Physical Activity Policies at National and Subnational Levels: A Study in Colombia, Costa Rica, Ecuador, and Mexico.

BACKGROUND: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries. METHODS: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics. RESULTS: Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages. CONCLUSIONS: This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.

Unhealthy food consumption among Ecuadorian children: A cross-sectional study in the context of the school food regulation / Consumo de alimentos poco saludables en niños ecuatorianos: estudio transversal en el contexto del reglamento de alimentación escolar

Introduction. The intake of energy-dense unhealthy food at school could influence the overall energy intake of children. Objective: To characterize the patterns of buying a snack at school and to analyze the association of these patterns with the source of the school snack (brought from home or bought at school) and screen time. Materials and methods: A cross-sectional study was conducted from October 2018 until May 2019 among school children (9 to 12-year-olds) from Cuenca-Ecuador. Intake of energy-dense unhealthy food groups, the source of the school snack, and screen time were assessed using questionnaires. Multiple correspondence analysis was used to identify intake patterns of unhealthy food groups, and logistic regression to assess the association between intake of energy-dense unhealthy food groups (FG) with the school snack source. Results: Among 1,028 children recruited 63%, 42%, 30% and 22% of the children reported consuming sweets/confiture, savory snacks, fast food, and pastry products, respectively, at least two days per week. Around 39% of the children were classified as "Frequent consumers of energy-dense unhealthy FG". Buying the snack at school was associated with a more frequent intake of sweets/confiture (OR=1.56, CI 95% =1.05-2.32) and fast food (OR=2.01, CI 95% =1.15-3.50) during the week, as well as with being classified in the "frequent consumer of energy-dense unhealthy FG" (OR=1.99, 95% CI=1.40-2.82). Conclusions: Ecuadorian children still consume prohibited unhealthy foods at school. These results reinforce the importance of evaluating, monitoring, and adapting strategies to promote a balanced diet(AU)

Introducción. La ingesta de alimentos poco saludables con alto contenido energético en la escuela podría influir en la ingesta energética total de los niños. Objetivo: Caracterizar los patrones de compra de snacks en el colegio y analizar la asociación de estos patrones con la procedencia del snack escolar (de la casa o comprada en el colegio) y el tiempo de pantalla. Materiales y métodos: Se realizó un estudio transversal (octubre 2018-mayo 2019) en escolares (9-12 años) Cuenca- Ecuador. La ingesta de grupos de alimentos (FG) no saludables altos en energía, la fuente del snack escolar y el tiempo de pantalla se evaluaron mediante cuestionarios. Se utilizó análisis de correspondencias múltiples para identificar patrones de ingesta de FG poco saludables y la regresión logística para evaluar asociación entre la ingesta FG no saludables con la fuente del snack escolar. Resultados: En 1.028 niños 63%, 42%, 30% y 22% declararon consumir dulces/golosinas, aperitivos salados, comida rápida y productos de pastelería, respectivamente, al menos dos/días/ semana. Un 39% fueron clasificados como "Consumidores frecuentes de FG poco saludables de alta densidad energética". La compra de los snacks en el colegio se asoció con una ingesta más frecuente de dulces/golosinas (OR=1,56; IC95%=1,05-2,32) y comida rápida (OR=2,01; IC95%=1,15-3,50) durante la semana y con la clasificación en el grupo" consumidores frecuentes de FG poco saludables de alta densidad energética" (OR=1,99; IC95%=1,40- 2,82). Conclusiones: Los niños ecuatorianos aún consumen alimentos no saludables prohibidos en la escuela. Estos resultados refuerzan la importancia de evaluar, monitorear y adaptar estrategias para promover una dieta balanceada(AU)

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

BACKGROUND: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Cardiovascular risk among 6-8-year-old children living in urban and rural communities in Ecuador: A cross-sectional analysis.

