Physical activity of poor urban women in Cali, Colombia: a comparison of working and not working women.

We have previously presented evidence that the physical activity level (PAL) and total energy expenditure (per kg body weight) of poor urban women who "work" (engage in income-earning activities) is similar to those who do not "work" (but do tend to household and childcare responsibilities) (Spurr et al. [1996] Am J Clin Nutr 63:870-878; [1997] Med Sci Sports Exerc 29:1255-1262). These findings were unexpected and raised questions regarding the actual types of activities engaged in by the two groups. In this article we address those questions by comparing the time allocation of the two groups. Time allocation during waking hours (14.2 +/- 1.1 hours/day) was recorded in minute-by-minute diaries by trained observers for two consecutive days for 52 working women and 28 not-working women. The working women were engaged in predominately informal sector economic activities, such as street vending, childcare, and domestic service, in addition to their own household and childcare responsibilities. The activities of the not-working women were largely restricted to household and childcare responsibilities. The working women tended to spend less time in resting activities and TV-watching and more time in travel and miscellaneous work activities, but other between-group differences were not significant. We conclude that the time allocation of working women is similar to that of not-working women because 1) many of the activities engaged in are the same or similar, and 2) some working women are only engaged in income-earning activities for limited time periods.

Energy intake and expenditure of free-living, lactating Colombian women in an urban setting.

OBJECTIVES: To examine the components of energy balance during lactation in a population of economically disadvantaged women in an urban developing country setting in order to better understand the metabolic response to lactation. DESIGN: Cross-sectional comparison of lactating (LACT) and non-pregnant non-lactating (NPNL) women. Body size and composition were assessed via anthropometry, energy intake was measured using estimated diet records and energy expenditure using indirect calorimetry and the Flex-Heart Rate method. SETTING: Low-income neighborhoods of Cali, Colombia. SUBJECTS: Lactating women (n=15) studied at 2.4+/-0.8, 5.5+/-0.8 and 8.9+/-1.2 months postpartum, and NPNL women (n=48) studied in three measurement rounds at 0, 3.5+/-0.6 and 7.1+/-1.0 months. RESULTS: There were no significant differences between LACT and NPNL women in anthropometric dimensions, but LACT women showed decreases in waist-hip ratio, lean body mass and increases in mid-arm circumference and percentage body fat with time. Energy intake was higher in LACT women (P=0.04), but there were no significant between-group differences in energy expenditure variables. CONCLUSION: This group of women met the cost of lactation principally via increased energy intake.

Anthropometric characteristics of pregnant women in Cali, Colombia and relationship to birth weight.

Anthropometric dimensions were collected from 46 pregnant women living in Cali, Colombia to gain a better understanding of how poor, urban women deal with the demands of pregnancy and to identify relationships between maternal characteristics and infant birth weight. Height, weight, skinfold thicknesses (subscapular, suprailiac, thigh, calf, and triceps), and circumferences (hip, thigh, calf, and mid-upper arm) were measured on all women. Infant measurements were weight and length. The women were measured in the second and third trimesters, and a subsample (n = 16) was measured twice in the third trimester. Mean birth weight was 3,137.6 +/- 488.5 g (n = 44), and mean length was 49.8 +/- 3.0 cm. All but three of the infants were full-term, and the incidence of low birth weight (LBW) was 9%. The 46 women showed a significant increase in weight (P < 0.001); subscapular, suprailiac, and mid-thigh skinfold thicknesses (P < or = 0.01) and in hip, thigh, and calf circumferences (P < or = 0.01) between trimesters 2 and 3. Women who gave birth to both normal birth weight (NBW) and LBW infants showed significant increases in weight (P < 0.001 and P = 0.02, respectively), but only women who had NBW infants showed significant increases in the suprailiac skinfold and hip circumference (P < 0.001). In the third trimester, attained weight, skinfold thicknesses, and circumferences tended to be greater in women who had NBW infants. In general, this group of women gained less weight and had a greater incidence of LBW infants compared with women in developed countries, but changes in skinfold thicknesses over the course of pregnancy were similar compared with other studies.

