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2.
Glob Heart ; 14(2): 155-163, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31324370

RESUMO

BACKGROUND: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities. OBJECTIVES: This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned. METHODS: We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention. RESULTS: The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components. CONCLUSIONS: We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.

3.
Public Health Nutr ; 22(13): 2509-2520, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31109393

RESUMO

OBJECTIVE: To examine the frequency of television (TV) food and beverage advertisements (F&B ads) to which children (4-11 years) are likely exposed and the nutrient profile of products advertised. DESIGN: TV broadcasting between September and November 2016 was recorded (288 h of children's programming; 288 h of family programming) resulting in 8980 advertisements, of which 1862 were F&B ads. Of those, 1473 could be classified into one of the seventeen food groups, and into permitted/non-permitted according to the WHO-EU nutrient profile model. Persuasive marketing techniques used were also identified. SETTING: TV programming was recorded for four weekdays and four weekend days, between 06.00 and 00.00 hours (576 total hours), for four channels (two national and two cable), in Costa Rica. RESULTS: Mean (sd) number of F&B ads/h was greater in cable than national channels (3·7 (0·4) v. 2·8 (0·4), P < 0·05) and during children's peak viewing hours (4·4 (0·4) v. 2·9 (0·3)). Of F&B ads classified with WHO-EU nutrient profile model (n 1473, 71·1 %), 91·1 % were non-permitted to be marketed to children. Categories most frequently advertised were ready-made/convenience foods (16 %), chocolates/confectionery/desserts (15 %), breakfast cereals (14 %), beverages (15 %), edible ices (9 %) and salty snacks (8 %). Non-permitted F&B ads were more likely to use promotional characters, brand benefit claims, and nutrition and health claims than permitted F&B ads. CONCLUSIONS: Children watching popular TV channels in Costa Rica are exposed to a high number of unhealthy F&B ads daily. Our findings help justify the need for regulatory actions by national authorities.

4.
BMC Womens Health ; 19(1): 53, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943958

RESUMO

BACKGROUND: Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women's Circles) in a population with significant need but no access to mental health services. METHODS: A parallel group pilot randomised study was undertaken in five rural Mam and three periurban K'iche' communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility. RESULTS: The intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores. CONCLUSIONS: The pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women's groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing. TRIAL REGISTRATION: ISRCTN13964819 . Registered 26 June 2018, retrospectively registered.


Assuntos
Redes Comunitárias/organização & administração , Serviços de Saúde do Indígena/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Feminino , Guatemala , Humanos , Lactente , Serviços de Saúde Materna/organização & administração , Projetos Piloto , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Adulto Jovem
5.
Obes Rev ; 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30977265

RESUMO

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

6.
Obes Rev ; 2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30609260

RESUMO

The Healthy Food Environment Policy Index (Food-EPI) aims to assess the extent of implementation of recommended food environment policies by governments compared with international best practices and prioritize actions to fill implementation gaps. The Food-EPI was applied in 11 countries across six regions (2015-2018). National public health nutrition panels (n = 11-101 experts) rated the extent of implementation of 47 policy and infrastructure support good practice indicators by their government(s) against best practices, using an evidence document verified by government officials. Experts identified and prioritized actions to address implementation gaps. The proportion of indicators at "very low if any," "low," "medium," and "high" implementation, overall Food-EPI scores, and priority action areas were compared across countries. Inter-rater reliability was good (GwetAC2 = 0.6-0.8). Chile had the highest proportion of policies (13%) rated at "high" implementation, while Guatemala had the highest proportion of policies (83%) rated at "very low if any" implementation. The overall Food-EPI score was "medium" for Australia, England, Chile, and Singapore, while "very low if any" for Guatemala. Policy areas most frequently prioritized included taxes on unhealthy foods, restricting unhealthy food promotion and front-of-pack labelling. The Food-EPI was found to be a robust tool and process to benchmark governments' progress to create healthy food environments.

7.
Salud Publica Mex ; 60(5): 592-597, 2018 Sep-Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-30550121

RESUMO

There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.