Cardiovascular diseases have their origins in childhood. At least 20% of children and adolescents in Latin America are overweight or obese. However, little is known regarding the cardiovascular risk of young children living in the region. This paper aims to identify associations between socio-demographics, adiposity, and dietary intake with cardiometabolic risk among children between 6- and 8-years old living in urban and rural Andean regions of Ecuador. A cross-sectional study was conducted among 267 children attending elementary schools between February and August 2018. Sociodemographic data were collected using a structured interview. Bodyweight, height, and waist circumference were measured in duplicate; blood samples were taken after overnight fasting to determine blood lipids, hepatic enzymes, and adipokines; food intake data was assessed by two 24-h recalls administered to the guardians. Associations between cardiometabolic risk (i.e., blood lipids, hepatic enzymes, and adipokines) with sociodemographic characteristics, dietary intake, and waist circumference were tested using multiple hierarchical regression models. Twenty-nine percent of the children were overweight or obese, 12% had low HDL levels, and over 18% had high levels of LDL and triglycerides. Children living in the urban region had lower levels of HDL (ß-4.07 mg/dL; 95% CI: -7.00; -1.15; P = 0.007) but higher levels of LDL cholesterol (ß 8.52 mg/dL; 95% CI: 1.38; 15.66; P = 0.019). Hepatic enzymes were also higher among urban children (SGOT: ß% 22.13; 95% CI: 17.33; 26.93; P < 0.001; SGPT: ß 0.84 U/L; 95% CI: 0.09; 1.59; P = 0.028). Leptin blood levels were higher (ß% 29.27; 95% CI: 3.57; 54.97; P = 0.026), meanwhile adiponectin plasma concentrations were lower among urban children (ß%-103.24; 95% CI: -58.9; -147.58; P = < 0.001). Fiber intake was inversely associated with total cholesterol (ß-9.27 mg/dL; 95% CI -18.09; -0.45; P = 0.040) and LDL cholesterol blood levels (ß-9.99 mg/dL; 95% CI: -18.22; -1.75; P = 0.018). Our findings demonstrate that young children are at high cardiovascular risk; if no actions are taken, the burden of non-communicable diseases will be substantial. The differences in risk between rural and urban areas are evident; urbanization might predispose children to a different reality and, in most cases, result in poor habits.

Physical activity during recess in elementary schoolchildren in Belgium and Ecuador: The role of the physical environment at school.

To increase physical activity levels in children, knowledge on how school playgrounds can be optimally designed is important. Until now, the contribution of playground variety and greening to children's physical activity level during recess remains unclear. This study examined the associations of school playground variety and greening with energy expenditure (EE) in elementary school children in Ecuador and Belgium. Additionally, moderating effects of study site and gender were studied. Observational data were collected using SOPLAY in ten schools in East Flanders (Belgium) and Cuenca (Ecuador). Data were analysed with linear mixed-effects model analyses. Results showed that independent of study site, EE was higher in playground areas with less green elements, and a higher level of total variety. Primary surface was only associated with EE in boys, they were more active when an artificial surface was present. Implementation of loose equipment was somewhat more strongly positively associated with EE in Ecuadorian than in Belgian children. Because of the well-known restorative effects of green elements, we do not wish to suggest that less greening should be implemented at schools. However, ideally green spaces should be designed in a way that active play is stimulated by combining green elements with other improvements.

Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador.

BACKGROUND: Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. METHODS: We used data from a prospective cohort of 213 children aged 5-17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). RESULTS: During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72-1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14-0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04-0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90-1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10-1.58, P = 0.003). CONCLUSIONS: In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.

Nature relatedness as a potential factor to promote physical activity and reduce sedentary behavior in Ecuadorian children.

