Prevalence of overweight and metabolic syndrome, and associated sociodemographic factors among adult Ecuadorian populations: the ENSANUT-ECU study.

BACKGROUND: Obesity and metabolic syndrome (MetS) are key risk factors for type 2 diabetes and cardiovascular disease. Little information exists on the prevalence of obesity and MetS in Latin America and specifically in Ecuador. We aimed to estimate the prevalence of overweight, obesity, and MetS among adults in Ecuador. METHODS: We analyzed data from a nation-wide population-based survey in Ecuador (ENSANUT-ECU) among 10,318 participants (3684 men, 6634 women; age range: 18-59 years) conducted in 2012. Data related to residential location (urban versus rural), altitude (< 500, 500-1500 or > 1500 m above sea level (MASL)), region (highland, coast, amazon, or Galápagos), and socioeconomic status were collected. BMI, waist circumference, blood lipids, glucose, and blood pressure were measured by trained fieldworkers following standardized procedures. RESULTS: The age-standardized prevalence of overweight was 39.5%; 22.3% was obese; and 31.2% had MetS. The prevalence of obesity, low HDL-cholesterol, and abdominal obesity were higher in women than in men, whereas men had a higher prevalence of hypertension (p < 0.05). Sex differences were not observed regarding the prevalence of combined MetS. Prevalence of both obesity and MetS was higher in urban areas, at low altitude regions (coast and Galapagos), and at high socioeconomic status (all p < 0.05). CONCLUSIONS: Prevalence of obesity and MetS in Ecuador are high. There are important demographic differences in the prevalence of MetS between Ecuadorian subpopulations that requires targeted research and prevention efforts, to hold and reduce the current public health problem of metabolic disorders.

Hemoglobin as a predictor of response to iron therapy and its use in screening and prevalence estimates.

The use of hemoglobin as a predictor of response to iron therapy, for screening, and for prevalence estimates was studied. An Fe supplementation trial was performed in Quito, Ecuador, in which 412 pregnant women were randomly assigned to treatment and control groups. Women in the treatment group received 390 mg ferrous sulfate/d for 2 mo. The prevalence of Fe deficiency as defined by response to therapy was found to be 60.8%. Sensitivity and specificity were calculated at various cutoff points of hemoglobin. The estimates of sensitivity and specificity allow for the use of hemoglobin in screening for Fe deficiency anemia and in the estimation of the prevalence in populations with characteristics similar to those found in the sample of pregnant women in Quito. Hemoglobin was shown to be a good predictor of response to Fe treatment and a good estimate of prevalence of Fe deficiency when prevalence is high.

Strategies of the Pan American Health Organization/World Health Organization for the control of iron deficiency in Latin America.

Iron deficiency anemia is one of the major micronutrient deficiencies in the world. Its etiology is well understood, and inexpensive solutions to the problem have been identified. Nevertheless, the problem persists. This paper estimates the magnitude of iron deficiency anemia and presents strategies suggested by the Pan American Health Organization of the World Health Organization (PAHO/WHO) for adoption by individual countries.

Altitude correction for hemoglobin.

OBJECTIVE: To propose a correction for the hemoglobin (Hb) increase induced by altitude-associated hypoxia. DESIGN: Part of a national study of nutrition and health of preschool children (0-59 months), based on a stratified, probabilistic, cluster sample. SETTING: Coastal and Andean regions of Ecuador, comprising about 97% of the population, living at altitudes ranging from sea level to 3400 m. SUBJECTS: Subsample of 469 girls and boys, 6-59 months old, with normal iron (Fe) status parameters, i.e serum ferritin > or = 10 micrograms/l, transferrin saturation > or = 12%, zinc protoporphyrin < or = 2.8 micrograms/g Hb. RESULTS: Exponential regression curves are adapted through the Hb values of the children, grouped by altitude ranges, and through the data reported by Hurtado in 1945 for male adults. From these exponential curves, correction factors for Hb are derived for altitudes ranging from sea level to 3400 m. CONCLUSION: The striking parallelism between the hypoxia-induced hemoglobin increase with altitude in young children (girls and boys) and that in male adults strongly suggests that the proposed correction factors for Hb are applicable for all ages and possibly both genders, at least in the Andes.