Assuntos
Conflito de Interesses , Indústria Alimentícia , Indústria Alimentícia/normas
8.
JMIR Mhealth Uhealth ; 6(11): e10226, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389646

RESUMO

BACKGROUND: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant's stage of readiness to change behaviors. OBJECTIVE: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial's pooled results, and by each participant's stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome-blood pressure-for each country. METHODS: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants' stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. RESULTS: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants' stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. CONCLUSIONS: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake. TRIAL REGISTRATION: ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B).

9.
Food Nutr Bull ; : 379572118808639, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30458642

RESUMO

BACKGROUND:: Polyunsaturated fatty acid (PUFA) intake is low throughout Latin America. Improving PUFA status could be an effective intervention against chronic disease, but information on sociodemographic and dietary patterning of PUFA status in the region is limited. OBJECTIVE:: To characterize sociodemographic, anthropometric, and dietary predictors of PUFA status biomarkers in adipose tissue among children and their parents from Mesoamerica. METHODS:: This was a cross-sectional study of 220 children aged 7 to 12 years and 471 parents from capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, and Belize, as well as Tuxtla Gutiérrez in Mexico. The PUFA from gluteal adipose tissue was quantified using gas chromatography. Participants reported sociodemographic information and the type of vegetable oil used for cooking. We estimated percent mean differences in linoleic acid (LA), total long-chain n-6 PUFA (n-6 LCPUFA), α-linolenic acid (ALA), and total long-chain n-3 PUFA (n-3 LCPUFA) between levels of predictors using multivariable-adjusted linear regression models. RESULTS:: Country was the strongest predictor of any PUFA, whereas body mass index was positively associated with n-6 LCPUFA in children and adults. Cooking primarily with soybean oil was positively associated with LA in children and adults and ALA in adults. Cooking with canola oil was positively related to n-6 LCPUFA in adults and n-3 LCPUFA in children and adults. Cooking with palm oil was associated with low adipose tissue levels of all n-6 and n-3 PUFA. CONCLUSIONS:: Adipose tissue PUFA status in Mesoamerica is associated with country of origin and the type of oil used for cooking.

10.
Salud pública Méx ; 60(5): 592-597, sep.-oct. 2018.
Artigo em Espanhol | LILACS-Express | ID: biblio-1004664

RESUMO

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.


Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

11.
Lancet Glob Health ; 6(8): e875-e884, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30012268

RESUMO

BACKGROUND: Low-income and middle-income countries with populations that are chronically undernourished in early life are undergoing a nutrition transition and are experiencing an epidemic of cardiometabolic disease. These dual burdens are thought to be causally related; therefore, the extent to which improvements in early-life nutrition can offset adult-onset disease is important. The aim of this study was to examine whether improvement of protein-energy nutrition from conception to age 2 years can attenuate the risk of cardiometabolic disease. METHODS: We followed up a cohort of 2392 individuals born between Jan 1, 1962, and Feb 28, 1977, in four villages in Guatemala who had participated in a cluster-randomised protein-energy nutritional supplementation (Atole) trial. Of 1661 participants available for follow-up from Feb 26, 2015, to April 29, 2017, we studied 684 women and 455 men. We assessed cardiometabolic disease risk at ages 37-54 years using anthropometry, fasting and post-challenge glucose, fasting lipid concentrations, and blood pressure. We used generalised linear and logistic regression modelling to estimate the effect of Atole from conception to age 2 years (the first 1000 days) on cardiometabolic disease risk. FINDINGS: Exposure to Atole from conception to age 2 years was associated with increased fatness (body-mass index [1·29 kg/m2, 95% CI 0·08 to 2·50], body fat [1·73%, 0·20 to 3·26], and obesity [odds ratio 1·94, 1·11 to 3·40]), diastolic blood pressure (1·59 mm Hg, -0·74 to 3·92), and blood lipids (total cholesterol [10·10 mg/dL, 0·80 to 19·40] and non-HDL cholesterol [10·41 mg/dL, 1·51 to 19·31]), reduced post-challenge glucose (-5·84 mg/dL, -12·51 to 0·83), and reduced odds of diabetes (odds ratio 0·46, 0·21 to 0·97). We found stratum heterogeneity by sex in pooled models for non-HDL cholesterol (4·34 mg/dL, 95% CI -6·86 to 15·55 for women vs 19·84 mg/dL, 5·86 to 33·82 for men) and post-challenge glucose (-0·19 mg/dL, -8·63 to 8·24 for women vs -13·10 mg/dL, -23·64 to -2·56 for men). p values for interaction of sex and exposure to Atole from conception to age 2 years were 0·09 and 0·04, respectively. INTERPRETATION: Improved protein-energy nutrition from conception to the 2nd birthday reduced the odds of diabetes at ages 37-54 years; however, this protein-energy supplementation also increased the risk of obesity and several obesity-related conditions. Our findings suggest a mixed ability of protein-energy nutritional supplementation in early life to prevent adult cardiometabolic disease incidence in the context of high childhood stunting and high adult overweight and obesity. FUNDING: National Institutes of Health.