BACKGROUND: Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior. METHODS: A cross-sectional study involving 9-12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score. RESULTS: A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (ß = 0.07; CI 95%: 0.05-0.09; p < 0.001) and non-screen-related sedentary leisure (ß = 3.77 minutes; CI 95%: 0.76-6.68; p < 0.05); it was negatively associated with screen time (ß = -5.59 minutes; CI 95%: -10.53-0.65; p < 0.05). CONCLUSIONS: Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

Síndrome de Intestino Irritable en personal de enfermería de un Hospital de Cuenca-Ecuador / Irritable Bowel Syndrome in nursing staff at a hospital in Cuenca-Ecuador

INTRODUCCIÓN: El síndrome de intestino irritable (SII) es un trastorno funcional digestivo frecuente en personal de salud, con importantes repercusiones en la calidad de vida, en el trabajo, en el sistema de salud y la sociedad. El objetivo del presente estudio fue determinar la frecuencia de reporte del SII y sus subtipos en los historiales médicos del personal de enfermería de un hospital en Cuenca - Ecuador. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, en una muestra aleatoria de trabajadores del área de enfermería del José Carrasco Arteaga de Cuenca-Ecuador, entre junio 2017-abril 2018. De acuerdo con los criterios de Roma III, se valoraron los historiales médicos de los trabajadores para determinar la frecuencia de SII y sus subtipos. Finalmente, se describieron los factores sociodemográficos, laborales y psicológicos del personal de enfermería. RESULTADOS: Fueron evaluados los historiales médicos de 214 miembros del personal de enfermería (media de edad: 38.7±10.4 años, sexo: 95.3% de mujeres). Se encontró diagnóstico de SII en el 7.0% (15/214) del personal evaluado, siendo los subtipos indeterminado (7/15) y mixto (4/15) los más frecuentes. El 20% del personal del área de enfermería con SII tenía trastornos mentales (ansiedad, depresión y/o distimia) y el mismo porcentaje trabajaban por turnos CONCLUSIÓN: Los resultados obtenidos permiten evidenciar que el SII reportado en historiales médicos de personal de enfermería, en la ciudad de Cuenca-Ecuador, es menor a lo esperado (7%). Los subtipos de SII más frecuentes fueron el subtipo indeterminado, seguido del subtipo mixto.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional-digestive disorder in health personnel, with significant repercussions on life quality, work, healthcare system and society. The aim of this study was to determine the frequency of reported IBS and its subtypes in the nursing staffs' medical records of a public hospital, in Cuenca - Ecuador. METHODOLOGY: A cross-sectional, descriptive study, with a randomized sample of nursing workers of Hospital Jose Carrasco Arteaga, Cuenca- Ecuador; between June 2017 and April 2018. According to Rome III criteria, medical records were assessed looking for IBS diagnosis and the subtype. Finally, sociodemographic, occupational and psychological factors among the nursing staff was also described. RESULTS: Two-hundred and fourteen medical records were evaluated (average age: 38.7 ± 10.4 years, 95.3% women). A diagnosis of IBS was found in 7.0% (15/214) of the personnel evaluated. The most frequent IBS subtypes were undetermined (46.7%, 7/15) and mixed (26.7%, 4/15). Twenty percent of the nursing staff with IBS, had mental disorders diagnosis (anxiety, depression and/or dysthymia), the same percent worked shifts. CONCLUSION: The diagnosis of IBS reported in the nursing staff medical records, in Cuenca- Ecuador was lower than expected (7%). The most frequent IBS subtypes were undetermined subtype, followed by mixed subtype.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Food allergy, airborne allergies, and allergic sensitisation among adolescents living in two disparate socioeconomic regions in Ecuador: A cross-sectional study.