Estimating energy intake of urban women in Colombia: comparison of diet records and recalls.

As part of a larger study of energy-nutrition, we compared the performance of 24 h diet recalls with estimated diet records kept by trained observers. The subjects were economically disadvantaged women (n = 85) in the city of Cali, Colombia. A 24 h recall and an estimated diet record were collected for each woman at 0 and approximately 3 and 6 months. Energy intake obtained from the estimated dietary records was validated against energy expenditure and used as the reference method. Energy and macronutrient intake were calculated from published food composition tables and proximate analyses of common foods. The number of food items consumed per woman per day, total and in each of 16 food groups, was tabulated. Energy and macronutrient intakes were 11-13% lower in the 24 h recalls. The discrepancy energy could be largely accounted for by the lower number of food items in the recalls. The number of food items in eight of 16 food groups was significantly lower in the recalls compared to the records. Underreporting on the recalls was a general tendency in these subjects and not clearly related to average energy intake. We conclude that 24 h diet recalls underestimate energy and nutrient intake in this population and are not suitable for studies of human energetics.

Food and macronutrient intake of economically disadvantaged pregnant women in Colombia.

The objective of this article is to assess changes in diet composition, defined in terms of macronutrient intake and types of foods consumed, in pregnancy in poor urban women in Colombia. The subjects were 20 pregnant and 20 matched nonpregnant, nonlactating (NPNL) women 19 to 35 years of age. The pregnant women were studied in three measurement rounds at 14.0 +/- 3.6, 27 +/- 2.2, and 35 +/- 1.7 weeks gestation, and the NPNL women in three measurement rounds approximately 3 months apart. Dietary intake was obtained from estimated food records and macronutrient composition from published sources. Types of foods consumed were aggregated into 16 groups: alcohol; breads; candy; coffee, chocolate; juices; fruit; legumes; meat, fish, offal; dairy; vegetable dishes; other; rice, pasta; tubers, plantains; salads; soft drinks; and soups. Macronutrient intakes showed nonsignificant increases in pregnancy. There were no significant differences between pregnant and NPNL women, except for carbohydrate intake in late pregnancy (P = 0.03). Carbohydrate, fat, and protein provided 74%, 17%, and 12% of dietary energy, respectively, in pregnant women at baseline, and did not change significantly. Except for a decrease in fruits, the types of foods consumed did not change significantly in pregnancy. There were no between-group differences in types of foods consumed except for the greater number of fruits consumed by pregnant women at baseline (P = 0.004). We conclude that in this population there were no changes in diet composition in pregnancy, except for an increase in fruit consumption in Round 1. Am. J. Hum. Biol. 11:753-762, 1999. Copyright 1999 Wiley-Liss, Inc.

Gastrointestinal parasitic infection, anthropometrics, nutritional status, and physical work capacity in Colombian boys.

This article tests the hypothesis that the presence of gastrointestinal parasites in Colombian boys is negatively associated with anthropometric characteristics, physical work capacity, blood hemoglobin (Hb) levels, and nutritional status. Anthropometric, Hb, &Vdot;O(2) max, and parasite load data were collected on 1,016 boys in Cali, Colombia. The boys were classified as lower socioeconomic class (SEC) from either urban or rural environments, and upper SEC from an urban environment. Sixty-three percent of the boys were infected with gastrointestinal parasites and, of the infected boys, 80-95% had light parasite loads. Parasites found included Necator americanus, Ascaris lumbricoides, Entamoeba histolytica, Trichuris trichiura, Giardia spp., and Enterobius vermicularis. Infected boys had significantly lower weight, stature, weight-for-height (among 6-9-year-old boys), Hb levels, and &Vdot;O(2) max (ANCOVA, controlling for age and SEC). In terms of nutritional status, infected boys were 1.47 times more likely to be classified as iron deficient than noninfected boys (chi-square, P < 0.001), and 1.61 times more likely to be classified as stunted (P < 0.001). Infection was not associated with wasting in any SEC group. In conclusion, light to moderate gastrointestinal parasite loads were associated with significantly lower weight, stature, weight-for-height (in 6-9-year-old boys), Hb levels, and &Vdot;O(2) max, and a significantly higher frequency of IDA and stunting. These data suggest that comprehensive analyses of the nutritional status of populations in regions endemic for parasitic infection should include testing for the presence of infection. Am. J. Hum. Biol. 11:763-771, 1999. Copyright 1999 Wiley-Liss, Inc.