(-)-α-Bisabolol inhibits preferentially electromechanical coupling on rat isolated arteries.

Previous findings enable us to hypothesize that (-)-α-bisabolol acts as inhibitor of voltage-dependent Ca(2+) channels in smooth muscle. The current study was aimed at consolidating such hypothesis through the recording of isometric tension, measurement of intracellular Ca(2+) as well as discovery of channel target using in silico analysis. In rat aortic rings, (-)-α-bisabolol (1-1000 µM) relaxed KCl- and phenylephrine-elicited contractions, but the IC50 differed significantly (22.8 [17.6-27.7] and 200.7 [120.4-334.6] µM, respectively). The relaxation of phenylephrine contractions remained unaffected by l-NAME, indomethacin, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, tetraethylammonium, glibenclamide or KT-5720. Under Ca(2+)-free conditions, (-)-α-bisabolol did not alter the contractions evoked by phenylephrine or caffeine whereas it reduced those evoked by CaCl2 in KCl-, but not in PHE-stimulated preparations. Furthermore, it did not significantly alter the contractions evoked by phorbol 12,13-dibutyrate or induced by the extracellular Ca(2+) restoration in cyclopiazonic acid-treated preparations. In mesenteric rings loaded with Fluo-4 AM, (-)-α-bisabolol blunted the tension and the cytosolic levels of Ca(2+) in response to K(+) but not to norepinephrine. Silico docking analysis of the Cavß2a subunit of voltage-dependent Ca(2+) channel indicated putative docking sites for (-)-α-bisabolol. These findings reinforce the ability of (-)-α-bisabolol to inhibit preferentially contractile responses evoked by Ca(2+) influx through voltage-dependent Ca(2+) channels.

[Iron-deficiency anemia: PAHO/WHO strategies to fight it]. / La anemia por deficiencia de hierro: estrategias de la OPS/OMS para combatirla.

Iron deficiency anemia is among the greatest nutritional problems in the world. Although its etiology is understood and intervention at low cost is available, the problem persists. The present review begins with a general estimate of the dimensions of the problem. It suggests the necessary elements for the design, implementation, and measurement of the impact of iron supplementing and fortification as the most effective forms to intervene and diminish iron deficiency anemia. Several preliminary steps are proposed previous to the preparation of a project and several recommendations are made to be included in a project for fortification and iron supplementing. A list of complementary activities offered by PAHO/WHO as part of the package of technical cooperation is included.

Tetanus and diphtheria immunization coverage in Ecuadorian children after a national vaccination campaign.

Between October 1985 and June 1986, a national vaccination campaign was launched in Ecuador. Between March and November 1986, 7798 Ecuadorian children < 5 years old were enrolled in a representative health survey. According to their vaccination cards, 65% of children had a complete series of three doses of diphtheria-tetanus-pertussis (DTP) vaccination. Serum samples were obtained from a subset of 1400 children; by ELISA, 80% had serologic evidence of recent DTP vaccination and > 80% of the newborns had tetanus antitoxin titers, indicating recent tetanus vaccination of their mothers. For all 1400 children, median tetanus and diphtheria antitoxin titers were 1.0 and 0.6 IU/mL, respectively. These data indicate the possibility of success of such vaccination campaigns if supported by the government.

Effect of malnutrition in Ecuadorian children on titers of serum antibodies to various microbial antigens.