12.
PLoS One ; 12(12): e0189255, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29236788

RESUMO

Liver cancer is an emerging global health issue, with rising incidence in both the United States and the economically developing world. Although Guatemala experiences the highest rates of this disease in the Western hemisphere and a unique 1:1 distribution in men and women, few studies have focused on this population. Thus, we determined the prevalence and correlates of aflatoxin B1 (AFB1) exposure and hepatitis virus infection in Guatemalan adults. Healthy men and women aged ≥40 years (n = 461), residing in five departments of Guatemala, were enrolled in a cross-sectional study from May-October of 2016. Serum AFB1-albumin adducts were quantified using isotope dilution mass spectrometry. Multivariate linear regression was used to assess relationships between AFB1-albumin adduct levels and demographic factors. Biomarkers of hepatitis B virus and hepatitis C virus infection were assessed by immunoassay and analyzed by Fisher's exact test. AFB1-albumin adducts were detected in 100% of participants, with a median of 8.4 pg/mg albumin (range, 0.2-814.8). Exposure was significantly higher (p<0.05) in male, rural, low-income, and less-educated participants than in female, urban, and higher socioeconomic status participants. Hepatitis B and C seropositivity was low (0.9% and 0.5%, respectively). Substantial AFB1 exposure exists in Guatemalan adults, concurrent with low prevalence of hepatitis virus seropositivity. Quantitatively, AFB1 exposures are similar to those previously found to increase risk for liver cancer in Asia and Africa. Mitigation of AFB1 exposure may reduce liver cancer incidence and mortality in Guatemala, warranting further investigation.


Assuntos
Aflatoxina B1/toxicidade , Exposição Ambiental , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adulto , Aflatoxina B1/sangue , Aflatoxinas/sangue , Idoso , Idoso de 80 Anos ou mais , Albuminas , Estudos Transversais , Feminino , Guatemala/epidemiologia , Hepatite B/complicações , Hepatite C/complicações , Humanos , Incidência , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco
13.
Public Health Nutr ; 20(15): 2754-2765, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28735597