Increased muscular efficiency during lactation in Colombian women.

OBJECTIVE: To determine the muscular efficiency of lactating women and compare it to that of nonpregnant, nonlactating (NPNL) women. DESIGN: The study was retrospective. The subjects were selected randomly in the two groups and studied on three occasions (rounds) separated by approximately three months. SUBJECTS: There were 109, 101, and 80 NPNL women and 45, 31 and 16 lactating women in rounds 1, 2 and 3 respectively, 19-43 y of age, living under economically deprived conditions in Cali, Colombia, who participated in the study. METHODS: Muscular efficiency was measured as delta efficiency on a cycle ergometer. RESULTS: Muscular efficiency was significantly higher in lactating women in all three rounds compared to NPNL women. In six women it was possible to measure efficiency at variable times prior to their pregnancies, and again during lactation about three months post partum. There was a statistically significant (P = 0.03) increase in muscular efficiency during lactation. CONCLUSION: Lactation results in about a 5% increase in muscular efficiency which may contribute to the adaptation of the mother to the increased energy demands associated with lactation.

PIP: The muscular efficiency of low-income lactating women living in Cali, Colombia, was compared to that of nonpregnant, nonlactating women from the same neighborhoods in a retrospective study that involved 3 rounds separated by about 3 months. Rounds 1, 2, and 3 (occurring at an average of 2.4, 5.3, and 8.6 months postpartum) included 109, 101, and 80 nonpregnant, nonlactating women, respectively, and 45, 31, and 16 lactating women, respectively. Muscular efficiency, measured as delta efficiency on a cycle ergometer, was significantly higher among lactating than nonlactating, nonpregnant women in all 3 rounds. In the 6 women in whom it was possible to measure muscular efficiency at variable times prior to their pregnancy as well as at 3 months postpartum, there was a statistically significant increase in muscular efficiency during lactation. Overall, lactation resulted in about a 5% increase in muscular efficiency. This phenomenon may contribute to the adaptation of the mother to the increased energy demands associated with breast feeding.

Household headship and nutritional status: Female-headed versus male/dual-headed households.

Approximately one-third of all poor urban households in Latin America are headed by females. This study compares the nutritional status of women and children from female-headed (FHH) and male/dual headed (MHH/DHH) households in economically disadvantaged neighborhoods in Cali, Colombia. Data collected included socioeconomic indicators, anthropometric dimensions, dietary intake, and interviews documenting household composition. Classification of household headship was based on the acknowledged head and the primary economic provider of the household. Of the households in this study, 81 (80%) were from MHH/DHHs and 20 (20%) from FHHs. FHHs had fewer material possessions and lived in houses made of less expensive materials compared to MHH/DHHs. However, there were no significant differences in the nutritional status of women or children in FHHs vs MHH/DHHs. Most women had BMIs within the normal range (19-29 kg/m2 ). The majority of children (95%) had weight-for-height z-scores within ±2 of the NCHS references. These results suggest that while FHHs in Cali were economically poorer, the women studied appeared to have had access to sufficient food sources for themselves and their children. Am. J. Hum. Biol. 10:699-709, 1998. © 1998 Wiley-Liss, Inc.

Daily energy expenditure of women by factorial and heart rate methods.