The titers of serum antibodies to natural infection with enteric and respiratory pathogens, to a food antigen and to tetanus and diphtheria toxoid were evaluated by enzyme-linked immunosorbent assay in 1,554 Ecuadorian children younger than 5 years of age. The nutritional status of the children was assessed by anthropometry and measurement of biochemical status indicators. The children were enrolled in a representative national nutrition and health survey. Antibody titers were analyzed as a function of the nutritional status of the children. For 12 of 14 antibody concentrations tested, underweight children showed lower antibody titers than did control children. The difference was statistically significant for antibody to both T-cell-dependent antigens (tetanus toxoid, rotavirus, respiratory syncytial virus) and T-cell-independent antigens (lipopolysaccharide, polyribosyl-ribitol phosphate, capsular polysaccharide). When children with a recent episode of diarrhea were excluded, many of the differences remained significant. When these children were further classified by age, only difference in titers of antibodies to respiratory syncytial virus and tetanus toxoid remained significant. No statistically significant difference was detected between underweight and control children with respect to protective antibody levels to four bacterial antigens. Anemic children showed significantly lower antibody levels to both T-cell-dependent and T-cell-independent antigens than did control children, and a higher proportion of anemic children had diphtheria antitoxin below a conservatively defined protective antibody level. No major differences in antibody titers were seen between children with different retinol and zinc concentrations in serum.

Prevalence and serotype specificity of rotavirus antibodies in different age groups of Ecuadorian infants.

The age-specific prevalence of antibody to rotavirus was studied in 1404 Ecuadorian children enrolled in a national nutrition and health survey. ELISA and neutralizing antibody analysis showed evidence for primary rotavirus infection in 6- to 12-month-old children, who showed also a more-than-threefold increase in significant diarrheal episodes in comparison with infants less than 6 months old. At this age, 56% of the sera with neutralizing antibody were monospecific. With increasing age a gradual decrease in prevalence of monospecific sera, to 10% in 5-year-old children, was observed. Monospecific sera were directed in decreasing frequency against serotypes 4 (56%), 3 (20%), 2 (14%), and 1 (10%). Serotype 4-specific antibody was acquired at an earlier age than were antibodies to the other serotypes, and 91% of sera with dual specificity neutralized serotype 4, whereas only 2% of sera that neutralized three serotypes failed to neutralize serotype 4.

Nutritional and environmental risk factors for diarrhoeal diseases in Ecuadorian children.

Risk factors associated with diarrhoea, based on the recall of a recent episode were evaluated from a cross-sectional national nutrition and health study in 1,620 Ecuadorian children less than 5 years old. Prevalence of diarrhoea varied with the age of the children; 6- to 23-months-old children showed the highest prevalence. In this age range the prevalence of diarrhoea was significantly associated with hygienic factors (quality of drinking water, sanitation and refuse system), but not with demographic factors (sex, altitude, population density, family size). The nutritional status of the children was determined by anthropometry and blood chemistry. After stratification for sanitation levels, a low weight-for-age Z-score and low serum retinol and zinc concentrations showed a statistically significant (p < or = 0.06) association with diarrhoea prevalence only in children living under better hygienic conditions. Multivariate analysis revealed significant associations between both sanitation levels and nutritional level as defined by anthropometry, but not by blood chemistry, and diarrhoea prevalence.

Age-specific prevalence of antibody to enterotoxigenic Escherichia coli in Ecuadorian and German children.

Serum samples from 1397 Ecuadorian children 0-5 years of age were tested by ELISA for antibodies to enterotoxigenic Escherichia coli (ETEC). A gradual prevalence and titer increase was seen for IgG antibodies to heat-labile enterotoxin in children 6-18 months old; 90% prevalences were reached in the second year of life. At this age less than 10% of West German children showed IgG antibodies to heat-labile enterotoxin. In Ecuador age-related ETEC-specific antibody titer increases correlated with age-related prevalence of diarrheal disease. On the other hand, pooled lipopolysaccharide from different ETEC-associated O serogroups could not be used as a seroepidemiologic marker of ETEC infections.