BACKGROUND: Allergic diseases are under-investigated and overlooked health conditions in developing countries. We measured the prevalence of food allergy (FA), airborne allergic disease, and allergic sensitisation among adolescents living in 2 socio-demographically disparate regions in Ecuador. We investigated which risk factors are associated with these conditions. METHODS: A cross-sectional study involved 1338 students (mean age: 13 ± 0.9 years old) living in Cuenca (n = 876) and Santa Isabel (n = 462). History of allergic symptoms (noted by parents or doctor) to food, house dust mites (HDM), pollen, and pets were recorded. Sociodemographic characteristics, environmental exposures, and parental history of allergic disorders data were collected. Sensitisation to 19 food and 20 aeroallergens was measured by skin-prick testing (SPT). FA and airborne allergic diseases (to HDM, pollen, cat, or dog) were defined as a report of allergic symptoms noted by doctor, together with a positive SPT (wheal size ≥3 mm). Logistic regression models were used to identify environmental and parental factors associated with allergic conditions. RESULTS: FA was prevalent among 0.4% (95% CI 0.2%-0.9%), and food sensitisation among 19.1% of the adolescents. Shrimp was the most frequent food linked with FA and food sensitisation. Risk factors associated with FA could not be evaluated due to the low prevalence. Food sensitisation was higher among adolescents exposed to family smoking (OR 1.63, 95% CI 1.14-2.34, p = 0.008) and those with parental history of allergic disorders (OR 1.68, 95% CI 1.13-2.49, p = 0.01), but less common among adolescents owning dogs (OR 0.59, 95% CI 0.41-0.84, p = 0.003).Airborne allergic diseases were prevalent amongst 12.0% of the adolescents (95% CI: 10.4-13.9, n = 1321), with HDM as the primary allergen (11.2%). Airborne allergic diseases were less common among adolescents with more siblings (OR 0.79, 95% CI 0.65-0.96, p = 0.02) and those who lived with farm animals in the first year of life (OR 0.47, 95% CI 0.23-0.95, p = 0.04), but, most common among adolescents with a smoking family (OR 1.67, 95% CI 1.04-2.70, p = 0.03) and with a parental history of allergic disorders (OR self-perceived: 2.62, 95% CI 1.46-4.71, p = 0.001; OR diagnosed by a doctor: 4.07, 95% CI 2.44-6.80, p < 0.001). CONCLUSIONS: FA and airborne allergies are less prevalent in Ecuador than in developed regions; there is a great dissociation between the prevalence of allergic disease and allergic sensitisation. Shrimp and HDM were the most prevalent allergens. Risk factors identified in this study to be related to allergic diseases should be considered by physicians, health practitioners, and epidemiologists in Ecuador.

Viperidae snakebites in Ecuador: A review of epidemiological and ecological aspects.

Snakebite envenoming is a neglected disease of public health concern. Most snakebite accidents occur in developing countries. In Ecuador, 17 viper species are responsible for 99% of official accidents, and ten species are in critical conservation states. This report analyzes the snakebite incident cases and mortality rates in Ecuador between 2014 and 2019. The data obtained from the national surveillance system suggests that the incidence and mortality rates remained constant. The geographic region with the highest incidence rates is the Amazonian region. National policies are urgently needed to prevent snakebite accidents and to protect snakes in danger of extinction.

Prevalence and risk factors for asthma, rhinitis, eczema, and atopy among preschool children in an Andean city.

BACKGROUND: Limited data are available on prevalence and associated risk factors for atopy and allergic diseases from high-altitude urban settings in Latin America. OBJECTIVE: To estimate the prevalence of atopy, asthma, rhinitis, and eczema, and associations with relevant risk factors in preschool children in the Andean city of Cuenca. METHODS: A cross-sectional study was undertaken using a representative sample of 535 children aged 3-5 years attending 30 nursery schools in the city of Cuenca, Ecuador. Data on allergic diseases and risk factors were collected by parental questionnaire. Atopy was measured by skin prick test (SPT) reactivity to a panel of relevant aeroallergens. Associations between risk factors and the prevalence of atopy and allergic diseases were estimated using multivariable logistic regression. RESULTS: Asthma symptoms were reported for 18% of children, rhinitis for 48%, and eczema for 28%, while SPT reactivity was present in 33%. Population fractions of asthma, rhinitis, and eczema attributable to SPT were 3.4%, 7.9%, and 2.9%, respectively. In multivariable models, an increased risk of asthma was observed among children with a maternal history of rhinitis (OR 1.85); rhinitis was significantly increased in children of high compared to low socioeconomic level (OR 2.09), among children with a maternal history of rhinitis (OR 2.29) or paternal history of eczema (OR 2.07), but reduced among children attending daycare (OR 0.64); eczema was associated with a paternal history of eczema (OR 3.73), and SPT was associated with having a dog inside the house (OR 1.67). CONCLUSIONS: A high prevalence of asthma, rhinitis, and eczema symptoms were observed among preschool children in a high-altitude Andean setting. Despite a high prevalence of atopy, only a small fraction of symptoms was associated with atopy. Parental history of allergic diseases was the most consistent risk factor for symptoms in preschool children.