To compare the minute-by-minute heart rate (Flex-HR) reference method with the factorial method, total daily energy expenditure (TDEE) and the pattern of daily energy expenditure (EE) were measured in nonpregnant, nonlactating women 19-40 yr of age, working at their household chores (at home, N = 20) or for remuneration in various kinds of employment (at work, N = 28). The factorial method used three data sets described in the compendium of Ainsworth et al. (CMD), FAO/WHO/UNU (FAO), and James and Schofield (J&S). Measurements were repeated on three rounds separated by 3 months. The TDEE by Flex-HR method, by round, was 9.0 +/- 2.6, 8.9 +/- 1.4, and 10.3 +/- 3.4 MJ.d-1 in the women at home and 9.7 +/- 2.3, 11.4 +/- 3.2, and 11.3 +/- 3.6 MJ.d-1 in the women at work. Values using the CMD data set were not significantly different from Flex-HR in either group in any round, but FAO and J&S data sets gave significantly lower values than both of the former methods in all rounds. The same statistical results were obtained for the patterns of activity. Since the timing of activities by the observers was the same, it is concluded that the major source of error in applying the factorial method is in the values for energy expenditure assigned to the various activities and the ability of investigators to properly judge EE from available data sets.

Understanding the nutrition of poor urban women: ethnographic and biological approaches.

To better understand how women respond to conditions of urban poverty in a developing country a sample of 85 women living in Cali, Colombia was studied. Anthropometric indicators of nutritional status were normal for the group. However, many women indicated that they did not always have sufficient money to purchase food, and described the strategies they used when financial resources were inadequate. These strategies included changes in meal composition, reductions in food portion size, and reductions in the number of meals eaten. Evidence of the use of these strategies was identified in 17.1% of all diet records (n = 509). The adequate nutritional status of this group of women suggests that their strategies were usually successful in maintaining adequate energy intake, but the frequent use of these strategies suggests that the women are potentially at risk for undernutrition.

Living on the edge: dietary strategies of economically impoverished women in Cali, Colombia.

Economically impoverished women in Cali, Colombia, have restricted access to food in a city where food is abundant. Ethnographic observations, interviews and 2 day food records were used to better understand the coping strategies used by a group of these women (n = 85) to maintain adequate levels of energy intake. Anthropometric indicators of nutritional status were normal for the group. Interview data revealed that the ability to purchase food was a concern for 58% of the women. When faced with a restricted ability to purchase food, the women indicated they made compromises in meal composition, reduced portion sizes, and/or reduced the number of meals. They also relied on relatives, friends, neighbors, store credit, or local government programs for access to food. Changes in meal composition were identified in 17.1% of all diet records (n = 509). Low energy intake (defined as energy intake < or = 1.27 x BMR) was identified in 17.1% of all diet records. Carbohydrate consumption was significantly greater on low-energy intake days. The adequate nutritional status of this group of women suggests that their coping strategies are usually adequate to maintain energy intake, but the presence of uncertainty, the frequency of compromises in diet composition, and the frequency of low-energy intake days suggest that these women are at risk for undernutrition.

Comparative study of flex heart rate in colombian children and in pregnant, lactating, and non-pregnant, nonlactating women.

The heart rate (HR) value employed to separate resting and active portions of the calibration curves used to estimate energy expenditure (EE) from minute-by-minute HR recordings is called the flex-HR. The present study has characterized it, the resting HR and the average daily HR during the awake portion of the day (12-14 h) by comparing age, gender and nutritional status effects related to measured maximum oxygen consumption (V̇ O 2 max; ml/min/kg body weight)in school-aged Colombian children (145 boys and 132 girls), 6-16 years of age. The same HR variables have been individually measured in nutritionally normal, nonpregnant, nonlactating (NPNL; n = 48), pregnant (n = 26), and lactating (n = 18) women, 19-43 years of age, on three occasions separated by 3 months. In general, the flex-HR followed the differences observed in resting and average daily HRs. All three values decreased with age in children, were higher in girls than boys, and did not exhibit differences between nutritionally normal and undernourished children. All three HRs had a statistically significant negative relationship with V̇ O 2 max in boys but not in girls. NPNL and lactating women showed no significant change in the mean values of the repeated HR measurements but exhibited maximum individual differences of flex-HR of -56 to +42 beats/min. Pregnant women had higher HRs in all 3 rounds of measurement compared to NPNL subjects. The data support the generalization that the flex-HR method of estimating EE is appropriate in groups of subjects but not in individuals, and that individual calibration of subjects close to the time of application to the making of EE measurements is an important feature of its use. Am. J. Hum. Biol. 9:647-657, 1997. © Wiley-Liss, Inc.

