A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition.

BACKGROUND: Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients. OBJECTIVE: This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries. METHOD: Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method. RESULTS: In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status. CONCLUSIONS: There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

Plain language titleDescription of the Vitamin and Mineral Consumption Status in Urban Cities of Latin America: Results of the Latin American Health and Nutrition Study.Plain language summaryVitamins and minerals are essential for maintaining good health. However, traditional Latin American diets are changing to include foods that have a lot of sugar and fat but fewer vitamins and minerals. This study was designed to analyze the consumption of these nutrients in urban cities of 8 Latin American countries. We collected food consumption information from September 2014 to August 2015 from 9216 men and women between 15 and 65 years old using a method called 24-hour recall. To find out if participants were consuming the necessary daily amounts of vitamins and minerals, intakes were compared with the daily recommended amounts suggested by the Institutes of Medicine of the United States. We found that Latin American urban populations consume fewer vitamins and minerals than recommended. In some cases, few people do not consume the required amounts of vitamins and minerals, but in other cases, many do not. For example, few do not consume enough thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium. However an intermediate number of people do not consume enough pyridoxine and zinc, a high number consume little vitamin C and vitamin A, and many people consume very little magnesium, calcium, and vitamin D. We found that the people who consume fewer vitamins and minerals are mostly males, overweight/obese, have lower education and varies according to their financial resources. A deficient intake of vitamins and minerals showed up in most age groups, from adolescence to adulthood. To improve vitamins and minerals intake, it is important that some foods that are frequently eaten are fortified or that the price of foods that are high in vitamins and minerals is lowered.

Joint Association between Sedentary Time and Moderate-to-Vigorous Physical Activity with Obesity Risk in Adults from Latin America.

Recent studies have shown various relationships between physical activity and the incidence of obesity, but this study critically explored the association of sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) with obesity risk in adults from eight Latin American countries. ST and MVPA were assessed with accelerometers and stratified into 16 joint categories. Multivariate logistic regression models were used. The obesity risk indicators evaluated were body mass index (BMI), waist circumference (WC), and neck circumference (NC). Quartile 4 of ST and ≥300 min/week of MVPA was associated with lower odds of BMI compared to quartile 1 of ST and ≥300 min/week of MVPA. Quartile 1 of ST and 150-299 min/week of MVPA, quartile 1 of ST and 76-149 min/week MVPA, quartile 3 of ST and 76-149 min/week MVPA, and quartiles 1, 2, and 3 of ST with 0-74 min/week MVPA were associated with higher odds of high WC compared to quartile 1 of ST and ≥300 min/week of MVPA. Quartile 3 of ST and 150-299 min/week of MVPA, quartiles 1 and 3 of ST and 76-149 min/week of MVPA, and quartile 1 of ST and 0-74 min/week MVPA were associated with higher NC compared to quartile 1 of ST and ≥300 min/week of MVPA. This study suggests that achieving the MVPA recommendations will likely protect against obesity, regardless of ST.

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).

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.

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.

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.

Meeting 24-h movement guidelines and markers of adiposity in adults from eight Latin America countries: the ELANS study.

This study aimed to compare compliance with 24-h movement guidelines across countries and examine the associations with markers of adiposity in adults from eight Latin American countries. The sample consisted of 2338 adults aged 18-65 years. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) data were objectively measured using accelerometers. Sleep duration was self-reported using a daily log. Body mass index and waist circumference were assessed as markers of adiposity. Meeting the 24-h movement guidelines was defined as ≥ 150 min/week of MVPA; ≤ 8 h/day of SB; and between 7 and 9 h/day of sleep. The number of guidelines being met was 0.90 (95% CI 0.86, 0.93) with higher value in men than women. We found differences between countries. Meeting two and three movement guidelines was associated with overweight/obesity (OR: 0.75, 95% CI 0.58, 0.97 and OR: 0.69, 95% CI 0.51, 0.85, respectively) and high waist circumference (OR: 0.74, 95% CI 0.56, 0.97 and OR: 0.77, 95% CI 0.62, 0.96). Meeting MVPA and SB recommendations were related to reduced adiposity markers but only in men. Future research is needed to gain insights into the directionality of the associations between 24-h movement guidelines compliance and markers of adiposity but also the mechanisms underlying explaining differences between men and women.

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.

Prevalence and sociodemographic correlates of meeting the Canadian 24-hour movement guidelines among latin american adults: a multi-national cross-sectional study.

