Prevalence of stunting and obesity in Ecuador: a systematic review

Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019

OBJECTIVE

This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019.

STUDY DESIGN

Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study.

METHODS

Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries.

RESULTS

Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%).

CONCLUSIONS

Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF (n 28) consumed by children in the community. In this cohort (n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) (β = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile (β = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores (β = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ (β = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.

Analysis of Saliva Composition: Parathyroid Hormone-Related Protein, Total Protein, and Secretory Immunoglobulin A (sIgA) in Rattus norvegicus with Stunted Growth

OBJECTIVE

 This study aimed to determine total protein, secretory immunoglobulin A (sIgA) and parathyroid hormone-related protein (PTHrP) levels in the saliva of rats with stunted growth.

MATERIALS AND METHODS

 Experimental laboratory research with a pre-and posttest control group design was conducted. Seventeen albino rats (Rattus norvegicus) were divided into the control group (eight rats) and the treatment group (nine rats). Rats in the treatment group were exposed to aflatoxin B1 5µg/kg orally for 5 weeks. Anthropometry data (body length, body weight) and saliva of R. norvegicus were collected. The levels of PTHrP and sIgA in the saliva were measured using an enzyme-linked immunosorbent assay kit for rats and the Bradford test for total protein and analyzed using SPSS 25.0.

RESULTS

 Aflatoxin caused stunted growth in rats in the treatment group. There was a significant difference in body length, salivary flow, PTHrP, sIgA, and total protein in the treatment group compared with the control group. The average rat's body length change in the control group was 6.4 ± 1.1mm/5 weeks, while in the treatment group, the change was 3.7 ± 0.9 mm /5 weeks. There was no significant weight gain in the treatment group compared with the normal group. The average values of PTHrP, sIgA, and total protein in the control group were x̄0.9, x̄18, and x̄0.7 m./L, respectively, while in the treatment group, they measured x̄0.4, x̄10.7, and x̄0.5 mg/L, respectively.

CONCLUSION

 This study showed that salivary flow, PTHrP, sIgA, and total protein levels in the saliva were significantly lower in stunted rats compared with normal rats.

A Qualitative Study of Food Choice in Urban Coastal Esmeraldas, Ecuador

Background

Constraints on food choice increase risk of malnutrition worldwide. Residents of secondary cities within low- and middle-income countries are a population of particular concern because they often face high rates of food insecurity and multiple nutritional burdens. Within this context, effective and equitable interventions to support healthy diets must be based on an understanding of the lived experience of individuals and their interactions with the food environment.

Objectives

The primary objectives of this study were to describe considerations that drive household decision making around food choice in the city of Esmeraldas, Ecuador; to identify trade-offs between these considerations; and to understand how an evolving urban environment influences these trade-offs.

Methods

Semistructured interviews were conducted with 20 mothers of young children to explore drivers in food choice throughout the purchase, preparation, and consumption chain. Interviews were transcribed and coded to identify key themes.

Results

Personal preference, economic access (costs), convenience, and perceptions of food safety were key influencers of decision making related to food. In addition, concerns about personal safety in the urban environment limited physical access to food. This, combined with the need to travel long distances to obtain desirable foods, increased men's participation in food purchasing. Women's increasing engagement in the workforce also increased men's participation in food preparation.

Conclusions

Policies to promote healthy food behavior in this context should focus on increasing access to health foods, such as affordable fresh produce, in convenient and physically safe locations. CurrDev Nutr 2023;x:xx.

Socioeconomic and Demographic Factors Associated with the Influence of the Food Traffic Light Labeling on the Decision of the Adult Population of Ecuador to Purchase Processed Foods, 2018

To determine the socioeconomic and demographic factors associated with the influence of the nutritional traffic light (NTL) on the decision to purchase processed foods using information from the National Health and Nutrition Survey (ENSANUT) 2018 of Ecuador, a cross-sectional and analytical study based on a secondary analysis of the information from the ENSANUT 2018 was performed. We collected data from 25,932 participants 18 years of age or older who knew or had seen the NTL, and for whom complete information on the variables of interest for the study was available. The "Influence of the NTL on the purchase decision of processed foods" was the outcome variable of the study. Generalized linear models of the Poisson family, with log link, were used to assess the association between socioeconomic factors and outcome, using crude (PR) and adjusted (aPR) prevalence ratios, with 95% confidence intervals (CI) and a p-value < 0.05. Participants who understood the NTL (aPR: 2.49; 95% CI: 2.19-2.83), with a higher educational level (aPR: 1.33; 95% CI: 1.09-1.61), women (aPR 1.06; 95% CI: 1.01-1.10), and who had a partner (aPR 1.09; 95% CI: 1.04-1.14) were more likely to be influenced by the NTL when deciding to purchase processed foods, compared to people who did not understand the NTL, who had no educational level or who only attended a literacy center, were men, and those without a partner. The inhabitants of the coastal region (aPR: 0.92; 95% CI: 0.88-0.97), the Amazon (aPR 0.93; 95% CI: 0.88-0.98), and the insular region (aPR 0.76; 95% CI: 0.68-0.84) had few probabilities of being influenced by the NTL in the decision to purchase processed foods, in comparison with the residents of the highlands. Similarly, compared to non-poor people, poor people had a lower probability of being influenced by the NTL (aPR 0.89; 95% CI: 0.82-0.97). Factors associated with the influence of NTL on the decision to purchase processed foods were identified. It is recommended to reformulate and focus awareness strategies for using the NTL to purchase processed foods by taking into account the associated factors.

