gained 125 g less than did NBFP infants (about 15% of mean weight gain). A sustained decline would result in a -0.7 z score change in weight-for-age by 6 months. CONCLUSIONS: A lactation-pregnancy overlap had a negative effect on early infant outcomes. Additional studies are needed to determine whether the effect continues past 1 month of age.