RESUMO

OBJECTIVE: To determine the associations of sociodemographic characteristics, diet and outdoor activity as an indicator of sun exposure with serum 25-hydroxyvitamin D (25(OH)D) concentrations in children and their parents from Mesoamerica. We also quantified family aggregation of serum 25(OH)D. DESIGN: Cross-sectional study. Serum 25(OH)D concentrations were quantified using immunoassay. We compared the distribution of 25(OH)D concentrations in adults and children by levels of each correlate with the use of linear regression. Family aggregation was estimated using Pearson and intraclass correlation coefficients. SETTING: Capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Costa Rica, Panama and Belize, and Tuxtla Gutiérrez in Mexico. SUBJECTS: Children (n 223) aged 7-12 years and 492 parents. RESULTS: Mean (sd) 25(OH)D concentrations in adults and children were 81·3 (21·1) and 79·5 (18·1) nmol/l, respectively. Prevalence of vitamin D deficiency (VDD; 25(OH)D <50 nmol/l) was 3·9 % among adults and 3·6 % among children. In adults, adjusted mean 25(OH)D concentrations were highest in Nicaragua (P<0·0001). Serum 25(OH)D was positively related to time spent gardening (P=0·03). Among children, 25(OH)D concentrations were positively associated with male sex (P=0·005), dairy intake (P=0·03) and mother's serum 25(OH)D concentrations (P<0·0001); and inversely associated with mother's BMI (P=0·02) and number of home assets (P=0·04). Family membership explained 31 % of the variability in 25(OH)D concentrations; aggregation was highest between mothers and children. CONCLUSIONS: VDD prevalence was low in this study. Sociodemographic characteristics, diet and outdoor activity predict serum 25(OH)D. Family aggregation of serum 25(OH)D is high between mothers and children.


Assuntos
Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Adulto , Índice de Massa Corporal , América Central/epidemiologia , Criança , Estudos Transversais , Dieta , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Fatores Socioeconômicos , Luz Solar , Inquéritos e Questionários , Vitamina D/administração & dosagem
14.
Am J Hum Biol ; 29(3)2017 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-27891759

RESUMO

OBJECTIVE: Telomere length is a biomarker of cumulative stress and inflammation related to chronic disease risk. We examined the associations of leukocyte telomere length (LTL) with sociodemographic and anthropometric variables and estimated LTL family aggregation in Central America, a region with a high burden of chronic disease where LTL has not been studied. METHODS: We conducted a cross-sectional study of 174 school age children and their parents in the capital cities of Belize, Honduras, Nicaragua, Costa Rica, Panama, and the city of Tuxtla-Gutierrez in Mexico. We measured LTL by quantitative PCR in DNA extracted from whole blood. We compared the distribution of LTL by categories of sociodemographic and anthropometric characteristics using linear regression. Family aggregation was estimated with correlation coefficients and intraclass correlations. RESULTS: In mothers, LTL was inversely associated with age (P, trend < .0001) and positively associated with height (P = .0002). Among fathers, LTL was inversely associated with food insecurity (P, trend = .0004). In children, boys had 0.10 log units shorter LTL than girls (95% CI: -0.17, -0.03; P = .004). LTL was inversely associated with parental education (P, trend = .01) and positively associated with paternal age at birth (P, trend < .0001), maternal LTL (P, trend = .007), and paternal LTL (P, trend = .02). LTL varied significantly by country of origin among all family members. Aggregation was greatest between children and their mothers, and mostly occurred at the country, rather than family, level. CONCLUSION: LTL is associated with age and height in women; food insecurity in men; and sex, parental education, parental LTL, and paternal age at birth among children.


Assuntos
Leucócitos/fisiologia , Encurtamento do Telômero , Adulto , Fatores Etários , Índice de Massa Corporal , América Central , Criança , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores Sexuais , Fumar/fisiopatologia , Classe Social
15.
Public Health Nutr ; 20(2): 255-265, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27609776

RESUMO

OBJECTIVE: To ascertain the prevalence and sociodemographic correlates of cardiometabolic risk factors in adults and school-aged children from Mesoamerica. DESIGN: Cross-sectional study with convenience sampling. In adults, metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP III) criteria. In children, we calculated a continuous sex- and age-standardized metabolic risk score using variables corresponding to adult ATP III criteria. Metabolic syndrome prevalence in adults and risk score distribution in children were compared across levels of sociodemographic characteristics with use of Poisson and linear regression, respectively. SETTING: Capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, the Mexican State of Chiapas (Tuxtla Gutiérrez city) and Belize. SUBJECTS: Families (n 267), comprising one child aged 7-12 years and their biological parents. RESULTS: The prevalence of metabolic syndrome was 37·9 % among women and 35·3 % among men. The most common component was low HDL cholesterol, 83·3 % in women and 78·9 % in men. Prevalence was positively associated with age. In women, metabolic syndrome was inversely related to education level whereas in men it was positively associated with household food security and height, after adjustment. The metabolic risk score in children was inversely related to parental height, and positively associated with height-for-age and with having parents with the metabolic syndrome. CONCLUSIONS: Metabolic syndrome is highly prevalent in Mesoamerica. The burden of metabolic risk factors disproportionately affects women and children of lower socio-economic status and men of higher socio-economic status.