Evaluation of School Children Nutritional Status in Ecuador Using Nutrimetry: A Proposal of an Education Protocol to Address the Determinants of Malnutrition

The education sector is a cornerstone in the battle against malnutrition in children. However, there are still no consolidated protocols that outline strategies for how nutrition programs in low- and middle-income countries can be delivered through the education sector. Establishing the correct community diagnosis is essential prior to the elaboration of an intervention plan for a school population that takes into account more than just traditional variables related to the nutritional status. A total of 574 boys and girls aged 3–11 years from three educational institutions in different municipalities in Ecuador participated in the study. Sociodemographic, anthropometric (weight and height) and coproparasitological data were obtained. Nutrimetry, which is a combination of two classical anthropometrics indicators, was used for the analysis of the nutritional status, and the indicators’ frequencies varied among the schools. In order to improve the nutritional status of children, we proposed a framework mainly focusing on establishing alliances with the education sector and taking into account gender equality; respect for the environment; and the customs, beliefs and traditions of each population. The results obtained from the analyses of other variables demonstrated the importance of an adequate diagnosis prior to any type of intervention at the nutritional level, since characteristics could vary by local area and have an impact on the successfulness of the intervention.

The burden of hypertension in Ecuador: a systematic review and meta-analysis

Hypertension is a major risk factor of cardiovascular diseases, which occurrence has increased consistently worldwide. With this in mind, this review was designed to evaluate the prevalence of hypertension in Ecuador. We systematically searched publications in Medline, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database, and Ibero-America electronic databases for articles published through September 2019 and reporting the prevalence of hypertension in Ecuador. Selected data were subjected to meta-analysis, and pooled prevalence and their 95% (95% CI) were calculated. Seventeen articles have been selected according to the inclusion/exclusion criteria of the study. The overall estimate of the pooled prevalence of hypertension was 35.8% (CI: 31.3-38.4). Most importantly, the prevalence of hypertension increased markedly with age and obesity. Pooled estimates for the four age subdivisions (<30 years), (≥30 and ≤50 years), (>50 and ≤60 years) and (>60 years) were 9.4% (CI: 7.3-11.5), 22.0% (CI: 19.0-25.0), 26.1% (22.2-30.0) and 48.7% (CI: 45.4-52.0), respectively. Moreover, the pooled estimate of subjects with BMI ≥ 30 kg/m² (57.7%, CIs: 45.6-69.8) was markedly higher than those with BMI < 30 kg/m² (30.4%, CI: 23.3-38.4). Although limited, available data reported higher rates of hypertension in Afro-Ecuadorians than other ethnicities. This study underlines a high prevalence of hypertension in adults nationwide, but mostly in elderly and obese individuals. The magnitude of this burden emphasizes the need for robust and targeted interventions to control hypertension, and ultimately reverse the trend of cardiovascular diseases.

Impact of Home Parenting Environment on Cognitive and Psychomotor Development in Children Under 5 Years Old: A Meta-Analysis

This study aims to evaluate the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old by using meta-analysis. A systematic search of the Chinese and English databases including Pubmed, Embase, the Cochrane Library, CNKI, Weipu, Wanfang, and CBMdisc databases from January 1, 1990, to July 31, 2021, was performed. Articles concerning the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old were included. Review Manager 5.4 was used for meta-analysis. Subgroup analysis in terms of age and region were performed. A total of 12 articles were included, including 11 in English and 1 in Chinese. Meta-analysis showed that there was significant relationship between home parenting environment and the cognitive and psychomotor development of children (r = 0.31; r = 0.21). Subgroup analysis showed that correlation between home parenting environment and the cognitive and psychomotor development of children was stronger in children over 18 months compared to those under 17 months [(r = 0.33, r = 0.21) vs. (r = 0.28, r = 0.17)]. The converted summary r value between home parenting environment and cognitive development in developing and developed countries was both 0.32. Conclusively, there is a positive correlation between the home parenting environment and the cognitive and psychomotor development of children under 5 years old. Improving the home parenting environment of children is beneficial to promote their early development.