Correction: Prevalence and risk factors for asthma, rhinitis, eczema, and atopy among preschool children in an Andean city.

[This corrects the article DOI: 10.1371/journal.pone.0234633.].

Report Card Grades on the Physical Activity of Children and Youth From 10 Countries With High Human Development Index: Global Matrix 3.0.

BACKGROUND: The Global Matrix 3.0 brings together the Report Card grades for 10 physical activity indicators for children and youth from 49 countries. This study describes and compares the Global Matrix 3.0 findings among 10 countries with high Human Development Index. METHODS: Report Cards on physical activity indicators were developed by each country following a harmonized process. Countries informed their Report Cards with the best and most recent evidence available. Indicators were graded using a common grading rubric and benchmarks established by the Active Healthy Kids Global Alliance. A database of grades from the countries was compiled, and letter grades were converted to numerical equivalents. Descriptive statistics and scores for groups of indicators were calculated, and correlation analyses were conducted. RESULTS: Grades for the 10 countries clustered around "D" ranging from "F" to "B+." Active Transportation had the highest average grade ("C"), whereas Overall Physical Activity had the lowest average grade ("D-"). Low grades were observed for both behavioral and sources of influence indicators. CONCLUSIONS: In the context of social and economical changes of high- Human Development Index countries, urgent actions to increase physical activity among children and youth are required. Surveillance and monitoring efforts are required to fill research gaps.

A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial.

BACKGROUND: In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents. METHODS: A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage. RESULTS: Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one. CONCLUSIONS: The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale. TRIAL REGISTRATION: ClinicalTrial.gov-NCT01004367 .

Estudio Transversal: Factores de Riesgo para Alergia Alimentaria en Adolescentes de Cuenca y Santa Isabel, Ecuador / Cross-Sectional Study: Risk Factors for Food Allergy in Adolescents from Cuenca and Santa Isabel, Ecuador

INTRODUCCIÓN: La alergia alimentaria en adolescentes ha sido asociada ampliamente con ciertos factores de riesgo. El objetivo de esta investigación fué determinar y comparar, entre adolescentes de Cuenca y Santa Isabel, la prevalencia de alergia alimentaria y la asociación con factores de riesgo demográficos, genéticos, medioambientales y clínicos determinados por autoreporte y test cutáneo. MÉTODO: Se realizó un estudio transversal en 1508 adolescentes de Cuenca (n=1008) y Santa Isabel (n=500) entre julio de 2013 y julio de 2014. Para determinar alergia alimentaria y sus factores de riesgo se aplicaron cuestionarios de autoreporte y de necesidades básicas insatisfechas, excepto para sensibilización a aeroalérgenos. Este factor de riesgo fue establecido por test cutáneo. Se emplearon modelos de regresión lineal para determinar las asociaciones entre alergia alimentaria y factores de riesgo. RESULTADOS: La prevalencia de alergia alimentaria (síntomas de alergia alimentaria autoreportada más test cutáneo positivo al menos a un alimento), para 1411 participantes con información completa, fue de 2.34 %; no se observó diferencias estadísticamente significativas entre las áreas de estudio (Cuenca: 2.31 % vs. Santa Isabel: 2.39 %; p: > 0.05). La rinoconjuntivitis fue el único factor de riesgo asociado con la alergia alimentaria. Los adolescentes que reportaron síntomas de rinoconjuntivitis fueron 5.4 % más propensos a presentar alergia alimentaria que reportaron (p: < 0.001). Ninguna otra interacción persistió estadísticamente significativa en el modelo de regresión lineal completo por lo que ningún resultado fue estratificado por cantón. CONCLUSIONES: La alergia alimentaria determinada por auto reporte y test cutáneo fue prevalente en los adolescentes de Cuenca y Santa Isabel. Para este grupo la rinoconjuntivitis fue el único factor de riesgo relacionado con alergia alimentaria, denotando una predisposición genética a presentar enfermedades alérgicas. La rinoconjuntivitis incrementó un 5.4 % la probabilidad de padecer alergia alimentaria para los adolescentes de las regiones estudiadas.