Assuntos
Demografia , Síndrome Metabólica/epidemiologia , Adulto , Fatores Etários , Estatura , América Central/epidemiologia , Criança , HDL-Colesterol/sangue , Estudos Transversais , Escolaridade , Feminino , Abastecimento de Alimentos , Humanos , Masculino , Síndrome Metabólica/etiologia , Pais , Prevalência , Fatores de Risco , Fatores Sexuais , Classe Social
16.
BMC Nutr ; 32017.
Artigo em Inglês | MEDLINE | ID: mdl-29892467

RESUMO

Background: Latin America is facing an increasing burden of nutrition-related non-communicable disease. Little is known about dietary patterns in Guatemalan adults and how dietary patterns are associated with cardio-metabolic disease (CMD) risk. Methods: This analysis is based on data from a 2002-04 follow-up study of the INCAP Nutrition Supplementation Trial Longitudinal Cohort. Diet data were collected using a validated, semi-quantitative food frequency questionnaire. We derived dietary patterns using principal components analysis. CMD risk was assessed by anthropometry (body mass index, waist circumference), biochemistry (fasting blood glucose and lipids), and clinical (blood pressure) measures. We used sex-stratified multivariable log binomial models to test associations between dietary pattern tertile and CMD risk factors. The sample included 1,428 participants (681 men and 747 women) ages 25-43 years. Results: We derived 3 dietary patterns (traditional, meat-based modern, and starch-based modern), collectively explaining 24.2% of variance in the diet. Dietary patterns were not associated with most CMD risk factors; however, higher starch-based modern tertiles were associated with increased prevalence of low high density lipoprotein cholesterol (HDL-c) in men (Prevalence Ratio (PR) 1.17, 95% Confidence Interval (CI) 1.01, 1.20 for tertile 2; PR 1.20, 95% CI 1.00, 1.44 for tertile 3; p trend 0.04). Higher traditional tertile was associated with increased prevalence of abdominal obesity in women (PR 1.24, 95% CI 1.07, 1.43 for tertile 2; PR 1.19, 95% CI 1.02, 1.39 for tertile 3; p trend 0.02) but marginally significant reduced prevalence of low HDL-c in men (PR 0.88, 95% CI 0.76, 1.00 for tertile 2; PR 0.85, 95% CI 0.72, 1.00 for tertile 3; p trend 0.05). Conclusion: Our findings suggest the presence of two 'modern diet' patterns in Guatemala - one of which was associated with increased prevalence of low HDL-c in men. The association between the traditional dietary pattern and some CMD risk factors may vary by sex.

