Concordance with dietary and lifestyle population goals for cancer prevention in Dutch, Scottish, Mexican, and Guatemalan population samples

Adherence to cancer prevention guidelines in 18 African countries

BACKGROUND

Cancer rates in Africa are projected to double by 2030 due to aging and increased exposure to cancer risk factors, including modifiable risk factors. We assessed adherence to 5 modifiable cancer risk factors across 18 African countries.

METHODS

Data on adults 18 years and older were obtained from the 2002-2004 World Health Survey. Adherence to current World Cancer Research Fund guidelines on smoking, alcohol, body weight, physical activity, and nutrition was assessed. Adherence scores ranged from 0 (no guideline met) to 5 (all guidelines met). Determinants of adherence were assessed using multivariable linear regression adjusted for individual and country level characteristics.

RESULTS

Across all countries, adherence to the guidelines among adults was high for smoking (72%-99%) and alcohol (85%-100%), but low for body weight (1.8%-78%), physical activity (3.4%-84%) and nutrition (1.4%-61%). Overall adherence score ranged from 2.32 in Mali to 3.72 in Comoros. In multivariable models, residing in low versus high SES households was associated with reduced adherence by 0.24 and 0.21 points for men and women respectively after adjusting for age, gender, education, and marital status (p<0.001). Every % increase in GDP spent on health was associated with increased adherence by 0.03 in men and 0.09 in women (p<0.001).

CONCLUSIONS

The wide variation in adherence to cancer prevention guidelines observed across countries and between population sub-groups suggests the need for targeted public health efforts to improve behaviors related to body weight, physical activity and nutrition.

The concept of "critical nutrient density" in complementary feeding: the demands on the "family foods" for the nutrient adequacy of young Guatemalan children with continued breastfeeding

BACKGROUND

The WHO recommends the introduction of nutritionally adequate, safe, and appropriate complementary foods at 6 mo of age, with continued breastfeeding up to 2 y and beyond. Suggested strategies to support continued breastfeeding often postulate optimal use of customary "family foods" and adequate amounts of indigenous foodstuffs and local foods.

OBJECTIVE

The objective was to determine the nutrient adequacy of the diet of Guatemalan children aged 6-24 mo receiving continued breastfeeding and "family foods" rather than specially formulated "baby foods" as complementary foods.

DESIGN

"Critical nutrient densities" for complementary foods were determined by using specific energy and protein requirements, assuming children to be in the 50th or 15th weight percentile of the 2006 WHO standards. Nutrient requirements for the total diet were determined by using the recommended nutrient intakes. Breast milk was assumed to provide 75% of total energy between 7 and 9 mo, 50% between 10 and 12 mo, and 40% between 13 and 24 mo. Gaps between computed critical nutrient densities and the best-scenario Guatemalan adult's diet, as a proxy for family foods, were examined.

RESULTS

Energy complementation with these diets provided adequate nutrient density for protein, thiamine, riboflavin, and vitamins B-6, B-12, and C but not vitamin A, niacin, and folate in some groups. Major gaps for calcium, iron, and zinc were ubiquitous.

CONCLUSIONS

The critical nutrient density concept is useful to evaluate the nutrient adequacy of the young child's diet. Multiple micronutrients are likely to be limited in the diets of Guatemalan young children with continued breastfeeding and family foods.

Concordance with selected population recommendations for cancer prevention among third- and fourth-grade schoolchildren in Quetzaltenango, Guatemala

BACKGROUND

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 1997 recommendations for cancer prevention were meant to apply to children as well as adults.

OBJECTIVE

To assess the concordance of behaviors and body composition of urban Guatemalan schoolchildren with the tenets of the WCRF/AICR 1997 recommendations.

METHODS

A survey was conducted involving determination of 24-hour consumption of foods and beverages by a pictorial registry and height and weight measurements in 355 third- and fourth-grade schoolchildren in the western highland city of Quetzaltenango, Guatemala. Based on a previous, exhaustive parsing of the population goal recommendations of the WCRF/AICR 1997 report, 25 subcomponents were identified. Eleven could be evaluated with the survey data collected. Adult population criteria could be applied in seven, whereas four components had unique criteria adapted to this juvenile survey setting.

RESULTS

The study sample was concordant on seven components-nutrient adequacy, total variety of foods consumed, plant-based diets, body mass index, vegetable and fruit intake, limitation of red meat consumption, and limitation of total fat consumption, and nonconcordant on four-variety of fruits and vegetables consumed, variety of starchy foods consumed, total intake of starchy foods, and limitation of sugar consumption.

CONCLUSIONS

Educational and public health actions need to be conceived and implemented to further improve the rate of concordance of these 11 components with the WCRF/AICR 1997 recommendations for cancer prevention.