BACKGROUND: Food allergy in adolescents has been widely associated with risk factors. The aimofthis investigation was determined, among adolescents of Cuenca and Santa Isabel, the prevalence of food allergy and its association with reported risk factors determined by self-report and skin prick test. METHODS: A cross-sectional study was developed in 1508 adolescents (n = 1008) of Cuenca and Santa Isabel (n = 500), between July 2013 and July 2014. To define food allergy and risk factors of food allergy self-reported and unsatisfied basic needs questionnaires were applied. Aeroallergen sensitization was determined by skin prick test with aeroallergens. Linear regression models were applied to determine the associations between food allergy and factors risks. RESULTS: The prevalence of food allergy (self-reported allergy symptoms and positive skin prick test to at least one food), for 1411 participants with complete information was 2.34 %. Do not was observed statistically significant differences between the study areas (2.31%Cuenca vs. 2.39%in Santa Isabel; p > 0.05). Rhino-conjunctivitis was the only risk factors associated. Adolescents who self-reported rhino-conjunctivitis were 5.4 % more likely to have food allergy than adolescents who not reported it (p: < 0.001). No other statistically significant interaction persisted in the full linearregression model so result no was stratified by canton. CONCLUSIONS: Food allergy determined by skin testwas prevalentin adolescents ofCuenca and Santa Isabel. Rhinoconjunctivitis forthis group was the only risk factor associated with food allergy, denoting a genetic predisposition to develop allergic diseases. Rhinoconjunctivitis increased 5.4 % chance of developing the food allergy for adolescents in the regions studied.

Evaluación del Consumo de Macronutrientes, Sodio, Calcio y Azúcares Añadidos de Acuerdo A las Recomendaciones de la Oms en Adolescentes de 9 A 18 Años de Cuenca y Nabón / Evaluation of Macronutrient Intake, Sodium, Calcium and Added Sugars According to WHO Recommendations in Adolescents 9 to 18 Years of Cuenca and Nabon