17.
Rev. urug. enferm ; 11(2): 78-88, nov. 2016.
Artigo em Espanhol | LILACS, InstitutionalDB | ID: biblio-849036

RESUMO

Se considera que la publicidad televisiva es el medio de comunicación con mayor influencia en las preferencias de consumo de alimentos energéticamente densos contribuyendo a la aparición de la obesidad en edades tempranas. Objetivo: Determinar el nivel de influencia de la publicidad televisiva sobre las decisiones o preferencias para consumir alimentos energéticamente densos en niños de edad escolar de nivel económico medio y bajo de la ciudad de Guatemala. Metodología: Investigación cuantitativa, descriptiva transversal, realizada en la Ciudad de Guatemala. El estudio se realizó con niños y niñas pertenecientes a establecimientos educativos públicos y privados. Se relaciona el Índice de masa corporal (IMC) y la Desviación Estándar (DE). Con un estado nutricional normal (IMC +1DE y -2DS), con sobre peso (IMC >de +1DS) u obesidad. Se seleccionaron 303 niños y niñas que se encontraban en el intervalo de edad de 9 a 12 años; se seleccionaron en jornada matutina y los que contaban con la disposición y consentimiento del establecimiento y los padres o tutores para realizar las encuestas. El estudio se realizó en varias fases: 1. Diseño de instrumentos de recolección de datos 2. Validación del instrumento con 6 niños pertenecientes a establecimientos educativos privados y 6 niños de establecimientos públicos. 3. Se pesó y midió a los niños y niñas para seleccionar la muestra 4. Aplicación de la entrevista a 303 niños y niñas. Selección de la información. Los resultados de la entrevista se analizaron con estadística descriptiva. Se ha realizado estudios anteriores para determinar el nivel de influencia de la publicidad como por ejemplo de la radio en las preferencias de alimentos energéticamente densos en niños y niñas de establecimientos educativos de nivel económico medio y bajo, realizado en la Universidad Rafael Landívar por KM Barahona Escobar. Resultados: El Nivel socio-económico (NSE), medio tuvo veinte puntos porcentuales más de obesidad y sobrepeso que el NSE bajo. En el NSE medio y en NSE bajo coincidieron en observar los mismos cuatro canales, los cuales fueron Disney Channel (15.1%), Disney XD (14.8%), Cartoon Network (13.9%), y Nickelodeon (13.5%) Existe diferencia estadísticamente significativa del nivel de influencia de los anuncios entre los niveles socioeconómicos, siendo en el NSE Medio en donde existe más influencia de la publicidad televisiva. En la televisión nacional el 60% de alimentos que se anuncian son ultraprocesados y en la televisión por cable, el 83% también pertenece a este grupo de alimentos. No hay diferencia estadísticamente significativa entre la asociación del nivel de influencia y IMC. No existe diferencia estadísticamente significativa en cuanto al nivel de influencia televisiva según el sexo. Conclusiones: Se observó que las preferencias alimentarias de los niños y niñas de edad escolar, son influenciadas por la publicidad televisiva y este nivel de influencia no varió según estado nutricional y entre niños y niñas, pero sí en cuanto al nivel socioeconómico de la población evaluada


The authors considere that the television publicity is the means of communication with more influence in the preferences of consumption of foods energily dense, contributing to the appearance of the obesity in early ages. Objective: to determine the level of influence of the television publicity on the decisions or preferences to consume foods energily dense in children of school age of half and low economic level of the city of Guatemala. Methodology: Transversal descriptive ,quantitative investigation carried out in the City of Guatemala. The study was carried out with children and girls belonging to educational publics and private establishments, it is related the Index of corporal mass (IMC) and the Standard Deviation (OF). With a normal nutritional state (IMC +1DE and -2DS), with overweight (IMC >de +1DS or obesity, 303 children and girls were selected that were in the age interval from 9 to 12 years, they were selected in morning day and those that had the disposition and consent of the establishment and the parents or tutors to carry out the surveys. The study was carried out in several phases: 1. design of instruments of gathering of data 2. Validation of the instrument with 6 children belonging to private educational establishments and 6 children of public establishments. 3. it was weighed and it measured the children and girls to select the sample 4. Application of the interview to 303 children and girls. Selection of the information. The results of the interview were analyzed with descriptive statistic. It has been carried out previous studies to determine the level of influence of the publicity like for example of the radio in the preferences of foods energily dense in children and girls of educational establishments of half and low economic level, carried out by the University Rafael Landívar, by KM Barahona Escobar. Results: The socio-economic Level (NSE), middle had twenty percentage points more than obesity and overweight that the low NSE. In the half NSE and in NSE under it coincided in observing the same four channels, which were Disney Channel (15.1%), Disney XD (14.8%), Cartoon Network (13.9%), and Nickelodeon (13.5%). There is a difference statistically significant of the level of influence of the announcements among the socioeconomic levels, being in the Half NSE where more influence of the television publicity exists. In national television 60% of foods that are announced is extraprocessing and in television for cable, 83% also belongs to this group of foods. There is not difference statistically significant between the association of the influence level and the Index of Corporal mass (IMC). There is not diference statistically significant for the level of television influence according to the sex. Conclusions: It was observed that the alimentary preferences of the children and girls of school age, it is influenced by the television publicity and this influence level didn't vary according to nutritional state and between children and girls, but it varied according to the population's socioeconomic level evaluated