Energy expenditure of urban Colombian women: a comparison of patterns and total daily expenditure by the heart rate and factorial methods.

The heart rate and factorial methods of measuring both total daily energy expenditure (TDEE) and the daily pattern of energy expenditure (EE) were compared in nonpregnant, nonlactating women aged 19-43 y living in urban conditions of economic deprivation. The methods were applied on each of 2 successive days. There were no significant differences between the 2 d by either method. Women who worked at their household chores at home (n = 29) and those who also worked for remuneration (at work) in various kinds of employment (n = 23) were compared. The factorial method gave values for TDEE and for the pattern of EE that were significantly lower than those obtained by the heart rate method. This was related to lower values for EE for certain activities obtained from the literature than for values measured in these subjects. Women at work had significantly higher values for both TDEE and for the pattern of EE than did those at home. The TDEE at home by the heart rate method was 8.83 +/- 1.94 MJ/d and at work was 9.99 +/- 1.91 MJ/d (P = 0.036); this difference disappeared when adjusted for body weight or fat-free mass. Physical activity levels were 1.83 +/- 0.43 for women at home and 1.90 +/- 0.46 for women at work, which indicate moderate to heavy work. The factorial method should be used with measured EE values in the present subject population. The heart rate method can detect differences in TDEE and in the pattern of EE between women engaged in different activities and may offer an experimental approach to the study of the effects of daily variations in EE on nutritional energy intake.

Energy expenditures of urban Colombian girls and women.

Anthropometry, basal metabolic rate (BMR), and resting energy expenditure (RMR) measured by indirect calorimetry and total daily energy expenditure (TDEE) by the minute-by-minute heart rate (HR) method have been studied in 52 school-aged girls 6-16 years and 46 nonpregnant, nonlactating women 19-43 years of age. BMR, RMR, and TDEE increased with age in children, reaching approximate adult values by 15 years. TDEE averaged 9.29 ± 2.32 MJ/d in women 19-43 years. The ratio RMR/BMR averaged 1.27 ± 0.29 across all age groups. TDEE/BMR varied from 1.41 ± 0.28 to 1.62 ± 0.37 in the girls and averaged 1.78 ± 0.43 in adults. Application of empirical equations to estimates of BMR showed that those of Schofield gave values of +3.1% (P = 0.03) and of Henry and Rees -3.8% (P = 0.052) of measured BMR (Schofield [1985] Hum Nutr Clin Nutr 39C [Suppl 1]:5-41; Henry and Rees [1991] Eur J Clin Nutr 45:177-185). The pattern of daily energy expenditure is highly variable across age groups during the awake portion of the day (0700-2000 hours). In the averaged data of women at home, there is a gradual increase in the morning, a decline at noon, followed by some increase in the early afternoon and decline in late afternoon and early evening. © 1996 Wiley-Liss, Inc.

Body composition of Colombian women.

Measurements of anthropometry and total body water (TBW) were made in 99 women 19-44 y of age living in socioeconomically deprived circumstances in Cali, Colombia. TBW was measured by dilution of deuterium oxide. An empirical equation for estimating lean body mass (LBM) was derived and applied satisfactorily to an independent study group. Comparisons were also made with body-composition values obtained by the Durnin and Womersley equations and an equation derived from rural women living in Guatemala. Neither set of equations was suitable for use with the Colombian subjects because both significantly overestimated LBM and therefore underestimated body fat. Lower values of standing height in older women suggest that they may have been subjected to more severe undernutrition during their growth than the younger subjects. When compared with a group of US women, Colombian subjects were less physically fit and had greater subcutaneous-fat deposits, which were distributed over the trunk and limbs, whereas body mass indexes and waist-hip ratios were not significantly different.

Variation of the basal metabolic rate and dietary energy intake of Colombian women during 1 y.