Antecedentes: La adolescencia es un periodo de crecimiento acelerado en donde se producen una serie de cambios físicos, lo que origina una mayor demanda de necesidades nutricionales, tanto de energía como de carbohidratos, proteínas, grasas, vitaminas y minerales. Estas características condicionan la posibilidad de producirse deficiencias nutricionales en esta edad si la ingesta no es la adecuada.Objetivo: El objetivo de este estudio es evaluar el con-sumo de macronutrientes, sodio, calcio y azúcar añadido en adolescentes de Cuenca y Nabón de acuerdo a las recomendaciones establecidas por la OMS. Materiales y Método: Un estudio descriptivo transversal fue realizado desde enero 2008 hasta abril 2009 en 765 adolescentes de 8vo, 9no y 10mo de educación básica de Cuenca y Nabón (Ecuador). La recolección de la ingesta dietaria fue mediante recordatorio de 24 horas aplicado en 2 días no consecutivos. Se utilizó el Software Lucille 0.1 para el ingreso y el cálculo de la ingesta de alimentos. El análisis de los datos fue realiza-do mediante el programa estadístico STATA 12, donde se determinó el consumo diario de nutrientes ajustado para la energía total y se calculó el porcentaje de adolescentes que cumple con las recomendaciones de la OMS. resultados: La ingesta de carbohidratos (80%), grasas (76%) y proteínas (67%), en la mayoría de los adolescentes se encuentran dentro del rango recomendado por la OMS; sin embargo, en el caso del consumo de sodio y azúcar añadido, los valores de más de la mitad de los adolescentes están por encima de las recomendaciones. Así también, solo alrededor del 1% de la población estudiada cumple con los requerimientos diarios de consumo de calcio. Conclusión: Esta población de adolescentes presenta un desequilibrio en la ingesta dietética, especialmente de micronutrientes y azúcar añadido. Por lo que se ven necesarios programas de intervención en alimentación saludable y prevención de la obesidad e hipertensión sobre todo en las instituciones educativas.

Objective: The objective of this study is to evaluate the intake of macronutrients, sodium, calcium and added sugar in adolescents of Cuenca and Nabón according to the recommendations established by the WHO. Materials and Method: A cross-sectional descriptive study was conducted from January 2008 to April 2009 in 765 adolescents from 8th, 9th and 10th grade basic education in Cuenca and Nabón (Ecuador). The collec-tion of dietary intake was through a reminder of 24-hours that was applied in 2 non-consecutive days. The Softwa-re Lucille 0.1 was used for the intake and calculation of ingested food. Data analysis was performed using the statistical program STATA 12, which determined the daily intake of nutrients that were adjusted for the total energy and calculated according to the percentage of adolescents that follows the WHO recommendations.rEsults: The intake of carbohydrates (80%), fats (76%) and proteins (67%) in most adolescents are within the range recommended by the WHO; however, in the case of consumption of sodium and added sugar, the values of more than half of adolescents are above re-commendations. Thus, only about 1% of the population studied meets the daily requirements of calcium con-sumption. Conclusion: This population of adolescents presents an imbalance in dietary intake, especially of micronu-trients and added sugar. Therefore, intervention pro-grams in healthy eating and prevention of obesity and hypertension are necessary especially in educational institutions.

Individual and Environmental Factors Influencing Adolescents' Dietary Behavior in Low- and Middle-Income Settings.

OBJECTIVE: Given the public health importance of improving dietary behavior in chronic disease prevention in low- and middle-income countries it is crucial to understand the factors influencing dietary behavior in these settings. This study tested the validity of a conceptual framework linking individual and environmental factors to dietary behavior among Ecuadorian adolescents aged 10-16 years. METHODS: A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents in urban and rural Southern Ecuador. Participants provided data on socio-economic status, anthropometry, dietary behavior and its determining factors. The relationships between individual (perceived benefits and barriers, self-efficacy, habit strength, and a better understanding of healthy food) and environmental factors (physical environment: accessibility to healthy food; social environment: parental permissiveness and school support), and their association with key components of dietary behavior (fruit and vegetables, sugary drinks, breakfast, and unhealthy snack intake) were assessed using structural equation modeling. RESULTS: The conceptual model performed well for each component of eating behavior, indicating acceptable goodness-of-fit for both the measurement and structural models. Models for vegetable intake and unhealthy snacking showed significant and direct effects of individual factors (perceived benefits). For breakfast and sugary drink consumption, there was a direct and positive association with socio-environmental factors (school support and parental permissiveness). Access to healthy food was associated indirectly with all eating behaviors (except for sugary drink intake) and this effect operated through socio-environmental (parental permissiveness and school support) and individual factors (perceived benefits). CONCLUSION: Our study demonstrated that key components of adolescents' dietary behaviors are influenced by a complex interplay of individual and environmental factors. The findings indicate that the influence of these factors varied by type of dietary behavior.