Considera-se que a publicidade na televisão seja o meio de comunicação com maior influência nas preferências de consumo de alimentos energeticamente densos, contribuindo para o aparecimento de obesidade em idade precoce. Objetivo: determinar o nível de influência da publicidade televisiva sobre as decisões ou preferências para consumir alimentos energeticamente densos, nas crianças em idade escolar de nível médio e baixo da Cidade de Guatemala. Metodologia: pesquisa quantitativa descritiva transversal, realizada na Cidade de Guatemala. O estudo foi realizado com crianças pertencentes a instituições de ensino públicas e particulares. Relacionou índice de massa corporal (IMC) e desvio padrão (DE), em estado nutricional normal (IMC +1DE e -2DS), e com sobrepeso (IMC > de +1DS) ou obesidade. Foram selecionadas 303 crianças, meninos e meninas, que se encontravam no intervalo de idade entre 9 e 12 anos, do turno matutino, e que contavam com a disposição e consentimento da instituição e/ou pais ou responsáveis para realizar os questionários. O estudo foi realizado em várias fases: 1)Desenho dos instrumentos de coleta de dados 2) Validação do instrumento com seis meninos pertencentes a colégios particulares e seis meninos de colégios públicos 3) As crianças foram pesadas e medidas para selecionar a amostra 4) Aplicação da entrevista a 303 meninos e meninas. Seleção da informação. Os resultados da entrevista foram analisados com estatística descritiva. Anteriormente, já tinham sido realizados estudos para determinar o nível de influência da publicidade, por exemplo, das emissoras de rádio, nas preferências por alimentos energeticamente densos, em crianças de instituições de ensino de nível econômico médio e baixo, trabalho conduzido por KM Barahona Escobar, da Universidad Rafael Landívar. Resultados: o nível socioeconômico (NSE) médio mostrou 20 pontos percentuais a mais de obesidade e sobrepeso que o NSE baixo. Coincidiu que tanto o NSE médio como o baixo assistiam aos mesmos quatro canais, que eram: Disney Channel (15,1%); Disney XD (14,8%); Cartoon Network (13,9%), e Nickelodeon (13,5%). Há diferença estatisticamente significativa no nível de influência dos anúncios entre esses dois níveis socioeconómicos, sendo que no NSE médio é onde existe maior influência da publicidade televisiva. Na televisão aberta do país, 60% dos alimentos anunciados é ultraprocessado, e na televisão a cabo, 83% também pertence a este grupo de alimentos. Não há diferença estatisticamente significativa da associação entre nível de influência e IMC. Não há diferença estatisticamente significativa quanto ao nível de influência televisiva segundo o sexo. Conclusões: observou-se que as preferências alimentares dos meninos e meninas em idade escolar são influenciadas pela publicidade televisiva e que este nível de influência não varia segundo o estado nutricional ou sexo, mas conforme o nível socioeconômico da população avaliada


Assuntos
Humanos , Comportamento Alimentar , Obesidade Pediátrica , Alimentação Escolar , Televisão , Índice de Massa Corporal , Controle da Publicidade de Produtos
18.
J Nutr ; 146(11): 2368-2374, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27655759