Anthropometry, basal and resting metabolic rates (BMR and RMR), and dietary energy intake were measured on five occasions approximately 3 mo apart for 1 y in 21 nonpregnant, non-lactating women 20-42 y of age living under deprived economic conditions in Cali, Colombia. There was a significant increase in body weight (1-1.5 kg) because of increased body fat during the last two rounds of measurement. BMR was elevated in the first round but fell to stable values that did not vary significantly from 3 to 12 mo. The intraindividual CV of BMR was 8.3% whereas the intraindividual CV of dietary energy intake was 17%. Measured BMR was closely related to the BMR estimates provided by the empirical equations of Schofield, but significantly higher than estimates from the equations of Henry and Rees. RMR-BMR ratios were very close to those published by FAO/WHO/UNU. Autocorrelation analysis of BMR showed weak ability to predict subsequent variation of BMR over time and is consistent with random variation of the data.

Anthropometry and secular changes in stature of urban Colombian women of differing socioeconomic status.

Anthropometric dimensions were taken on 1,572 women, 18-44 years of age, from Cali, Colombia, from three different socioeconomic (SEC) groups: low (LEC), mid-low (MLEC), and upper (UEC). LEC and MLEC women were significantly shorter and had higher body mass indices (BMIs) than UEC women, and a significantly larger number had BMIs over 27.3 kg/m2 . There were no significant differences between SEC groups for skinfolds on the arm, but skinfolds on the trunk, the subscapular-triceps ratio, and the waist-hip ratio followed an inverse SEC gradient, indicating a greater tendency for upper body fat distribution in the lower SEC groups. SEC differences in body fatness and fat distribution diminished with age, suggesting that health risks associated with obesity and an upper body fat distribution may be similar in all three groups by ages 40-44 years. Secular changes in stature were similar, 0.12 cm/year for LEC/MLEC women and 0.15 cm/year for UEC women, and there was no indication that the statural differences between the groups is diminishing. The results indicate that women from Cali exhibit anthropometric characteristics seen in both developing countries (stature positively associated with SEC) and developed countries (fatness and centralized fat distribution inversely related to SEC). These findings may reflect the relative economic prosperity of Colombia as a "developing country". © 1994 Wiley-Liss, Inc.

V̇ O 2 max and nutritional status in Urban Colombian girls and women.

Maximal oxygen consumption (V̇ O 2 max, liters min-1 ) was measured in 60 nutritionally normal and 74 marginally undernourished girls 6-16 years of age and 27 upper socioeconomic (UEC) women and 22 women living in economically deprived conditions (LEC) in Cali, Colombia. All girls were recruited from the LEC neighborhoods. Lower values for V̇ O 2 max (liters min-1 ) in undernourished girls were replaced by a nutritionally normal status in adulthood in which V̇ O 2 max was not significantly different from that measured in UEC women. Physical condition varied from average to fair in the younger to older subjects compared to women from industrialized countries. When V̇ O 2 max is expressed as ml min-1 kg-1 of lean body mass (LBM), all age and group effects disappear, confirming regression analysis which demonstrated a close relationship (r2 = 0.81) between V̇ O 2 max (liters min-1 ) and LBM in which there were no significant differences between nutritional or socioeconomic groups. © 1994 Wiley-Liss, Inc.

Basal metabolic rate of Colombian children 2-16 y of age: ethnicity and nutritional status.

Measurements of basal metabolic rate (BMR) were made in 528 children 2-16 y of age living in underprivileged areas of the city of Cali, Colombia (153 control and 186 undernourished boys, 93 control and 96 undernourished girls). The data are related to BMR calculated from the equations of Schofield and to estimates of the lean body mass (LBM). The ethnic composition of the subjects was 80% mestizo (mixed European and South Amerindian ancestry), 15% black, and 5% white. The data do not show any variations due to race in these subjects. The Schofield equations overestimate the BMR of boys by approximately 6% whereas the estimation of BMR in girls is not significantly different from measured values. More than 65% of the variation in BMR of both nutritionally normal and undernourished boys and girls is explained by variation in body size as estimated by the LBM.