BACKGROUND: 24-hour movement behaviors, including moderate-to-vigorous physical activity (MVPA), sedentary time (ST), and sleep duration, have important implications for health across the lifespan. However, no studies exist that have examined the integration of these 24-hour movement behaviors in Latin America. The purpose of this study was to examine the prevalence of meeting the Canadian 24-Hour Movement Guideline recommendations and sociodemographic correlates of meeting the guidelines in adults from eight Latin American countries. METHODS: This was a multi-national cross-sectional study of 2338 adults aged 18 to 64 years from the Latin American Study of Nutrition and Health. MVPA and ST data were collected using accelerometers. Sleep duration was self-reported using a daily log. Socio-demographic correlates included sex, age, education level, and marital status. Meeting the 24-hour movement guidelines was defined as: ≥150 min/week of MVPA; ≤8 h/day of ST; and between 7 and 9 h/day of sleep. Logistic regression models were estimated on pooled data. RESULTS: The prevalence of adults who met the MVPA, ST, sleep duration, and integrated recommendations was 48.3, 22.0, 19.4, and 1.6%, respectively. Overall, being a woman (OR: 0.72; 95%CI: 0.55,0.93) and having a middle (0.63; 0.47,0.85) or high education level (0.31; 0.17,0.56) was associated with lower odds of meeting all three of the 24-hour movement guideline recommendations. Being married (1.70; 1.25,2.29) was associated with greater odds of meeting all three recommendations. Being a woman (0.46; 0.39,0.55), aged 50-64 years (0.77; 0.60,0.97), and married (0.79; 0.65,0.96) were associated with lower odds of meeting the MVPA recommendation. Having a middle (0.64; 0.50,0.80) or high (0.36; 0.23,0.55) education level was associated with lower odds and being married (1.86; 1.46,2.36) was associated with greater odds of meeting the ST recommendation. Being a woman (0.63; 0.51,0.78) was associated with lower odds; whereas being aged 50-64 years (1.40; 1.04,1.88) and having a middle education level (1.37; 1.09,1.73) were associated with greater odds of meeting the sleep duration recommendation. CONCLUSIONS: Overall, the proportion of Latin American adults achieving healthy levels of 24-hour movement behaviors was low. Further efforts are needed to promote more MVPA, less ST, and sufficient sleep in Latin American adults. TRIAL REGISTRATION: Clinical Trials NCT02226627 . Retrospectively registered on August 27, 2014.

Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database.

BACKGROUND: Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. METHODS: We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. RESULTS: A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). CONCLUSIONS: This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.

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.

Alcohol Contribution to Total Energy Intake and Its Association with Nutritional Status and Diet Quality in Eight Latina American Countries.

Alcohol consumption is a modifiable risk factor for non-communicable diseases. This study aimed to characterize alcohol consumers at the nutritional, anthropometric, and sociodemographic levels. Data from 9218 participants from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela participating in "Latin American Health and Nutrition Study (ELANS)", a multi-country, population-based study, were used. Dietary intake was collected through two, 24 h recalls. Participants were classified into consumers (n = 1073) and non-alcohol consumers (n = 8145) using a cut-off criterium of ≥15 g/day of alcohol consumption calculated from the estimation of their usual daily intake. Among alcohol consumers, the mean alcohol consumption was 69.22 ± 2.18 grams (4.6. beverages/day), contributing to 484.62 kcal, which corresponded to 16.86% of the total energy intake. We found that the risk of alcohol consumption was higher in young and middle-aged men from low and middle socioeconomic status. Argentine, Brazil, and Chile had the highest percentage of consumers, while Ecuador showed the highest alcohol consumption. Alcohol drinkers were characterized by having higher body weight and wider neck, waist, hips circumferences. Alcohol drinkers had a higher energy intake, with macronutrients providing relatively less energy at the expense of the energy derived from alcohol. Alcohol drinkers showed lower and higher consumptions of healthy and unhealthy food groups, respectively. In addition, adequacy ratios for all micronutrients assessed were lower in alcohol consumers. All these deleterious effects of alcohol on nutritional and anthropometric parameters increased with the number of alcoholic beverages consumed daily. Altogether, these findings suggest that limiting alcohol consumption can contribute to reducing the risk of obesity, metabolic syndrome, and diet-related diseases.

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.

Anthropometric Profile of Latin American Population: Results From the ELANS Study.

Background: Latin America has experienced changes in lifestyle since 1960. Aim: The aim was to determine the prevalence of obesity and stunting among eight countries of Latin American and to identify the determinant risk factors for obesity. Subjects and Methods: Data were obtained from 9,218 participants of the Latin American Study of Nutrition and Health (ELANS), a multicenter cross-sectional study of the representative samples in eight Latin American countries. All the participants completed a standard protocol to investigate the nutrient intake and anthropometric variables (weight, height, and circumferences) analyzed by country, gender, age, and socioeconomic status. Results: The prevalence of obesity was higher in Costa Rica and Venezuela (29%) and lower in Colombia (16%), stunting was reported higher in Peru (47%) and lower in Argentina (17%), and waist and neck circumferences showed the higher values in Costa Rica (43%) and Chile (52%) and lower values in Colombia (23 and 26%). Conclusion: This study indicates an increasing trend toward overweight and obesity that are associated with lower socioeconomic status, being a woman, and concurs with inadequate intakes of calcium, which may be related to poor quality diet and in the long term could constitute risk factors for the chronic diseases and a health burden to the region.