RESUMO

BACKGROUND: Latin America has experienced increases in obesity. Little is known about the role of early life factors on body mass index (BMI) gain over the life course. OBJECTIVE: The objective of this research was to examine the role of early life factors [specifically, nutrition supplementation during the first 1000 d (from conception to 2 y of age) and childhood household socioeconomic status (SES)] on the pattern of BMI gain from birth or early childhood through midadulthood by using latent class growth analysis. METHODS: Study participants (711 women, 742 men) who were born in 4 villages in Guatemala (1962-1977) were followed prospectively since participating in a randomized nutrition supplementation trial as children. Sex-specific BMI latent class trajectories were derived from 22 possible measures of height and weight from 1969 to 2004. To characterize early life determinants of BMI latent class membership, we used logistic regression modeling and estimated the difference-in-difference (DD) effect of nutrition supplementation during the first 1000 d. RESULTS: We identified 2 BMI latent classes in women [low (57%) and high (43%)] and 3 classes in men [low (38%), medium (47%), and high (15%)]. Nutrition supplementation during the first 1000 d after conception was not associated with BMI latent class membership (DD test: P > 0.15 for men and women), whereas higher SES was associated with increased odds of high BMI latent class membership in both men (OR: 1.98; 95% CI: 1.09, 3.61) and women (OR: 1.62; 95% CI: 1.07, 2.45) for the highest relative to the lowest tertile. CONCLUSIONS: In a cohort of Guatemalan men and women, nutrition supplementation provided during the first 1000 d was not significantly associated with higher BMI trajectory. Higher childhood household SES was associated with increased odds of high BMI latent class membership relative to the poorest households. The pathways through which this operates still need to be explored.


Assuntos
Índice de Massa Corporal , Fenômenos Fisiológicos da Nutrição Pré-Natal , População Rural , Adulto , Envelhecimento , Criança , Suplementos Nutricionais , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Gravidez , Classe Social , Fatores Socioeconômicos
19.
Food Nutr Bull ; 37(4): 494-503, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27316762

RESUMO

INTRODUCTION: Breast-feeding practices (BFPs) can be assessed by interviewing the mother about current feeding practices and with a 24-hour recall. It is crucial to establish the accuracy of these methods, which are commonly used by public health decision makers to design health policies aimed at increasing exclusive breast-feeding rates. OBJECTIVE: We aimed to validate 2 self-report BFP instruments using the dose-to-mother deuterium oxide turnover technique (DMDOT) as the reference method. METHODS: Breast-feeding practices were assessed by interviewing the mother about current feeding practices and with a 24-hour recall in 36 Guatemalan mother-infant pairs. The validity of these instruments was assessed using DMDOT as the reference method. RESULTS: Both self-report instruments overestimated exclusively breast-fed (EBF) infants. Infants classified as EBF were 50% by the reported current feeding practice, 61% by the 24-hour recall, and only 36% using DMDOT. Sensitivity to detect EBF infants from the mother's self-report was 92% (95% CI: 62%-99%) while from the 24-hour recall was 100% (95% CI: 72%-100%, P < .01). However, specificity for both instruments was low, at 74% (95% CI: 51%-89%) for reported current feeding practice and at 61% (95% CI: 39%-79%) for the 24-hour recall (P < .01). CONCLUSION: Both reported current feeding practice and the 24-hour recall instruments overestimated exclusive breast-feeding. Nevertheless, the use of reported current feeding practice provided more accurate data to assess BFPs in a public health setting. Furthermore, population-based surveys should consider the overestimation of exclusive breast-feeding caused when using these BFP instruments.


Assuntos
Aleitamento Materno/métodos , Fenômenos Fisiológicos da Nutrição do Lactente , Entrevistas como Assunto/normas , Mães , Autorrelato/normas , Adulto , Aleitamento Materno/estatística & dados numéricos , Feminino , Guatemala , Humanos , Lactente , Masculino , Reprodutibilidade dos Testes
20.
Prog Cardiovasc Dis ; 58(6): 661-73, 2016 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27041078

RESUMO

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.


Assuntos
Tecnologia Biomédica/tendências , Doenças Cardiovasculares/prevenção & controle , Doenças Metabólicas/prevenção & controle , Serviços Preventivos de Saúde/tendências , Telemedicina/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Prestação Integrada de Cuidados de Saúde/tendências , Difusão de Inovações , Previsões , Humanos , América Latina/epidemiologia , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Fatores de Risco , Comportamento de Redução do Risco
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