Association between Active Transportation and Public Transport with an Objectively Measured Meeting of Moderate-to-Vigorous Physical Activity and Daily Steps Guidelines in Adults by Sex from Eight Latin American Countries.

This study aimed to examine the associations between active transportation and public transport and the objectively measured meeting of moderate-to-vigorous physical activity (MVPA) and steps per day guidelines in adults by sex from eight Latin American countries. As part of the Latin American Study of Nutrition and Health (ELANS), data were collected from 2524 participants aged 18-65 years. MVPA and steps per day were evaluated using Actigraph GT3X accelerometers. The mode of transportation, its frequency and duration were collected using a self-reported questionnaire. The average time dedicated to active transportation was 12.8 min/day in men (IQR: 2.8-30.0) and 12.9 min/day in women (IQR: 4.3-25.7). A logistic regression analysis was conducted, showing that active transportation (≥10 min) was associated with higher odds of meeting MVPA guidelines (men: OR: 2.01; 95%CI: 1.58-2.54; women: OR: 1.57; 95%CI: 1.25-1.96). These results show a greater association when considering active transportation plus public transport (men: OR: 2.98; 95%CI: 2.31-3.91; women: OR: 1.82; 95%CI: 1.45-2.29). Active transportation plus public transport was positively associated with meeting steps per day guidelines only in men (OR: 1.55; 95%CI: 1.15-2.10). This study supports the suggestion that active transportation plus public transport is significantly associated with meeting the MVPA and daily steps recommendations.

Correlation between Neck Circumference and Other Anthropometric Measurements in Eight Latin American Countries. Results from ELANS Study.

Neck circumference (NC) is being used to identify the risk of chronic diseases. There is a high prevalence of overweight and obesity in Latin America, and neck circumference is a simple and practical measurement to assess this, especially in primary health centers. We analyzed the correlation between the NC anthropometric indicator and other anthropometric measurements such as BMI and waist circumference (WC) in eight Latin American cities. We applied Pearson's correlation to identify the correlate NC with the other anthropometric variables stratified by sex; the sensitivity (Se) and specificity (Sp) by sex were evaluated according to the cut-off established with the Youden Index. The strongest correlations between NC and WC were found when stratified by sex (women: r = 0.71; men: r = 0.69, respectively) followed by the correlation between NC and BMI (r = 0.65, both sex). NC cut-off points of 39.0 cm in men and 32.9 cm in women identified those individuals with an increased WC and 39.8 and 33.7 cm, respectively, for a substantial increase in WC. For BMI ≥ 25.0 kg/m2 for men, the cut-off point was 37.5 cm, and for women, it was 33.1 cm, and for BMI ≥ 30 kg/m2, the cut-off points were 39.2 and 34.2 cm, for men and women, respectively. Conclusion: NC proved to be a useful, practical, and inexpensive tool that can be used to identify, evaluate, and monitor overweight and obese individuals.

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.

Co-Occurrence and Clustering of Sedentary Behaviors, Diet, Sugar-Sweetened Beverages, and Alcohol Intake among Adolescents and Adults: The Latin American Nutrition and Health Study (ELANS).

Poor diet, sedentary behaviors, sugar-sweetened beverages (SSB) and alcohol intake seem to co-exist in complex ways that are not well understood. The aim of this study was to provide an understanding of the extent to which unhealthy behaviors cluster in eight Latin America countries. A secondary aim was to identify socio-demographic characteristics associated with these behaviors by country. Data from adolescents and adults from the "Latin American Health and Nutrition Study" was used and the prevalence of screen-time, occupational and transportation-sedentary time, socializing with friends, poor diet, SSB and alcohol intake, alone and in combination, were identified. The eight Latin America (LA) countries added to analyses were: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Logistic regression was used to estimate associations between ≥2 behaviors clustering, socio-demographics and weight status. Among 9218 individuals, the most prevalent behaviors were transportation and occupation-sedentary time, SSB and alcohol intake. Younger, female, married/living with a partner, low and middle-income and obese individuals had higher chances for these clustering behaviors. These results provide a multi-country level of understanding of the extent to which behaviors co-occur in the LA population.